AANA journal
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Transfer of care is defined as the exchange of information and professional accountability for patient care between individuals. This article describes a qualitative content analysis (N = 19) using a closed-claims database generated by the American Association of Nurse Anesthetists (AANA) Foundation. The purpose of this study was to explore perioperative transfer-of-care events that contributed to professional malpractice claims to identify general themes, antecedents, and consequences to improve clinical practices and guide future research. A brief summary of the 6 themes that emerged in this study is as follows. (1) Patients should be transferred to an appropriate level of care based on their needs. (2) Production pressure leads to normalization of deviance. (3) Clinicians need to conduct their own patient assessments and health record reviews without relying solely on another clinician's report. (4) Interdisciplinary team communication failure is a leading cause of adverse outcomes. (5) Inadequate patient monitoring and physical assessment after the transfer of care is completed is a leading cause of adverse outcomes. (6) Transfer of care should not occur during high-risk patient care events or during periods of patient hemodynamic or respiratory instability.
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Lowering the dose of the local anesthesia significantly reduces the risks of spinal anesthesia-induced hypotension in an elective cesarean delivery. Determination of the mean effective dose of hyperbaric bupivacaine will aid clinicians in managing maternal hypotension. The systematic search of studies evaluating the mean effective dose of hyperbaric bupivacaine yielded 10 clinical trials reporting the minimum effective dose in 50% (ED50) and 95% (ED95) of patients. ⋯ Doses at the level of ED50 minimized spinal anesthesia-induced hypotension yet increased intraoperative pain supplementation, whereas doses at the level of ED95 provided adequate surgical anesthesia with increased risk of maternal hypotension. Furthermore, the addition of intrathecal administration of opioids reduced local anesthetic doses. In the clinical setting, low-dose spinal anesthesia should be used only in combination with the combined spinal-epidural technique.
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Patient safety may be at risk when details are omitted during anesthesia handoff. The Written Handoff Anesthesia Tool (WHAT), designed by the author, was implemented to improve the quality of anesthesia handoffs in the operating room and postanesthesia care unit (PACU). The author used the Anesthesia Handoff Communication survey to evaluate Certified Registered Nurse Anesthetist (CRNA) and PACU registered nurse (RN) satisfaction with anesthesia handoff and the Targeted Solutions Tool to identify the adequacy, contributing factors, and specific patient data omitted by senders of anesthesia handoff before and after implementation of the WHAT. ⋯ After implementation of the WHAT, satisfaction with anesthesia handoff significantly improved for CRNAs (P < .001) and PACU RNs (P = .001). Factors contributing to inadequate handoffs and omitted patient details were identified and significantly improved for CRNA-to-PACU RN and CRNA-to-CRNA handoffs, respectfully: ineffective method (P < .001; P < .001), baseline vital signs (P = .009; P = .014), and preoperative neurologic status (P = .012; P = .004). Implementation of the WHAT led to evidence-based changes in practice, standardization, and improved anesthesia handoff communication.