As President of the Anesthesia Patient Safety Foundation (APSF), it is my privilege to report annually on the activities of the foundation during the past calendar year. The APSF was saddened by the passing of Ellison C. Pierce, Jr., MD, on April 03, 2011. Dr. Pierce was the founding president of the APSF, and without his vision and persistence the APSF would not have happened! The Ellison C. Pierce, Jr., MD, Patient Safety Memorial Lectureship has been established with the first lecture in October 2012 during the annual meeting of the American Society of Anesthesiologists.
As in my last annual report, I believe it is important to recognize that the APSF, as an advocacy group, does not write standards. Recommendations developed and promulgated by the APSF are intended to assist professionals who are responsible for making health care decisions. Recommendations promulgated by the APSF focus on minimizing the risk to individual patients for rare adverse events rather than necessarily on practices that balance all aspects of population health quality and cost. The APSF does not intend for these recommendations to be standards, guidelines, practice parameters, or clinical requirements nor does application of these recommendations guarantee any specific outcome. Furthermore, these recommendations may be adopted, modified, or rejected according to clinical needs and restraints. The APSF recognizes that these recommendations are subject to revision as warranted by the evolution of medical knowledge, technology, and practice.
Postoperative Visual Loss Conference on September 12, 2012, in Phoenix, AZ
The APSF believes that increased awareness and understanding of risk factors associated with postoperative visual loss (POVL) is a timely patient safety topic. In this regard, the APSF is sponsoring a 1-day multidisciplinary conference to better define current information and understanding of “best practices” for patients at risk for POVL. Specific questions that will be addressed include
- Shared decision making (patient, surgeon, anesthesia professional)
- Who is “at risk”
- Informed consent (timing and by whom?)
- How is anesthetic and surgical management influenced?
If you are interested in attending this conference, please contact Dr. Stoelting at [email protected] for registration information.
The APSF Committee on Scientific Evaluation, chaired by Sorin J. Brull, MD, received 17 grant applications in 2011. In October 2011, the committee recommended funding the following 2 research awards to begin in January 2012:
Extubation Safety Quality Initiative Project – ESQIP
Miriam M. Treggiari, MD, PhD, MPH
Department of Anesthesia, University of Washington
APSF/ASA Endowed Research Award and Ellison C. Pierce, Jr., MD, Merit Award.
Enhancing Perioperative Safety through the Determination of Intraoperative Predictors of Post-Operative Deterioration
Jesse M. Ehrenfeld, MD, MPH
Department of Anesthesia, Vanderbilt University
APSF/Covidien Research Award and The Doctors Company Foundation Ann S. Lofsky, MD, Research Award
The total dollars awarded for these 2 grants was $309,999.
In addition, the APSF is partially supporting the MOCA GRANT and has announced the Safety Investigator Career Development Award ($150,000 over 2 years) to begin July 2012.
The APSF is the largest private funding source for anesthesia patient safety research in the world. Since the inception of the APSF grant program 522 grant applications have been received by the APSF. When the first grants were funded in 1987, funding for anesthesia patient safety was virtually unknown. Since 1987, the APSF has awarded 94 grants for a total of more than $7,070,000. The impact of these research grants is more far-reaching than the absolute number of grants and total dollars, as the APSF-sponsored research has led to other investigations and the development of a cadre of anesthesia patient safety investigators.
The APSF Newsletter continues its role as a vehicle for rapid dissemination of anesthesia patient safety information with Robert C. Morell, MD, and Lorri A. Lee, MD, acting as coeditors. The circulation of the APSF Newsletter exceeds 94,000 recipients and is provided as a member benefit by the ASA, American Association of Nurse Anesthetists (AANA), American Association of Anesthesiologists Assistants (AAAA) and the American Society of Anesthesia Technologists and Technicians (ASATT) and the American Society of PeriAnesthesia Nurses (ASPAN).
Important issues presented in recent editions of the APSF Newsletter included the report of the Board of Directors Workshop: 360° Assessment of the APSF, authored by Drs. Robert C. Morell and Lorri A. Lee, and Maria A. Magro, CRNA, and appearing as the lead article in the Winter 2011 issue. The Spring-Summer 2011 issue included an article entitled “Opioid Prescribing: Methadone Risk Mitigation authored by Joan M. Christie, MD, and an article by Stephen E. Abram, MD, on “Avoiding Catastrophic Complications from Epidural Steroid Injections.” The Fall 2011 ASPF Newsletter included the proceedings of the APSF-sponsored conference on “Essential Monitoring Strategies to Detect Clinically Significant Drug-Induced Respiratory Depression in the Postoperative Period.” This report was authored by Drs. Matthew B. Weinger and Lorri A. Lee. This same issue included a Dear SIRS article on reusable anesthesia breathing circuits by James M. Maguire, PhD, member of the APSF Committee on Technology. Drs. J. Paul Curry and Lawrence A. Lynn contributed an article entitled, “Threshold Monitoring, Alarm Fatigue, and the Patterns of Unexpected Hospital Death.”
The “Question and Answers” and “Dear SIRS” (Safety Information Response System) columns in the APSF Newsletter provide rapid dissemination of safety issues related to anesthesia equipment in response to questions from readers. These columns are coordinated by Drs. A. William Paulsen (chair, APSF Committee on Technology) and Robert C. Morell (co-editor, the APSF Newsletter). The value of industry to anesthesia patient safety is reflected by these columns.
The APSF website design and appearance (www.apsf.org) continues under the direction of the APSF Executive Vice President, George A. Schapiro. The APSF website includes a monthly poll question related to anesthesia patient safety issues. The poll question is coordinated by Timothy N. Harwood, MD, a member of the APSF Committee on Education and Training chaired by Richard C. Prielipp, MD. Online donations to the APSF are possible via the website.
Sorin J. Brull, MD, chair of the APSF Committee on Scientific Evaluation, continues as the Patient Safety Section editor for Anesthesia & Analgesia.
APSF sponsored a panel entitled Drug Errors You Must Avoid: Mishaps and Management at the 2011 Annual Congress of the International Anesthesia Research Society. This panel was organized and moderated by Richard C. Prielipp, MD.
Fire Safety Video
More than 4,000 requests to receive the complimentary APSF fire safety video entitled “Prevention and Management of Operating Room Fires” have been received since the DVD became available in April 2010 (complimentary copies may be requested on the APSF website, www.apsf.org).
More than half the requests have come from registered nurses in their roles as safety educators in the operating room. The fire safety video emphasizes the appropriate use of supplemental oxygen for decreasing the risk of operating room fires. A survey to determine the impact of the APSF fire safety video on clinical practice has been conducted and the results are available on the APSF website (www.apsf.org).
The Food and Drug Administration has undertaken a fire safety initiative based on the initial role of the APSF and the ECRI Institute, bringing this safety issue to the forefront. A survey of recipients of the complimentary fire safety DVD is underway to determine how the DVD was used and its impact, if any, on clinical practice.
Monitoring Strategies Conference
The Conclusions and Recommndations from the APSF-sponsored conference,
Essential Monitoring Strategies to Detect Clinically Significant Drug-Induced Respiratory Depression in the Postoperative Period are available on the ASPF website (www.apsf.org). The conference attendees agreed that monitoring oxygenation and ventilation should be available for all adult patients receiving opioids for pain management in the postoperative period.
Annual Board of Directors Workshop
The annual APSF Board of Directors Workshop on October 15, 2011, entitled Current Anesthesia Patient Safety Issues-Help Set the Priorities for Immediate Short-Term Resolution included more than 700 attendees. A unique feature of the workshop was the use of an audience response system. The answers to the questions posed using the audience response system are available on the APSF website (www.apsf.org).
Medication Safety in the Operating Room Video
A complimentary copy of the 18-minute educational DVD, Medication Safety in the Operating Room: Time for a New Paradigm may be requested on line (www.apsf.org)
Financial support to the APSF from individuals, specialty and components societies, and corporate partners in 2010 has been most gratifying. This sustained level of financial support makes possible the undertaking of new safety initiatives, the continuation of existing safety initiatives, and funding for anesthesia patient safety research. The level of research support is particularly dependent on the level of financial support received.
The APSF website permits “online” credit card contributions to the APSF. Go to “Donate” on the APSF home page and follow the prompts.
The APSF wishes to thank retiring Board of Directors members, Albert L. deRichemond, Thierry Leclercq, Susan R. Fossum, RN, Douglas M. Hansen, MD, and Robert A. Wise, MD, for their years of service.
As in the previous annual report, I wish to reiterate the desire of the APSF Executive Committee to provide a broad-based consensus on anesthesia patient safety issues. We welcome the comments and suggestions from all those who participate in the common goal of making anesthesia a safe experience. There remains much still to accomplish and everyone’s participation and contributions are important.
Best wishes for a prosperous and rewarding year 2012.
Robert K. Stoelting, MD