Iatrogenic harm and anaesthesia in Australia

Publisher's copy made available with the permission of the publisherW. B. Runcimanhttp://www.aaic.net.au/Article.asp?D=200513

The Australian Incident Monitoring Study in intensive care: AIMS-ICU. An analysis of the first year of reporting.

Publisher's copy made available with the permission of the publisher Copyright © 1996 Australian Society of AnaesthetistsThe AIMS-ICU project is a national study set up to develop, introduce and evaluate an anonymous voluntary incident reporting system for intensive care. ICU staff members reported events which could have reduced, or did reduce, the safety margin for the patient. Seven ICUs contributed 536 reports, which identified 610 incidents involving the airway (20%), procedures (23%), drugs (28%), patient environment (21%), and ICU management (9%). Incidents were detected most frequently by rechecking the patient or the equipment, or by prior experience. No ill effects or only minor ones were experienced by most patients (short-term 76%, long-term 92%) as a result of the incident. Multiple contributing factors were identified, 33% system-based and 66% human factor-based. Incident monitoring promises to be a useful technique for improving patient safety in the ICU, when sufficient data have been collected to allow analysis of sets of incidents in defined “clinical situations”.U. Beckmann, I. Baldwin, G.K. Hart, W.B. Runcima

A tragic death: a time to blame or a time to learn?

W.B. Runciman and A. Merr

Crisis management during anaesthesia: difficult intubation

BACKGROUND: Anaesthetists may experience difficulty with intubation unexpectedly which may be associated with difficulty in ventilating the patient. If not well managed, there may be serious consequences for the patient. A simple structured approach to this problem was developed to assist the anaesthetist in this difficult situation. OBJECTIVES: To examine the role of a specific sub-algorithm for the management of difficult intubation. METHODS: The potential performance of a structured approach developed by review of the literature and analysis of each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. RESULTS: There were 147 reports of difficult intubation capable of analysis among the first 4000 incidents reported to AIMS. The difficulty was unexpected in 52% of cases; major physiological changes occurred in 37% of these cases. Saturation fell below 90% in 22% of cases, oesophageal intubation was reported in 19%, and an emergency transtracheal airway was required in 4% of cases. Obesity and limited neck mobility and mouth opening were the most common anatomical contributing factors. CONCLUSION: The data confirm previously reported failures to predict difficult intubation with existing preoperative clinical tests and suggest an ongoing need to teach a pre-learned strategy to deal with difficult intubation and any associated problem with ventilation. An easy-to-follow structured approach to these problems is outlined. It is recommended that skilled assistance be obtained (preferably another anaesthetist) when difficulty is expected or the patient’s cardiorespiratory reserve is low. Patients should be assessed postoperatively to exclude any sequelae and to inform them of the difficulties encountered. These should be clearly documented and appropriate steps taken to warn future anaesthetists.A D Paix, J A Williamson and W B Runcima

Improving patients' safety by gathering information - Anonymous reporting has an important role

Bill Runciman, Alan Merry and Alexander McCall Smit

Australian GP attitudes to clinical practice guidelines and some implications for translating osteoarthritis care into practice

Abstract Clinical practice guidelines (CPGs) have been shown to improve processes of care and health outcomes, but there is often a discrepancy between recommendations for care and clinical practice. We sought to explore general practitioner attitudes toward CPGs, in general and specifically for osteoarthritis (OA) with the implications for translating OA care into practice. A self-administered questionnaire was conducted in January 2013 of a sample of 228 GPs in New South Wales and South Australia. Seventy-nine GPs returned questionnaires (response rate 35%). Nearly all GPs considered that CPGs support decision making in practice (94%) and medical education (92%). Very few respondents regarded CPGs as a threat to clinical autonomy, and most recognised that individual patient circumstances must be taken into account. Shorter CPG formats were preferred over longer and more comprehensive formats, with preferences being evenly divided amongst respondents for short, 2-3 page summaries, flowcharts or algorithms and single page checklists. GPs considered accessibility to CPGs to be important, and electronic formats were popular. Familiarity and use of The Royal Australian College of General Practitioners OA Guideline was poor with most respondents either not aware of it (30%: 95% CI 27% - 41%), had never used it (19%; 95% CI 12% - 29%), or rarely used it (34%; 95% CI 25% - 45%). If CPGs are to assist with the translation of evidence into practice, they must be easily accessible and in a format that encourages use. Key words: arthritis, primary care, evidence-based medicine, decision making Summary statement What is known about the topic? • Clinical practice guidelines (CPGs) can improve processes of care and health outcomes, however, there is often a gap between evidence-based recommendations for care and clinical practice. What does this paper add? • A better understanding of GP attitudes toward CPGs helps to explain potential barriers to the uptake of evidence-based practice and provides guidance on remedial action that may lead to better health outcomes.a National Health and Medical Research Council Program Grant (Australia, no.568612

Shared meanings: preferred terms and definitions for safety and quality concepts

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.William B Runcima

The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. The development and evaluation of an incident reporting system in intensive care

Publisher's copy made available with the permission of the publisher © 1996 Australian Society of AnaesthetistsIntensive care units are complex, dynamic patient management environments. Incidents and accidents can be caused by human error, by problems inherent in complex systems, or by a combination of these. Study objectives were to develop and evaluate an incident reporting system. A report form was designed eliciting a description of the incident, contextual information and contributing factors. Staff group sessions using open-ended questions, observations in the workplace and a review of earlier narratives were used to develop the report form. Three intensive care units participated in a two-month evaluation study. Feedback questionnaires were used to assess staff attitudes and understanding, project design and organization. These demonstrated a positive attitude and good understanding by more than 90% participants. Errors in communication, technique, problem recognition and charting were the predisposing factors most commonly chosen in the 128 incidents reported. It was concluded that incident monitoring may be a suitable technique for improving patient safety in intensive care.U. Beckman, L.F. West, G.J. Groombridge, I. Baldwin, G.K. Hart, D.G. Clayton, R.K. Webb, W.B. Runcima