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Patient Safety/Risk Management Tips

Anesthesiology

As the first medical professional liability insurer to establish a patient safety department, The Doctors Company sets the industry standard with innovative tools that can help you reduce risk and keep your patients safe.

Turn your alarms on—and keep them on!

Anesthesia “disasters” can still occur in spite of the sophisticated monitoring machines in use. Most of these events should not occur but do because alarms had been silenced or were silenced at the end of the prior case and not turned back on. (Be aware that some machines do not automatically reset the alarm.) Do not neglect the pulse oximeter and CO₂ alarms. (The American Society of Anesthesiologists’ guidelines require that alarms be audible to the anesthesiologist or members of the anesthesia care team.)

Perform and document a thorough preanesthesia evaluation and include an airway evaluation.

Such an exam is essential to patient safety, and using a classification system (such as Mallampati) demonstrates that a thorough airway exam was performed.

Include a dental exam as part of your preanesthesia evaluation and include dental injury as a risk in your informed-consent discussion.

Dental injuries remain the most frequently encountered adverse event in anesthesia. Performing and documenting a dental exam and including dental injury as an identified risk in your informed-consent discussion may be effective in mitigating the exposure.

Be aware of the risks of postoperative narcotic pain medication in patients suspected of sleep apnea syndrome (SAS), also referred to as obstructive sleep apnea (OSA).

Many patients with OSA have not yet been diagnosed Be sensitive to the risk factors and potential indicators of the condition, and be aggressive in asking questions when the condition is suspected. It’s important to use pulse oximetry postoperatively if you suspect SAS. Also consider the use of epidural anesthesia during the postsurgical period.

Pay attention to perioperative normothermia.

Using warming techniques to maintain body temperature (except in those cases where hypothermia is intended) appears to be a factor in reducing the risk of surgical infections and cardiac events, along with decreasing the duration of postanesthesia recovery and extubation time. Steps taken to maintain normothermia should be documented. On the flip side, use care in warming efforts, especially in patients who may be frail or have thin skin (such as the very young or the very old), as burns can occur easily and are a source of claims.

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