Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
21 Cards in this Set
- Front
- Back
|
open disclosure |
- process of clinician informing patient about adverse event, cause of event and what steps have been taken to fix the problem
- not necessarily a direct apology - promotes open relationship built on trust, and reduces chance of litigation |
|
|
clinical governance
|
- systematic approach to maintaining and improving quality of patient care within the healthcare system
|
|
|
drug/ETOH abuse priorities
|
- patient care
- welfare of colleague - mandatory reporting |
|
|
confronting colleague
|
- ensure confidentiality
- consult specialist practitioners eg psych, drug and ETOH - collect evidence, may take time (major and minor criteria) - intervention (pre-planned, senrior staff, advocate for patient) - planned rehab admission for colleague - must have colleague acompanied at all times as at risk of selfharm/suicide - madatory reporting - rehabilitation |
|
|
mandatory reporting to medical board
|
- medical board present to protect public
- sexual misconduct with patient -ETOH/drug intoxication at work - behaviour due to impairment putting patient safety at risk - large deviation from accepted practice putting patient at risk |
|
|
professional attributes
|
- CCHAMMPS
collaborator - member of multidisciplinary team demonstrating leadership, consultation and delegation - shows respect for expertise brought by each team member communicator - effective relationships with staff, family, patient - sound ethical reasoning - respect rights of patients and staff health advocate - maintains personal health, has own GP - promotes preventative health - occupational safety - role of medical board Manager - manager of resources and staff - respects views of others medical expert - excellence in clinical practice - vigilant - patient safety paramount - sound ethical reasoning professional - patient confidentiality - abides by ANZCA professional documents - respectful - acknowledges and deals with limitations - personal and interpersonal professional behaviour scholar and teacher - values advances in scientific knowledge - life long learning - learns from errors - contributes to education of junior staff |
|
|
patient handover suitability
|
- end of shift
- fatigue - illness - other legitimate reason - suitable and willing colleague (appropriate competence, training and expertise who is willing to accept care) |
|
|
process of handover
|
- patient factors
- anaesthetic factors (A-E) - surgical factors (surgery, indications, complications) - post op plan - documentation of handover |
|
|
mandatory monitoring requirements
|
- ETCO2
- O2 analyser - SpO2 probe - disconnection alarm - ET volatile monitor |
|
|
must be available
|
- IABP
- NIBP - temp probe - ECG - NMJ when clinically indicated: depth of anaesthesia monitor (eg BIS), TTE, CO monitor, CVP) |
|
|
quality assurance
|
- organised process of assesses and evaluates patient care to improve practice and quality of care
- cycle of: planning implentation review set standards |
|
|
consent
|
- requirement of ANZCA
- autonomous decision by patient to proceed after given risks, benefits and alternatives to procedure, including if dont perform procedure - voluntary and without coercion and can be withdrawn at any stage - provided by someone with sufficient expertise and understanding - patient of sound mind - provided information about all risks that patient might consider important - gillick - bolam - emergency situation able to proceed if in patients best interests and thought patient would have chosen same course of action - can be provided by parents, guardian or board if patient unable to provide - interpreter if language barrier - documentation |
|
|
procedures suitable for day surgery
|
surgical
- minimal risk of bleeding postop anaesthetic - low risk of postop airway compromise - pain management controllable via outpatient technique patient - rapid return to eating and drinking - responsible adult can care for patient, additional requirements can be met as an outpatient |
|
|
patient requirements for day surgery
|
- ASA 1-2 or stable 3-4 at anaesthetists discretion
- willingness to have procedure performed with understanding of process and follow up - paediatrics must be >6/52 if term or >52 PCA if prem |
|
|
social requirements
|
- be within 1/24 of facility that can care for patient in event of complication in 1st 24/24
- responsible adult can care for patient for first night - access to telephone - responsible adult can transfer home in suitable vehicle - understanding of post anaesthetic care particularly in regards to public safety |
|
|
discharge from DSU
|
- stable obs for 1/24
- tolerating oral intake - N and V controlled - pain controlled - able to ambulate - if at risk of urinary retention have passed urine - correctly orientated to time, place and person - minimal bleeding or wound discharge - provided with written and verbal instructions on postop care including a contact number if complication - suitable analgesia for 1st day with instructions on how to use |
|
|
transport of critically ill
|
- transport must have had risk: benefit assessment
- dedicated equipment - must monitor HR, ECG, BP, SpO2, ETCO2 if mechanically ventilated - defib and suction - full O2 cylinders - portable ventilator with disconnection alarm - selfinflating bag - emergency drugs and equipment for reintubation - infusion pumps - procedure to check equipment - need at least a qualified nurse, tech and doctor - freed from duties, know route - all equipment checked - enough IV fluids, infusions - re-assess patient before departure ABCDE - QA of process |
|
|
PACU requirements
|
- general principles: recovery should occur in location close to where anaesthesia occured, should occur under supervision by suitably trained and dedicated staff
Layout - must be accessible from both theatre and rest of hospital - lift and w/chair access - adequate space for each bed - 1.5 beds/theatre to cope with high turnover - must be a nursing station with phone, overhead page and access to switchboard - uninterrupted view of several patients at once - each bed must have: O2, suction, lighting, 2 power outlets, facilities to mount charts - space to scrub - radiology access - emergency power supply Equipment - Each bed space must have :O2, suction, SpO2, facilties for BP measurement stethoscope, means to monitor temperature - in recovery area: ETCO2, mechanical ventilator, self inflating bag, emergency drugs and equipment for reintubation, drugs for acute pain management, range of IV fluids, patient warming devices - access to: defib, 12 lead ECG, NMJ, chest drains, surgical equipment, blood and ABG testing, ICC - bed: tilt head up and down, brakes, sit up staffing - suitable trained and qualified - ANUM - 1;3 if awake, 1:1 if unconscious management and supervision - written protocol for management incl checking drugs and equipment - obs recorded - remain until meet DC criteria - anaesthetist responsible must accompany to recovery and provide verbal and written handover and available for review |
|
|
ANZCA policy on smoking
|
- advocate cessation >12/24 and preferably >2/12 pre-op
Resp effects - CO t1/2 4/24, therefore 12/24 will significantly reduce CO levels in blood and improve O2 carrying capacity, and reverse arrhythmogenic and negative inotropic effects on heart - increased mucus production, impaired tracheobronchial clearance and small airway narrowing in 1st 2/52, then reduced to baseline by 6/12 - pulmonary complications to baseline after 2/12 CVS: - nicotine effects normalise after 12/24 (increased HR, increased BP, positive ionotrope and peripheral vasoconstriction) Haem: -polycythaemia, increased fibrinogen and hypercoagulable state normalised after 2/52 immune - reduced IgG and cells in immune system normalised after 6/12 pain: - reduced to baseline after 2/12 PONV - reduced to risk of non-smoker after 2/12 |
|
|
policy on sedation
|
- awake - GA is continuum, no discrete well defined stages
- except for very light conscious sedation (eg oral benzo, N2O) must be minimum of 3 suitably trained staff (proceduralist, practitioner for sedation and nurse to provide assistance to both) - assistant must be dedicated to practioner giving sedation at start and end of case - if GA, must have dedicated assistant and either anaesthetist or suitably trained practitioner - if sedation, must have airway skills and CPR - cant use IV anaesthetic agents unless dedicated practitioner giving sedation with suitable training |
|
|
sedation equipment
|
- must have SpO2 as minimum with regular checks of conscious state
- available: room for resus, lights, suction, O2 source with ability to deliver to SV and also mechanical ventilation, drugs and equipment for intubation, device for BP, ECG, way to get emergency assistance |
