Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2011
ReviewThe contribution of labelling to safe medication administration in anaesthetic practice.
The administration of medications is central to anaesthetists' care of patients. Errors are inevitable in any human endeavour, but should be distinguished from violations. The incidence of medication errors in anaesthesia has been estimated as 1 per 13,000 administrations, excluding errors in recording. ⋯ All lines and catheters should be labelled. Any medicine or fluid that cannot be identified (e.g., in an unlabelled syringe or other container) should be considered unsafe and discarded. Reducing adverse medication events will require the engagement of individual anaesthetists.
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Based on results recorded of perioperative mortality, anaesthetic care is often cited as a model for its improvements with regard to patient safety. However, anaesthesia-related morbidity represents a major burden for patients as yet in spite of major progresses in this field since the early 1980s. More than 1 out of 10 patients will have an intraoperative incident and 1 out of 1000 will have an injury such as a dental damage, an accidental dural perforation, a peripheral nerve damage or major pain. ⋯ To minimise the impact of human errors, guidelines and standardised procedures should be widely implemented. Deficient teamwork and communication should be addressed through specific programmes that have been demonstrated to be effective in the aviation industry: crew resource management (CRM) and simulation. The impact of the overall safety culture of health-care organisations on anaesthesia should not be minimised, and organisational issues should be systematically addressed.
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Following the overwhelming evidence of adverse events in hospital practice, the World Health Organization (WHO)'s World Alliance for Patient Safety has launched the 'Safe Surgery Saves Lives' campaign, which has developed a surgical safety checklist aimed to improve patient safety. The implementation of this checklist has met with mixed reactions in different institutions. Many countries have still not adopted its use. In this article, a brief review is presented regarding the role of the WHO checklist, barriers to its implementation and strategies for successful adoption.
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Best Pract Res Clin Anaesthesiol · Jun 2011
ReviewEducation, teaching & training in patient safety.
Patient Safety is not a side-effect of good patient care by skilled clinicians. Patient safety is a subject on its own, which was traditionally not taught to medical personnel. This must and will dramatically change in the future. ⋯ But Anaesthesiology must continue in its efforts in order to stay at the top of the patient safety movement, as many other disciplines gain speed in this topic. We should strive to fulfill the Helsinki Declaration and move even beyond that. As the European Council states: "Education for patient-safety should be introduced at all levels within health-care systems"
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Incident reporting can be a powerful tool to detect weaknesses in the complex system of anaesthesiology. Having its roots in aviation, incident reporting today is used in a variety of medical disciplines at the local and even on the national level. Strength of incident reporting is the potential for learning from rare and potentially dangerous events. ⋯ It, furthermore, needs a sound definition or a model of a critical incident as well as a strategy to analyse the reported events. In Europe, a number of countries already run a national reporting system in anaesthesiology with large collections of critical events. These national systems, furthermore, distribute hazard warnings to spread the information on critical incidents among all specialists in that country.