Episode #52 Celebrating 1 Year of Anesthesia Patient Safety Podcasts

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. It is hard to believe that the Anesthesia Patient Safety Podcast is celebrating its 1 year anniversary! Thank you for listening and contributing and sharing and joining the #APSFpodcast crowd. For our show today, we are going to look back at Episode #4, The 2020 APSF President’s Report. In this episode, we discussed the 2020 Top 10 Perioperative Patient Safety Issues. After we do our look back, we are going to talk about the Updated 2021 Patient Safety Priorities from the June 2021 APSF Newsletter!

Before we dive into today’s episode, we’d like to recognize Masimo, a major corporate supporter of APSF. Masimo has generously provided unrestricted support as well as research and educational grants to further our vision that “no one shall be harmed by anesthesia care”. Thank you, Masimo- we wouldn’t be able to do all that we do without you!”

Now, let’s take a listen to a review of the 2020 Perioperative Patient Safety Priorities. Here we go.

[Episode 4 Clip Here: Today, we are going to talk about the 2020 President’s Report, delivered this year by Mark Warner, MD the current president of the APSF.  You can find this report by clicking over to the APSF Newsletter archives and checking out the February 2020 edition. We’ll also put a link in the show notes for this podcast.  Warner starts his report with a call to action for APSF and the specialty of anesthesiology to focus on high-value issues that absolutely need to be addressed and then gives us all a call to action as individuals who take care of patients undergoing anesthesia care to concentrate on the safety of each of our patients every day.  It is this passion for patient safety and mission of no patient ever harmed by anesthesia that drives those of us within the APSF family and hopefully all of you listening to this podcast and this is something that you can share with you colleagues and institutions and healthcare systems as well.

So, what are these high-value issues that need to be addressed?

What better way to share them, then with a top 10 list.  So, now I give you the APSF 2020 Top 10 Perioperative Patient Safety Issues that we believe require targeted attention, continued or renewed discussion, and further support regardless of your practice environment and location.  Can I get a drumroll please?

[Drumroll]

Number 1 is the Prevention, Detection, and Mitigation of Clinical Deterioration in the Perioperative Period.  Although it may sound simple or obvious to be prepared and stay vigilant, and that we can prevent problems by detecting them earlier, this is exactly where we have an opportunity to improve care.  This includes early warning systems in all perioperative patients, monitoring for patient deterioration with continuous postop monitoring on the floor, opioid-induced ventilatory impairment and monitoring, and monitoring for early signs of sepsis…and finally early recognition and appropriate response to the decompensating patient.  As they say, timing is everything, and this is true in patient safety as well.

The second priority for 2020 is Improved safety in out-of-OR locations such as endoscopy and interventional radiology.  This is so important because some of these locations can be far away from supplies and additional sets of hands. As a result, these locations can have particular vulnerabilities when the rare emergency or unexpected event occurs. An important consideration during the Covid pandemic continues to be safety for patients and anesthesia professionals in the endoscopy suite.  Upper endoscopy procedures, transesophageal echocardiography, and bronchoscopies may increase the risk of aerosolized airborne pathogens. One proposed solution to minimize the risk of contamination of the endoscopy suite environment was to provide general endotracheal tube anesthesia for all of the procedures.  However, this method is not without risk for aerosolization of viral particles if there is coughing during intubation and extubation and it may be difficult to provide general endotracheal anesthesia in an endoscopy suite especially if there is no anesthesia machine available.  Other risks include hemodynamic instability, aspiration, and difficult airway management. For some patients…patients with full stomachs for emergency procedures…general endotracheal anesthesia may be the best choice.  For other patients, during the covid pandemic and going forward, monitored anesthesia care with IV sedation will likely continue to be appropriate and safe.  The question is, how can we do this safely? A simple and low cost mitigation strategy is using a plastic endoscopic oxygen facemask as a barrier against airborne pathogens during and after endoscopy.  The Procedural Oxygen Mask is an example and has been FDA-approved for upper endoscopies. It is a clear plastic O2 mask with self-sealing oral and nasal endoscopy ports and a capnography port, which is vital for monitoring, and an optional oxygen reservoir side bag if a higher FiO2 is needed.  In addition, all of the healthcare providers in the room should wear proper PPE.

Next up, is Developing a Culture of Safety by highlighting the importance of team work and promoting interpersonal relationships and interactions that support patient safety. There has been considerable progress in this area over the past years, but there’s lots of room for even more improvement. We highlight the importance of effective leadership and patient safety culture in the June 2020 newsletter in the article by Albright-Trainer and colleagues.  The authors discuss the importance of effective leadership in medicine to develop a patient safety culture within an organization.  An environment of psychological safety is necessary so that people feel safe to communicate any threats to patient safety and this allows leaders to take timely action to protect patients and employees. A positive and psychologically safe environment will lead to an improved culture of safety, but wait there is more…other benefits will likely include higher job satisfaction among employees, decreased burnout, and less medical errors.

The 4th priority is another big one that we have been working on for a while, but there is still more work to be done…and it is…Medication Safety including paying attention to drug effects, correct and safe drug labeling, drug shortages, medical safety through technology such as barcoding and RFID, and having appropriate processes in place to avoid and detect drug errors.

The next priority, number 5 is  Perioperative delirium, cognitive dysfunction, and brain health.  It is not enough to keep patients safe only while they are in the OR, but we need to be thinking about and researching how to keep their brains safe and functioning throughout the perioperative period and beyond.

Our 6th priority is especially pertinent these days and it is Hospital-acquired infections and environmental microbial contamination and transmission.  This is an important issue that spans from the individual with hand hygiene and maintaining sterile fields to healthcare systems and institutions with appropriate contact precautions and monitoring. While this obviously isn’t specific to COVID, the current pandemic certainly makes this a highly relevant priority.

We are now at the 7th priority which is something that we do every day as anesthesia providers, talk about our patients.  This priority calls for improvements in patient-related communication issues, handoffs of care, and transitions of care.  If you are starting to think about implementing a handoff protocol, here are some opportunities to consider including administration and staff support for the new handoff protocol, editing to fit local needs, training at the onset and ongoing training, pilot testing with feedback from the staff to team leaders and to the staff during the testing phase, trialing the handoff protocol in simulated scenarios and simulation centers. Threats may include team leadership to head up the new initiative and obstructionists. The APSF has created a roadmap to create an effective handoff and I will link to it in the show notes. Start with an audit to access the need for a new handoff protocol, then discuss the results of the audit with the staff. Next, you are going to have to obtain support from leadership and administration as well as assign a team leader and a focus group or committee.  The next step is research in the literature and reviewing existing protocols and you can use this research to draft a tool and then review and edit and adapt the tool to fit local institutional and practice setting needs. At this point, it is important to consult with a human factors expert to weigh in on the new protocol and finally, you are ready to try out the new tool and get feedback from the stakeholders. Examples of key handoffs include operating room to PACU or ICU handoff as well as provider handoffs during transitions of care due to fatigue or provider scheduling.

The 8th priority shines the spotlight on how we can make anesthesia safer in terms of airway management difficulties, developing and maintaining skills for safe airway management and appropriate use of airway management equipment and other aspects of airway equipment including malfunction, supply, developing new technologies to help keep our patients safe.

We are now at the penultimate priority.  Healthy anesthesia professionals are better able to provide safe patient care and that is why the 9th priority in this list focuses on anesthesia professionals and burnout including what are the effects of burnout and how can we better recognize and manage burnout.

Alright, we made it to the 10th priority in our top ten list.  This priority has implications in all of our other patient safety priorities that I already discussed today and it is a constant threat to patient safety and the priority is Distractions in procedural areas.  We know how dangerous distractions are when we are driving and staying safe on the roads and distractions in procedural areas are just as dangerous for patient safety.  We need to be able to identify and remove distractions to help keep our patients safe when they are in our care.   Especially in the modern day with technology being so tightly linked to patient care, distractions related to this tech represents a double-edged sword.]

That was a good review of the 2020 APSF patient safety priorities, but we are providing the latest in perioperative anesthesia patient safety, so let’s review the 2021 priorities now. To follow along with us, click on the Newsletter heading. First one down is the current issue. Then, scroll down until you get to our featured article today, “The APSF Revisits Its Top 10 Patient Safety Priorities” by Steven Greenberg. Figure 1 in the article highlights these priorities and I will include a link in the show notes.

At the top of the list is Culture of safety, inclusion, and diversity. This is such an important consideration for delivering safe anesthesia patient care. For more information about creating a culture of safety, check out Episode #6 of this podcast where we discuss healthy relationships between the surgery and anesthesia teams with practical tips for building a culture of safety as it pertains to the anesthesiologist-surgeon dyad. The next priority is Teamwork, collegial communication, and multidisciplinary collaboration. The multicenter handoff collaborative is an example of the work that the APSF has contributed to in order to help keep patients safe throughout the handoff or transfer of care process by preventing medical errors or the loss of information during this critical time. The multicenter handoff collaborative seeks to develop evidence based strategies to achieve safe handoffs of care, every time. The 3^rd priority is Preventing, Detecting, Determining Pathogenesis, and  Mitigating clinical deterioration in the perioperative period. Have you taken care of patients in endoscopy, cardiac catheterization suite or in interventional radiology? The next priority includes safety in these locations and all non-operating room locations. The 5^th priority is related to something we talked about recently on this podcast, Perioperative delirium, cognitive dysfunction, and brain Health. This was one of the featured articles from the October 2020 ASPF Newsletter as well, called “Brain Safety: The Next Frontier for our Specialty” by Kamdar and colleagues.

Moving to the next priority we see that the APSF has supported research and published 11 Newsletter articles on this important area as well as worked to promote postoperative monitoring of patients who have received opioids. The 6^th priority is Prevention and mitigation of opioid-related harm in surgical patients. The 7^th priority remains on the list and that is a very good thing because Medication Safety including drug effects, labeling issues, shortages, technology issues, and processed for avoiding and detecting errors remains an important area for improved anesthesia patient safety. Next up, we have the 8th priority which is Emerging infectious diseases including, but no limited to COVID-19 including patient management, guideline development, equipment modifications, and determination of operative risk. The APSF is committed to addressing strategies to prevent intraoperative infection. In addition, throughout 2020 and going forward, the APSF continues to share up-to-date information related to anesthesia patient care during the COVID-19 pandemic.

Just 2 more priorities to go. The 9^th priority is Clinician Safety: Occupational Health and Wellness. This is going to be the topic of the 2021 ASPF Stoelting Conference in September. There have been 5 articles and 1 research grant supported by the APSF on this topic and we’ll be covering this topic in more detail after the Stoelting Conference as well. The final priority is Airway Management Difficulties, Skills, and Equipment. Safe airway management is vital to providing safe anesthesia care.

In the article Greenberg highlights the additions to the Priority list this year which includes #2, 6, 8, and 9. The #1 priority this year related to Creating a Culture of Safety is in that position because we are learning that we can only provide safe anesthesia care if there is a culture of inclusion and diversity as well.

So, what are the next steps? Well, there is a lot to look forward to when it comes to patient safety. The APSF is in the process of forming advisory groups that will be charged with the development of recommendations related to expert guidance and further education and research related to the 2021 Top 10 Patient Safety Priorities. We hope that all of you listening to the show today will use the Patient Safety Priorities to make changes in your practice to help improve patient safety going forward.

Thank you for tuning into the first year of the Anesthesia Patient Safety Podcast and we hope that you will continue on this journey with us towards improved patient safety during anesthesia care.

If you have any questions or comments from today’s show, please email us at [email protected] or connect with us on Twitter, Instagram, Facebook, or LinkedIn.

Visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. If you have enjoyed listening to this show, please rate us and leave us a review anywhere you get your podcasts and we hope that you will share the #APSFpodcast with any healthcare professionals who are interested in improving patient safety.

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2021, The Anesthesia Patient Safety Foundation