Administering anesthesia to patients before surgery is sometimes considered a process where once the medication is given, the rest of the time is mostly waiting. But that process can become problematic if there’s a lack of communication and guideline among medical personnel.
That’s the conclusion of two speakers in an educational session titled, “What Anesthesia is Thinking When They Look Like They Are Doing Nothing and How You Can Help,” at the AORN Global Surgical Conference and Exposition in Nashville, TN, earlier this week. The speakers were anesthesiologist Dr. Brian Cammarata and Lynn Reede, CRNA and director of the Anesthesia Patient Safety Foundation.
Dr. Cammarata related the real-life tale of a four-year old child undergoing an MRI for a febrile seizure who suddenly experienced a Laryngeal Mask Airway (LMA) problem and was unable to ventilate. The patient’s heartrate slowed, and Dr. Cammarata noted that staff members present were discussing non work-related matters and for a while were almost oblivious to the situation.
While this situation had a happy ending, Dr. Cammarata cites a problem with situational awareness, where there is a need to know “what is happening around me, what decisions do we need to take, how these decisions will impact the patient, and what do I need to communicate to the (medical) team.”
Reede concurs, emphasizing that communication is a foundational cornerstone. She adds that barriers to proper communications include handoffs, checklists, production pressure, distraction, and cultural biases. Handoffs are a particular problem, which often occurs when nurses change shifts. Reede cites statistics that show a 43 percent increase in in-hospital cardiac and non-cardiac surgery morbidity for intraop anesthesia provider handoffs.
Overworked nursing staffs are also a factor. However, Cammarata says this is not a new problem. “A survey 20 years ago showed that 62 percent thought production pressures was a concern, the same as today.”
Cammarata adds that communications issues occur because of noise and confusion during events such as induction, unexpected procedural events, and emergencies. He emphasizes the importance of everyone involved in anesthesiology procedures, including those not doing the actual work but assisting, in understanding proper technique. He also calls for greater care in positioning patients because some may have existing conditions that make them particularly vulnerable to being moved or repositioned.
A list of proper anesthesiology procedures should be established, says Reede. Best practices should be researched and followed with a written checklist to document what has and needs to be done. She adds that medical personnel need to conduct training sessions with this checklight so they can properly respond to emergencies and take contingent courses of action if needed.