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22 Cards in this Set
- Front
- Back
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surgical safety checklist |
components sign in time out sign out objectives risk and harm prevention (correct surgery, anaesthesia, allergy, bleeding, infection, counts) teamwork communication record keeping surveillance barriers design implementation staff institution |
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QA |
definition organised process for evaluation and improvement regular consistent with standards encompass all staff steps planning implementation review standards |
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Professional Roles |
SHaME-CCP Scholar Health_advocate Manager Expert Communicator Collaborator Professional Medical expert knowledge, skills and attitudes audit and QA risk and decision making Communicator patients and family history discussions Collaborator Cooperates active team member conflict resolution Documentation Manager protocols and standards Leadership efficiency Health advocate community patient rights Promoting health cultural awareness Scholar lifelong learning Teaching Research critical appraisal Professional Awareness and insight ethical health and wellbeing regulatory framework |
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consent |
capacity & 'person responsible' information voluntary exemptions duty to warn (material risks) documentation Cases Capacity - Gillick 1986 Material risks - Rogers v Whitaker 1992 - "a reasonable person, in that person's position...would likely attach significance to it" Special circumstances - can't consent for another person - sterilisation, termination, organ retrieval - emergency (life saving, present serious injury or suffering) OPA Consent decision making: 1 - emergency? 2 - capacity? 3 - refusal of treatment certificate? 4 - person responsible? EPOA(med) > VCAT guardian > other person documented as decision maker, then: spouse > primary carer > adult child > parent > sibling > grand parent > grand child > uncle/aunt > nephew/neice |
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handover |
indications fatigue illness other committment emergency end of anaesthesia care Components competent safe and stable information (history, anesthesia, surgery, plan and disposition, documentation) confirm (machines, monitoring, lines, airway) notify team PACU devices and lines observations pain and ponv fluids regionals |
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NHMRC Evidence Levels |
I - systematic review of RCT II - single well designed RCT III - non-randomised (1blinded, 2prospective, 3retrospective) IV - case series |
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Ethics Review Commmitte |
validity justification respectfulness voluntary privacy minimisation of harms Declaration of Helsinki - right to autonomy of participants - risk/benefit of research & ethics review National Statement on Ethical Conduct in Human Research (NHMRC) |
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conducting a study |
question - PICO literature search methods ethics review recruitment and data collection analysis safety monitoring submission and publication |
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systematic review |
define question and keyword database search selection criteria qualitative or quantitative analysis (meta-analysis) |
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weakness of meta-analysis |
publication bias individual study bias heterogeniety complex and expensive outdated |
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human error types |
active slip - unintentional, sequence, description, mode lapse - omission fixation latent |
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high risk sedation criteria |
age <2 or elderly ASA 4-5 acute bleeding aspiration or difficult airway previous complication |
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equipment for sedation |
basic - area, lighting, table airway - oxygen, suction, basic airway monitoring - SpO2, BP, IV (EtCO2, ECG, defib ready) drugs - adrenaline, dextrose, lignocaine, naloxone, flumazenil, O2, fluids access and emergency |
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requirements for assistant |
requisites 150hrs log book assessments anaesthetist input in curriculm 1-3 years content sciences equipment safety techniques emergency management duties direct supervision at start and end available during exclusive senior supervision |
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mandatory monitoring |
SpO2 If circuit: disconnection alarm gas analysis (O2, CO2, volatile) |
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available monitoring |
ECG NIBP IABP temp neuromuscular depth of anaesthesia others e.g. TOE, CVP |
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abuse addiction dependence |
abuse - use of detrimental substance addiction - chronic disease with loss of control, denial, compulsion or craving, despite adverse effects physical dependence - withdrawal syndrome and adaptation psychological dependence - seeking positive or avoid negative effects |
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major signs of substance abuse |
direct witness administration, diversion or falsification injection and paraphenalia intoxication or withdrawal indirect drug quantities record keeping consistent pain change in attitude or behaviours |
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Safe Transport |
airway - emergency equip. O2, suction, bag, ventilator cardiac - defib, pacing, IV drugs - emergency and specific monitor - O2, ECG, BP, CO2 pressure and protection |
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difficult airway equipment |
guedel and NPA laryngoscopes LMA ETT introducer + bougie cricothyrodotomy kits high pressure ventilators CO2 detector oesophageal bulb Available FOB aintree, bite block, LA indirect laryngoscope |
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Personnel & equipment requirements for sedation for diagnostic and interventional procedures
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PS 09
Personnel: Proceduralist sedation (with airway skills) – nitrous or oral sedation only (no IV) – one assistant – conscious sedation ASA 1–2 – can use IV (midaz, opioid) but no anaesthetic agents (e.g. propofol) – two assistants Medical sedationist – Conscious sedation ASA 1–3 – one assistant who must be exclusively available to seditionist at start and end and if problems arise. Can use propofol if trained in use Anaesthetist – Deep sedation or GA – any drugs – with assistant exclusively available at start and end of case and if problems arise – Dedicated assistant if likely to be complex, emergency or assistance likely required for duration of case Anaesthetist if: child, ASA 4–5, difficult airway, emergency, aspiration risk, cardiovascular instability Other requirements – Assessment & consent as per PS07 and PS26 – Facilities, lighting, area for recovery – oxygen & suction, BMV, mask/OPA/LMA/ETT – Monitoring – SpO2, BP, access to ECG/Defib/capno – Drugs (sedatives & reversal, emergency) |
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Pre-anaesthetic consult |
Identify - patient, procedure Assess - Hx/Ex/Ix Consult Optimise Risk discussion & consent Planning & pre-medication Documentation |
