Chapter 43 Quality of Care and Patient Safety
Basic principles
1. What is the principle of nonmaleficence in regard to patient safety?
2. What elements constitute The Joint Commission National Patient Safety Goals and how often are these updated?
3. What is the triad of excellence in health care in the authors’ opinion?
4. What is included in assessing quality of care?
5. What resources are available to measure quality and efficiency in the operating room (OR)?
Anesthesiology and patient safety
6. Why is anesthesiology often considered a leader in systematic improvement of patient safety in the OR?
7. What are examples of common safety features on anesthesia machines that promote the safe delivery of anesthesia?
8. What is the American Society of Anesthesiologists (ASA) Closed Claims Database?
9. What changes in practice have resulted, in part, from the findings of the ASA Closed Claims Database?
10. What are the goals of the Anesthesia Patient Safety Foundation and who does it include?
11. What are estimates of mortality from anesthesia in today’s surgical population?
Patient Safety, Medical Error, Adverse and Sentinel Events
12. What broad types of medical or health care errors exist?
15. What are the most commonly reported sentinel events?
16. What is a root cause analysis (RCA)?
17. How many patients die annually as the result of medical errors?
18. What is the National Surgical Quality Improvement Program (NSQIP)?
19. What are the primary tenets of the NSQIP?
20. What is the central venous catheter checklist advocated for use in intensive care units (ICUs)? What is the evidence for its efficacy?
Preventing wrong-site surgery
23. What is the definition of wrong-site surgery?
24. Is the incidence of wrong-site surgery increasing or decreasing?
25. What steps has The Joint Commission taken to prevent wrong-site surgery?
26. What are the essential elements of a preprocedural “time-out”?
Medication safety
31. What is medication reconciliation in the context of anesthesia?
32. When should medication reconciliation be performed?
33. How should medication labeling be performed in the OR?
34. When should medication labeling be performed in the OR?
35. What elements of proper medication name and dose labeling help ensure patient safety?
36. How can look-alike and sound-alike drugs be differentiated?
Answers*
Basic principles
1. Nonmaleficence is a basic tenet of medical ethics based on the Latin primum non nocere, or “first, do no harm.” (746)
2. The Joint Commission National Patient Safety Goals are updated yearly, and for 2010 include the following:
3. In the authors’ opinion, (1) patient safety, (2) improved outcomes, and (3) improved patient satisfaction with their care constitutes the triad of excellence in clinical care. (747, Figure 41-1)
4. Quality of care includes not only the clinical care indicators, but also the measures of efficiency, such as timely starts, short turnaround times between cases, appropriate access for emergencies, and effective utilization of the ORs, equipment, and staff. (746-747)
5. The American Association of Clinical Directors has developed a Procedural Times Glossary to measure and compare OR efficiency benchmarks. The ASA also established the Anesthesia Quality Institute (AQI) in 2009 to establish standardized quality measures, promote research, and obtain useful data to improve the quality of patient care. (747)
Anesthesiology and patient safety
6. Anesthesiology has often been cited as an example of how a medical specialty has systematically improved patient safety. In 1954, Beecher and Todd’s review of mortality during anesthesia found a mortality rate of 1 in every 1561 operations, and was one of the first studies to scientifically identify and quantify risks associated with anesthesia. Patient safety efforts have included features on the anesthesia delivery systems used in patient care (e.g., Pin Index Systems), founding of the ASA Closed Claims Database in 1985, and establishment of the Anesthesia Patient Safety Foundation (APSF) also in 1985. (747)
7. Many of the features of the anesthesia machine, such as Pin Index Safety Systems, oxygen fail-safe controls, prevention of hypoxic mixtures, and elimination of hanging bellows, were developed to enhance patient safety by avoiding critical technical failures. (747)
8. In 1985 the ASA established the Closed Claims Database with the goal of reviewing closed malpractice claims to identify sources of technical failure and human error that lead to patient injury, and to then share this information with the anesthesia community. (747)
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