Capnography, Patient Safety

1/3 of Healthcare Providers Believe Medical Practices Are Not in Accordance with Basic Monitoring Standards

by Michael Wong

In the PPAHS survey conducted among healthcare providers (for pdf download of survey report, please see link below), more than a third believe medical practices are not completely in accord with the Standards for Basic Anesthetic Monitoring set by the American Society of Anesthesiologists (ASA). Most of the respondents (about 60%) indicated anesthesiology as their medical practice.

The ASA recently updated its Standards for Basic Anesthetic Monitoring to require, “During moderate or deep sedation the adequacy of ventilation shall be evaluated by continual observation of qualitative clinical signs and monitoring of the presence of exhaled carbon dioxide unless precluded or invalidated by the nature of the patient, procedure, or equipment.”

The ASA Standards were issued October 2010 for implementation July 1, 2011, and part of this survey evaluated whether healthcare facilities are in accord with these new standards.

“The safety of patients under anesthesia is extremely good, and the majority who believe that ASA Standards have been completely implemented is an indication of this. However, a significant minority clearly see room and areas for improvement, and I would concur with their observations,” observes Dr Richard Dutton (executive director of the Anesthesia Quality Institute).

“Quality of anesthesia provision can affect patient safety, quality outcomes, and finances facility,” Dr Dutton explains. “With the goal that no patient shall be harmed from anesthesia, healthcare facilities need to continually locate and deal with those areas.”

Expanding on this thought of continuous improvement, one medical expert explained to me, “Anesthesiologists have long been on the forefront of using monitoring for patient safety. As a profession, we must continually search for improvement.”

A capnograph is a measuring device that measures the concentration of carbon dioxide that a person breathes out in exhaled air.

“Capnography has been used in operating rooms for decades now with a long track record of ‘saves’ due to this one device,” says this expert. “Many ICUs are beginning to use capnography as well. The next frontier for capnography is on the hospital floor patients. We have a lot of patients these days with obstructive sleep apnea and who receive narcotics for pain control.”

Ensuring healthcare providers utilize the latest knowledge and technology requires continuing education.

As Dr Philip Lumb (Chair of Anesthesiology, Keck School of Medicine at the University of Southern California) says, “Continuing education should be provided for all individuals taking care of patients who have received procedural anesthesia/sedation. Special emphasis should be given to ‘non-traditional’ areas outside the purview of normal operating room and perioperative procedures and surveillance.  This is increasingly important for office-based practices, interventional suites (GI, Radiology, etc) and ambulatory surgery centers.”

To obtain a pdf copy of the survey report, please click Survey on ASA Standards and APSF Recommendations.

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