sri ramajeyam om anandamayi chaithanyamayi sathyamayi parame! dr. s. ahanatha pillai, m.d.,d.a.,...
TRANSCRIPT
Sri Ramajeyam
Om Anandamayi Chaithanyamayi Sathyamayi Parame!
Dr. S. Ahanatha Pillai, M.D.,D.A.,
Emeritus Professor
The Tamil Nadu Dr. M.G.R.
Medical University. Chennai
Former Professor of Anaesthesiology
Madurai Medical College
Sri Ramajeyam
Om Anandamayi Chaithanyamayi Sathyamayi Parame!
Dr. S. Ahanatha Pillai, M.D.,D.A.,
Emeritus Professor
The Tamil Nadu Dr. M.G.R.
Medical University. Chennai
Former Professor of Anaesthesiology
Madurai Medical College
DEPARTMENT OF ANAESTHESIOLOGY
Madurai Medical College, Madurai
Sri RamajeyamOm Anandamayi Chaithanyamayi Sathyamayi Parame!
‘Patient Safety’
Are we following the Standards ?
Self Analysis
Assessment of ‘Safety profile’
Am I well prepared ? Am I well equipped? (Do I have everything ready to meet the
challenges on my way ?)
‘Yes’ – Very Good Safety Profile
Discuss
Less Technical aspects
More of Professional ..
Ethics Discipline Responsibilities
“Eternal vigilance is the price of safety”
Basic principle
Safety standards formulated Monitors - designed & built
Patient Safety
Definition:
Actions taken by individuals and
organizations to protect patients
from being harmed by the effects
of health care services
In Anaesthesia
“Actions taken by Anaesthetist and
Hospital administrators to protect
patients from being harmed by the
effects of Anaesthesia”
Anaesthesia has
No Primary Therapeutic Purpose !
There are No
Safe Anaesthetic Drugs or
Safe Anaesthetic Techniques,
but there are only …
Safe Anaesthetists !
- M H. King
“It is not
the drug that is dangerous, but
the man who administers it is”
- Sir Robert Macintosh
Anaesthetic Accidents - Causes
Human errors Lack of vigilance Distractions Fatigue Inexperience Inadequate supervision Failure of communications Drug reactions & Equipment failure
Accidents
“Anaesthetic accidents hardly
ever happen without warning”
The combination of causes or
sequence of failures that cause
an accident may indeed be unique,
but the mistakes are common
Attitude
“All Anaesthetists, however experienced and however accident - free, should be humble enough to realise and understand that they may make mistakes in any part of their work”
These errors may be in technique, judgment or simply failure of vigilance
- John Alfred Lee
Fatigue “The Anaesthetist has to be prepared to face the unexpected and be alert”
Commonsense says, a reasonable amount of sleep & rest is necessary before taking up a patient’s life into his hands
- John Alfred Lee (D yer C . B r. Med. J.1989)
Ten Golden Rules
● Assess & Prepare the patient well
● Starve him - even for L. A.
● Anaesthetise him on a tipping table
● Check your drugs & equipments
● Keep an effective suction ready
Ten Golden Rules ..
● Keep his airway clear
● Be ready to control his ventilation
● Have a vein open
● Monitor his Pulse and B.P.
● Always keep an assistant who can
apply cricoid pressure
Comparing Anaesthesia
Flight of an Aircraft
Takeoff Flying Landing
Induction Maintenance Recovery
● > 90 % aircraft accidents during landing
● > 80 % anaesthetic accidents during recovery The Anaesthesia Safety Foundation. USA 1980
The Australian Patient Safety Foundation first reported in 1988. Confidential Enquiry into Perioperative Deaths (CEOPD) in UK in 1987
In this comparison
Both are not entirely safe
Time & the rate of accidents
Nothing else is similar
Here only the patient is at risk
Emphasis is “Preparedness”
Cockpit check by Pilot
Before induction, Check Anaesthetic machine Drugs Monitors Accessories
Are we doing it every time ?
Preparation
Legal Responsibility
Anaesthetist is legally responsible
for functioning of the equipments
he uses and the drugs he gives
“A high index of suspicion”
Pre-op Assessment
● Careful physical examination
● Necessary Basic investigations
● Identify pre-existing diseases
● When possible correct them
Are we doing it always?
Grading the “Risk”
Anaesthetist only Grades “Risk”
Consider risk factors
● Patient’s condition
● Choice of anaesthesia
● Proposed Surgery
Who else can give fitness ?
Cardiologist Diabetologist
They may not comprehend the specific problems of anaesthesia
May advise therapy for correcting
specific problems – Not fitness
Choosing the Technique
“Surgeon should not demand or insist on a particular technique of anaesthesia, as he may not know the limitations of the technique or the capability of the anaesthetist to manage the particular technique”
- John Alfred Lee
May prove fatal
Pre-op Starvation
● Even for L A or Day case
● Vomiting & fatal aspiration
Human Assistance
Skillful assistant (O.T Assistant)
● Securing I.V. line
● Getting necessary drugs
● Intubation
● Renders help throughout
Anaesthesia and Recovery Most important & vital for Safety
Basic Monitors
Every Operation Table
● Pulse oximeter
● Non invasive B.P.
● E.C.G. Monitor
● Capnograph
Human Monitor
“No monitor can ever replace
a human being as, he has
the 6th sense”
“Continuous presence of an
anaesthetist is essential to monitor the patient”
- Eichhorn J. H.
Care during Recovery
“All the intensive care given to the patient during intra-operative period is only to be totally abandoned in the immediate postoperative period”
- Wylie W D
“The safest place
for patients to recover is
the operating theatre itself”
Michael B. Dobson
Recovery RoomAs per the standards
Space Personnel
Monitors
Equipments
Do we have it always ?
Transfer to P.O. Ward
Not in a hurry - Only when
● Awake and comfortable
● Adequate Respiration
● Stable C V S
In Anaesthesia
● No mortality is acceptable
● Percentages mean death
● 0.001 % means 1 patient died
● The family suffers 100 % loss
Patients place their ‘Trust’ on us
We are responsible for ensuring their ‘Safety’
Professionally, Morally & Legally
Are we following all the
basic standards of safety ?
If we don’t do it - Why ?
Let us answer honestly
Carry Home Message
● Death due to a disease may
be inevitable, but a death due
to Anaesthesia is a tragedy
- M H. King
Let us prevent such tragedies
Identity of Patient
Check for correctness
● Patient identity
● Informed Consent
● Intended Surgery & Side
Basic Infrastructure
“If we cannot undertake
a clinical responsibility
with proper safety, the only
honest and forthright attitude
must be - not to undertake it”
- A. Lal (IJA 37:1 Editorial - 1989)