Circulation 122,210 • Volume 33, No. 3 • February 2019   Issue PDF

2019 President’s Report: Taking Action – APSF’s Renewed Commitment to Implementation of Changes That Can Improve Perioperative Patient Safety

Mark A. Warner, MD, APSF President
Dr. Mark Warner

Dr. Mark Warner

Improving patient safety seems so simple since we all share, to various degrees, the desire to help our patients—to guide, escort, and usher them through the perils that come with surgeries and other procedures. APSF’s vision that “no patient shall be harmed by anesthesia” is clear. Yet why is improving perioperative patient safety so difficult?

For more than a decade, the APSF has used consensus conferences to identify important patient safety issues in anesthesia care (Table 1). The recommendations from those conferences (Table 2) have been based on strong science and have been formatted to be logical, reasonable, and actionable. A close review of these recommendations seems to support the first two of these assessments; they appear logical and reasonable. However, they have not been uniformly, and certainly not readily, actionable. Broad implementation of these recommendations would likely have improved the perioperative safety of countless patients.

Table 1. APSF Consensus Conferences 2001–2018

APSF Stoelting Conferences
2018 Perioperative Medication Safety: Advancing Best Practices
2017 Perioperative Handoffs: Achieving Consensus on How to Get it Right
APSF Consensus Conferences
2016 Distractions in the Anesthesia Work Environment: Impact on Patient Safety
2015 Implementing and Using Emergency Manuals and Checklists to Improve Patient Safety
2014 Patient Safety and the Perioperative Surgical Home (PSH)
2013 Anesthesia Professionals and the Use of Advanced Medical Technologies: Recommendations for Education, Training, and Documentation
2012 Perioperative Visual Loss: Who is at risk, What should we tell patients preoperatively, and How should we manage their intraoperative care?
2011 Essential Monitoring Strategies to Detect Clinically Significant Drug-Induced Respiratory Depression in the Postoperative Period
2010 Medication Safety in the Operating Room: Time for a New Paradigm
2009 Cerebral Perfusion Pressure and the Beach Chair Position
2008 Medication Safety and Its Impact on Patient Safety
2007 Improving Training in Advanced Anesthesia Technology: Ensuring Patient Safety
2006 Patient-Controlled Analgesia and Opioid-Induced Ventilatory Depression: Recognition and Prevention
2005 Carbon Dioxide Desiccation
2004 The Long-Term Impact of Anesthesia on Patient Outcomes (and a second one) Ensuring Patient Safety By Requiring the Use of Audible Alarms
2003 Essential Monitoring Strategies to Detect Clinically Significant Drug-Induced Respiratory Depression in the Postoperative Period
2002 Advancing the Use of Anesthesia Information Systems to Improve Patient Safety
2001 The Impact of Production Pressure on Anesthesia Patient Safety

Beginning with the September 2018 APSF’s Stoelting Conference on Medication Safety, the foundation will more vigorously pursue implementation of the recommendations that come from the APSF’s annual consensus conferences on patient safety. For this year’s conference on medication safety, the recommendations focus on changes that address safety issues related to drugs and their administration. The specific recommendations of the conference are found in Table 2. Teams for each of the four major categories have provided an implementation plan for each recommendation. APSF has prioritized these and will now provide the resources needed to move them forward. We will engage with all of the appropriate stakeholders as we address these issues.

Table 2. APSF’s Medication Safety Recommendations 2018

Drug Safety: Identify and promote potentially safer anesthetics

  • Encourage reviews and research to assess the risks and benefits of nitrous oxide
  • Endorse and encourage the routine use of multimodal approaches for the reduction of postoperative pain
  • Endorse and encourage continuous monitoring of oxygenation and ventilation for all perioperative hospitalized patients receiving opioids
  • Encourage the FDA to review the hepatotoxicity risk of approved and future volatile anesthetics
  • Collaborate with the FDA and convene a work group to identify novel and potentially safer anesthetics for future use in the United States. Examples include inhaled xenon and propofol long chain triglyceride/medium chain triglyceride (propofol-LCT/MCT)

Drug Shortages: Share information, simplify ordering, and establish contingency plans

  • Provide up-to-date anesthesia-related drug shortage information on the APSF website and coordinate APSF’s efforts with professional and patient safety organizations and regulatory agencies
  • Encourage and support efforts to standardize and consolidate concentrations of commonly-used, anesthesia-related drugs
  • Encourage the FDA or other appropriate agencies or organizations to develop a manufacturer/supplier quality report card for anesthesia-related drugs
  • Collaborate with appropriate organizations to encourage contracting processes that lead to shared risks between health systems and manufacturers and group purchasing organizations for drug shortages and quality issues
  • Encourage the FDA to require drug manufacturers to have implementable contingency plans that reduce the risks of drug shortages

Reducing Drug Administration Errors: Standardize procedures and doses, carefully document administration, and simplify preparation

  • Encourage and endorse the use of prefilled, sealed syringes and standardized carts, trays, and surface arrangement of drugs in perioperative settings
  • Encourage the perioperative practice of identifying and documenting drugs before administering them
  • Encourage and support the development of technologies that can identify drugs and their administered doses and directly link these to documentation in electronic medical records
  • Develop collaborative efforts with electronic medical record corporations that support drug identification, documentation, and patient safety
  • Encourage professional organizations and health systems to support efforts that provide perioperative work environments in which collaboration is encouraged and all individuals are encouraged to identify opportunities to improve patient safety

Standardization and Innovation: Collaborate across specialties and establish consensus for refined standards

  • Promote consensus between professional and patient safety organizations on standardization of drug concentrations and labelling of drugs that are used in syringes and infusion administration
  • Collaborate with professional and patient safety organizations and encourage health systems and surgical/procedural facilities to standardize the delivery processes of high-risk drugs and drugs in which concentration variations can create high risks to patients
  • Develop and support a request-for-proposal and grant(s) for the development of standardized labeling of vials and syringes. The grant(s) would specifically support efforts that integrate the contributions of human factors experts, graphic designers, and clinicians.

APSF Will Take “Action” On Implementing Safety Recommendations From APSF Consensus Conferences

Our goal is to develop and then support implementation plans for perioperative patient safety that are actionable—the key being “action.” Actions that can improve perioperative patient safety may take many forms, including:

  • Improved and expanded dissemination of information about safety issues
  • Increased and targeted support for research that generates new knowledge on priority patient safety issues
  • Strong collaborations with professional societies, industries, and regulatory agencies to support implementation of perioperative patient safety initiatives

True to our heritage, APSF will be relentless in pursuing actions that improve perioperative patient safety. We look forward to working with all of you on this noble quest.


Dr. Mark Warner is currently President of the APSF and the Annenberg Professor of Anesthesiology, Mayo Clinic, Rochester, MN.

Dr. Warner has no disclosures with regards to the content of the article.