Anaesthesia services plays a crucial role in patients’ safety, especially for patients undergoing surgery or under critical care. As it is closely linked to patient safety, NABH has focussed on anaesthesia services and has given certain requirements to be fulfilled by it. These requirements are largely to ensure safety of patients from adverse and sentinel events related to Anaesthesia. The list of requirements is as given below.
Note: These requirements are applicable to all types of anaesthesia (general, regional, spinal) except local anaesthesia
1. Anaesthesia services should be given by qualified anaesthetist only. The hospital’s credentialing and privileging policy must specify the names of doctors, who has the privilege of providing different types of anaesthesia. Technician shall not administer anaesthesia.
2. An informed consent for anaesthesia should be taken from patient. This should be separate from surgery consent. The consent form should specify, risks, benefits and alternatives of anaesthesia.
3. For each patient who require anaesthesia following documentation should be done, prior to administration
a. Indications for anaesthesia (or reason for anaesthesia)
b. Type of anaesthesia to be given
c. Procedure or method of administering anaesthesia
4. A pre-anaesthesia assessment should be done for every patient who has to undergo anaesthesia. Following points must be taken care of under pre-anaesthesia assessment.
a. The pre-anaesthesia assessment should be done by a qualified anaesthetist
b. There should be a standard format of doing pre-anaesthesia assessment. The findings of the assessment should be documented in the format
c. Current medicines being taken by patient should be reviewed during assessment
d. The pre-anaesthesia assessment should be done prior to surgery, before the patient is wheeled into OT. In case of elective surgeries, pre-anaesthesia assessment can be done before admission
e. At the end of pre-anaesthesia assessment, the anaesthetist should determine and document the anaesthesia plan, which must include, pre-medication required, type of anaesthesia to be given, special requirements and anticipated post-anaesthesia care.
f. The pre-anaesthesia assessment should be done for routine as well as emergency cases, including urgent cases
g. In case the surgery is postponed, a fresh pre-anaesthesia assessment should be done before surgery
5. An immediate pre-operative (pre-induction) evaluation of patient is performed and documented by anaesthestist, before administering anaesthesia. This should also be done on a standard format.
6. If there is any change in plan of anaesthesia, it should be documented in patients’ file (or on immediate pre-operative form)
7. In urgent cases also, pre- anaesthesia assessment and immediate pre-operative assessment, both should be done and documented
8. A protocol should be in place to monitor various parameters of patient during anaesthesia. Monitoring must include, temperature, heart rate, cardiac rhythm, respiratory rate, blood pressure, oxygen saturation and end tidal carbon dioxide.
9. Monitoring during anaesthesia should be documented
10. Anaesthetist must be present during the procedure to take care of any adversities
11. Patients’ post- anaesthesia status is assessed and documented by anaesthetist.
12. After surgery patient should be kept in recovery area under observation of anaesthetist.
13. Clinical criteria should be in place to determine, when a patient is fit to be transferred out of recovery area. The criteria should be applied by anaesthetist to take decision
14. Documentation should be done in patients’ record about type of anaesthesia given and medication used
15. A documented guideline of infection prevention during anaesthesia should be available and it should be followed.
16. A list of various adverse anaesthesia events shall be available
17. Any occurrence of adverse anaesthesia event should be recorded.
18. Adverse anaesthesia event must be reported to a designated authority
19. Every adverse anaesthesia event must be assessed and monitored to find the causes and take corrective and preventive action
20. The corrective and preventive action taken on each adverse anaesthesia event should also be documented
Quality Indicators
1. % of adverse anaesthsia events
2. Incidence of sentinal events related to anaesthesia
3. % of surgery patients for whom pre-anaesthesia check up was done
4. % of surgery patients for whom immediate pre-anaesthsia evaluation was done
5. % of patients for which seperate anaesthesia informed consent was taken
6. % of modification of anaesthesia plan
7. % of unplanned ventilation
Checklists of other departments
