Introduction to Anesthesia Safety 2024.pptx

Technology and Safety in Anesthesia Practice Vicente Gonzalez, DNP, CRNA, APRN Florida International University Department of Nurse Anesthesiology Importance of Human-Anesthesia Equipment Interface Role of Human Factors in Anesthesia Equipment Human factors play...

Technology and Safety in Anesthesia Practice Vicente Gonzalez, DNP, CRNA, APRN Florida International University Department of Nurse Anesthesiology Importance of Human-Anesthesia Equipment Interface Role of Human Factors in Anesthesia Equipment Human factors play a crucial role in the interface between anesthesia caregivers and equipment. Designing anesthesia equipment with human factors in mind can help prevent errors. Importance of Communication Continuous communication between designers and users is essential for optimal equipment design. Importance of Human-Anesthesia Equipment Interface Challenges in the Operating Room Anesthesia equipment faces physical and environmental stresses in the operating room. Understanding User Needs Understanding user needs and preferences is vital for effective equipment design. Challenges of Sustained Vigilance Vigilance Challenges in Anesthesia Monitoring Complexity of monitoring equipment High cognitive load on anesthesia providers Need for continuous attention Human Errors in Anesthesia Incidents Miscommunication among staff Incorrect dosage administration Failure to follow protocols Impact of Environmental Factors on Vigilance Noise levels in the operating room Lighting conditions Temperature and comfort Challenges of Sustained Vigilance Effects of Fatigue on Anesthesia Performance Reduced reaction time Impaired decision-making Increased likelihood of errors Importance of Sustained Vigilance in Anesthesia Care Ensures patient safety Prevents adverse events Improves overall outcomes Role of Alarms in Anesthesia Caregiving Role of Alarms in Anesthesia Caregiving Alarms play a crucial role in anesthesia caregiving. They assist in detecting adverse conditions in patients and equipment. Alarms aid fatigued or nonvigilant anesthesia providers. Effective Alarm Management Alarms provide essential information to address alarm conditions effectively. Properly designed alarms optimize the probability of successfully managing critical situations. Individualized alarm limits can reduce unnecessary alarms significantly. Role of Alarms in Anesthesia Caregiving Mitigating Alarm Fatigue Alarm fatigue can be mitigated by setting personalized alarm parameters. Smart alarms are being developed to enhance event recognition and reduce false alarms. Rule-based expert systems and neural networks are utilized in developing intelligent alarm systems. Importance of Regular Testing Testing alarms regularly is essential to ensure they function as expected. Preventable Anesthesia Mishaps Anesthesia-related Death or Brain Damage Incidents 3000 preventable cases in the US in 1985. Reduction in Anesthesia Mishaps France saw a 10-fold decrease in anesthesia-related deaths between 1979 and 1999. Human Error Contribution In early studies, clinician errors, such as gas flow changes or syringe swaps, accounted for up to 70% of anesthesia mishaps. Preventable Anesthesia Mishaps Preventable Incidents Nearly half of claims under monitored anesthesia care could have been prevented by better monitoring. 75% of intraoperative cardiac arrests were attributed to preventable anesthetic errors in a study. Anesthesia-related Death Incidence Approximately 1 per million population in the US. 8 per million surgical discharges. Understanding Human Error in Anesthesia Incidents Role of Errors in Cognitive Function Errors are a normal part of cognitive function Errors play a role in learning Common Types of Errors in Anesthesia Slips Mistakes Factors Contributing to Errors Sleep deprivation Miscommunication Equipment problems Understanding Human Error in Anesthesia Incidents Exploring Critical Incidents Simulation studies help explore critical incidents Simulation studies help explore human-machine interactions Impact of Cognitive Biases Cognitive biases can affect clinical decision-making in anesthesia Factors Contributing to Anesthesia Errors Poorly Designed User Interfaces Complex navigation Lack of intuitive controls Human Error Susceptibility Fatigue Inexperience Distraction Factors Contributing to Anesthesia Errors Environmental Stressors Noise Lighting Temperature Equipment and System Factors Malfunctioning equipment Inadequate maintenance Task Complexity Impacting Performance Multitasking demands High cognitive load Impact of Fatigue on Anesthesia Performance Impact of Fatigue on Anesthesia Performance Fatigue and performance degradation correlation Effects of sleep loss on anesthesia providers Importance of addressing fatigue in medical professionals Impact of fatigue on vigilance and clinical performance Challenges of managing fatigue in anesthesia practice Some studies suggest providing time off during every semester when on a clinical calendar (for your first year you are on an academic one) Effects of Sleep Deprivation on Anesthesia Providers Decreased Performance on Complex Tasks Impact on vigilance and response time Influence of fatigue on cognitive ability Importance of Rested Anesthesia Providers Response delays during high workload Novice anesthesia providers' response slower Effects of Sleep Deprivation on Anesthesia Providers Need for Well-Controlled Studies Understanding anesthesia vigilance Factors affecting clinical performance Environmental, Human, and Equipment Factors Noise levels in operating rooms Impaired vigilance and increased risk Circadian Rhythm Disturbances in Anesthesia Practice Disruption of Circadian Rhythms in Anesthesia Practice Definition and importance of circadian rhythms How anesthesia practice can disrupt these rhythms Consequences of disrupted circadian rhythms Impact on Anesthesia Providers' Performance Effects on cognitive function Impact on decision-making and reaction times Long-term health consequences Circadian Rhythm Disturbances in Anesthesia Practice Sleep-Wake Cycle Disturbances Common disturbances experienced by anesthesia providers Factors contributing to sleep-wake cycle disturbances Short-term and long-term effects Effects of Shift Work on Anesthesia Care Challenges of night shifts and rotating schedules Impact on patient safety and care quality Strategies to mitigate negative effects Strategies for Managing Circadian Rhythm Disruptions Importance of sleep hygiene Use of light therapy and melatonin Scheduling practices to minimize disruptions Vigilance and Alarms in Anesthesia Workspace Importance of Vigilance in Anesthesia Workspace Ensures patient safety Prevents adverse events Maintains optimal anesthesia levels Role of Alarms in Enhancing Monitoring Performance Immediate alert to changes Supports quick decision-making Reduces risk of oversight Need for Smart Alarms to Aid Anesthesia Providers Adaptive to patient conditions Minimizes false alarms Improves response times Vigilance and Alarms in Anesthesia Workspace Challenges of Displaying Complex Data in a Compressed Manner Information overload Difficulty in interpretation Potential for missed details Use of Color and Time-Independent Display Modalities Enhances data visibility Facilitates quick comprehension Reduces cognitive load Environmental Factors in Operating Room Vigilance Noise Levels in the Operating Room Sources of noise: equipment, conversations, alarms Average decibel levels Comparison with recommended levels Impact of Noise on Vigilance Reduced attention span Increased cognitive load Higher risk of errors Effects of High Noise Levels on Anesthesia Performance Impaired communication Delayed response times Increased stress and fatigue Environmental Factors in Operating Room Vigilance Strategies to Mitigate Noise Distractions Use of noise-reducing equipment Implementing quiet protocols Regular noise level monitoring Importance of Maintaining a Quiet Environment for Optimal Vigilance Enhanced focus and concentration Improved patient safety Better overall team performance Noise and Temperature Effects on Anesthesia Performance Effects of Temperature on Performance Temperature variations can affect cognitive function. Extreme temperatures may lead to discomfort and reduced focus. Impact of Noise Pollution in the Operating Room Noise can cause distractions and reduce concentration. High noise levels are linked to increased stress and errors. Environmental Stressors Affecting Cognitive Performance Stressors such as noise and temperature can impair decision- making. Chronic exposure to stressors may lead to burnout. Noise and Temperature Effects on Anesthesia Performance Influence of Noise and Temperature on Anesthesia Provider Vigilance Both noise and temperature can reduce vigilance. Maintaining optimal conditions is crucial for patient safety. Challenges of Maintaining Performance in High-Pressure Environments High-pressure environments demand high levels of focus. Strategies are needed to mitigate the effects of environmental stressors. Sleep Deprivation and Anesthesia Providers Sleep Deprivation Impacts on Anesthesia Providers Reduced cognitive function Increased risk of errors Impaired decision-making Effects of Lack of Sleep on Anesthesia Providers Decreased alertness Slower reaction times Higher stress levels Provider Fatigue and Anesthesia Performance Lowered performance levels Increased likelihood of complications Negative impact on patient safety Breaks and Performance Enhancement in Anesthesia Regular Breaks Enhance Performance in Anesthesia Monitoring Breaks help mitigate the impact of high workload on anesthesia providers. Scheduled breaks can prevent task omissions and errors during anesthesia administration. Benefits of Properly Timed Breaks Improve vigilance and reduce the risk of human error. Essential for maintaining optimal performance in the complex task environment of anesthesia care. Workload and Boredom in Anesthesia Monitoring Workload and Boredom in Anesthesia Monitoring Increasing number of variables to monitor Complexity of equipment Need for alarms due to task demands Role of Alarms in Anesthesia Monitoring Assist in detecting adverse conditions Aid fatigued or nonvigilant individuals Help in stressful situations Provide information to identify causes Workload and Boredom in Anesthesia Monitoring Design Principles for Effective Alarms Should be easy to comprehend Should minimize interference Human factors principles in alarm design Stress Management for Providers Mindfulness Practices Incorporate meditation into daily routine Practice deep breathing exercises Engage in mindful walking or movement Regular Breaks During High-Pressure Situations Schedule short, frequent breaks Use breaks to step outside or change environment Avoid work-related discussions during breaks Utilizing Relaxation Techniques Practice progressive muscle relaxation Engage in guided imagery or visualization Listen to calming music or nature sounds Stress Management for Providers Team Debriefings for Emotional Support Hold regular team meetings to discuss experiences Encourage open communication and sharing of feelings Provide a safe space for expressing concerns Physical Exercise for Stress Relief Incorporate regular physical activity into routine Choose activities that are enjoyable and sustainable Consider group exercises for social support Burnout and Substance Use Among Physicians High Rates of Burnout Among Physicians Burnout is prevalent in the medical profession. Physicians experience higher burnout rates compared to other professions. Burnout Linked to Increased Substance Use Burnout can lead to higher rates of substance use. Physicians may turn to substances as a way to cope with burnout. Stress and Workload Contributing to Burnout High stress levels contribute to physician burnout. Heavy workloads and long hours are significant factors. Burnout and Substance Use Among Physicians Substance Use as a Coping Mechanism Physicians may use substances to manage stress. Substance use can become a harmful coping strategy. Importance of Addressing Physician Well-Being Addressing well-being is crucial for physicians' health. Improving well-being can reduce burnout and substance use. Equipment Design and Human Error Prevention Importance of Equipment Design in Anesthesia Equipment design plays a crucial role in preventing human errors in anesthesia. Proper equipment design can significantly reduce the occurrence of anesthesia mishaps. Impact of Inadequate Equipment Design Human error in anesthesia incidents can often be attributed to inadequate or inappropriate equipment design. Design flaws in equipment, including failures in device performance and maintenance, can lead to errors. Inadequate equipment design contributes to a significant portion of human errors in anesthesia practice. User-Centered Design in Medical Devices Incorporating Human Factors in Medical Device Design Understanding user needs and limitations Designing for ease of use and safety Conducting usability testing Usability Engineering for Medical Devices Applying ergonomic principles Iterative design and testing Regulatory requirements and standards Continuous Monitoring of Oxygen Delivery Systems Importance of continuous monitoring Technologies used in monitoring Challenges and solutions User-Centered Design in Medical Devices Medical Simulation for Equipment Failures and Human- Machine Interactions Role of simulation in training Identifying potential failures Improving human-machine interactions Standards for Small-Bore Connectors in Healthcare Applications Importance of standardization Current standards and guidelines Impact on patient safety Challenges of Auditory Alarms in the OR High Prevalence of False Alarms in the OR False alarms are frequent in the operating room (OR). They can lead to alarm fatigue among healthcare providers. Impact of False Alarms on Patient Safety False alarms can desensitize staff to real emergencies. They may delay response times to actual critical events. Challenges in Identifying the Source of Alarm Tones Multiple alarms can sound simultaneously. It can be difficult to distinguish between different alarm sources. Challenges of Auditory Alarms in the OR Difficulties for Healthcare Providers with Hearing Deficits Hearing deficits can impair the ability to hear alarms. This can compromise patient safety and care quality. Importance of Auditory and Visual Cues for Effective Alarm Response Combining auditory and visual cues can improve alarm recognition. It helps in quicker identification and response to critical events. Challenges of Auditory Alarms in the OR Distinct Auditory Signatures for Different Alarm Categories Different alarm categories should have unique sounds. Helps in quick identification of the type of alarm. Coding of Auditory Signals for Clear Differentiation Use different tones and rhythms. Ensures clear differentiation between alarms. Importance of Consistency in Alarm Tones Consistent tones help in recognition. Reduces confusion and improves response time. Display Formats for Physiologic Monitoring Various Display Formats for Physiologic Monitoring Graphic displays for improved performance Sound and color signatures for enhanced data interpretation Animation and highlighting features for better visualization Object displays aiding in rapid interpretation Advanced Display Technologies Utilization of wearable head-mounted displays Incorporation of traditional physiologic displays and trend plots Innovative Monitoring Solutions Introduction of the Philips IntelliVue X3 portable monitor Errors in Anesthesia Slips vs. Mistakes in Anesthesia Errors of omission or commission outside conscious thought Technical or judgmental errors Recovery from Anesthetic Errors Factors like sleep deprivation, miscommunication, and equipment issues can impact error recovery Human Error Frequency Most critical events in anesthetic practice are identified and corrected before serious mishaps occur Human Error Analysis in Anesthesia Management Simulation Studies Valuable for understanding types and causes of critical incidents in anesthesia Cognitive Biases Confirmation bias, overconfidence, and other biases can affect clinical decision-making Substance Use in Healthcare Substance Use Among Healthcare Workers Common substances used Reasons for substance use Consequences on health and job performance Addressing Substance Use Issues in Healthcare Importance of early detection Support systems and resources Rehabilitation and recovery programs Anesthesia Hazards Physical Exposure Inhalational Agents Radiation Ionizing Radiation (X-rays) Non-ionizing radiation (Lasers) Smoke Anesthesia Hazards Inhalational agents Potential for harm Infertility? Immune suppression Health Effects Performance? Decreasing effects of exposure Anesthesia Hazards Previous studies show conflicting evidence Difficult to conduct randomized studies Safe recommended concentrations are exceeded during delivery of anesthesia, especially pediatric anesthesia One study showed that the guidelines were violated 50% of the time Anesthesia Hazards Health Effects 1970s study showed decreased psychomotor performance in volunteers Study has not been able to be replicated by others Another study showed no decrease in performance during normal OR activity Anesthesia Hazards Infertility and fetal effects A study in the 1960s concluded there was a higher incidence Another study published in 2002 showed the incidence of infertility and spontaneous abortion to be the same as other physicians ASA report states that there is no evidence that trace concentrations of anesthetics where scavenging is practiced have no mutagenic effects Mitigation Decreasing exposure to AAs Universal use of scavenger systems Turn off AA when the patient not connected to circuit Ensure a tight seal when using masks to induce NIOSH recommendations 25ppm of N2O and 2ppm of halogenated agents Infection Exposure Universal (Standard) Precautions Airborne Droplet Contact Environmental Hazards Radiation Ionizing X-rays Vary by organ Most exposure results from the scattering of X-rays Decreasing exposure Protection Distance exposure is inversely proportional to distance Wearing appropriate protection All recommend lower exposures during pregnancy Other Risks Non-ionizing Radiation Lasers Eye injuries Smoke from burning tissue Live bacteria and viruses have been found in smoke Other Risks Decreasing possible damage Wear appropriate eye protection (eye injury greatest risk) Can result from direct or reflected beams Avoid smoke from laser plumes Surgical masks not enough Need an N95 or better Smoke plumes Carcinogens Live bacteria and viruses Regular masks not helpful Summary of Exposure Risks and Prevention From Miller’s Anesthesia p2779 References Miller’s Anesthesia 9th ed Anesthesia Equipment 3rd edition Google pictures