Page 37 - Part 1 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

Recommendations that may have helped keep this type of

situation from developing include:

• Anesthesiologists/CRNA should provide information about
patients with anticipated problems to physicians assuming

care

• Upon transfer to the medical-surgical unit, the

anesthesiologist should ensure proper orders for the care
of the epidural are in place

• Anesthesia should have a protocol for removal of
indwelling catheters that also specifically addresses

patients on anticoagulants

• Anesthesia should document their postoperative

assessments and visits to the patient until the epidural is

removed

The most prevalent communication issues involved breakdowns

in communications between the physician (which could be
the surgeon or anesthesiologist) and CRNA. Examples include

a difficult intubation where apparently the anesthesiologist
was unavailable. The anesthesiologist has oversight liability

for the CRNA. The CRNA and the anesthesiologist need to
communicate regarding any plans for a difficult intubation and

the anesthesiologist should be available for induction.

A more specific case example involved an anesthesiologist who

prepared a morphine bolus to be given by epidural catheter

for postoperative pain control in an 11-month-old. He was then
called out of the room, leaving the CRNA to oversee the infusion.
The morphine infused in 20 minutes. When the anesthesiologist

returned, he realized that the timing of the pump had been set

inaccurately as he had intended to give a small dose over a

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