Patient Safety News
August 2020
Continue to Protect Others from COVID
- Keep masks on at all times unless eating or drinking.
- Be cognizant of how many people are in a given break room at one time.
- Invite others in the OR to be at least 6 feet away (and potentially out of the room) for intubation/extubation.
- Please assist Anesthesia Techs in ensuring their names are attached to our anesthetic records under “Staff”. This is helpful for contact tracing when there is an unexpected COVID+ patient that has been to the OR.
Airway Management in Our Current Times
Per ASA website:
“At this time, no studies exist that assess risk of various airway techniques and anesthetic choices. While LMA usually seal the airway at low pressures, there is concern that higher positive pressure, if used, might create a leak with aerosol production. LMA may be an acceptable option with selected patients because of the lower risk of coughing.”
Suspend Code Status for OR
- Order is in our pre and post op order sets, right at the top.
Blood samples for T&S and ABO/Rh
- Samples can be drawn from the same source (ie. same PIV or a line).
- Orders MUST be written separately.
- They require different time stamps.
- Consider ordering T&S → go draw your labs → then order ABO/Rh.
Remifentanil Infusion Updated on Medfusion Pumps
- Pre-programmed start rate: 0.05 mcg/kg/min.
- Optional loading dose of 0.5 mcg/kg/min.
- Soft upper limit of 0.2 mcg/kg/min.
- No hard upper limit.
- Special thanks to an anesthesia team that recognized and owned a recent error in programming that highlighted the lack of safety rails on this function.
Drug Shortages – August 2020
Dexamethasone
- Expected shortage following preliminary results of the RECOVERY trial for COVID-19.
- Vials removed from A-machines, and consolidated to central MAIN-OR Pyxis machines.
- Please refrain from using for PONV prophylaxis.
- Alternative agents include scopolamine, ondansetron, promethazine, prochlorperazine, haloperidol, or ephedrine.
GU Irrigant
- Stock centralized to MAIN-OR 1 Pyxis (near OR5/OR6), CARDIOCATH Pyxis, and OR Pharmacy for now.
Local Anesthetics
- Continued national shortage of lidocaine, bupivacaine, and combinations with epinephrine.
- Stock has been centralized in order to conserve supply. Please contact OR Pharmacy to obtain.
Cisatracurium
- Reserve for patients with poor renal/liver function.
- Stock centralized in MAIN-OR Pyxis fridge for extended expiration dating.
Gelfilm
- Next release date is December 2020.
- To obtain Durepair, please reach out to Materials Supply Chain.
Drug Shortage information can also be found on the PSQI SharePoint site (available only when connected to the hospital’s secure network/wifi).
Improvement Scholars Symposium
Tuesday, Sept. 15, 2020 on Zoom (link shared after registration)
2:00 – 3:35 Presentations
3:35 – 4:00 Online Breakout Room Reception
Celebrating the hard work and success of IHQI’s 2019 – 2020 projects.
Register here: https://tinyurl.com/ihqi2020
Log in for the full event, or come and go as needed.
2:10
Reducing Length of Stay for Pediatric Patients with Gastrostomy Tubes
Michael Phillips, MD
2:23
Advance Care Planning in Outpatient Primary Care
Katherine Aragon, MD & Karen Halpert, MD
2:36
Communicating Prognosis with Seriously-Ill Patients and Families in the Surgical Intensive Care Unit
Joanna Grudziak, MD, MPH & Trista Reid, MD, MPH
2:54
Same Day Acute Care for Patients with Cancer
Hanna Sanoff, MD, MPH & Anna Griffith, MD
3:07
Reducing Low-Value Care Through Syncope Standardization
Michael Craig, MD, MPH, SFHM
3:20
Improving Obesity Treatment in Primary Care
Sarah Ro, MD & Shannon Aymes, MD, MPH
