The specialty of anesthesiology has been at the forefront of the patient safe movement. Mortality rates due to anesthesia have generally believed to have decreased over the past two decades, attributed to advances in patient monitoring techniques, incorporation of practice guidelines, and approaches at error reduction. The American Society of Anesthesiologists has created standards, advisories, and guidelines to improve care. Formation of the Anesthesia Patient Safety Foundation (APSF), whose goal is to assure patient safety with the mission that “no patient shall be harmed from anesthesia,” has helped to increase safety efforts.
One area of focus for the improvement of patient safety has been the development and improvement of patient monitoring, in combination with the establishment of practice guidelines for usage. The use of pulse oximetry, gas analysis, and capnography has been attributed to reduction of catastrophic mishaps such as unrecognized esophageal intubation and hypoxic gas delivery. In 1986, the ASA established the Standards for Basic Anesthetic Monitoring, requiring qualified anesthesia personnel be present throughout anesthetic administration, and the continued evaluation of the patient’s oxygenation, ventilation, circulation, and temperature.
Communication is paramount to coordinating effective and quality patient care. Unfortunately, communication failures contribute to a large number of medical errors. Building a culture of structured open communication among team members and between teams can help to reduce errors. Standardization of communication via techniques such as SBAR (Situation, Background, Assessment, and Recommendation) has become a highly reliable way to effectively convey information. SBAR was developed by the United States Navy as an effective and efficient form of communication on nuclear submarines, then used successfully by the aviation industry, and transitioned into healthcare. It is especially useful for transitions of care, a point in which communication breakdowns can commonly occur.
The “Time-Out” process or safety checklist is used to ensure that all safety precautions have been met and discussed prior to the initiation of anesthesia, prior to the start of surgery or procedure, and prior to the patient leaving the operating facility. The Time-Out should include, but not be limited to, patient identification, type of procedure, location and laterality of procedure confirmed by marking, allergies, anticipated needs and difficulties of patient care, available and functioning anesthetic and surgical equipment, necessary imaging, and antibiotic requirements. The Time-Out should be used as a venue for open discussion among team members regarding any aspects of the patient’s care.
The most common eye injury under anesthesia is corneal abrasion. The incidence of eye injury is as high as 44% under general anesthesia if the eye is unprotected. Holding the eye closed with coverings such as tape reduces the incidence to 0.1%–0.5%. Corneal abrasions can occur from direct trauma (face mask, ID badges, drapes), chemical exposure (prep solution), and exposure keratitis (drying of the cornea leading to adherence to the ...