Practice guidelines 2022 Flashcards
what are the duties of an anaesthetic provider?
• Maintaining personal knowledge and skills.
• Providing anaesthesia services or supervising trainees who provide anaesthesia services.
• Anaesthetists may be directly responsible for only one anaesthesia at any specific time unless acting in a supervisory capacity.
• Carrying out a preoperative risk assessment and management for all types of patients and surgery.
• Delegating responsibility for patient supervision to a suitably trained substitute when a local anaesthetic technique is used for pain relief without concomitant surgery, e.g., labour epidural.
• Supervising the recovery room activities.
• Participating in postoperative management where appropriate.
• Managing or supervising the management of patients in the intensive care unit (ICU).
• Providing services related to the management of acute pain.
• Providing services related to resuscitation and advanced airway management in adults and children.
• Taking responsibility for supervising the maintenance of anaesthesia, monitoring, and other life-support equipment relevant to anaesthesiology and critical care. This must occur in conjunction with a suitable technical or biomedical
engineering service.
• Taking responsibility for the safe use of anaesthetic drugs.
• Providing anaesthesia services that relate to obstetrics, including pain relief in labour.
• Providing monitored anaesthesia care services in and out of the hospital.
• Keeping complete documentation and records of the anaesthesia administered to patients.
• Obtaining informed consent to all invasive procedures, including those performed under local anaesthesia, spinal- or epidural anaesthesia, monitored anaesthesia care or general anaesthesia, and specific non-anaesthesia interventions such
as blood transfusion or HIV testing.
• Maintaining personal and professional wellbeing.
what are additional duties of the anesthesia provider are included as per 2022 guidelines
• Providing services related to chronic pain management and consulting in pain clinics.
• Providing consultative anaesthesia and ancillary services.
• Carrying out administrative, educational, and managerial
duties locally or regionally.
• Providing information and training on methods of handling mass casualties, trauma, and basic life support techniques to:
◦ paramedical staff,
◦ interested community groups (particularly basic life support), and
◦ contributing to the activities of professional associations.
• Auditing and reviewing the quality of care and participating in hospital-based, regional and/or national efforts to improve patient safety.
• Participating in theatre complex management.
• Involvement in the conduct and/or supervision of research on drugs, equipment, clinical management methods, and physiological and pharmacological matters relevant to
anesthesiology and intensive care and keeping up to date with such research.
• Providing and/or taking part in advisory services to hospital
committees, health commissions and other organisations to improve health care services.
• Encouraging and supervising research.
• South African adapted CANmeds competencies in training a medical expert include being a medical expert, communicator, collaborator, leader, health advocate, scholar and professional.
who is allowed to provide supervison for Intern doctors?
It is recommended that medical
interns receive direct supervision by a diplomate anaesthetist or,
if not available, an anaesthetist designated as intern supervisor
(see below).
In the absence of a specialist,
the supervisor should preferably possess the Diploma in
Anaesthetics (DA) of the College of Medicine of South Africa
(CMSA), or at a minimum, have three (3) years full-time experience
of administering anaesthesia as a medical officer.” Irrespective of
the qualification, the constant presence of the senior physician
on a one-to-one basis is strongly recommended.
what are the recommanetions on intern training?
It is recommended that
undergraduate teaching outcomes in anaesthesia at different
training institutions across South Africa be standardised.
• Interns must receive a minimum of two months of supervised
anaesthesia training (4–6 months is desirable).
• It is considered mandatory that interns are trained in the anaesthesia module of the Essential Steps in the Management of Obstetric Emergencies (ESMOE) training programme.
Community service doctor in anesthesia
Provision of
anaesthesia must be supervised.
• It is recommended that supervision of community service doctors in a training institution is done by either an anaesthesiologist or a diplomate anaesthetist.
• It is recommended that a diplomate anaesthetist supervises at all other facility levels of care.
• It is recommended that the option for 6 months training in anaesthesia be available in institutions accredited for DA training.
• Even though the community service period is a period of service, and not of training, it is advisable that community service doctors keep a logbook of all supervised completed cases for these to be recognised toward qualifying to write the DA examination.
Independent practitioners/ GP recommendations
SASA recommends that general practitioners with less than three years experience and less than 75% working time spent in anaesthesia, and who have had no additional training in anaesthesia and rely on undergraduate, internship and com-
munity service training when performing anaesthesia services,
should not be involved in the independent administration of
anaesthesia.
The only exception would be in a dire emergency, where a patient of the American Society of Anesthesiologists (ASA) class VE requires urgent anaesthesia, and no other clinician trained in anaesthesia is available.
As soon as feasible, every effort should be made to transfer the patient to a centre where more specialised care is available.
To gain experience when there is no recourse to supervised training, a newly qualified general practitioner is advised to join SASA as an associate member to benefit from guidance and contact with diplomate anaesthetists and specialists and CPD activities in the local SASA branch and nationally.
It should be noted that proof of experience in anaesthesia care may be required in peer-review processes or medico-legal investigations. Therefore, SASA recommends keeping a professional portfolio, including a registered logbook of cases before and after being registered as an independent practitioner with the HPCSA.
Practitioners should inform patients of their level of experience and qualification during their first encounter with the patient.
Diplomate anaesthetists with less than three years
of full-time anaesthesia practice or ‘experienced’
anaesthetists without DA
‘Experience’ for non-diplomate anaesthetists is defined as at least
3 years of anaesthesia practice and at least 75% of working time spent in anaesthesia
It is highly recommended that evidence of CPD activities relating to
anaesthesia practice be kept up to date.
It is reasonable to expect the diplomate to provide safe
anaesthesia for fit and healthy (ASA class I & II) paediatric patients over the age of two years, provided the practitioner has maintained the necessary skills and the nature of the intended
surgery is minor and elective. If that is not the case, supervision
or referral should be sought.
In an emergency, or where no alternative exists, the diplomate
may administer anaesthesia to patients with severe systemic
disease (ASA class IV and V) in consultation with a specialist
anaesthesiologist. This constitutes supervised practice.
Surgical severity/ grading : Minor
Minor surgery includes procedures lasting less than 30 minutes that are performed in a dedicated operating room, which would often involve extremities or body surface, or brief diagnostic and therapeutic procedures, e.g., arthroscopy without intervention, removal of a small cutaneous tumour, diagnostic proctology, biopsy of small lesions, etc.
Surgical severity: Intermediate surgery
Intermediate procedures are more prolonged or complex and may pose the risk of significant complications or tissue injury.
Examples include laparoscopic cholecystectomy, arthroscopy
with intervention, bilateral varicose vein removal, tonsillectomy, inguinal hernia repair, breast lump resection, haemorrhoidectomy, appendicectomy, partial thyroidectomy, cataract surgery, uvuloplasty, minimally invasive repair of vaginal prolapse, vaginal hysterectomy, tendon repair of hand, fixation of mandibular fracture, etc.
Surgical severity : Major
Major surgical procedures are expected to last more than 90
minutes. They include major gut resection, major joint replacement,
mastectomy, extensive head and neck tumour resection, abdomi-
nal aortic aneurysm repair, major vascular bypass procedure,
procedures involving free flap to repair tissue defects, amputation,
total thyroidectomy, cystectomy, transurethral resection of the
prostate, resection of liver tumour, carotid endarterectomy,
nephrectomy, total abdominal hysterectomy, spinal discectomy,
etc.
Experienced diplomate anaesthetists scope of practice
Experienced diplomate anaesthetists may have extensive experience in specific surgical categories or types but not in others.
If experienced and spending at least 75% of their time providing anaesthesia care, the diplomate may be responsible for ASA III patients or patients undergoing major surgery. The provider must realise that peer review for this practice will be assessed at a specialist level.
Family physicians scope of practice
The family physician practitioner has an invaluable role in the perioperative care of patients, especially at the district level.
We recognise that due to the diverse background of training, experience, and competence, they might be in different categories above, e.g., experienced without a diploma or
experienced with a diploma. Therefore, we cannot make specific
recommendations about family physicians.
Specialist trainees (registrars) scope of practice
The anaesthetic registrar is permitted to administer anaesthesia under specialist supervision.
Although the revised recommended
ratio by the HPCSA ratio is set at 4:1, i.e., four registrars to each specialist for elective procedures, SASA recommends that a ratio of 2:1, i.e., two registrars to one specialist, is preferable
In circumstances where the anaesthesia is classified as “high risk”, the ratio may be reduced to 1:1.
Specialist anaesthetists (anaesthesiologists) scope of practice
The specialist anaesthetist can be expected to provide anaesthesia services independently to all patients, irrespective of the state of health or co-existing disease (ASA classes I, II, III, IV, V and VI).
It behoves the individual practitioner to confine their practice to those areas where they have maintained the necessary advanced skills.
This applies particularly to cardiac,
thoracic, neuro- and paediatric anaesthesia sub-specialities.
Clinical head clinical time regulation
• For heads of departments, it is recommended that
30–50% of non-clinical time is allowed for this man-
agement function.
◦ In clinical departments with academic programme
responsibilities, up to 50% of total time should be
dedicated to non-clinical time. Non-clinical time should
be allowed for the training programmes’ administration,
professional development, and academic management.
◦ In service departments without teaching responsibilities
at undergraduate and postgraduate levels, up to 30%
of total time should be dedicated to non-clinical time.
Non-clinical time should be allowed for administration,
training, and professional development.
