Module 1 Safety in OR Flashcards
The Safety of the anesthesia, OR personnel and hospital staff. Regulated by numerous agencies private and federal.
Occupational Safety
Increased Safety concerns, avoidance of adverse incidents and events.
Patient Safety
ANSI
. Replaced by ASTM ( American Society for Testing and Materials).
.Standards reviewed every 8 years
ANSI/ASTM makes sure of standardization of equipments Ex ETT( all ETT fit anesthesia machines and ICU ventilators)
. Cover equipment used from different industries.
NIOSH
Department of CDC
Focus on prevention of illness and workplace injury.
OSHA
Department of the DOL Power of enforcement Follows NIOSH guidelines Regulates issues of workplace safety Mandates levels of anesthetic gases, laser protection , UP, etc
Factors affecting occupational Hazard of Anesthesia
Physical, Emotional and Environmental Factors.
FDA
Responsible for protecting the public health by assuring the safety, efficacy, and security:
humans and veterinary drugs, biological products
medical equipments
food supply,
FDA Chapter 21
Part 868 deals with :
anesthesia diagnostic devices and therapeutic devices.
JCAHO
Private , Non-profit
Certifying agency for Medicaid
Critical Incident
Human error or equipment failure, if not discovered and corrected in time, or lead to an undesirable outcome ranging from extended stay or death. (Cooper, 1978)
Name the two most common sources of Error?
Human and Equipment
Name an Occupational Hazard specific to Anesthesia Personnel?
Anesthetic Gasses
Name some common anesthesia equipment errors.
Breathing circuit disconnections, leaks, defective valves, misconnections, control errors.
Gas supply
Intravenous drug dose errors (including infusion and syringe pumps)
Intravenous drug/fluid delivery system problems
Ventilator missetting or malfunction
Misuse of monitors
Laryngoscope malfunction
Scavenging system problems
Name two sources of error made by Humans?
Rule Based Error : occur when rules are deviated from.
Knowledge based error: occur when the event is outside of the experience of the provider.
Provider gets fixated on a wrong diagnostic with a “closed mind”
Two sources of equipment failure?
Device failure: Device its not working properly, needs to be replace.
Use error: using a device for other than its intended purpose. Poor or insufficient training in the proper use of the equipment
When does Patient Safety begins?
Pre- op Area
Patient Safety in the OR
Everyones responsibility
Extends from Pre op, Intra op and PACU
Patients under anesthesia cannot protect themselves
Patient safety its your fully responsibility when under anesthesia .
Major Contributors of Stress for Anesthesia Personnel?
Lack of time to establish rapport with patient Quick Turn over Long work hours , night calls , fatigue Alarm Fatigue Bad communication between OR team Interpersonal conflict Sleep Deprivation Production Pressure
Locations that use remote Anesthesia. More specifically areas in the hospital or health organization not designated to provide anesthesia
ER
Psychiatric wards
Hospital Wards
Name locations with fixed equipment installed requiring anesthesia service.
MRI
CT scan
IR
Radiation therapy
Designated ORs outside main operating rooms
Dental Surgery
Outpatient Surgery
OB units
Burn Units
Specialized Diagnostic suites
GI center
Cardiovascular ( Cath lab)
3 main variables to take into consideration when delivering anesthesia in a remote , Outside OR area.
Where- Equipment available, obstacles to overcome
What- Procedure specific
Who- Patient condition and pre-existing morbidity
What are the standards to follow when delivering anesthesia outside the main OR in remote areas?
Must maintain same standards as in the OR at all times.
Additional Vigilance needed.
Name some of the problems you can encounter and be ready to act upon at remote locations?
Lack of continuous electrical supply
Lack of continuous supply of oxygen and nitrous oxide
Difficulty with storage of drugs and equipment
Lack of maintenance of equipment
Lack of skilled assistance
Special scenarios requiring delivery of anesthesia outside OR.
Pain management
Children, elderly, or disabled patients that will not follow instructions
Psychiatric disorders: anxiety and panic disorders, claustrophobia
Neurological disorders: movement and seizure disorders, cerebral palsy
Trauma: unstable cardiovascular, respiratory, or neurological status
Patients with significant co-morbidities that require monitoring
Difficult airway
Ohm’s Law
E= I X R
Current in amps = volts/resistance in ohms
Current in amps is in mV
In Ohm’s Law E stands for?
Electromotive force ( unit of measure is Voltage)
In Ohm’s Law I stands for?
Current (unit of measure is Amps)
In Ohm’s Law R stands for?
Resistance ( unit of measure is Ohms)
How is electrical power measure?
Electrical power is measured in watts.
A watt is equal to the product of the voltage and the amperage.
W= E x I.
A joule ( J )
Unit of electrical or mechanical work
defined as the amount of energy spent by 1 watt for 1 second in 1 ohm
energy = watts x seconds
Electrons flowing in the same direction; an electric current flowing in one direction only.
Direct Current
Alternating Current
The flow of electrons reverses at given intervals
Impedance
the sum of forces that impede (oppose) electron movement in an AC circuit. (Z).
Resistance to flow
What two factors affect Impedance?
Capacitance and Inductance
Inductance
magnetic field that is created as electricity flows thru a coiled wire.
.resists the flow of electrons.
.the ability to store a charge
.facilitates the flow of electrons.
.In AC capacitors allows continuous current to travel along the circuit even if no completed circuit exists.
Capacitance
What substance opposes the flow of electrons?
Insulator
Conductor
Substance that facilitates the flow of electrons
What is Frequency ?
Rate in 1 second, in alternating current (AC)
changes direction. Commonly 60 Hz.
What do you need for current to flow ?
- you need a circuit ( electrons flow from high to low concentration)
- Consist of 2 wires
Hot( carries voltage )
neutral ( returns the current to the source )
What happens if an individual becomes part of the circuit ?
Completes the circuit and receives an electric shock.
Name two types of grounding ?
Electrical power grounding
Electrical Equipment grounding
When and why is Electrical Power grounded ?
when a wire is intentionally connected to ground (earth).
Prevents build up of electricity in the wiring of the house preventing electrical shock
Why ground electrical equipment?
Prevents electrical shock to patients and staff if the equipment happens to have a short in it.
the current will be carried by the ground wire and reduce the electric shock.
How is the electrical power in the OR supplied ?
Via Isolation Transformer
Which separates the ES rom the OR system
no ground
risk for electrical shock greatly reduce since no circuit is created.
What is the maximum current leakage in OR equipment?
10µA
What cable serves as a ground when connected to the hospital grade plugs?
The first cable connected into the plug.
What does ungrounded means ?
No connection between the ( HOT) and ground of the household electrical supply.
Preventing completion of the circuit and thus preventing electrical shock
Why u need a Line Isolation Monitor (LIM)?
Monitors electrical supply and warns if there is a grounded connection.
LIM= protects staff and patients from shock
Placed between live wires and ground to measure impedance
What is a Macro shock ?
shock applied to the surface of the body,
different tissues have different conduction properties
current that reaches the heart is very low with Macro Shock
Effects body through intact skin
high voltage or current through direct skin or other tissue contact.
What are some things that could make a patient more electrically susceptible to micro-shock?
patients with :
pacer wires
fluid filled catheters
direct connection to the heart to the external environment
very small amounts of current, in the order of milliamps.
Effects through the electrically susceptible patient
Electrical current is delivered directly to the heart
Importance of grounding the patient ?
ensures that the current density is low and thereby avoiding injury.
Properties of Laser
mono-chromatic (one color, one wavelength)
light energy used to achieve a surgical goal.
Power described in Watts.
wavelength is specified by the medium used for lasing
(gas, solid, liquid)
Laser most common caused injuries are (thermal ).
What organ is most affected by the use of Laser in the OR?
The eyes.
Protect patients eyes
Protect staff eyes
Use recommended eyewear
Invisible Ultraviolet
Lasers operating in the ultraviolet spectrum (315 nm to 390 nm)
absorbed by the eye lens.
ultraviolet laser Example: excimer laser used in eye surgery
Visible
Laser radiation in the visible region ( 400 to 700 nm)
absorbed within the retina.
An eye can focus a collimated visible beam by as much as 100,000 times.
Visible laser Example:
Argon and KTP lasers
Invisible Near-Infrared
Laser radiation, in the near-infrared region (700 to 1400 nm),
absorbed by the retina.
An eye can concentrate a laser beam on the retina as much as 100,000 times.
Eye don’t have an aversion response in the near- or far-infrared portion.
Victims usually do not know that they have been overexposed until injury occurs.
invisible near-infrared lasers are very dangerous.
Far-Infrared
Laser radiation in the far-infrared region of 1400 nm to 1 mm the midultraviolet (180 to 315 nm) affects the cornea. Far-infrared Example: A CO2 laser
Mention other hazards caused by Laser not related to the eyes ?
Airborne contaminants
Fumes
Particulate Matter
Bio- aerosols
Injuries caused by laser ?
Eye damage
respiratory infections
PPE for laser exposure
Special mask and eyewear
Challenge to anesthesia provider when laser use in the airway
Surgical fire can occur
use designated ETT coverings reduce FIO2 as low as 30% if tolerated by patient.
Fluoroscopy
Most significant source of radiation in the OR
How to protect yourself and patients from radiation risk ?
Wear appropriate protection
Reduce prolonged exposure
2 reasons the LIM could alarm?
- A faulty piece of equipment plugged into the system, converting it to a grounded system
- Many pieces of equipment w/ small amounts of leakage current plugged into the isolated power system
With Micro shock
As little as 10-100 microamps can cause v-fib in the electrically susceptible patient.
How do you fix a LIM alarm?
The last piece of equipment plugged in may have a fault or that too much equipment is being used simultaneously- unplug the last piece of equipment plugged in to get rid of alarm and follow safety measures.
Current can only travel through what kind of circuit?
Closed circuit
Circuit has 3 wires, what do they do?
1) Hot wire- supplies current
2) neutral wire - return path
3) ground wire- safety, provides a low resistance path for leakage current to flow away from electrical equipment and avoid harm.
LASER definition
Light Amplification through Stimulated Emission of Radiation
3 factors affecting Laser hazard
- capability to injure people
- environment where the laser is used
- personnel using or exposed to laser
The unit of measure that is equal to the product of the voltage and the amperage
(E x I).
A Watt
The SI unit of electrical or mechanical work, defined as the amount of energy spent by one watt for one second in a resistance of one ohm.
A joule
