NAP5 - any thoughts?

[deleted59964]

NAP5 Chapter 4 -- executive summary

http://nap5.org.uk/NAP5report

i can't say I was surprised by any of the main findings of the NAP 5 audit, except that use of processed EEG monitoring even in cases with TIVA and NMB is uncommon in GB and Ireland, compared to what I have experienced.

The recommendation of adding to the WHO surgical checklist surprised me though - it seems like a lot of bureaucratic time wasting to me.

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[deleted59964]

crickets ....

 

[IlDestriero]

While the WHO checklist is a pain, and we adopted it, if forces some of the more aloof surgeons to actually think their plans through and share them with the team, and it can pick up on something before it is missed.

 

[urge]

crickets ....

These are all good common sense recommendations.

If anyone alters their practice because of this means that they were way behind.

 

[pgg]

These are all good common sense recommendations.

If anyone alters their practice because of this means that they were way behind.

Agreed. Of the 64 recommendations (s i x t y - f o u r !) it's nothing but "be careful" and "talk to your patients" rephrased 64 times.

I only read the executive summary but my eyes hurt from all the rolling from gems like

Care should be exercised in the handling of syringes of neuromuscular blocking drugs prepared ‘in case’ of need: inadvertent administration may have catastrophic results.

I'm not sure how they expect recommendations of this caliber to actually change the world.

 

[deleted59964]

I agree about getting surgeons to engage with the checklist.
Have you seen the anaesthetic checklist using an A,B,C,D approach they want to add???


maybe those who still induce in a separate "anaesthetic room" and then transfer into OR will stop doing so. I believe this is fairly common in the UK? otherwise, yeah it's hardly ground breaking.

What about frequency of use of processed EEG (BIS etc.) -- seems like they do a lot of TIVA with paralysis but without BIS in the UK -- this is very uncommon here, how about in the US?

 

[urge]

I agree about getting surgeons to engage with the checklist.
Have you seen the anaesthetic checklist using an A,B,C,D approach they want to add???


maybe those who still induce in a separate "anaesthetic room" and then transfer into OR will stop doing so. I believe this is fairly common in the UK? otherwise, yeah it's hardly ground breaking.

What about frequency of use of processed EEG (BIS etc.) -- seems like they do a lot of TIVA with paralysis but without BIS in the UK -- this is very uncommon here, how about in the US?

I don't know what you find so interesting about this report.

In summary it says: Don't be a ******.

I don't think anyone can argue with that.

 

[deleted59964]

I don't know what you find so interesting about this report.

In summary it says: Don't be a ******.

I don't think anyone can argue with that.

thanks for the summary - i'll say that in my exams if asked about it
perhaps you'd prefer another thread about midlevels?

 

[urge]

thanks for the summary - i'll say that in my exams if asked about it
perhaps you'd prefer another thread about midlevels?

So, it comes on your test. That explains why.

 

[pgg]

What about frequency of use of processed EEG (BIS etc.) -- seems like they do a lot of TIVA with paralysis but without BIS in the UK -- this is very uncommon here, how about in the US?

I don't see the BIS being used much here. TIVA with relaxant seems to me to be about the only good reason to use it. At least until that end-tidal propofol monitor is available.

 

[deleted59964]

So, it comes on your test. That explains why.

yep - anything of clinical relevance is fair game - as no doubt it is for anyone sitting your "boards".

 

[Hockeyguy]

I don't know what you find so interesting about this report.

In summary it says: Don't be a ******.

I don't think anyone can argue with that.

I personally think we need to move away from this checklist path we're going down and everything being a "system error". Some things are system errors, and should be rectified, but more often than not it's human error and that needs to be recognized and if repetitive or egregious enough corrected. Case and point I reviewed a GI doc for a "screening colonoscopy" that resulted in a colon perforation on a patient with stage 4 lung Ca with brain mets that had been on/off chemo for the last year and had a clean colonoscopy seven years ago.

Committee asked essentially why would you perform this on a patient with no bleeding no colon issues etc. His argument - recommendations say this guy needs a colon screening every five years it was "malpractice" not to offer this screening. OK we said but he's been on high dose chemo wouldn't that would likely kill any slow growing colon mass and his life expectancy is less than 1 year would colon cancer if he had it kill him? Well his life was greatly shortened after his left colectomy and poor would healing subsequent infection anastomotic breakdown and death. Shouldn't a well trained physician be able to override society recommendations when appropriate? This provider has had other issues but always finds a technicality usually through a policy or checklist. He stuck to his guns and skated free - deemed a system error in the end (by a nurse administrator). Now all the GI docs have to fill out an additional form or "checklist" if you will justifying colonoscopies. The road to hell is being paved by good intentions/checklists.

 

[deleted59964]

couldn't agree more.
we'll need a checklist to make sure we've completed all the checklists.