6 I AnesthesiologyNews.com
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Near Misses and Snacking Patients To the Editors:
If it doesn’t, I think that it mayy certainlyy put lawyyers, who represent patients harmed bby opioid analgesics, on notice of what theey should look for in and the standard of care they will be asking courts to measuure health w care providers against.
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he recent article, “Near-Miss Data Show Signs of Trouble Outside OR”” (March 2013, page 1) outlines the causative mechanisms associated with near misses in non–operating room situations. The increase in near misses underscores the necessity for increased safety measures. As the provision of anesthesia outside the operp ating room increases in freqquency, hospitals need to ensure safety strategies are extended be yond the operating room as weell. In 2012, the Joint Comm mission issued Sentinel Event Alert 49 on safe use of opioids in hospitals, whicch underscores the associatioon of adverse events with use of opioid analgesics. In particular, the Sentinel Event Alert highlights some of the causes for opioid-related adverse events: lack of knowledge about opioid potency, improper prescribing and administration, and inadequate patient monitoring. These causative issues are consistent with many of the mechanisms uncovered by Dr. [Angela] Lipshutz and her team that indicate that the majority could be fixed by hospitals. However, more importantly, if these causes can be fixed, this leaves open the larger question of the liability of hospitals that know and do not fix. For example, in the Sentinel Event Alert, the Joint Commission cautioned against relying on pulse oximetry alone when it stated, “Staff should be educated not to rely upon pulse oximetry alone because pulse oximetry can suggest oxygen
—Michael Wong, JD Mr. Wong is executive direector of the Physician-Patient Alliance for Health & Safety.
saturation in patients who are actively experiencing respiratory depression ... .” Clinicians need to monitor patients outside of the operating room for hypoxia and hypoventilation to mitigate the risk for respiratory arrest induced by opioid analgesics. In the checklist we recently released, which can be downloaded for free from our website (www.ppahs.org), one recommended step is to electronically monitor patients with both pulse oximetry and capnography. Many of the causative mechanisms uncovered by Dr. Lipshutz and her colleagues are within the control of hospitals. Does this study and the Joint Commission’s Sentinel Event Alert put hospitals and anesthesiologists and other health care providers and staff who work in them on notice of the issues they should know and fix?
To the Editors: he article “Saying No to NPO” (March 2013, page 38) describes how carb drinks may improve the surgical experience of patients who would otherwise suffer from being NPO from midnight for their afternoon procedure. What the story does not mention is the noncompliant patient who eats a late, full breakfast or snacks at noon. It takes only one or two patients who do not comply to cause disarray in the surgical schedule. The result is an inconvenience to the patient and his or her family, and to the surgeon, not to mention the associated costs of a cancelled case.
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—Marc Reichel, MD Dr. Reichel is a partner in a private anesthesiology group in Beaufort, S.C.
Chronic Post-op Pain: A Clinician/Patient’s Perspective
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s an anesthesiologist who is currently debilitated and who has been unable to carry out my practice for the past three years because of complications from chronic postoperative pain, I feel compelled to share my thoughts on the February 2013 article “Chronic Post-op Pain Takes Toll on Patients, Resources” (page 10). The authors present statistics showing that such pain disorders outnumber the incidence of diseases in the forefront of medical attention, such as breast cancer. Thus, it should strike us all that this area of discussion is long past due. Although I am delighted to see an article that addresses this highly overlooked and significant issue, I would like to note several points unmentioned in the story. I understand the primary focus and financial drive of our modern
practice model. However, I am left wondering if we might someday feature an article titled “Chronic Post-op Pain Takes Toll on Patients.” Although pain management deals with a diverse array of complex issues, I have been startled to find myself on the other end as a patient and the frank lack of dignity this population must endure. Certain psychosocial issues may play a role in the care of pain patients, but our stereotype of the prevalence of psychological factors is highly outdated. Pain as a subjective experience, without any means of quantification, should not lump all patients together as having underlying psychiatric diagnoses. This is not to say that lack of appropriate diagnostic codes to protect us from the scrutiny of insurance carriers is completely without cause, but it continues to define and limit our access to care.
Through my personal struggle with adhesion-related disease, I have endured extensive specialty consultation in an attempt to evaluate—or, more appropriately, to “document”— my condition and limitations. I am familiar with the blank stares from medical professionals but am fortunate to have the educational capacity to help myself. What does work is focusing on what you can do rather than what you can’t, regardless of the ongoing medical focus dictated by an insurance-driven industry. Patients are more resourceful than we often give them credit. I had to make my own personal and educated decisions after numerous treatment failures. More patients should be afforded the opportunity to explore and pursue alternative treatment options. In my particular case,
I encountered little support in my choices not to pursue traditional narcotic and poly-pharmaceutical management; yet for me, this was the best choice. It has been my experience as a patient and a practitioner that pain as a disease makes us all uncomfortable. The more we try to avoid the issue, the larger it becomes. If we can leap the hurdle of guilt associated with not having the ability to cure pain, then we become able to help our patients cope. To shift the focus from “treating” to supporting would afford an opportunity for chronic pain sufferers to be OK with things not being OK. —Joy Whipple, MD Dr. Whipple is an anesthesiologist in Rapid City, S.D.