QS/RIP/PD Flashcards
Crisis Management Non technical skills
Many problems faced in a crisis find solution in design and psychology, not education- i.e. Human factors.
These skills are not inherent. Taught at EMAC.
Task Management: Plan, prepare, prioritise provide/maintain standards, identify and utilise resource
Team work: coordinating activities, shared mental model, using authority, supporting others
Situational Awareness: gathering information, recognising and understanding, anticipating
Decision making: Identify options, weigh risk, reevalaulate
PS04 PACU
General principles- staff training, ability, PACU location, equipment, drugs
Handover
Individual bay and wider requirements
Bed requirements
Discharge criteria
PS15 Day case
Benefits vs risk
Organisaitonal- ring fenced, admission ability, staff trained, criteria for patients
Audit
Selection- patient
- ASA 1-2 or stable 3 - 4. Would anything different be done as inpatient. BMI > 35 anaesthetist r/v preop. OSA minimal opioids, none on discharge
Live in 1 hour of hospital, 24 hours supervised
Surgical- min risk airway/haemoarrhage/pain issues, return to normal fxn
Anaesthesia
- Short acting
- Multimodal
-Avoid emetogenic agents
Discharge
- Criteria: A- E, anaesthetic, Surgery
- medication
- Written advice
- Supervision
ANZCA major Regional
Practitioner competence
Assistance and environment
Consent
Monitoring and management
Infectionn control
Documentation and handover
Handovers
Background
Record UTD
Equipment working
Anaesthetic technique/drugs/lines/current state
Keep others in the Know - tech, surgeon, pt
Environmentally sustainable anaesthesia
Principles:
- pt safety not compromised
-All countries should participate
- Health systems must reduce climate change contribution
Strategies
- Sustainable equipment
- Reduce volatile impact - no des, low flow, Tiva, regional
-waste management and recycling
-Rational drug use
-anaesthesiologists as leasers in sustainability
Error Types
Error: action intended but not performed
Mistakes: errors in planning actions
- Knowledge based
- Rule based
—— Good rule Misapplied
——-Bad rule
Skill based errors: errors in executing correctly planned actions
- Slips: action based
- Lapses: memory based
Medication errors
Right patient/drug/dose/route/time
Root Cause analysis
A structured problem solving approach to investigating serious adverse events
- Team
- Review documentation/recounts
- Identify Contributing factors
- Identify root causes- 5 whys
- Develop corrective actions
- Implement and monitor improvements
Culture
Ccompetency: Awareness, attitude, knowledge and skills in working with different cultures
Csafety: Doctors ability to recognise own culture/biases to allow provision of safe, unbiased, non racist/discriminatory care as defined by the patient
Respect and understanding
Culturally tailored communication
Patient centred approach
Partnership
Specific circumstances
- Vulnerable
- Pain
- Other- birth, death, blood/tissue donation/receiving
Peer Performance
Principles: Fair/transparent, Defined standards, Conflict of interest disclosure
Steps
- Establish terms of reference- reason for review
- Identify applicable standards
- Review complaints/records/incidents/health info, confirm review objective, meet with practitioner discuss concerns, self reflection, ≥1 session clinical observation
- MSF
- Report and recommendations
QA
Purpose- justify cost
Planning
Implementation
Review outcome
Incorporate improvements
Reaudit
QI
Plan
Implenemt
Audit
Revise
EOLC
Advanced directives- who what when where why- ?Application to now
Mitigate clinical momentum
culturally safe care
Management of DNR/DNI orders
All in context of benef/non-mal/auton/justice
Documentation
QA/QI Triple aim
Individual patient health/safety
Populaiton health
Efficiency of resource use
Fatigue
Subjective feeling of need to sleep, physiological drive to sleep, decreased alertness
Personal- sleep, leave
Departmental
- life/limb night
- Rostering, staffing
- Safety culture
- Sleep room
Auditing
Fire Safety features OT
Regular maintenance/socket checks/equipment checks for faults
Fire stop doors
Fire resistant cladding
storage of flammable equipment away from fire fighting equipment
Fire alarms, sprinklers
CO2 fire extinguishers
Human factors
- Training
_fire drills
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Responsibilities to assistant
Safe staffing
Educational. allowance
Scope of practice
Fatigue managemnt
