Welcome to the next installment of the Anesthesia Patient Safety podcast hosted by Alli Bechtel. This podcast will be an exciting journey towards improved anesthesia patient safety.
Today, we are going dive into our 35th Anniversary Newsletter, the Jade edition. You can find the Newsletter here. https://www.apsf.org/newsletter/october-2020/
We review Eichhorn’s reflections on this special newsletter. Eichhorn served as the founding editor of the APSF Newsletter from 1985 until 2001 and provides some insider information about the creation and production of the Newsletter.
The Top 10 articles that are covered in the 35th Anniversary Newsletter are the following:
We round out the show by returning to our discussion on Cardiac Implantable Electronic devices which is article #6. This topic may sound familiar to the listeners of this podcast because we talked about this article on our 9th podcast episode. On the show today, we provide you with the updates for 2020 that you can find in the October 2020 Special Edition Anniversary APSF Newsletter. It is electrifying! You can find the article here. https://www.apsf.org/article/change-of-pace-an-update-on-the-perioperative-management-of-cardiovascular-implantable-electronic-devices-cieds/
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© 2020, The Anesthesia Patient Safety Foundation
Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Alli Bechtel and I am your host. Thank you for joining us for another show.
We are going to start the day off with a quiz. Pencils out. Textbooks closed. Here we go. What important event happened 35 years ago? I am going to keep you in suspense for a little bit.
You’ve heard me recognize our corporate sponsors on this show, but there’s another supporter who is absolutely essential – YOU! Every individual donation matters so much. Please visit APSF.org and click on the Our Donors heading and consider making a tax-deductible donation to the APSF. I will include a link to this in our show notes.
Now, do you have your answer? If you said, the founding of the APSF, then you would be correct. The APSF was created in 1985 and we are celebrating this milestone with the 35th Anniversary Newsletter. We are so excited for you to dive into the Newsletter and read through all of the content. If you haven’t done so already, then this is a spoiler alert because we are going to talk about some of the 35th Anniversary Newsletter today and in a couple of the shows that follow!
And what better way to start off this podcast then by hearing from Steven Greenberg, the APSF Newsletter Editor and Chief. I asked Dr. Greenberg a couple of questions about this special newsletter, so I’ll let him kick things off.
Steven Greenberg Voice Clip:
Good afternoon everybody. My name is Steven Greenberg and I’m the Anesthesia Patient Safety Foundation newsletter editor and chief and I’m delighted to inform you that the 35th anniversary of the APSF newsletter edition will be coming out in October 1st. It is actually been released online at our website at www.APSF.org. This is an incredibly special issue. It’s actually the Jade issue not only for being 35 years of recognition of patient safety but also Jade recognizes and symbolizes our International attention and exposure and outreach as it relates to engagement of the International Community with patient safety. Now Dr. Bechtel asked me a few questions to address today and one is the anniversary issue is entitled what then and what now and what she asked me is “what do you envision the next 10 years of the APSF newsletter to be.” Now, that’s an incredibly important question. I think as it relates to patient safety we will be focusing on our top 12 APSF perioperative patient safety priorities which include preventing, detecting, and mitigating clinical deterioration in the perioperative period; safety in non-operating room environments; culture of safety; medication safety; perioperative delirium, cognitive dysfunction, and brain health; hospital-acquired infections and an environmental microbial and contamination and transmission; patient-related communication issues, hand offs, and transitions of care; airway management difficulties and skills; cost-effective protocols and monitoring that have a positive impact on safety; integration of safety into the process of implementation and continuous improvement; and Burnout and distractions in a procedural areas. And I think that we’ll be diving more into the depth of research and education as it relates not only to the United States but all around the world as it relates to these patient safety priorities. You can also find articles that have touched on these top 12 priorities in the last several years as well.
So my favorite section of the newsletter is hands-down the rapid response section. That section is led by Dr. Feldman who is the head of committee on technology for the APSF and he’s done a fantastic job in engaging our industry community to answer tough questions from our readership regarding technological issues that they face on a daily basis when they are performing anesthesia practices. So how this really works is that a provider is working with a machinery or technology either in or outside of the operating room and something goes wrong. What Dr. Feldman and myself and others really try to engage is figuring out what the problem is and how we can partner with our industry professionals to solve the problem and this has been extremely helpful over the years in terms of helping providers solve problems but also improving patient safety. For instance, we’ve been able to change medication labels for better identification of specific drugs. We’ve been able to do a variety of other things that are so important to the bedside practitioners. So really should tune into the rapid response section.
If I was a future author, trying to be an author for the apsf newsletter, I would ask myself what problems in terms of patient safety risk do I see in the operating room and outside when I engage in my clinical practice and when you look at those problems, try to figure out ways that you might be able to solve them or the ways that you could partner with us or other organizations to solve those problems and then write about it. You can find our guide to the authors on our www.apsf.org website. We will be moving towards an editorial manager like submission process very soon and hopefully we can get that information out to you as soon as it becomes a reality.
Now, do I have any thoughts or reflections on the 35th Anniversary issue that I would like to share? Well, I have to tell you that it’s been an honor and pleasure to put this thing, this newsletter, together with my editor partners, Dr. Edward Bittner from Massachusetts General Hospital and Dr. Jennifer Banayan from Northwestern Memorial hospital and Dr. Meghan Lane-Fall from the University of Pennsylvania Medical Center. They have been fantastic in developing our top 10 articles in the last 35 years and we actually this was a huge task and we actually tasked our editorial board to go through 35 years of APSF newsletters and really decide and vote among all of us what were the 10 most impactful patient safety issues that we try to address through our newsletter. So you’ll see the original article links and then you’ll see the commentary from the 10 authors on what now is important as it relates to those topics. Dr. Eichhorn, Dr. Morell and myself provided an introduction to the newsletter and gave you a real historical perspective on the APSF newsletter itself when it was really produced by Dr. Eichhorn and one of our publishers, Bonnie Burkert, on pieces of paper and then sent in by mail, to now where it’s much more seamless as we’ve been able to utilize software techniques and so on and so forth. So please tune in and grab your APSF newsletter when it comes in your mail or get it online at www.APSF.org. Appreciate all your participation and we hope to hear from you, your patient safety issues that you might be grappling with in the operating room. Thank you very much.”
Thank you Dr. Greenberg for helping to introduce this special newsletter and for sharing some of your insights into the APSF newsletter.
Our 35th Anniversary Newsletter is the Jade edition and it opens with an article by John Eichhorn, Robert Morell, and Steven Greenberg entitled, “What Then?” and “What Now?” 35th Anniversary Edition of the APSF Newsletter. The authors goal for this very special newsletter is to provide vital information for our national and international readers about perioperative patient safety and the contributions of the APSF for improved patient safety over the years. In creating this Newsletter, the APSF Editorial Board, putting on their reading glasses and they read through 35 years of APSF Newsletter articles and I will note that this was done prior to the onset of the Covid-19 pandemic. The editorial board voted on a top 10 most impactful articles to include in this newsletter and review through the lens of What then and What now with the help of our current editorial team and past editors.
Before I get to reveal the Top 10 articles, I want to review Eichhorn’s reflections on this special newsletter. Eichhorn served as the founding editor of the APSF Newsletter from 1985 until 2001. He writes about the APSF vision that “no patient shall be harmed by anesthesia” and that the work towards this vision depended on creating and disseminating a high quality publication to serve as the foundation for the APSF to bring together the different arms of communication, research, education, initiatives, and debate. 35 years ago, this newsletter was created in a world that looked very different then the world we live in today, there was no social media, personal email addresses, smartphones, or google. Thus, the printed version of the APSF Newsletter started out as a quarterly newsletter publication sent out in the mail to anesthesia and related professionals in the United States as well as to patient safety leaders in other countries. The Newsletter was printed in black and white and included green accents and this was no accident. The goal for the bright green accent color that is associated with the American medical oxygen tanks was to make it easily recognizable by members of the anesthesia community.
Now, I have talked about the founding of the APSF before, but Eichhorn shares some additional details to give us the insiders look into the creation of the APSF Newsletter. In the beginning, the Newsletter received a boost from the first APSF Treasurer, Burton Dole who was the CEO at Puritan-Bennett Corp at that time. He provided 33% of the seed money to start the APSF and then he went above and beyond by providing his company’s in-house print shop to typeset, proof, and print the APSF Newsletter. That is fascinating and we are so thankful for this awesome contribution. The first issue was sent out right on schedule in March 1986 to 45,000 people and included an article about the founding of the APSF as well as an article about the minimal intraoperative monitoring and about the initiation of the ASA Closed Claims Study. The rest of the newsletter included articles on the expansion of the Confidential Enquiry into Perioperative Deaths in England, statistics on cardiac arrest due to anesthesia at one teaching hospital, and the relative dangers of hypoxemia and hypercarbia. 35 years later, the APSF is still producing high quality newsletters, sharing vital information and working hard to accomplish the vision that no patient shall be harmed by anesthesia care. Another insider tidbit shared by Eichhorn is that of the contributions from Hewlett-Packard, Inc. This company donated the following pieces of equipment to help with the continued newsletter publications including a desktop personal computer, a laser printer with lots of font cartridges, a scanner, and a word processing program! Now, many of us have all of that equipment in our home offices these days, but back then it was state of the art and really helped to give the APSF a great start. Today, authors submit articles by email and you can find information about publication on our website at APSF.org. Back then, authors first submitted their work on paper and then later on floppy disks that were delivered by the US Mail. By the 1990s, the APSF Newsletter production office moved to Wilmington, DE and production of over 60,000 copies continued due to significant corporate support from Bob Black, the president of AstraZeneca.
And now, it’s time for the moment you have been waiting for…what are those top 10 articles that made it into the Jade Edition of the Newsletter. Drumroll please!
There is so much great content here and all of these topics have really stood the test of time. They were important for patient safety when they were first published and they are all still relevant today. Article #6 may sound familiar to listeners of this podcast because we talked about this article on our 9th podcast episode. I hope that you will check out that podcast! The 2013 article on Perioperative Management of Cardiovascular Implantable Electronic Devices provided an algorithm for managing patients with these devices for elective and emergent surgeries depending on the risk of EMI to the device, different management for ICDs and pacemakers, and altering the management depending on pacemaker dependence. Since we already did a whole show on this article, we are not going to review it today, but we are going to finish the show today by talking about What’s new in 2020?
The authors asked some important questions as we may be asked to provide perioperative care for some of the 1.7 million patients with these CIEDs or Cardiovascular Implantable Electronic Devices in the United States alone. “Are we too concerned about CIED management in the perioperative settings? Has technology improved so much since the last APSF article that anesthesia professionals should not worry about perioperative CIED care? These are great questions and we are happy to provide an update. A recent study confirmed that EMI is still an important consideration for patients with an implanted device since the monopolar electrocautery would have led to inappropriate antitachycardia pacing or defibrillation in 20% of patients undergoing non-cardiac surgery above the umbilicus and 29% of patients undergoing cardiac surgery. The good news is this did not occur in patients undergoing surgery below the umbilicus. It continues to be important to consider the type of electrocautery used as well as location of the surgery.
The past 7 years has brought us newer types of pacemakers and ICDs. For example, the Medtronic Micra device is a leadless pacemaker with a self-contained generator and electrode in a single chamber device that is implanted in the right ventricle by way of the femoral vein. This is a pacemaker only and cannot perform defibrillation. For perioperative care, it is important to know that there is no magnet sensor (the device is very small after all) and it is recommended that the device be reprogrammed to an asynchronous ventricular pacing mode to decrease the risk for oversensing.
Another newer device is the Boston Scientific subcutaneous ICD for patients. This extra thoracic device includes a pulse generator that you will find between the anterior and midaxillary lines in the 6th intercostal space and a single subcutaneous lead that is tunneled medially to the xiphoid process and then superiorly along the left parasternal border. This device is capable of defibrillation as well as pacing at 50 beats per minute for 30 seconds if needed following defibrillation. There is a magnet mode for this device that will turn off the antitachycardia therapies while the magnet is applied to the device, and you will know that the device is in magnet mode because the device will emit a beeping sound. Removal of the magnet will return the device to the prior programming. It is important to evaluate the patient and the positioning for surgery when deciding on using a magnet versus reprogramming the device.
Another important update for 2020 is that the ASA published an updated practice advisory for device management that highlights obtaining a preoperative device interrogation and figuring out the risk from EMI before entering the operating room. The updated advisory also provides information on what to do for emergency cardioversion or defibrillation for a patient with a device. Here are the steps to take: Stop all EMI, remove the magnet, watch the patient and monitors for appropriate antitachycardia therapy. If removing the magnet fails to re-activate the antitachycardia therapy or the antitachycardia therapy was programmed to OFF for the procedure, you have 2 options, either immediately re-program the device or perform emergent external cardioversion or defibrillation. There is also guidance about devices that are safe for MRIs and further emphasis on not putting a magnet on every device in the OR. It is very important to know what the magnet mode is for your patient’s device before you place a magnet. The authors leave us with the final thought that in 2020 and beyond, anesthesia professionals will have the ability to create thoughtful individualized plans for all patients with cardiac implantable electronic devices. Thank you Neelankavil, Thompson, and Mahajan for this wonderful update.
That’s all the time we have for today!! We can’t wait to crack open the Jade Edition Newsletter again in a future show!! Thank you so much for joining us today on this journey towards improved patient safety. If you have any questions or comments from today’s show, please email us at [email protected].
Visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today. Plus, you can find us on Instagram at APSForg! Follow along with us for anesthesia patient safety pictures and stories!!
Until next time, stay vigilant so that no one shall be harmed by anesthesia care.
© 2020, The Anesthesia Patient Safety Foundation