Opportunities to enhance perioperative patient safety: 2013 and beyond

Abstract

We are pleased to dedicate this special theme issue of the Journal to the important topic of perioperative patient safety. Anesthesiologists take justifiable pride in the development and implementation of robust patient safety initiatives throughout the world. At the same time, many of us are challenged daily in caring for patients with everincreasing medical complexity. We provide anesthesia for routine and complex surgical and interventional procedures in the operating room and ‘‘remote settings’’ within the context of an ever-complex working environment. In considering these contemporary and patient-focused challenges, some months ago, our editorial team invited experts from Canada and internationally to address current key issues in perioperative patient safety in a series of brief review articles. I acknowledge with special thanks our Board Member, Dr. Alan F. Merry, for his thoughtful input and contribution to this issue, and for his instrumental role as co-editor and editorialist. According to Journal policy, these articles have all been externally reviewed and edited, and for the benefit of our readers, we have harmonized the outline of each article to include a structured abstract, a list of key words, and two or three multiple choice questions to guide readers’ attention to the key points. In the first review article, Dr. John H. Eichhorn provides an overview of practical current issues in perioperative patient safety. He emphasizes the fact that important gains in patient safety over the past three decades have been attributed largely to the development of behaviours known as ‘‘safety monitoring’’. Extension of the human senses through electronic monitors, such as capnography and pulse oximetry, has been a major advance, but Dr. Eichhorn cautions that, ‘‘in the highly developed world, this current success is threatened by complacency and production pressure’’ which bring forth new challenges. Electronic medical records, hence, anesthesia information management systems (AIMS), provide enormous potential to enhance patient safety. Anesthesiologists have the opportunity to become key leaders in the adoption, implementation, and integration of AIMS and healthsystem information technology (IT) solutions in general. In their review article on the evolving role of IT in perioperative patient safety, Drs. Michael Stabile and Lebron Cooper identify that uptake of health IT and AIMS remains variable despite the potential benefits, and they identify advantages and barriers to the adoption and implementation of IT in general and AIMS in particular. Later articles in this theme issue address specific clinical issues that present ongoing challenges to the practicing clinician. Medication error remains a leading cause of adverse events in the perioperative setting. In their article ‘‘Improving drug safety for patients undergoing anesthesia and surgery,’’ Drs. Beverley A. Orser, Sylvia Hyland, C. Ruth Wilson, David U, and Ian Sheppard summarize recent advances, tools and interventions designed to improve drug safety, relevant to the practicing anesthesiologist. Important Canadian and international initiatives such as new standards for labelling of drug ampoules and vials, and the development of bar code systems that provide as systematic approach to ‘‘double checking’’ or drug verification in the operating room, are reviewed. This article also addresses the important subject of medication reconciliation as a means to enhance patient safety. There is now fairly compelling evidence that implementation of checklists into clinical practice can enhance D. R. Miller, MD (&) Department of Anesthesia, The Ottawa Hospital and University of Ottawa, General Campus CCW 1401, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada e-mail: dmiller@ottawahospital.on.ca