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Sri Ramajeyam Om Anandamayi Chaithanyamayi Sathyamayi Parame! Dr. S. Ahanatha Pillai, M.D.,D.A.,

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.

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Sri Ramajeyam Om Anandamayi Chaithanyamayi Sathyamayi Parame! Dr. S. Ahanatha Pillai, M.D.,D.A.,

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  1. Sri Ramajeyam Om Anandamayi Chaithanyamayi Sathyamayi Parame! Dr. S. AhanathaPillai,M.D.,D.A., Emeritus Professor The Tamil NaduDr. M.G.R. Medical University. Chennai Former Professor ofAnaesthesiology Madurai Medical College

  2. DEPARTMENT OF ANAESTHESIOLOGY Madurai Medical College, Madurai

  3. Sri RamajeyamOm Anandamayi Chaithanyamayi Sathyamayi Parame!‘Patient Safety’Are we following the Standards ?

  4. Self Analysis Assessment of ‘Safety profile’ • Am I well prepared ? • Am I well equipped? (Do I haveeverything ready to meet the challengeson my way ?) ‘Yes’ – VeryGood Safety Profile

  5. Discuss • Less Technical aspects More of Professional .. • Ethics • Discipline • Responsibilities

  6. “Eternalvigilance is theprice ofsafety” Basicprinciple • Safety standards formulated • Monitors - designed & built

  7. Patient Safety Definition: Actions taken by individuals and organizations to protect patients from being harmed by the effects of health care services

  8. In Anaesthesia “Actions taken byAnaesthetist and Hospitaladministrators to protect patients frombeing harmed by the effectsof Anaesthesia” Anaesthesia has No PrimaryTherapeutic Purpose !

  9. There are No Safe Anaesthetic Drugsor Safe Anaesthetic Techniques, but there are only … Safe Anaesthetists ! - M H. King

  10. “It is not the drug that is dangerous, but the man who administersit is” - Sir Robert Macintosh

  11. Anaesthetic Accidents - Causes • Human errors • Lack of vigilance • Distractions • Fatigue • Inexperience • Inadequate supervision • Failure of communications • Drug reactions & Equipment failure

  12. Accidents “Anaesthetic accidentshardly ever happenwithoutwarning” The combination of causes or sequenceof failures that cause an accidentmay indeed be unique, but themistakes are common

  13. 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 maybe in technique, judgment or simplyfailure ofvigilance - John Alfred Lee

  14. 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(Dyer C. Br. Med. J.1989)

  15. Ten Golden Rules • Assess&Preparethe patientwell • Starve him-even for L. A. • Anaesthetise himon a tipping table • Check your drugs& equipments • Keep aneffectivesuctionready

  16. Ten Golden Rules .. • Keep hisairwayclear • Be ready to control hisventilation • Have a veinopen • Monitor his Pulseand B.P. • Always keep anassistant who can applycricoid pressure

  17. Comparing Anaesthesia Flight of an Aircraft Takeoff Flying Landing Induction Maintenance Recovery

  18. > 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

  19. In this comparison • Both are not entirely safe • Time & the rate of accidents Nothing else is similar • Here onlythe patient is at risk • Emphasis is “Preparedness”

  20. Preparation Cockpit checkbyPilot Before induction,Check • Anaesthetic machine • Drugs • Monitors • Accessories Are wedoing itevery time?

  21. Legal Responsibility Anaesthetist is legally responsible for functioning of the equipments he uses and the drugs he gives “A high index of suspicion”

  22. Pre-op Assessment • Careful physicalexamination • Necessary Basicinvestigations • Identify pre-existingdiseases • When possiblecorrect them Are we doingit always?

  23. Grading the “Risk” Anaesthetistonly Grades “Risk” Considerrisk factors • Patient’s condition • Choice of anaesthesia • Proposed Surgery

  24. Who else can give fitness ? • Cardiologist • Diabetologist They may not comprehend thespecificproblems of anaesthesia May advise therapy forcorrecting specificproblems – Not fitness

  25. 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 AlfredLee May prove fatal

  26. Pre-op Starvation • Even for L A or Day case • Vomiting &fatal aspiration

  27. Human Assistance Skillful assistant(O.T Assistant) • Securing I.V. line • Getting necessarydrugs • Intubation • Renders help throughout Anaesthesia andRecovery Most important & vital for Safety

  28. Basic Monitors Every Operation Table • Pulse oximeter • Non invasive B.P. • E.C.G. Monitor • Capnograph

  29. Human Monitor “No monitor can ever replace a human beingas,he has the 6th sense” “Continuous presenceof an anaesthetist is essential to monitor the patient” - Eichhorn J. H.

  30. Care duringRecovery “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

  31. “The safest place for patientsto recover is the operating theatre itself” Michael B. Dobson

  32. Recovery Room As per the standards • Space • Personnel • Monitors • Equipments Do we have it always ?

  33. Transfer to P.O. Ward Not in a hurry - Only when • Awake andcomfortable • Adequate Respiration • Stable C V S

  34. In Anaesthesia • No mortalityis acceptable • Percentagesmean death • 0.001 % means1 patient died • The family suffers100 % loss

  35. Patients place their‘Trust’ on us • We are responsible for ensuringtheir ‘Safety’ • Professionally,Morally & Legally

  36. Are we followingall the basic standards of safety ? • If we don’tdo it -Why ? Let us answer honestly

  37. Carry Home Message • Death dueto a disease may be inevitable,but adeath due to Anaesthesiais a tragedy - M H. King Let us prevent suchtragedies

  38. Thank You

  39. Identity of Patient Check for correctness • Patient identity • Informed Consent • Intended Surgery & Side

  40. Basic Infrastructure “If we cannotundertake a clinicalresponsibility with proper safety, the only honest andforthright attitude must be - nottoundertake it” - A. Lal (IJA 37:1 Editorial - 1989)

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