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Simple things you can do daily to make anesthesia safer !

It is NOT the most dangerous job in the world

There is no doubt that providing anesthesia is a critical task where the cost of error can be very serious. But relax. With appropriate care to safety, it really isn't such dangerous job. It is certainly not as dangerous as the job below. The calm gentleman has the job of holding up a target practice board. After the shooting practice is over , he shouts back the results, (provided he is still alive).

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Emotional Bags

We all have emotional bags that we carry around. These could be sad things such as financial worries, sickness of a loved one, or relationship issues. On the other hand , they could be very exciting things such as successfully buying a new home or perhaps winning the lottery! However, either way, these things can affect the way one thinks and performs. Preoccupation with such thoughts can consume your thinking power, leaving less 'space' available for critical thinking in hospital. This can adversely affect patient safety. Therefore, it is important to try and leave these thoughts before entering your work environment.

Once in hospital, of course we acquire new set emotional bags, and these can, on occasion, be depressing. So, just as one should let go of 'home emotional bags' when you enter hospital, it is equally important to let go of your 'hospital emotional bags' when you enter your home. There is no point making your family suffer your work stress !

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Has everyone got the same picture ?

It is very important for everyone involved with the patient to know what is happening. There should be a common understanding about what is happening to the patient. As an anesthetists, you may be well aware about the anesthetic status of your patient. But that is not enough. You also need to have a wider awareness of things around you that can impact the patient. For an example, the surgeon may be discussing with his assistant about the tumor being unexpectedly very vascular, not realising that he should also be telling the anesthetists this important information. All members of the team, regardless of who they are, should have a common idea of things that may affect the patient.

For an example, you the anesthetist may see this beautiful girl.

But the surgeon, from his / her angle of vision may see a beautiful fish instead !

For the well being of the patient, everyone should have the same idea as to what is happening to the patient. Not like the thoughts in the image below:

So , is everyone in your team seeing the same ? : Get a group of people (your team) and look at the turning woman below.

Can all of you agree about which direction she is turning ? Is she now turning clockwise or anticlockwise ?

You will find that not everyone agrees about which way she is turning, even though everyone is looking at the same woman at the same time !

For optimum safety, everyone in your operating room should have the same picture of the patients situation. This can be achieved by alertness and good communication between team members.

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If safety of your patients is your primary concern, ROSE will be of great interest to you. And don't worry about the cost, as these roses (unlike the ones you buy for your love) are completely free!

So what is ROSE all about ? Well, it is a very simple system that you can apply to your daily anesthesia practice to make things safer for your patients.

We all know, (from personal research !), that the human mind can easily forget things that are not reviewed regularly. In anesthesia, emergencies such as failed intubation and intra operative cardiac arrests are rare. While this rarity is fortunate, it also makes it difficult to remember how to manage these emergency scenarios since they don't happen often.

Various courses and simulators are of great benefit to review anesthesia emergencies. But you cannot attend these everyday.

This is where ROSE comes in. ROSE is a simple way to exercise your brain synapses so that the management of emergencies will always be fresh in your mind: ready to work when the real emergency happens.

All you need to do is to Review One Scenario Everyday (ROSE). During a quiet moment in the day, just think of one emergency scenario that could happen to a patient. Perhaps you might choose something like anaphylaxis or maybe tension pneumothorax. It is useful to have a printed list of scenarios to choose from so that you do not forget some of the more uncommon ones ( you can download such a list from below).

Having selected a scenario, go over, in your mind, how you would detect and manage it. It will only take a few minutes to refresh your memory. If you have someone with you , to make it more interesting you can discuss it with him or her.

It is very important to keep things simple and to avoid unnecessary theory such as the detailed discussion about the ryanodine receptors in Malignant Hyperpyrexia etc. All you need to review is the basic emergency management steps, as you would do if the real emergency happens. Keeping it simple and brief will help you to develop ROSE into a daily habit.

Have a daily ROSE. Start today. It is simple, but it may someday save your patient and you.

You can download a sample chart of scenarios below. You can modify the chart to suite your local needs.

The chart does NOT describe how to manage each emergency. This is because:

To download a sample chart of scenarios (Microsoft Word) please click here .

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Cross checking

Our eyes and brain can deceive us. Even what appears to be obviously correct may not actually be correct. Look at the image below and answer the simple question:

You will be surprised that the truth is that both square A and square B are equally dark. Square A is NOT darker !

You probably don't believe that both squares are equally dark. I know it looks impossible, but here is how you can easily prove to yourself that square A and square B are exactly equally dark.

As shown in the image below, take a piece of scrap paper and place it over the image. With a pen, mark two circles above square A and square B.

As shown below, tear holes in the paper at areas you previously marked. Place this paper with the two holes over the image.

You will see that both squares are equally dark !

This hopefully has shown you how what is obvious may not be actually so. This kind of error can easily happen in anesthesia when for example administering drugs. Two drug ampoules / bottles may superficially look the same. Cross checking things with a colleague can help minimise such errors.

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