In support of ambulatory surgery…

In support of ambulatory surgery…

I have worked in ambulatory surgery since 1995.  I love the safe quality care our industry provides.  When people ask me why we are good at what we do, my answer is always simple.  We specialize in one thing.  Surgery.  As with any business, when you are highly specialized, it means that most often, with a single focus, you do it well.  There has been some recent media buzz that suggested, without real facts, that this may not be the case.

I could write a response to this most recent discussion defending my opinion, offer facts to support my perception and experience, and the like.  I could also finger point and share examples of care misses in other types of care environments, as  if to say: look – we all have room to improve!  But instead, I decided to offer a list of easy checks to ensure our facilities are prepared to respond to possible emergent scenarios.  So here are some of the things I do to ensure readiness and safety, in no particular order:

  1.  Check your Lipid Rescue kit.  The American Society of Regional Anesthesia recommends that you keep 1 L of Lipid Emulsion 20% available if regional anesthesia is used, in the event of regional toxicity.  You can find out more, and what to put in your kit from asra.com or lipidrescue.org/ 
  2. Perform a Safe Injection Audit.  I recommend that, even if this is a routinely delegated task, that you occasionally do an audit yourself to ensure patient injection safety.  Here is a resource I like to use from: The one and only campaign.
  3. Beef up your next code drill.  Have everyone dig in the crash cart, review the supplies, and emulate your response with the tools you have available, especially airway supplies.  Do you have all the tools needed to establish and maintain an airway, including an emergency trach kit?  Are all supplies still in date and in working order? Will your ET tubes fit all of your patients?  I once was in a case where we started having a reactive airway, had to re-intubate a patient, and had to use the smallest ET tube we had.  Discuss any potential quantity changes, supply updates or item placements.
  4. Test your portable suction.  Does it have a battery back up?  If  you aren’t near an electrical outlet, will it still work?  I’ve had to respond to an emergency in a parking deck, a lobby, and a hallway.
  5. Check your ambu-bag masks.  Over time, they lose elasticity and need to be replaced.
  6. Have you reviewed your emergency drugs lately?  Do they meet the current ACLS guidelines, and do you have the right quantity?  Involve your anesthesia team to review and revise if needed.
  7. Are all your laryngoscope blades and handles in good working order?  I recommend putting them together and checking them monthly.
  8. Are you checking your portable oxygen tanks?  They can be a challenge to work, and may not be charged.  Include practice use and checks as part of your routine safety drills.

We cannot prevent bad things from happening.  We live in a high risk environment where unknown health problems, allergies and potential for complications are knocking on our doors.  Bad things will and do happen in healthcare.  All we can do is be prepared for the worst and be diligent in our readiness, so that our response is never in question.  I trust that, for the most part, we stand ready as an industry to respond to these potential bad things effectively.  I hope that my constructive readiness tips add some confirmation to your readiness response, to support the quality, safe care your facilities provide every day.

 



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