Theatre Complex Research Articles

Defective heat moisture exchange filter causing 'block' in anaesthesia breathing circuit.

Sir, We describe a case where a blocked heat moisture exchange (HME) filter was missed in the pre-anaesthesia machine check leading to a potentially life-threatening situation. An American Society of Anaesthesiologists physical status I, female patient was scheduled for exploratory laparotomy. Anaesthesia Machine (Datex Ohmeda S/5 Avance®) with disposable anaesthesia breathing circuit from “Airway Surgicals®,” was used for the case. Anaesthesia machine was checked as per the Association of Anaesthetists of Great Britain and Ireland (AAGBI) recommendations, and standard monitoring recommended by AAGBI was attached to the patient.[1] The patient was pre-oxygenated and administered glycopyrrolate 0.2 mg, fentanyl 100 μg and propofol 120 mg intravenously. Once the patient stopped breathing, mask ventilation was attempted which was unsuccessful even after insertion of an oral airway. The immediate concern was that this was an unanticipated difficult airway. As the patient was apnoeic and adequately relaxed under the effect of propofol, the airway was quickly secured by endotracheal intubation. The airway resistance remained high after intubation and auscultation revealed a silent chest. Considering bronchospasm as a likely cause, intravenous hydrocortisone and vecuronium were administered and the depth of anaesthesia was increased with sevoflurane. There was no change in the resistance to ventilation, but the capnography showed a trace of low amplitude. As the reservoir bag felt different, some malfunction of the anaesthesia equipment was suspected. A non-rebreathing (AMBU) bag was connected with the filter and catheter mount in the circuit, but the air entry did not improve. The catheter mount and filter were removed immediately, and the AMBU bag was directly connected to the tube and the lungs could be ventilated easily. Air entry was bilaterally equal. ETCO2 trace was normal and airway pressure was also reduced. Auscultation of the chest showed clear breath sounds. It was evident that the problem was due to blocked filter which was immediately replaced. The surgery was completed and the patient made an uneventful recovery from anaesthesia. The oxygen saturation did not drop below 96% at any point during the episode. Possibly, there was some air entry in the lungs through the blocked filter, and the actions described above were carried out swiftly with the help of other anaesthetists who were in the theatre complex. On subsequent investigation, it was discovered that the two bag test was completed without connecting the HME filter and catheter mount.[2] Probably, the obstruction in the breathing system would have been picked up, had the circuit been completely assembled while checking. Obstructions in the anaesthesia breathing circuits have been reported due to various foreign bodies.[3] We concluded that the HME filter had a manufacturing defect on the basis of elimination. The filter was dismantled and assessed. It consisted of two discs, one of green foam and another thin white papery disc. On using individual components of the filter, it was evident that the green foam of the filter was blocked. On pressing the oxygen flush, the blast could not be felt at the tube connector end. As there was no possible technique to confirm the structural defect in the foam, one possibility that can be considered is compression of the disc in the filter making them impermeable. This report adequately delineates the importance of anticipating problems and finding prompt solutions by stepwise exclusion of apparatus failure. Anticipating trouble, innovating and learning from the experience of others are inherent in the anaesthesia community. An important learning point from this case is, in the event of ‘Tight Bag’ during anaesthesia, the anaesthesia circuit should be immediately replaced by the AMBU bag at the end of the endotracheal tube.[4] This will ensure that the patient is safely oxygenated while the equipment issues are resolved. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

A low cost, customised anaesthesia information management system: An evolving process.

Traditional techniques of record keeping in most hospitals include manual entry in case sheets and then adding to piles of paper files.[1] Although gradual transition towards automated and computerized record systems is in place, it is still a distant prospect in many peripheral institutes and low resource hospitals. An anaesthesia information management system (AIMS) is an electronic record system that allows collection, storage and presentation of patient data during the peri-operative course.[2] Our institute is a research oriented referral institute and we have designed a low cost model of an AIMS, which can be customized to local needs. We briefly describe the process and evolution of this recording system in our anaesthesiology department and operation theatre complex, its effect on the staff including the doctors, nurses and technicians and how it can be incorporated on a wide scale to other institutes and hospitals, where modern, automated and technology heavy systems[2,3] will take time to establish.

Redefining America, Arena Stage, and Territory Folks in a Multiracial Oklahoma!

In 2010, Arena Stage, the pioneering regional theatre of Washington, D.C., celebrated its sixtieth anniversary and new theatre complex with a multiracial production of Richard Rodgers and Oscar Hammerstein’s Oklahoma! This production helped to rebrand the company as “Where American Theatre Lives” by mobilizing a popular musical of American nation-formation populated by multiracial territory folks on the frontier and in the nation’s capital. This essay argues that Arena’s production stages a utopian performative of inclusion and harmony, but that utopia troublingly rests on indigenous genocide and elision of racial difference and inequality. Both parts of this argument are crucial when many Americans openly celebrate diversity, but deny the structural significance of race and racism despite vast disparities. To understand how bodies become variously interpellated and interpreted into existing racial projects and the shifting (re)productions of Americanness, the essay theorizes three terms for the production and consumption of this Oklahoma! : multiracial-conscious , whitened , and post-racial . Spectators could view the territory folks as people of color, whites, and/or beyond race. The casting, marketing, and critical reception reveal the struggles for defining race and American identity at a moment when people of color appear to have significant representation, enabling a post-racial project in which many with privilege disavow that privilege and perpetuate existing inequities.

Outside the Operating Theatre Anaesthesia

Modern hospital practice has seen the role of the anaesthesiogist expand beyond the operating theatre complex. While the operating theatres have experienced staff, adequate equipment and monitors, providing anaesthesian outside this complex is challenging and requires expertise and skill. Journal of Bangladesh Society of Anaesthesiologists 2015; 28(1): 32-38

Audit of Orthopaedic trauma theatre usage : Observation from Nizwa regional referral Hospital

Background: The operation theatre complex is an important pillar of any hospital and its optimum and efficient functioning reflects on the overall functioning of any busy hospital. There is no study done till date on the operation theatre utilization in Oman and its cost effectiveness. This audit is carried out on the utilization of orthopaedic trauma theatre which can be used as reference for other specialty operation theatres and overall theatre efficiency in our hospital. Methods: Prospective audit was carried out over period of one year in department of orthopaedics,nizwa hospital and data collected from our hospital was analyzed. All the components of the operation theatre were taken into account to arrive at theatre utilization, end utilization and operating timing. Results : 853 cases were electively operated upon during from Ist January 2011 to 31st December 2011 in orthopaedic operation theatre which was run for 261 days electively during that period. 74% cases started later than scheduled time with average of 22.8 min late start time. The total operating time(OT) was 81% of the total allocated theatre time(ATT) with a mean of 05:15 hrs. The total Surgical and anaesthesia time (63%) and (15%) respectively. Changeover time was 70.39 hrs(4%) with average of 22.6 min and no useful activity(NSU)amounted to total of 310.32hrs(18%)based on above calculations it amounted to end utilization(EU) of 94% and Operation theatre utilization(OUT) of 81.8% respectively.. 4.2% cases were cancelled for various reasons . Conclusion: The various reasons for under utilization of the orthopaedic operation theatre are due to delay in starting list, increase changeover time, anaesthetic ,surgeon and administrative factors.The corrective measures which can be applied to improve this have been discussed.

Implementation of a Hang Time Project in a private hospital in the Eastern Cape

Background: Surgical site infections (SSIs) are the second most common cause of hospital acquired infection (HAI) and defined as infections that occur within 30 days of surgery or within 1 year of surgery if an implantable device is used. SSIs result in increased morbidity and mortality and result in increased length of hospital stay (LOS) and health care and reputational costs. Selection and dosage of antibiotics; the timing prior to incision (0-60min) and the duration of surgical prophylaxis after surgery (< 24hours post surgery except cardiac surgery <48hours) are of particular importance in surgical antibiotic prophylaxis. The aim of this study is to ensure and monitor that all patients receive the correct antibiotic at the correct dose, at the correct time before incision and for the correct duration of surgery. Methods & Materials: 375 peri-operative cases were audited over a 32-week period in the main theatre complex. The following parameters were monitored: (1)appropriate use and dosage of antibiotics according to theNetcare Ltd. Surgical antibiotic prophylaxis guidelines (2) time of administration of antibiotic prior to the incision and (3) duration of therapy after surgery. Improvement methodology was used therefore six data points above the median suggests a significant improvement. Results: It was found that over the 32week period the % of cases with a surgery-choice of antibiotic match has shown no improvement, although the median were 96%. There has been a significant improvement in the cases with the correct prophylactic dose given and with the amount of cases with the correct time of antibiotic dose given prior to incision. No improvements have been made with regards to the duration of prophylactic antibiotic treatment after surgery. Furthermore no improvements could be shown with the overall compliance to the surgical prophylactic protocol. Conclusion: Themajority of surgical cases at Netcare Christiaan BarnardMemorial Hospital (CBMH) are compliantwith theNetcare Ltd surgical antibiotic prophylactic guidelines. Although improvements could not be shown in all the aspects of surgical prophylaxis, the journey will continue until the destination is reached: “Perfect Prophylaxis”.

Interactive Multimedia Solutions Developed for the Opening of the New Stage of the Alexandrinsky Theatre

This paper focuses on teamwork by the National Research University of Information Technologies, Mechanics and Optics (NRU ITMO) and the Aleksandrinsky Theatre in preparation of opening of the New Stage of the Alexandrinsky Theatre. The Russian State Pushkin Academy Drama Theatre, also known as the Alexandrinsky Theatre, is the oldest national theatre in Russia. Many famous Russian actors performed on the Alexandrinsky’s stage and many great directors. May 2013 marked the opening of the New Stage of the Alexandrinsky Theatre. The theatre complex comprises three buildings: the new stages building, a media center, and the building housing a center of theatre education. Several plays shown simultaneously on multiple stages within the new complex’s buildings constituted the opening gala of the New Stage of the Alexandrinsky Theatre. The works of Fyodor Dostoyevsky were the plays’ un ifying theme. NRU ITMO employees developed several interactive theatre project solutions implemented for the opening of the Alexandrinsky Theatre’s New Stage.

Endotracheal tube cuff pressures – the worrying reality: A comparative audit of intra-operative versus emergency intubations

The primary aim was to assess the need for objective cuff pressure monitoring in the theatre complex and trauma centre at Groote Schuur Hospital, Cape Town, South Africa. Secondary aims were to determine whether the tube size, tube make or place of intubation affected cuff pressure. Endotracheal tube cuff pressures of 91 patients in the trauma centre and 100 patients in the theatre complex were randomly measured using a Mallinckrodt cuff pressure gauge. The measurements were recorded on a standardised data sheet and transferred to an electronic database for analysis. There was a significant difference between cuff pressures in the trauma centre and those in the theatre complex (p<0.001), the means being 55 cmH2O and 25 cmH2O, respectively. The site of intubation had a significant (p=0.001) effect on cuff pressures, with mean pressures as follows: on scene - 71 cmH2O; referral hospital - 57 cmH2O; and Groote Schuur trauma centre - 42 cmH2O. Only 30% of cuff pressures measured in the trauma centre were below 30 cmH2O, and, alarmingly, 17% were between 91 and 120 cmH2O. In the theatre complex, 77% of cuff pressures were in the acceptable range. Digital balloon palpation corresponded poorly (correlation coefficient 0.47) with measured cuff pressure, and statistical analysis showed that it tended to underestimate the pressure at higher cuff pressures. The risk of a high cuff pressure is roughly two- to threefold higher in emergency patients than in theatre patients. These unacceptably high cuff pressures are especially concerning in view of the fact that many trauma patients are hypotensive and therefore more susceptible to mucosal ischaemia.

Private theatre utilisation in South Africa: A case study

A large private operating theatre complex was investigated to address the lack of published South African benchmarks for utilisation. All major theatres were staffed during normal working hours (07h00 - 19h00), emergency cases being provided for on an ad hoc basis through spare capacity. An extensive billing database, amounting to 28 991 records of procedures performed during normal working hours and spanning the period October 2007 - February 2010, was data-mined using Visual Basic for Applications (VBA) scripts. Theatre utilisation was analysed per day, per theatre. The results showed an average utilisation of 43% with significant variation in day-to-day operations. If the very underutilised minor theatre was excluded from the analysis, overall utilisation rose to 48%. Individual theatre utilisation ranged from 14% to 61%. An analysis of change in utilisation with time during a day showed that peak utilisation of 71% was achieved at 09h30 (90 minutes after lists start). Utilisation dropped to 25% at the end of the working day and was sustained for some time after hours. The 48% utilisation observed was significantly lower than the global benchmark of between 70% and 80%.

Evaluation of operating department practitioners’/circulation nurses’ role in managing a can’t intubate can’t ventilate scenario using cannula cricothyroidotomy

Evaluation of operating department practitioners’/circulation nurses’ role in managing a can’t intubate can’t ventilate scenario using cannula cricothyroidotomy

Bacterial contamination of re-usable laryngoscope blades during the course of daily anaesthetic practice

Hospital-acquired infections (HAIs) are largely preventable through risk analysis and modification of practice. Anaesthetic practice plays a limited role in the prevention of HAIs, although laryngoscope use and decontamination is an area of concern. We aimed to assess the level of microbial contamination of re-usable laryngoscope blades at a public hospital in South Africa. The theatre complex of a secondary-level public hospital in Johannesburg. Blades from two different theatres were sampled twice daily, using a standardised technique, over a 2-week period. Samples were quantitatively assessed for microbial contamination, and stratified by area on blade, theatre and time using Fisher's exact test. A contamination rate of 57.3% (63/110) was found, with high-level contamination accounting for 22.2% of these. Common commensals were the most frequently isolated micro-organisms (79.1%), but important hospital pathogens such as Enterobacter species and Acinetobacter baumannii were isolated from blades with high-level contamination. No significant difference in the level of microbial contamination by area on blade, theatre or time was found (p<0.05). A combination of sub-optimal decontamination and improper handling of laryngoscopes after decontamination results in significant microbial contamination of re-usable laryngoscope blades. There is an urgent need to review protocols and policies surrounding the use of these blades.

Length of stay in the postanaesthetic care unit at the university of Benin Teaching Hospital: An observational study

Despite the importance and increased cost of patient stay in Post Anaesthetic Care Unit (PACU) there is no agreement in acceptable duration of stay. This was a prospective observational study todetermine the lengthof stay at thePostAnaesthesia Care Unit of the main theatre Complex of the University of Benin Teaching Hospital, Benin City. All patients scheduled for both elective and emergency surgical procedures in the main theatre complex of the hospital admitted into PACU were enlisted for the study. Length of stay in PACU was defined as the time from patients' admission into PACU to the time of discharge from PACU. Aldrete scoring system which monitors and scores physiological parameters such as pulse rate, respiratory rate, level of consciousness, level of activity was used to determine fitness for discharge fromPACU. Atotal of two hundred (200) patientswere studiedwith amean age of 30.81+/-21.49. The average length of stay in PACU was 75minutes +/-15 minutes. However, 10% of these patients stayed longer than 120 minutes in PACU which qualified for prolonged PACU stay. Patients' state at arrival in PACU and the preoperativeASAphysical statusweremain predictors of length of stay in PACU. The average length of stay in the PACU of the University of Benin Teaching Hospital from this studywas 75+/-15minutes.However, 10%of patients had prolonged stay, longer than 2 hours in the unit.

Audit of orthopedic trauma theatre usage: Observation from Secondary Regional Referral Hospital, Oman

Background: The operation theatre complex is an important pillar of any hospital and its optimum and efficient functioning reflects on the overall functioning of any busy hospital. There is no study done till date on the operation theatre utilization (OTU) in Oman and its cost effectiveness. This audit is carried out on the utilization of orthopedic trauma theatre, which can be used as reference for other specialty operation theatres and overall theatre efficiency in our hospital.

A Midsummer Night’s Dream (review)

Reviewed by: A Midsummer Night’s Dream Colette Gordon A Midsummer Night’s Dream Presented by Abrahamse and Meyer Productions at the Artscape Theatre, Cape Town. April 10—25, 2012. Direction and Set Design by Fred Abrahamse. Costumes by Marcel Meyer. Lighting by Fahiem Bardien. Sound by Charl-Johan Lingenfelder. With Marcel Meyer (Theseus/Oberon), Chi Mhende (Hippolyta/Titania) Nicholas Andrews (Puck), Sizwe Msutu (Egeus), Zondwa Njokweni (Hermia), James Macgregor (Lysander), Anelisa Phewa (Demetrius), Hanna Borthwick (Helena), David Dennis (Bottom), Luthando Mthi (Quince), Mdu Kweyama (Flute), Sipho Vara (Snout) and Malafane Moshuli (Snug). On 25 March, I joined Fred Abrahamse and company at the Artscape theatre complex to observe rehearsals for A Midsummer Night’s Dream. Rehearsals were located high and deep inside the massive brutalist complex originally built by the Apartheid state to accommodate its performing arts parastatal1 and large state-sponsored spectacles. The actors had been given a space the size of the opera stage in which to work, a “rehearsal room” for choruses and corps de ballet. Abrahamse and Meyer Productions (the director and his commercial partner) have in recent years carved out a niche in South Africa with Shakespeare scaled small for touring to schools and festivals. The last time the company performed at Artscape, their three-handed Richard III played to scattered audiences in the complex’s jerry-built side-of-theatre conversion. Now they were preparing to open on the main stage with a cast of fourteen. The rehearsal room presented a concrete and constant reminder of the problem of filling the physical and cultural space represented by the main stage. Given this space, the rehearsal was casual, but not intimate. Half of the cast were present, rehearsing scenes involving the Athenian nobles: a development from small rehearsal work on “the lovers,” In the large room, and with the actors now rehearsing full scenes, focus and energy seemed to dissipate easily. When focus shifted from full ensemble to individual couples, actors accustomed to sustained, focused work with one or two others, drifted about “offstage” in corners. At very few moments did the restive actors grow still. These rare moments of collective attentiveness marked key points in the rehearsal process. By this rehearsal, the actors already had their blocking; and the session aimed to allow them to shrug off patterns that had become fixed and stilted, while setting down the overall shape of the group scenes (which here included two pieces of silent choreography: a wedding and a dumbshow). These aims pulled in [End Page 543] opposite directions, making the rehearsal a little schizophrenic. But, in a couple of cases, changes to blocking and the relationship between bodies in the couples, produced effects that extended over the whole rehearsal. Unusually, there were two observers present. Before starting work on the scenes, the actors were required to run through them for the project’s sound designer. This “run through” meant a slow, unfocused start for the actors, but it afforded a useful opportunity to see the production concept framed. While the actors took a break, the director conferred with the composer. This was a difficult discussion, and the only time where I felt the director might be uncomfortable with my presence in the rehearsal. It was evident, even with minimal stage properties, that the company was taking Shakespeare on Safari. Setting Midsummer Night’s Dream in a game park allowed the company to locate a fantasy space of animistic, mystical Africa cheek by jowl with the reality of commercial tourism. The game lodge, it seemed, was thus a neat (and neatly ironized) substitution for Athens and its wild, fantastical woods. But Abrahamse clearly wanted to preserve, rather than ironize, the fantasy vision of Africa, to extend it over the whole production, raising the question of the colonial fantasy preserved in a white Theseus’ lordship over the estate (not to mention a black Hippolyta). While I scrutinized the production’s publicity poster (a Zebra’s head featured prominently) and props (a Livingstone hat and animal skins), Abrahamse attempted to achieve consensus that the composer’s score would evoke Africa in a new idiom, without using African music. But the composer seemed surprised, then frustrated, unable to...

Infection Control in Operating Theatres

The operating theatre complex is the heart of any major surgical hospital. Good operating theatre design meets the functional needs of theatre care professionals. Operating theatre design must pay careful consideration to traffic patterns, the number and configuration of nearby operating rooms, the space required for staff, administration and storage, provisions for sterile processing and systems to control airborne contaminants (Wan et al 2011). There have been infection control issues with private finance initiative built operating theatres (Unison 2003, Ontario Health Coalition 2005). The aim of this article is to address these issues as they relate to infection control and prevention.

Cell salvage for obstetric patients who decline blood transfusion – a national survey

Dear Sir, Parturients who decline blood transfusion are encountered and managed in all UK obstetric units. The majority are Jehovah’s witnesses (JWs) who refuse transfusion of blood and it’s major components due to religious belief, even when transfusion would be life saving. Major obstetric haemorrhage remains a leading cause of peripartum morbidity and mortality (Centre for Maternal and Child Enquiries, 2011). Refusal of blood products is associated with a six times increased risk for maternal death, and a 130 times increased risk for death due to obstetric haemorrhage (Van Wolfswinkel et al. 2009). This risk is greatest when operative delivery is required. There are many guidelines on the management of JW patients presenting for surgery. Specific to obstetrics is the recently updated care plan produced by the Hospital Information Services for Jehovah’s Witnesses (2011). Guidance universally advocates the use of cell salvage. The acceptability of autologous transfusion and the various forms of perioperative cell salvage is a personal decision for each JW. Some may specifically request that the system be set up to allow for continuous connectivity. This requires the system to be fully primed and the reinfusion bag to be connected to the patient via a cannula throughout (UK Cell Salvage Action Group, 2008). In this way, the JW’s blood does not lose continuity with the circulation. When no such specific request is received, cell salvage may be used in the usual way. Cell salvage can usually be organised for elective surgery, but the challenge is in providing a service to JW parturients when obstetric surgery is often emergency in nature, out-ofhours and haemorrhage rapid. This difficulty is exacerbated when obstetric theatres lie remote from a hospital’s main theatre complex. Significant resources in terms of equipment, training and personnel are required and this is unlikely to be available in all units. We sought to establish current UK obstetric cell salvage clinical practice when managing JWs. The survey was approved by the Obstetric Anaesthesia Association (OAA) Survey Subcommittee and subsequently distributed in December 2011 to all registered obstetric lead consultant anaesthetists through the OAA electronic survey

A reply

We would like to thank Drs Willcox and Turner for their interest in our paper [1]. We are pleased that our publication raised a number of discussion points and we welcome the opportunity to comment. We agree that the risk of transmission of infection from endoscopes is probably low. However, current guidelines suggest that single-use devices should be used where possible (although only if the performance is equivalent) [2, 3]. In addition, the Department of Health bulletin states that endoscopes should be cleaned before and after each use [3]. Consequently, the single-use Ambu aScope is likely to have a shorter ready-to-use time than a re-usable device. This is especially relevant when delay in securing the airway increases the risk to patients, i.e. the Plan B of the Difficult Airway Society guidelines [4]. Furthermore, the single-use fibrescope may be useful in locations remote from the main theatre complex where the fibrescope is infrequently used and an endoscope reprocessing unit may not be readily available. Provision and maintenance of re-usable fibrescopes in such remote locations may be prohibitively expensive. Lastly, the National Creutzfeldt-Jakob Disease Surveillance Unit provides fibrescopes only for established cases of vCJD. The lack of a suction port of the aScope may impair the operator’s ability to clear secretions and blood in the airway. However, the suction channel of the LF-GP Olympus re-usable scope used in our study is only 1.5 mm. Cautious use of external suction, accessing the airway thorough the mouth with either a soft or rigid suction catheter, is likely to provide much better clearance than the limited suction force from the re-usable fibrescope. There are limitations to extrapolating data from any study into clinical practice. Manikin studies have an established place in the evaluation process of an airway device [5, 6]. This is recognised by the Airway Device Evaluation Project Team (ADEPT) [7]. There are number of reasons why no newly introduced device should be used on patients before manikin evaluation is completed. Firstly, the findings of a manikin study can exclude unsafe devices from being used on patients [8, 9] and highlight the design features that require further evaluation on patients [10]. Secondly, they allow for the device to be tested by a large number of clinicians and not only by a small number of researchers and experts. Thirdly, the manikin study design allows for levels of simulation that are likely to be considered unethical if conducted on patients (i.e. crossover study design and simulation of a difficult airway). Although, in our institution, manikin studies go through the same rigorous review as the patient studies (Research and Development and Ethics Committee review), they are still likely to be faster than patient studies in providing initial evidence regarding the safety and usefulness of an untested device. Furthermore, data on historical controls that are required for obtaining level 3b evidence stated in the ADEPT article [7] may not be available for every device currently on the market. Our study was designed to provide evidence on the ease of use and manoeuvrabity of the Ambu aScope when used by a large number of anaesthetists in a manikin set to simulate difficult fiberscope placement. Although this single-use device has a number of potential applications and advantages, the clinical usefulness of the aScope remains to be established.

Prison Theatre: Letting the Light in to Disciplinary Relationships

Using a case study of recent applied theatre work within a secure setting in Auckland, New Zealand, we will consider the ways in which applied theatre can function as a multi-, inter- and trans-disciplinary form—multi- disciplinary in that it embraces the various arts disciplines in its makings inter-disciplinary in that it works with and within other disciplinary sites and, in doing so, is informed by and adapts to those site's discourses and practices trans-disciplinary in the ways applied theatre practice and research blur traditional disciplinary boundaries to create new approaches and outcomes. Trans-disciplinary work ‘leads to the evolution of disciplines, hybridisation and outcomes that are greater than the sum of the parts’ (Petts et al., 2008:597). The intention of this paper, therefore, is to present and to untangle some of the tensions and possibilities that reside within prison theatre's complex and many-layered disciplinary relationships.

Medication discontinuity errors in the perioperative period

Inappropriate withdrawal or continuation of medication in the perioperative period is associated with an increased risk for adverse events. To reduce this risk, it is important that patients take their regular medication as prescribed. We evaluated this treatment objective by studying the frequency and reasons for errors related to medication discontinuity in the perioperative period. Patients scheduled for non-cardiac surgery were included in this cross-sectional study. Perioperative medication intake was assessed at the holding area of the operation theatre complex and on the ward during the first 24 h after surgery. Medication intake data were obtained from medical records and by questioning patients and compared with pre-operative instructions. The study included 701 patients, of whom 485 (69%) used regular medication. Medication was incorrectly taken or discontinued before surgery in 27% of the patients. In 57% of these patients, the reason for incorrect intake was an unclear or a falsely understood instruction before surgery. Post-operative medication errors occurred in 26% of the patients. Medication errors occur frequently in the perioperative period, even in the era of an electronic medication file. Errors in prescription, administration and intake of medication are not easily solved because no single health care professional is responsible for adequate intake of medication in surgical patients. The anaesthesiologist should take on a more prominent role in regulating perioperative medication intake in surgical patients.

ENSURING PATIENT SAFETY IN THE NEW OPERATING THEATRE OF UMMC TRAUMA CENTRE; AN ANAESTHESIOLOGIST NOVICE EXPERIENCE

Patient safety is a serious global healthcare issue. Harm can be caused by a range of errors or adverse events. Therefore, it is vital that the commissioning of a new operating theatre should comply to the highest standard before it is allowed to function. This paper accounts our experience in the commissioning of the University Malaya Medical Centre (UMMC) trauma centre operating theatre (OT) complex in July 2008. We highlighted the problems we faced in adhering to the international standard guidelines. Unanticipated events were handled professionally and solved. With this experience, we hope that the identified problems would provide suggestions for commissioning an operating theatre in the local setting in the future.