Overview of Anesthesia Safety Advancements

The article ​To Err is Human: Building a Safer Health System​ defined safety as, “freedom
from accidental injury” (Institute of Medicine, 2000). Currently, there is a large emphasis on
safety in health care. However, the practice of anesthesia safety did not truly begin until the
1980’s, even though the practice of anesthesia began as early as the 1840’s (Rose &
McLarney, 2014). It is important for CRNAs to understand anesthesia safety advancements as it
impacts both their patients and them as providers. The knowledge of these tools will assist in
increasing patient outcomes and provide protection from errors in care (Weller & Merry, 2013).

Anesthesia Monitoring
The first known patient monitoring was documented around 1850 when Dr. John Clover
found he could monitor a patient’s pulse using his finger as he delivered chloroform. Pulse
monitoring was further advanced with a sphygmograph in 1860. The sphygmograph was able to
monitor the movement of the skin above the radial artery (Petty, 1995). This breakthrough was
closely followed by the invention of the non-invasive blood pressure cuff in 1881. The blood
pressure cuff was invented by Samuel Siegfried Karl Ritter von Basch (Booth, 1977). Even
though this instrument’s design has been improved over the years, its usefulness with patient
monitoring has remained the same. Many other tools have been invented to help monitor a
patient’s vital signs such as the electrocardiogram in 1903 by Willem Einthoven, the idea of
capnography was developed by German bioengineer Karl Luft in 1943, and the pulse oximeter
was invented in 1972 by Takuo Aoyogi and Michio Kishi (Tremper, 2011). Each one of these
devices has helped improve the safety of patients who are exposed to anesthetics.

Drug Delivery Safety

For patients who are undergoing anesthesia, medication errors are a leading cause of
adverse effects within the operating room. Due to this, many advancements have taken place to
increase patient safety by reducing errors. Examples of these changes include medication
barcode scanning, prefilled syringes, blood bag scanning, and customized drug trays (Simpao
and Galvez, 2015).
Misidentification of drugs is a common source of medication administration errors. As a
result of this, labeling and packaging of medications have changed to help providers
differentiate between drugs. For example, “Paralyzing Agent” can be seen on the cap of drug
vials containing neuromuscular blocking agents (Orser, Hyland, U, Sheppard, & Wilson, 2013).
Barcode scanning medications allows the provider to first verify that they are giving the right
drug, route of administration, and correct dose prior to administration (Grissinger, 2009).
Smart infusion pumps are now being used with drug libraries programed in, as well as
dose error reduction systems. These processes help decrease errors such as wrong rate or
dose being delivered to the patient. Recently, novel algorithm-based computer control is
available to control the rate of even the smallest infusions, allowing a closer match between an
anesthesia provider’s intent and drug infusion given by a pump (Simpao & Galvez, 2015).

Anesthesia Information
The development of anesthesia information management (AIMS) and clinical decision
support systems (CDSS) have made a large impact in increasing anesthesia safety and good
patient outcomes (Kadry, Feaster, & Ehrenfeld, 2012). The beginning of these systems were
merely basic record keeping and paper documents. Now AIMS and CDSS can be found infused
with technology and fully automated. AIMS specifically serves as a platform to document or
record events that occur perioperatively like the following: vital signs, drug administration,
anesthesia techniques, and event narrative. AIMS can be paired with EHR systems to allow
providers complete access to the patient’s medical history that is pertinent to anesthesia care
like previous surgeries, weight, allergies, and medications. The systems seamlessly share
information that can be placed into provider assessments and documentation (Simpao &
Galvez, 2015).
AIMs can also be paired with clinical decision support systems. CDSS serves as a
platform to monitor practice management, outcome-based decision support, and a process of
care. CDSS assists providers in many tasks such as the following: surgical anesthesia and
surgical protocols, billing, monitors perioperative efficiency, drug calculations and waste
reduction, and assists in outcome-based decision making. Smart Anesthesia Manager (SAM),
iCare, and AlertWatch are all examples of AIMS infused with a CDSS platform.
Lastly, large registries have been developed to organize information gleaned from
platforms like AIMS and CDSS. This has allowed providers across multiple anesthesia
departments to observe pertinent patient information to anesthesia care. These registries have
also allowed further research, through data mining, to develop new technologies and processes
to increase patient outcomes and safety in regard to anesthesia.

Conclusion
Over the years, anesthesia has had several important advancements that have helped
to keep patients free from accidental harm. The initiation and improvements of patient
monitoring systems, safer drug delivery systems, and various changes in record keeping have
all impacted the patient outcomes for the better. Safety advancements within anesthesia are
continually improving and remain an important aspect of ensuring the best possible care and
outcome of patients.

References

Booth, J. (1977). A short history of blood pressure measurement. ​Proceedings of the Royal Society of
Medicine​, ​70(​ 11), 793–799.

Grissinger, M. (2009). Paralyzed by mistakes, part I: Preventing errors with neuromuscular

blocking agents. ​P&T: A Peer-Reviewed Journal for Managed Care & Formulary Management,
34(​ 9), 466-481.

Institute of Medicine (2000). ​To err is human: Building a safer health system.​ Washington, DC:
National Academy Press.

Kadry, B., Feaster, W. W., & Ehrenfeld, J. M. (2012). Anesthesia information management
systems: Past, present, and future of anesthesia records. ​The Mount Sinai Journal of Medicine​,
79(​ 1), 154-165. doi.10.1002/msj.21281.

Orser, B. A., Hyland, S., U, D., Sheppard, I., & Wilson, C. R. (2013). Review article: Improving
drug safety for patients undergoing anesthesia and surgery. ​Canadian Journal Of Anaesthesia =
Journal Canadien D'anesthesie, 60(​ 2), 127-135. doi:10.1007/s12630-012-9853-y

Petty, W. (1995). Evolution of safety in anesthesia. CRNA: ​The Clinical Forum For Nurse
Anesthetists, 6​(2), 59-63.

Rose, G., & McLarney, J. T. (2014). ​Anesthesia equipment simplified​. New York, NY:
McGraw-Hill Education.

Simpao, A. F., & Galvez, J. A. (2015, June 25). Current and emerging technology in anesthesia.
Anesthesiology News,​ 1-7. Retrieved from
http://www.anesthesiologynews.com/Review-Articles/Article/06-15/Current-and-Emerging-Techn
ology-In-Anesthesia/32822/ses=ogst

Tremper, K. K. (2011). Anesthesiology: From patient safety to population outcomes: The 49th
annual Rovenstine lecture. ​Anesthesiology, 114​(4), 755-770.
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Weller, J. M., & Merry, A. F. (2013). Best practice and patient safety in anaesthesia. ​British
Journal of Anaesthesia,​ ​110(​ 5), 671-673. doi:10.1093/bja/aet011