The WFSA and patient safety in the perioperative setting

Abstract

Since its foundation in 1955, the World Federation of Societies of Anaesthesiologists (WFSA) has dedicated its resources to improving the standard of anesthesia world wide. It does this in a variety of ways—through education programs, publications, scientific collaboration, and the setting of standards for anesthesia practice. An independent International Task Force on Anaesthesia Safety developed a set of standards which were adopted by WFSA in 1992. These standards were updated and approved by the general assembly of WFSA in March of 2008. They are recommended for professionals throughout the world and are available on the WFSA website. In many areas of the world, these standards are already met or are even exceeded. However, in environments where resources are scarce, achieving these standards may remain a distant goal, yet a worthwhile goal nevertheless. In Uganda, a recent survey delineated the need, not only for monitors and machines, but also for some of the most basic essentials for safe anesthesia. Eighty percent of respondents did not always have electricity, 44% lacked running water, and 30% did not always have intravenous fluids. Twenty-three percent of participants had the essentials to provide safe anesthesia to an adult, but only 6% could provide a safe anesthetic for Cesarean delivery. Only 13% of respondents could provide safe anesthesia to a child less than 5 years old. A similar survey in Moldova in August 2007 (G. Iohom, personal communication) demonstrated a lack of anesthesia equipment that many would consider essential to the provision of safe anesthesia. So how do WFSA standards apply in such settings? In revising the standards, the WFSA has sought to identify those fundamental practices that, in the present day, should be the minimum observed during the provision of anesthesia for any elective procedure. Standards included in this basic category have been carefully limited to those likely to make a substantial difference to patient safety. Some may seem difficult to achieve, but all should be possible in any service providing elective surgery with general or major regional anesthesia. As before, the most important safety monitor is the presence of a well-trained anesthesia professional. The WFSA views anesthesia as a medical practice. In many parts of the world, anesthesia is delivered by non-medical personnel. The WFSA believes that not only should these providers be formally trained and accredited, but they should also be supervised by medically qualified anesthesia specialists. Unfortunately, this is not always the case. In some places, anesthesia may be provided by practitioners with absolutely no training; furthermore, input from any medically qualified anesthesiologist is often absent (even in the minimal form of oversight from a distance). The WFSA believes this state of affairs to be unacceptable in 2008. Elevating the continuous use of a quantitative monitor of oxygenation, such as pulse oximetry, to the list of minimal Dr. A. Enright is the President of the World Federation of Societies of Anaesthesiologists (WFSA). Dr. A. Merry is Chair of the Safety and Quality of Practice Committee of the WFSA.