The Midwestern Journal of Anesthesia Quality and Safety

Adherence to The Joint Commission Standards by Anesthesiology Providers after the Implementation of an Educational Intervention.

Binoy Samuel — 2019-10-10

Abstract

A medical error is defined as a preventable adverse effect of medical care. In anesthesiology practice, this is especially important as there is a specific risk related to it. Medical errors are the third most common cause of annual deaths in the US. The Joint Commission (TJC) develops standards of routine for the practice of anesthesiology with the aim of reducing the incidence of medical errors. The aim of this study is to determine adherence to TJC before and after the administration of educational material. The adherence to TJC standards was evaluated in two phases (A pre-interventional phase followed by an educational intervention; thereafter, a post-interventional phase) by random checks during cases in the operating room. For the data analysis, measures of central tendency and ratios were used. This quality assurance project was waived by the Institutional Review Board. During the pre-intervention phase a total of 525 cases were checked during a period of 3 months; 217 (41%) cases report non-compliance events. During the Pre-intervention phase, the average number of non-compliance events per provider was 24.11 and the Total events/Total cases ratio was 2:5. After the educational period (Post-intervention phase) a total of 1701 cases were randomly checked; 192 (11.3%) cases report non-compliance events. In a 9-month period, the average number of events per provider was 5.68 and the Total events/Total cases ratio was 1:9. The implementation of an educational intervention plus a systematic evaluation increases the adherence of the anesthesia providers to The Joint Commission standards.

Caring for the Care-Giver: Debriefing Following Intra-Operative Death

Roy Soto — 2019-10-10

Intraoperative death affects a team of individuals, each with different levels of training and experience. Although briefings, time-outs, and debriefings have been well described, it is unclear how often they occur following intraoperative catastrophic events. We utilized an electronic survey to assess the frequency and potential utility of a formal debriefing process following the intraoperative death of a patient, and discuss our findings in light of the mental well-being of perioperative medical personnel. An electronic survey was distributed to OR staff in two hospital systems. The survey was designed to identify which staff members had experienced intraoperative loss, what response was elicited, and what resources were available to them following this event. Of the 196 people who responded to the survey, over half (56%) had experienced the loss of a patient in the OR. 80% of those who had experienced the intraoperative loss of a patient reported moderate to strong emotional responses to the event. Almost no one reported formal support offered following the event, yet, over 50% people felt that a formal debriefing of the entire team would have helped either themselves or others members cope with the death. Over 85% of team members felt that the most effective strategy in reducing stress following intra-operative patient death is talking to co-workers. Over 80% of team members felt that their activities of daily living and relationships were not interrupted following the event. Our survey confirms that a lack of resources is available for health professionals after a catastrophic intraoperative event.

Trends in the use of Sugammadex for the Reversal of Neuromuscular Blockade in a Tertiary Care Academic Center

Kevin Li — 2019-10-10

Introduction: Neuromuscular blockade plays an integral role in anesthesia and surgery. However, residual paralysis has been associated with postoperative respiratory complications and increased airway collapsibility. Sugammadex, is a modified gamma-cyclodextrin used for the reversal of rocuronium and vecuronium. The aim of this retrospective descriptive study was to summarize the use of Sugammadex after non-cardiac surgery and identify factors that may be associated with any Sugammadex use.

Methods: 133,121 adult non cardiac surgeries were evaluated retrospectively, of these, 61,936 met inclusion criteria. Four descriptive aims were explored; dose of Sugammadex used, situational use of Sugammadex, Sugammadex use given type of steroidal muscle relaxant administered and class of muscle relaxant used before vs. after introduction of Sugammadex. 31 selected factors were used in a multivariable logistic regression model to find association with Sugammadex use.

Results: Of the 2,475 surgeries where Sugammadex was utilized, it was used as a primary reversal agent in 2,248 (90.8%) cases and as a secondary reversal after routine reversal with neostigmine in 225(9.1%) cases. The use of Sugammadex as a rescue reversal is limited to 3 cases (0.12%). Of 31 a priori selected factors believed to be potential influences in the decision to use Sugammadex, 12 were found to be associated.

Conclusions: Neostimine still remains the most commonly used reversal agent. Sugammadex is mostly being used as a primary reversal agent and its use is rising dramatically. The use of Sugammadex as a rescue agent in a cannot intubate/cannot ventilate event is exceedingly rare.

ASPIRE Featured Measure: NMB 01

Nirav Shah — 2019-10-10

ASPIRE (Anesthesiology Performance Improvement and Reporting Exchange) is a national anesthesia quality improvement collaborative that includes 21 hospitals across Michigan. Michigan hospitals are a core component of ASPIRE and make up almost half of all participating sites. We are pleased to share our 2^nd featured measure article, as part of our ongoing collaboration with the MSA and MJAQS.

An important focus for ASPIRE over the last 2 years has been reducing respiratory complications among patients undergoing general anesthesia with mechanical ventilation. ASPIRE has built 4 measures that, collectively can track processes of care that reduce perioperative pulmonary complications. These measures are:

Maintaining tidal volumes at ≤ 8cc/kg ideal body weight (PUL 02)
Maintaining positive end expiratory pressure (PUL 03)
Appropriate neuromuscular monitoring (NMB 01)
Appropriate neuromuscular blockade reversal (NMB 02)

In this issue, we discuss information and performance for our neuromuscular monitoring measure.

ASPIRE Featured Measure: PUL 02

Nirav Shah — 2019-10-10

ASPIRE (Anesthesiology Performance Improvement and Reporting Exchange) is a national anesthesia quality improvement collaborative that includes 21 sites across Michigan. Michigan-based sites are a core component of ASPIRE and make up almost 1/2 of all participating sites.

A total of 26 measures make up the ASPIRE database. This is the first in a series of articles that share quality improvement initiatives from ASPIRE. With this article we will highlight “PUL 02”, our low tidal volume measure. Specifically, tidal volume goals are ≤ 8cc/kg ideal body weight, and data is pulled from electronic health data to grade compliance throughout the initiative.