Review article: Practical current issues in perioperative patient safety

Eichhorn, John H.

doi:10.1007/s12630-012-9852-z

Cited by 43 publications

(37 citation statements)

References 15 publications

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“…We can also attribute this finding to several safety improvements, such as advancement in drugs, training programs, guidelines and checklists, investments in monitoring techniques, especially the capnograph and pulse oximeter, and systematic approaches to reduce errors 21–23 . According to Eichhorn, these initiatives, which are aimed at achieving “safety monitoring”, have resulted in a continuous increase in intraoperative vigilance and improved patient safety during anesthesia 24 . In our study, the relationship between anesthesia-related CA rates and time could not be evaluated in low-income countries because only two relevant articles were identified.…”

Section: Discussionmentioning

confidence: 99%

Perioperative and anesthesia-related cardiac arrests in geriatric patients: a systematic review using meta-regression analysis

Braghiroli

Bráz

Rocha

et al. 2017

Sci Rep

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The worldwide population is aging, and the number of surgeries performed in geriatric patients is increasing. This systematic review evaluated anesthetic procedures to assess global data on perioperative and anesthesia-related cardiac arrest (CA) rates in geriatric surgical patients. Available data on perioperative and anesthesia-related CA rates over time and by the country’s Human Development Index (HDI) were evaluated by meta-regression, and a pooled analysis of proportions was used to compare perioperative and anesthesia-related CA rates by HDI and time period. The meta-regression showed that perioperative CA rates did not change significantly over time or by HDI, whereas anesthesia-related CA rates decreased over time (P = 0.04) and in high-HDI (P = 0.015). Perioperative and anesthesia-related CA rates per 10,000 anesthetic procedures declined in high-HDI, from 38.6 before the 1990s to 7.7 from 1990–2017 (P < 0.001) and from 9.2 before the 1990s to 1.3 from 1990–2017 (P < 0.001), respectively. The perioperative CA rate from 1990–2017 was higher in low-HDI than in high-HDI countries (P < 0.001). Hence, a reduction in anesthesia-related CA rates over time was observed. Both perioperative and anesthesia-related CA rates only decreased with a high-HDI between time periods, and perioperative CA rates during 1990–2017 were 4-fold higher with low- compared to high-HDI in geriatric patients.

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Section: Discussionmentioning

confidence: 99%

Perioperative and anesthesia-related cardiac arrests in geriatric patients: a systematic review using meta-regression analysis

Braghiroli

Bráz

Rocha

et al. 2017

Sci Rep

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“…34 However, it was not simply the tool (ie, monitor) that made the difference, but a whole system in which safety monitoring behaviors obtained. 35 Global descriptions of what was needed were given, but local implementation was needed as well. While these monitors are now present for every patient, they were not at the time, and many of the same questions emerged: “Who should have them present?…”

Section: Discussionmentioning

confidence: 99%

Adherence to Guidelines for the Management of Local Anesthetic Systemic Toxicity Is Improved by an Electronic Decision Support Tool and Designated “Reader”

McEvoy

Hand

Stoll

et al. 2014

Regional Anesthesia and Pain Medicine

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Background and Objectives A hardcopy or paper cognitive aid has been shown to improve performance during the management of simulated local anesthetic systemic toxicity (LAST) when given to the team leader. However, there remains room for improvement in order to ensure a system that can achieve perfect adherence to the published guidelines for LAST management. Recent research has shown that implementing a checklist via a designated reader may be of benefit. Accordingly, we sought to investigate the effect of an electronic decision support tool (DST) and designated ‘Reader’ role on team performance during an in-situ simulation of LAST. Methods Participants were randomized to Reader+DST (N = 16, rDST) and Control (N = 15, memory alone). The rDST group received the assistance of a dedicated Reader on the response team who was equipped with an electronic DST. The primary outcome measure was adherence to guidelines. Results For overall and critical percent correct scores, the rDST group scored higher than Control (99.3% vs 72.2%, P < 0.0001; 99.5% vs 70%, P < 0.0001, respectively). In the LAST scenario, 0 of 15 (0%) in the control group performed 100% of critical management steps, while 15 of 16 (93.8%) in the rDST group did so (P < 0.0001). Conclusions In a prospective, randomized single-blinded study, a designated Reader with an electronic DST improved adherence to guidelines in the management of an in-situ simulation of LAST. Such tools are promising in the future of medicine, but further research is needed to ensure the best methods for implementing them in the clinical arena.

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“…It reflects hemoglobin saturation that can be negatively affected by the use of supplemental oxygen with oxygen saturation readings higher than the actual oxygen levels. 3 However, an SpO 2 level below 90% is considered to correlate with arterial hypoxemia (a PaO 2 less than 60 mm Hg at a pH of 7.4). 4 If the patient has poor limb perfusion, the readings can be falsely low.…”

Section: Contrasting Pulse Oximetry and Capnographymentioning

confidence: 99%

“…They identify the need for consistent monitoring of patients who are in the immediate postoperative period or who are being given postoperative pain medications. 3,6 Despite these recommendations, many patients continue to experience oversedation and adverse events. National accrediting bodies such as TJC, national professional organizations such as the ASA, and patient safety organizations such as ISMP have made recommendations to ensure patient safety and avoid oversedation while providing adequate pain relief in patients using opioids.…”

Section: Procedural Sedationmentioning

confidence: 99%

Turning the tide on respiratory depression

D’Arcy

2013

Nursing

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Review article: Practical current issues in perioperative patient safety

Cited by 43 publications

References 15 publications

Perioperative and anesthesia-related cardiac arrests in geriatric patients: a systematic review using meta-regression analysis

Perioperative and anesthesia-related cardiac arrests in geriatric patients: a systematic review using meta-regression analysis

Adherence to Guidelines for the Management of Local Anesthetic Systemic Toxicity Is Improved by an Electronic Decision Support Tool and Designated “Reader”

Turning the tide on respiratory depression

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