The Anesthesia Patient Safety Foundation improves patient safety

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

The Anesthesia Patient Safety Foundation (APSF) is celebrating its 25th anniversary. APSF is a patient advocate organization whose mission is to improve the safety of patients during anesthesia care by encouraging and conducting: safety research and education; patient safety programs and campaigns; and the national and international exchange of information and ideas.

“APSF has had a profound impact on the anesthesia patient safety movement,” said American Society of Anesthesiologists (ASA) President Mark A. Warner, M.D. “On behalf of ASA, I thank APSF for its many years of dedicated research and education to help improve safety for patients around the world. We look forward to the advances APSF will contribute to during the next 25 years.”

APSF focuses on several patient-safety initiatives, including adverse anesthesia events, anesthesia information management systems, fire and medication safety, technology training and much more. Its latest focus has been on reducing the number of adverse events related to drug-induced respiratory depression.

Last month, APSF sponsored a conference to discuss various monitoring strategies to help detect postoperative respiratory depression in patients who receive opioids for pain control or sedation. Health care providers, insurers, regulatory agencies and families of injured patients from across the nation gathered to discuss the issue.

The conference concluded that the continuous electronic monitoring of oxygenation and ventilation, with available and developing technology, offers the opportunity for prompt improvement in patient safety. Since it is difficult to predict which patients are susceptible to respiratory depression, the conference also recommended that all patients who receive opioids for acute pain control in the postoperative period be monitored.

For more information on APSF, please visit www.apsf.org.

Robert K. Stoelting is President of the Anesthesia Patient Safety Foundation.

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Comments

Marc Gorayeb, MD
“…all patients who receive opioids for acute pain control in the postoperative period be monitored.” (I.e., electronically monitored). It is just this kind of blanket one-size-fits-all, mindless, cookie-cutter approach to the practice of medicine that prompts organizations like JCAHO and the government to mandate the use of expensive technology across the board, driving up medical costs without adequate scientific validation. Not all surgeries are the same; not all patients are the same; not all opioids are the same; not all doses are the same; not all staffing is the same. People or organizations that make such sweeping generalizations have no credibility among many medical professionals.

Rick Dutton
Marc: Not all of your OR patients actually benefit from pulse oximetry, but you do it anyway because the potential benefits outweigh the risks at a price that’s affordable to the system. It’s reasonable to consider that the same might be true of monitoring systems for post-op patients on PCA, especially as newer technology makes this more do-able. George Blike’s publication from the Dartmouth experience is the best thing on this topic recently published. It’s not definitive science, but it certainly suggests one way that safety might be improved.

http://www.meyersmedmal.com Jivanmeyers
Marc, ask yourself whether your concern is focused on the cost of providing the recommended monitoring vs.the benefits conferred, or the minor loss of autonomy these guidelines represent. If it is in fact the former, what research have you done to determine the frequency and morbidity associated with untimely recognition of respiratory depression and the cost associated with the interventions recommended.
Anonymous
It was the purpose of the group to advocate for safety. It is the role of others to advocate for cost control. A review of the article “Patterns of Unexpected In-Hospital Death” reveals the varied, profound and unpredictable risk faced by certain post-op patient subgroups. On the other hand, relevant the second comment, as the above referenced review article also shows, those who would argue that a given non-intubated patient on the general floor would, with reasonable certainty, have been saved by monitoring, do so without sound scientific evidence.
Anonymous
It was the purpose of the group to advocate for safety. It is the role of others to advocate for cost control. A review of the article “Patterns of Unexpected In-Hospital Death” reveals the varied, profound and unpredictable risk faced by certain post-op patient subgroups. On the other hand, relevant the second comment, as the above referenced review article also shows, those who would argue that a given non-intubated patient on the general floor would, with reasonable certainty, have been saved by monitoring, do so without sound scientific evidence.
Anonymous
Marc,
Please let me know where you practice because it sounds like I may have finally found a hospital which has not suffered a preventable death due to opioid therapy. Or perhaps, the death was just filed under “cardiac arrest”. And the family was told “Oh, this is very unusual, never happens”.So may I assume you dont use a BIS monitor, you dont use ultrasound in central line placements, and your hospital doesnt use surgical TIME-OUT’s prior to a procedure? All these practices were advocated before clinical evidence was established (some actually exist without level 1 evidence to date supporting use). As was the initial adoption of pulse oximetry by the way. Use that gadget?You are spot on when you say not all patients/cases are the same. Opioid effects vary greatly as a result. I hope you dont use weight based guidance to dose because this ‘one size fits all’ dosing strategy has no scientific rationale for its use. How do you dose opioids, without risk of decompensation, in your 340 lb patient taking 10 Percocets a day for knee pain? Hope you are really good!Next time you get on a plane Marc, pop in the cockpit and rip up the pilots checklist. No level 1 evidence for these. Just a good idea. And then settle back in your seat as you roll down the runway, flaps in neutral setting.Preventable deaths due to our medical therapy (ie opioids) are one problem we cant afford to ignore any longer. The science will follow.

The Anesthesia Patient Safety Foundation improves patient safety

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