Adverse Incidents Research Articles

Causation, historiographic approaches and the investigation of serious adverse incidents in mental health settings.

To improve the safety of healthcare systems, it is necessary to understand harm-related events that occur in these systems. In mental health services, particular attention is paid to harm arising from the actions of patients against themselves or others. The primary intention of examining these adverse events is to inform changes to care provision so as to reduce the likelihood of the recurrence of such events. The predominant approach to investigating adverse incidents has relied on the cause-and-effect conceptualisation of past events. Whilst the merits of approaches which are reliant on cause-and-effect narratives have been questioned, alternatives models to explain adverse incidents in health settings have not been theoretically or empirically tested. This novel article (i) examines the notion of causation (and the related notion of omission) in the context of explaining adverse events in mental health settings, and (ii) draws on a long-established discipline devoted to the study of how the past is interpreted (namely historiography) to theoretically investigate the innovative application of two historiographical approaches (i.e. counterfactual analysis and historical materialism) to understanding adverse events in mental health settings.

The sterile insect technique: an international framework to facilitate transboundary shipments of sterile insects

The sterile insect technique (SIT) has been successfully used since the 1950s as part of an integrated pest management approach in large-scale programmes to prevent, contain, suppress and eradicate key insect pests in many countries throughout the world. During this period, over one trillion live sterile insects have been shipped across borders. The very few adverse incidents from this significant trade were managed and resulted in no significant impacts. The phytosanitary and zoosanitary requirements by importing countries have been simple, facilitating the transboundary shipment of sterile insects, which is carried out mostly under the framework of cooperative agreements between the governments of the countries involved, and under technical cooperation projects of the United Nations. However, the shipment of sterile insects from sources outside this governmental framework, including public-private facilities, has been complicated, despite the availability of harmonised international guidelines in some cases, such as those for fruit flies. The SIT has great potential for the control of endemic pests or against the growing threat of invasive pests that can affect whole regions and even continents. Since SIT is species-specific, with negligible risk of introducing unwanted invasive species to the environment, and with the advantage of reducing insecticide use, a harmonised framework that recognises the low risk of SIT would facilitate shipments of sterile insects across borders and help to expand the use of this effective and environmentally friendly technology. The scope of this paper is limited to insects that have been sterilised using ionising radiation.

Membrane Lipid Replacement with Glycerolphospholipids Slowly Reduces Self-Reported Symptom Severities in Chemically Exposed Gulf War Veterans

Background: Chemically exposed veterans of the 1991 Gulf War have few options for treatment of conditions and symptoms related to their chemical exposures. Membrane Lipid Replacement (MLR) with oral membrane glycerolphospholipids is a safe and effective method for slowly removing hydrophobic organic molecules from tissues, while enhancing mitochondrial function and decreasing the severity of certain signs and symptoms associated with multi-symptom illnesses. Methods: A preliminary open-label study utilizing 20 male veterans who were deployed to combat areas, exposed to environmental toxic chemicals and subsequently diagnosed with Gulf War Illnesses (GWI) were utilized. These subjects took 6 g per day oral glycerolphospholipids for 6 months, and the severities of over 100 signs and symptoms were self-reported at various times using illness survey forms. Results: In the sixteen patients that fully complied and completed the study, there were gradual and significant reductions of symptom severities in categories related to fatigue, pain, musculoskeletal, nasopharyngeal, breathing, vision, sleep, balance, and urinary, gastrointestinal and chemical sensitivities. There were no adverse incidents during the study, and the all-natural oral study supplement was extremely well tolerated. Conclusions: MLR with oral glycerolphospholipids appears to be a simple, safe and potentially effective method of slowly reducing the severities of multiple symptoms in chemically exposed veterans.

Administration of High-Risk Medication: A Hospital Based Prospective Study

Background: High-risk medicines are outlined as those medicines that have a high risk of inflicting pain or death once employed to patients in error. Hence, this work was done to identify key parameters of mishandling observed by the administration on high-risk medication.
 Methods: The audit team conjointly assessed compliance with policies and tips associated with the administration of medication. Moreover, key documents including several of the nursing ability checklists were reviewed. The major attributes are taken as ICU, ER, Wards, Pre-Post-Operative & CCU. The measurable elements include documented policies, and procedures for medication administration; close monitoring on records for adverse drug incidents. Analysis revealed that a significant improvement in high-risk medicine accessibility along with the provision of a list of drugs, high-risk medicines were still found at patient bedside in few scenarios. Nurses were found to be highly knowledgeable regarding high-risk medications policies but fall short in executing them at workstations.
 Results: Findings suggest that there is a need for revision in policies concerning high-risk medicines placement and storage; and also, they must be separated from the usually used medicines; timely training programs should be conducted for staff and individual attention. Documentation related to high-risk medicines starting from prescription, double authentication, verification, pre-, and post-administration should be improvised. Special attention needs to be paid to reporting medication errors like prescription errors; adverse drug reactions related to high-risk medicine administration.

One School's Management of Students With Intellectual Disabilities During the COVID-19 Outbreak in Japan: A Study Based on Interviews With Teachers.

This study aimed to elucidate how school employees caring for students with intellectual disabilities managed emergencies caused by the COVID-19 pandemic. It attended to decision-making by school managers as well as the engagement of local teachers in the outcome resolution process. A total of 10 teachers employed in different positions were purposefully selected from a school for students with intellectual disabilities in Osaka, Japan, and interviews were conducted with them via Zoom. The thematic analysis identified six significant premises: sensemaking, emergency responsive organization, high morale, planning through prioritization, risk management, and recovery from adverse incidents. The findings suggest distributed leadership functions to successfully sustain security in educational practices. Additionally, the empirical study consisting of interviews with staff in multiple positions reveals that all of the staff’s proactive participation in decision-making and the communication process enabled the school to cope with the pandemic crisis as a united organization.

A challenging case of an adolescent and young adult patient with high-risk acute lymphoblastic leukemia: the need for a multidisciplinary approach: a case report

BackgroundAdolescents and young adults diagnosed with acute lymphoblastic leukemia are treated according to pediatric-based regimens to achieve better results. However, implementation of intensive chemotherapy protocols in this age group is associated with increased treatment-related toxicities, affecting almost every organ and system. In this case, the focus of our interest was on rather rare entities: steroid-induced psychosis that seldom develops in children and adolescents, and choroid plexus hemosiderosis, infrequently identified as a first sign of iron overload.Case presentationThe aim of this paper is to present a challenging case of a 15-year-old Caucasian male patient treated for high-risk acute lymphoblastic leukemia and who experienced various adverse incidents during intensive chemotherapy, thus necessitating a high-quality multidisciplinary approach. Slow minimal residual disease clearance was an additional concerning issue. Induction and re-induction were complicated by steroid-induced hyperglycemia that required multiple-week insulin. During consolidation, acute kidney injury on the basis of chronic kidney disease was verified, demanding subsequent drug dose modifications. By the end of re-induction, after dexamethasone cessation, infrequent steroid-induced psychosis, presented as incoherent speech, aggressive behavior, and mood swings, required intensive psychiatric support. Neurological evaluation of seizures revealed uncommon choroid plexus hemosiderosis by brain magnetic resonance imaging, warranting appropriate selection of iron chelation therapy in the context of preexisting nephropathy. Ultimately, iron deposits of moderate intensity were verified by liver magnetic resonance imaging, while heart tissue remained intact. The early diagnosis and adequate treatment of aforementioned difficult toxicities resulted in complete recovery of the patient.ConclusionsTreating adolescents with high-risk acute leukemia and multiple therapy-related morbidities remains a challenge, even in the era of extensive and effective supportive therapy. Superior survival rates might be achieved by prompt recognition of both frequent and rarely encountered adverse episodes, as well as well-timed and appropriate management by a well-coordinated multidisciplinary team.

Preliminary Outcomes After Same Day Discharge Protocol for Robot-Assisted Partial Nephrectomy: A Single Centre Experience

ObjectiveTo assess the feasibility and safety of same-day discharge (SDD) surgery after robot-assisted partial nephrectomy (RAPN) in patients with small renal tumors. MethodsObservational, monocentric study conducted over a one-year period. Inclusion criteria: good performance status, Charlson score <5, cT1a renal mass and RENAL score <6. Exclusion criteria: coagulopathy or contraindication to outpatient surgery. RAPN was performed as the first case of the day. Anesthesia protocols allowed quick recovery and rapid hospital discharge. Patients were called systematically 1-day post-surgery to enquire about any early complications. Perioperative outcomes and complications were recorded according to Intraoperative adverse incident classification by the European Association of Urology and Clavien classifications 30- and 90-days post-surgery. Follow-up consultations were carried out with assessment of patient satisfaction. Primary outcomes were SDD failure, 30- and 90-day complications and readmission rate. Descriptive data were reported without statistical comparative analysis. ResultsTwenty patients were included (median age: 63 years [interquartile range: 57-64]). All patients were discharged home after a median surveillance time of 350 min (interquartile range: 270-420). One grade 1 intraoperative complication was reported. Two procedures were followed by an unplanned readmission due to early complications within the first 30 days (1 pain and anxiety [Clavien I], one active bleeding requiring embolization [Clavien IIIa]). The majority (85%) of patients were satisfied and would recommend day surgery. SDD failure rate was 10% at 90 days. ConclusionRAPN is safe as a SDD procedure without major perioperative morbidity for selected tumors and patients.

Proton pump inhibitors therapy and risk of hyperprolactinemia with associated sexual disorders.

Proton pump inhibitors (PPIs) are the most widely prescribed medications in the world. According to numerous studies, PPIs have been linked to hyperprolactinemia, which can lead to a variety of sexual and reproductive issues. This review summarizes the effects of numerous PPIs on the blood prolactin levels and associated sexual dysfunctions, which have an effect on the patient's life quality and fertility. The study is taken into account all the available resources till January 31, 2021. Out of total 364, only 27 relevant resources were involved in this review. In certain studies, short-term PPIs use has been shown to have little or no effect on the blood prolactin and other reproductive hormones levels. PPIs have been linked to the development of hyperprolactinemia in several case studies with varying degrees of the blood prolactin levels increase seen in individuals taking PPI alone or in combination with medications, like prokinetics. The relative risk of the sexual consequences development, such as gynecomastia, has been documented using lansoprazole and omeprazole in various cohort studies. On the other hand, other bits of data are insufficient to establish a definite relationship that can turn a possibility into certainty. The majority of the literature data is comprising of double-blind, randomized, crossover studies, case reports, and adverse drug reaction incidents reported to various pharmacovigilance centers. To investigate this link, high-quality studies in patients taking PPIs for a longer time period are needed. We conclude this article with a comprehensive discussion of the hyperprolactinemia clinical implications and the PPIs' function.

STORK: Collaborative Online Monitoring of Pregnancies Complicated with Gestational Diabetes Mellitus.

Background: A novel digital platform, named STORK, was developed in the COVID-19 pandemic when clinic visits were restricted. A study of its clinical use during the pandemic was conducted. The study aims to advance the state of the art in monitoring and care of pregnancies complicated with gestational diabetes mellitus (GDM) via online collaboration between patients and care providers. Methods: This study involved 31 pregnant women diagnosed with GDM and 5 physicians. Statistical comparisons were made in clinic-visit frequency and adverse outcomes between the STORK group and a historical control group of 32 women, compatible in size, demographics, anthropometrics and medical history. Results: The average number of submitted patient measurements per day was . The average number of clinic visits was for the STORK group vs. for the control group (). The number of neonatal macrosomia cases was 2 for the STORK group vs. 3 for the control group (); no other adverse incidents. Conclusions: The patient compliance with the pilot use of STORK was high and the average number of prenatal visits was reduced. The results suggest the general feasibility to reduce the average number of clinic visits and cost, with enhanced monitoring, case-specific adaptation, assessment and care management via timely online collaboration.

A pilot study on impact of use of medium molecular weight hydroxyethyl starch in granulocyte apheresis using Spectra Optia

IntroductionGranulocyte transfusion (GT) is a therapeutic option for prolonged neutropenic patients with severe bacterial or fungal infections. Efficient apheresis based granulocyte collection may be better achieved by infusion of high-molecular-weight (HMW) hydroxyethyl starch (HES). But multiple adverse incidents have been reported with HMW-HES. Due to availability issues and adverse incidents related to it, use of HMW-HES has become limited. Few studies have mentioned about medium molecular weight HES (MMW-HES) (130 kDa) as efficient for this purpose with minimal adverse incidents. So, the aim was to assess the impact of the use of MMW-HES in granulocyte apheresis when using Spectra Optia. MethodologyIn this observational study, donors who received MMW-HES during granulocyte harvest were included in HES group and another group who did not receive HES were grouped as non-HES. Injection G-CSF 10 microgram/kg and tablet dexamethasone 8 mg given 12 h before for non-HES group and 6 – 8 h in case of HES group blood donors. Number of adverse incidents observed were noted. Donor/procedure parameters were compared using Mann–Whitney U test / unpaired t test. ResultsGranulocyte yield was significantly higher in the HES group (2.5 × 1010 vs. 1.75 × 1010, p < 0.01) and was attributed to the difference in collection efficiency (22.61% vs. 10.15%, p < 0.01). There were no significant differences in occurrence of adverse events between HES and non-HES groups. ConclusionOur results clearly indicate that sufficient number of granulocytes can be harvested by using MMW-HES in Spectra Optia apheresis system even after short interval between mobilization to harvest.

Prevention of late complications of endoscopic resection of colorectal lesions with a coverage agent: Current status of gastrointestinal endoscopy

Endoscopic ectomy of large nonpedunculated colorectal lesions (≥ 20 mm) might cause significant adverse incidents, such as delayed perforation and delayed bleeding, despite the closure of mucosal lesions with clips. The conventional utilization of prophylactic clipping has not decreased the risk of postprocedural delayed adverse events, and additional outcomes and cost-effectiveness research is needed for patients with proximal lesions ≥ 20 mm, in whom prophylactic clipping might be useful. Coverage of the wound after endoscopic excision offers shield protection against delayed concomitant diseases.

Incident reporting in the outdoors: a systems-based analysis of injury, illness, and psychosocial incidents in led outdoor activities in Australia

Incident reporting systems are a fundamental component of safety management, however, most systems used in practice are not aligned with contemporary accident causation models. This article presents an analysis of a National Incident Dataset (NID) for adverse incidents occurring in the Australian Led Outdoor Activity (LOA) sector. The aim was to investigate the adverse Injury, Illness, and Psychosocial incidents reported to the NID. In total, 1657 injuries, 532 illnesses, and 146 psychosocial incidents were analysed from 357,691 program participation days. The findings show that the rate of incidents per 1000 program participant days in LOAs was 4.6 for injury, 1.5 for illness, and 0.04 for psychosocial incidents, and incident severity was predominately minor. The analysis of systemic contributory factors demonstrates that incidents in LOA are systemic in nature, with multiple levels of the LOA system identified as contributing to adverse incidents. For example, contributory factors were identified across local government (facilities), schools (communication), parents (communication), LOA management (policies and procedures), people involved in the incidents (mental and physical condition), and the environment (terrain) and equipment (clothing). This study presents an assessment of the current state of safety in the Australian LOA sector and demonstrates the utility of applying systems ergonomics methods in practice. Practitioner summary: This article presents an analysis of 1657 injury, 532 illness, and 146 psychosocial incidents occurring in the Australian Led Outdoor Activity (LOA) sector, using a systems ergonomics method. The findings demonstrate the incident charactersitics and how decisions and actions from across the system contribute to adverse incidents in LOAs.

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN PENERAPAN SASARAN KESELAMATAN PASIEN DI RUANG RAWAT INAP RSUD TELUK KUANTAN

Patient safety is a very serious global health problem. In recent years, countries have realized the importance of patient safety. The application of patient safety management in the hospital plays a very important role in preventing or minimizing adverse patient safety incidents. The purpose of this study was to determine the factors associated with the implementation of patient safety in Inpatient Rooms at Teluk Kuantan Hospital. This type of research was quantitative with a correlation design. The study was conducted from December 2020 to March 2021. The population in this study were nurses in the Inpatient Room with a total sample of 49 people who were taken using Disproportionate stratified random sampling. The results of this study found that the majority of the nurse's knowledge level was in the good category, namely 24 people (49.0%), the majority of the respondents 'attitudes were in the good category, namely 24 people (49.0%), the majority of the respondents' education level was intermediate, namely 36 people (73.5%), the majority of patient safety facilities were in the adequate category, namely as many as 33 people (67.3%) and the majority of the application of patient safety targets in the good category, namely 24 people (49.0%). There is a relationship between the level of knowledge (p value 0.000), attitude (p value 0.009), education (p value 0.034) and facilities and infrastructure (p value 0.000) with the application of patient safety goals in inpatient room nurses at Teluk Kuantan Hospital. It is suggested to Teluk Kuantan Regional Hospital to motivate nurses to improve their education to a higher level so that the implementation of patient safety targets can be carried out well and provide socialization to all parties to better understand the patient safety target indicators.

Safety and feasibility of delivery room cuddles in infants with surgical defects: A quality improvement project

Background: Delivery Room Cuddles (DRC) is a growing practice with recognized benefits for parent-infant bonding, breastfeeding rates, and infant stress responses. Methods: We introduced DRC at St. Mary’s NICU, Manchester, in October 2020. As part of a formal QI process, we have been continuously collecting data on all babies admitted to our NICU from the delivery suite to review rates of DRC and monitor for any beneficial effects / adverse events. From October 2020 to May 2021, we admitted 41 babies with known surgical defects; 56% of whom had a DRC, including intubated babies with congenital diaphragmatic hernias, and babies with open surgical defects. Results: There have been no adverse incidents directly related to DRC and more babies who had a DRC received breast milk than those who did not Conclusion: Our study demonstrates that DRC can be implemented safely in surgical babies.

A Scoping Review of Adverse Incidents Research in Aged Care Homes: Learnings, Gaps, and Challenges.

Background: Adverse incidents are well studied within acute care settings, less so within aged care homes. The aim of this scoping review was to define the types of adverse incidents studied in aged care homes and highlight strengths, gaps, and challenges of this research. Methods: An expanded definition of adverse incidents including physical, social, and environmental impacts was used in a scoping review based on the PRISMA Extension for Scoping Reviews Checklist. MEDLINE, CINAHL, and EBSCOhost were searched for English language, peer-reviewed studies conducted in aged care home settings between 2000 and 2020. Forty six articles across 12 countries were identified, charted, and analyzed using descriptive statistics and narrative summary methods. Results: Quantitative studies (n = 42, 91%) dominated adverse incidents literature. The majority of studies focused on physical injuries (n = 29, 63%), with fewer examining personal/interpersonal (15%) and environmental factors (22%). Many studies did not describe the country's aged care system (n = 26, 56%). Only five studies (11%) included residents' voices. Discussion: This review highlights a need for greater focus on resident voices, qualitative research, and interpersonal/environmental perspectives in adverse event research in aged care homes. Addressing these gaps, future research may contribute to better understanding of adverse incidents within this setting.

Building information security skills among young transport professionals

Today the world is faced with the problem of information security of young transport professionals’ safety in the information space because it is not possible to track the social impact on young people, and it is not even ethical. We are faced with the task of developing young transport professionals’ information security skills in the information space. In order to prevent the impact of adverse incidents or threats in developed countries, information protection is implemented at all levels of education, where teachers do the largest part, though, this is an issue of national security and requires the protection and control of the state. It is necessary to instill the skills of information security culture in the family, starting from preschool age, but often parents are not experts in modern technologies and are not informed about the existing threat or find out about the consequences quite late. According to the authors, the issue of information security of young transport professionals in the information space should acquire a national scale; otherwise, society will get incorrect informational behavior of young transport professionals and young people in general, examples of which are aggressive dialogues in social networks, increased interest in immoral, immoral sites, ignorance of security rules in the network, inability to protect themselves from virtual criminals.

Reversal of hypertensive heart disease: a multiple linear regression model.

Background: The development of left ventricular hypertrophy in primary hypertension increases cardiovascular mortality and morbidity. Reversal of left ventricular hypertrophy through therapeutic control of blood pressure reduces the risk of adverse cardiovascular incidents. Objective: In our study, we explored for the determinants of left ventricular hypertrophy regression. Methods: A cohort (n=217) of patients with hypertensive left ventricular hypertrophy was identified by screening consecutive patients in medical outpatient unit. The primary inclusion criteria were (i) Blood pressure more than140/90 mm of Hg (ii) Left Ventricular Mass Index more than 115 and 95 gm/m2 for males and females respectively. Left Ventricular Mass Index was determined by echocardiography at the time of recruitment and after 24 weeks of standard pharmacotherapy. The change in Left Ventricular Mass Index was modelled using multiple linear regression with both categorical and continuous explanatory variables. The effect of drug therapy on change in Left Ventricular Mass Index was tested in the model with dummy coded variables for the treatment categories. Results: In simple linear regression, the variables significantly correlating with change in Left Ventricular Mass Index were baseline Left Ventricular Mass Index (r=0.62, p<0.001), change in systolic blood pressure (r=0.22, p=0.001), change in mean blood pressure (r=0.16, p=0.02), baseline systolic blood pressure (r=0.15, p=0.02), age (r=0.12, p=0.09) and diabetes (r=0.12, p=0.09). The best fit model (r2=0.408) retained baseline Left Ventricular Mass Index (β=0.59, p<0.001), change in systolic blood pressure (β=0.14, p=0.01) and diabetes (β=-0.104, p=0.05) as the significant predictors. Introduction of treatment effect into the model non-significantly increased the fit of the model (r2=0.414, p=0.27-0.98). Conclusions: Pre-treatment Left Ventricular Mass Index and reduction in systolic blood pressure were the major determinants of left ventricular hypertrophy regression. We also observed that there is lesser left ventricular hypertrophy regression in diabetic patients, warranting future research to explore glycaemic control as a modifiable factor in left ventricular hypertrophy reversal.

Acupuncture Induced Multiorgan Failure

Dating back to 100 BC, acupuncture has been performed safely for centuries for a wide range of medical conditions. Although a technically invasive procedure, reports of adverse incidents in the medical literature are thankfully very rare. We present a case of acupuncture induced multi-sensitive Staphylococcus aureus (MSSA) bacteraemia and septic shock, resulting in multiorgan failure and a prolonged intensive care stay.

Gloss to the Judgment of the Court of Justice of the European Union of 29 April 2021 in the Case of Ostrów County v the Insurance Guarantee Fund (C 383/19)

On 29 April 2021, the Court of Justice of the European Union in Case C 383/19 passed a preliminary ruling on the interpretation of Article 3 of Directive 2009/103/EC of the European Parliament and of the Council of 16 September 2009 on insurance against civil liability in respect of the use of motor vehicles and the enforcement of the obligation to insure against such liability. This judgment is of key importance for Polish insurance industry, especially for maintaining the coherence of the compulsory insurance system of motor liability insurance for motor vehicle owners for damage caused by the use of their vehicles. The social function of this obligatory insurance is inextricably linked with the protection of third parties against the effects of frequent adverse incidents resulting from the use of motor vehicles in the modern world. What is more, a compulsory insurance contract ought not to be treated as a financial burden for vehicle owners, because it both protects possible perpetrators of motor accidents from serious financial charges and prevents an excessive depletion of their assets due to civil liability. The above-mentioned judgment concerns the confirmation of the principle that in the current Polish legal system there is no possibility of either ignoring the obligation to conclude a civil liability insurance contract or being exempt from such obligation, where the owner is not able to use the vehicle for some period owing to its technical condition.

171 Safe Patient Transfer: Getting Everyone in on the Acct

Optimal patient care frequently requires the safe inter-hospital transfer of critically ill patients for time-sensitive treatments, often outside of normal working hours. Safe transfer requires a multi-disciplinary approach including doctors (typically anaesthesiologists), nurses and paramedics. In a 2018 survey of anaesthesiology trainees in Ireland, 81% agreed that specific training in this area was ‘deficient’ or ‘absent’ Recognizing the lack of formal training, we identified the need for training in the transport of critically ill patients including familiarization with the ambulance environment and common critical transfer scenarios The ACCT methodology consists of (1) comprehensive Video-Assisted Learning (VAL) material for pre-course completion; (2) on-site face-to-face simulation; (3) an ACCT Train the Trainer (ACCT-TTT) for trainers to subsequently deliver the programme.The VAL material includes lectures (e.g. transport physiology), clinical skills demonstrations (e.g. transport and ambulance equipment) and simulation (e.g. safe packaging for transfer). There is an accompanying multiple-choice questionnaire (MCQ) to ensure full engagement and testing of core knowledge prior to the on-site component. On-site, small multispecialty delegate groups comprising of doctors, nurses and paramedics rotate through three simulations, allowing for enhanced experiential learning. Two take place in high-fidelity simulation laboratories, and one occurs in a fully operational ambulance. Delegates assume their real work roles and deal with common transport scenarios and adverse incidents. Debriefing focuses on reinforcing prescribed learning objectives. A post-course MCQ is used to validate learning, with feedback forms used for course evaluation. We plan to pilot the course and subsequently conduct ACCT-TTT courses. We aim to implement and expand ACCT nationwide, making it a mandatory component of anaesthesiology training.