Randy Graybeal, a Certified Registered Nurse Anesthetist (CRNA) with Somnia Anesthesia Services who works out of Providence Regional Medical Center in Washington, offers four ways anesthesiologists and CRNAs can reduce errors and improve communications while continuing to provide excellent quality care.
1. Build processes to reduce medication errors. Mr. Graybeal suggests drawing up drugs for a case when the patient arrives in the operating room, rather than doing so during the previous case. This process meets regulatory requirements and should ensure that the patient receives the correct medications. If, on the other hand, due to the fast-paced nature of room turnover, the drugs for a certain case need to be drawn up during the previous case, Mr. Graybeal says his anesthesia group is mandated to place the drugs in separate bags and label each bag with two patient identifiers to decrease the risk of a mix-up. Although the bagging and labeling method is helpful, he prefers to draw up drugs immediately before each case whenever possible.
"Yes, it's an additional step I have to take before I get the patient off to sleep, but I believe there’s a greater benefit that lies in the decreased likelihood of medication errors,” he says. "There's no chance of administering the wrong drugs to the wrong patient," he added.
2. Use technology to communicate among anesthesia providers. When anesthesia providers are spread across multiple sites (in Mr. Graybeal's case, three campuses), it's hard to connect in one place. Mr. Graybeal's group addresses the multiple-location issue by using tools from Google to coordinate communications. For example, the providers' daily assignments are laid out on a Google spreadsheet, giving each provider access to the schedule via smart phone or other device at the beginning of the day. "Each evening before she leaves, our anesthesia coordinator creates and posts assignments for the next day so the team can access them remotely, from anywhere at any time," he says.
Mr. Graybeal says his anesthesia group also uses a Google document to track challenging airway management cases. "Once again, we use technology to overcome location issues because a paper-based form can’t accommodate the logistical situation," he says. "Using a Google document, we put together a form that allows us to share best practices among ourselves. We simply click to find out what devices have been used in similar situations. At the same time, we're collecting that information and placing it in a database which we then present to the anesthesiology department."
Mr. Graybeal says the advent of social networking sites, especially Twitter, has increased the flow of information among anesthesia providers. "It's amazing, but Twitter has become my newspaper," he says. "I follow people from a bunch of different industries, and I'm reading articles from medical journals and magazines published around the world. It’s also connecting me to the thought leaders I should be learning from." He says Twitter is beneficial to providers looking for current news and information because so many people are updating the site constantly. "Sometimes Twitter gets ahead of CNN," he says.
3. Keep track of difficult cases to enable ongoing improvement. Mr. Graybeal says his anesthesia group is currently undergoing "practice improvement projects" involving airway management to determine why errors occur and how they can be avoided. "We're beginning to log all our challenging airway cases in terms of airway assessment and the devices being used to resolve airway difficulties," he says. "From a clinical quality perspective, we’re always looking for opportunities to learn from one another, to share best practices." Mr. Graybeal notes that because airway management is central to anesthesia procedures, gathering data and discussing common challenges can help each provider improve the quality of care they deliver.
Gathering data also helps anesthesia providers discuss airway management challenges with providers in other specialties — for example, ER physicians and the code team. "We really enjoy sharing our difficult airway data with them in order to facilitate their learning," he says. "It's a truly beneficial care collaboration." Mr. Graybeal also recommends collecting information on devices that aren't used as frequently and recording user experiences with those devices. By sharing that information, providers will be able to avoid any pitfalls associated with a piece of equipment in the event it is needed in an emergency situation.
4. Consider setting up a pre-anesthesia clinic. With the growing emphasis on quality perioperative care, Mr. Graybeal says his hospital has undertaken the task of setting up a pre-anesthesia clinic. The role of the clinic would be to identify patients who are not physically prepared for anesthesia due to a medical condition or dietary issues.
"It's a huge endeavor," he says. "We're developing an approach that will help us better manage common perioperative medical problems, such as conditions related to blood sugar or blood pressure levels, that might result in case cancellations.” He says the highest priority now is determining how the clinic should best function.
Although he has seen anesthesia providers set up online pre-anesthesia clinics, most are still in the development stages. "We haven't subscribed to a commercial source for that, but it could represent a great opportunity for anesthesiologists to develop and work on a centralized pre-anesthesia clinic," he says.
Learn more about Somnia Anesthesia Services.
1. Build processes to reduce medication errors. Mr. Graybeal suggests drawing up drugs for a case when the patient arrives in the operating room, rather than doing so during the previous case. This process meets regulatory requirements and should ensure that the patient receives the correct medications. If, on the other hand, due to the fast-paced nature of room turnover, the drugs for a certain case need to be drawn up during the previous case, Mr. Graybeal says his anesthesia group is mandated to place the drugs in separate bags and label each bag with two patient identifiers to decrease the risk of a mix-up. Although the bagging and labeling method is helpful, he prefers to draw up drugs immediately before each case whenever possible.
"Yes, it's an additional step I have to take before I get the patient off to sleep, but I believe there’s a greater benefit that lies in the decreased likelihood of medication errors,” he says. "There's no chance of administering the wrong drugs to the wrong patient," he added.
2. Use technology to communicate among anesthesia providers. When anesthesia providers are spread across multiple sites (in Mr. Graybeal's case, three campuses), it's hard to connect in one place. Mr. Graybeal's group addresses the multiple-location issue by using tools from Google to coordinate communications. For example, the providers' daily assignments are laid out on a Google spreadsheet, giving each provider access to the schedule via smart phone or other device at the beginning of the day. "Each evening before she leaves, our anesthesia coordinator creates and posts assignments for the next day so the team can access them remotely, from anywhere at any time," he says.
Mr. Graybeal says his anesthesia group also uses a Google document to track challenging airway management cases. "Once again, we use technology to overcome location issues because a paper-based form can’t accommodate the logistical situation," he says. "Using a Google document, we put together a form that allows us to share best practices among ourselves. We simply click to find out what devices have been used in similar situations. At the same time, we're collecting that information and placing it in a database which we then present to the anesthesiology department."
Mr. Graybeal says the advent of social networking sites, especially Twitter, has increased the flow of information among anesthesia providers. "It's amazing, but Twitter has become my newspaper," he says. "I follow people from a bunch of different industries, and I'm reading articles from medical journals and magazines published around the world. It’s also connecting me to the thought leaders I should be learning from." He says Twitter is beneficial to providers looking for current news and information because so many people are updating the site constantly. "Sometimes Twitter gets ahead of CNN," he says.
3. Keep track of difficult cases to enable ongoing improvement. Mr. Graybeal says his anesthesia group is currently undergoing "practice improvement projects" involving airway management to determine why errors occur and how they can be avoided. "We're beginning to log all our challenging airway cases in terms of airway assessment and the devices being used to resolve airway difficulties," he says. "From a clinical quality perspective, we’re always looking for opportunities to learn from one another, to share best practices." Mr. Graybeal notes that because airway management is central to anesthesia procedures, gathering data and discussing common challenges can help each provider improve the quality of care they deliver.
Gathering data also helps anesthesia providers discuss airway management challenges with providers in other specialties — for example, ER physicians and the code team. "We really enjoy sharing our difficult airway data with them in order to facilitate their learning," he says. "It's a truly beneficial care collaboration." Mr. Graybeal also recommends collecting information on devices that aren't used as frequently and recording user experiences with those devices. By sharing that information, providers will be able to avoid any pitfalls associated with a piece of equipment in the event it is needed in an emergency situation.
4. Consider setting up a pre-anesthesia clinic. With the growing emphasis on quality perioperative care, Mr. Graybeal says his hospital has undertaken the task of setting up a pre-anesthesia clinic. The role of the clinic would be to identify patients who are not physically prepared for anesthesia due to a medical condition or dietary issues.
"It's a huge endeavor," he says. "We're developing an approach that will help us better manage common perioperative medical problems, such as conditions related to blood sugar or blood pressure levels, that might result in case cancellations.” He says the highest priority now is determining how the clinic should best function.
Although he has seen anesthesia providers set up online pre-anesthesia clinics, most are still in the development stages. "We haven't subscribed to a commercial source for that, but it could represent a great opportunity for anesthesiologists to develop and work on a centralized pre-anesthesia clinic," he says.
Learn more about Somnia Anesthesia Services.