News

News items will appear on the home page for two months and in the News section for a period of six months.

If you require a news item older than six months, please search the Press Office Section of the site or contact the Association by email: press@aagbi.org giving further details.

New AAGBI Safety Guideline- Management of Severe Local Anaesthetic Toxicity 2

Now available to download is the latest version of ‘Management of Severe Local Anaesthetic Toxicity’. This guideline updates the 2007 document of the same name. There are a number of changes within the guideline, most notably the suggestion that lipid therapy be given to all patients who suffer circulatory arrest as a result of local anaesthetic (LA) toxicity, and that it should be considered even in the absence of circulatory arrest.

The AAGBI believes that a copy of this guideline should be available wherever LA is given in sufficient quantity to cause toxicity if given inadvertently into the circulation. Laminated copies are being made available free of charge to all Linkmen, Clinical Directors and NHS Trust Chief Executives but, for environmental reasons, are not being sent to all 10,000 AAGBI members. We recommend that individual departments download the guideline and arrange for it to be printed, laminated and placed in key areas throughout the hospital.

Download a copy of the guideline (pdf)

Download a copy of the guideline with page marks (pdf)

Download a copy of the accompanying notes (pdf)

Download a copy of the accompanying notes with page marks (pdf)

Download the accompanying podcast (mp3)

Download the accompanying movie presentation (mp4)

New AAGBI Safety Guideline- Pre-operative Assessment and Patient Preparation: The Role of the Anaesthetist 2

The Association is pleased to announce that the new Pre-op Safety Guideline is available for download. Below are the recommendations of the guideline: 

This guidance has been designed to help anaesthetists provide high quality pre-operative assessment services and patient preparation before surgery. In addition it defines the roles and responsibilities of anaesthetists both after planned and after unplanned admissions.

Anaesthetists should assume a central role in the organisation of pre-operative services that encompass much more than preparing the delivery of anaesthesia.

The anaesthetist has the skills necessary to assess, optimise and estimate risk and support patients deciding whether to proceed with surgery and anaesthesia.

Pre-operative anaesthetic assessment should minimise risk for all patients as well as identify patients at particularly high risk. The pre-operative anaesthetic clinic should co-operate with primary care to achieve these aims.

Skilled nurse practitioners are safe and cost-effective in preparing patients for anaesthesia and should work closely with anaesthetists with a special interest in pre-operative assessment and preparation.

After scheduled admissions, anaesthetists must confirm that patients have been prepared adequately by pre-operative services so that anaesthesia and surgery can proceed safely.

Tests performed before surgery should be limited to those recommended by national and local guidelines and protocols.

Most anaesthetic departments should plan for one consultant whole-time equivalent to run and manage daily high-risk clinics with appropriate secretarial support.

Download a copy of the guideline (pdf)

Download the accompanying podcast (mp3)

Download the accompanying PowerPoint presentation

Notice on behalf of NCEPOD

NCEPOD are looking for consultants or senior doctors in training who are critical care physicians, surgical or critical care nurses, anaesthetists, surgeons, and doctors from other disciplines, to form a multidisciplinary group of advisors.  These advisors will be invited to review and provide expert opinion on the care of a selection of patients. 
 
The study area is the peri-operative care of all patients aged 16 years or older, who undergo inpatient surgery (both emergency and elective) any time from 1-7 March 2010 inclusive.  Day cases, obstetrics, and cardiac, transplant and neurosurgical patients, will be excluded.  Casenote extracts for four surgical groups will be reviewed: high risk surgical patients and high risk patients (i.e. due to age) some of whom will be alive, and others deceased, as well as low risk surgical and low risk patients who are deceased. 
 
The deadline for applications is 5 March 2010.  For details of how to apply, please view the advertisement on the NCEPOD study page http://www.ncepod.org.uk/poc.htm, email periopcare@ncepod.org.uk or phone Karen Protopapa on 020 7631 3444.

> Download a copy of the PeriOpCare Publicity Flyer

A summary of the incidents reported via the anaesthetic eForm pilot project between May 2008 and August 2009 is now available to download. Please forward any queries or comments to SALG@rcoa.ac.uk

> Download summary of Incidents (January 2010)

Threat to Scottish Distinction Awards – and possibly ACCEAs

Every consultant in Scotland has been sent a copy of a letter from Nicola Sturgeon to NHS Hospital Medical Directors in Scotland that has also been sent to Health Ministers in England, Wales and Northern Ireland. Ms Sturgeon is the Scottish Deputy First Minister and Cabinet Secretary for Health and Wellbeing. The letter can be downloaded here.

The letter calls for Distinction Awards to be frozen for the 2010/11 round – not only in value but also in terms of the number available. The only new awards would be funded by awards relinquished by those retiring or leaving the service. She also calls for reform of awards schemes in all four devolved countries, expressing her view that a system that rewards only one professional group in the NHS is “increasingly difficult to defend”. She uses the current financial crisis as another excuse for her proposed action.

Ms Sturgeon’s proposals have been strongly opposed by both the AAGBI and BMA. Honorary Treasurer Dr Ian Johnston, a consultant anaesthetist from Inverness, said: “The 2009 Doctors and Dentists Review Body report acknowledged that ACCEAs and Distinction Awards form a key part of consultants’ pay structure. Therefore, to remove them would be effectively to force a pay cut on the 60% of consultants who hold awards and who are the doctors who put the most into the NHS. It is quite incredible that employees of the Royal Bank of Scotland, which is largely owned by the UK taxpayer, were paid more than £1 billion in bonuses last year when the Scottish Distinction Award scheme only costs a fraction of this. The RBS employees work for a failed bank whereas our consultants work in an NHS that delivers excellence”.

BMA CCSC joint deputy chair Paul Flynn said: “These schemes are long-established and central to the drive for quality in the NHS. They are funded from the overall pool for consultant pay and do not take money away from other staff or from services to patients. By encouraging innovation and research they also bring long-term benefits to the UK economy”.

Statement on GAT's current position regarding the European Working Time Regulation

> Download the statement (pdf)

Opportunity to join an Operation Hernia mission to Mongolia

Operation Hernia (www.operationhernia.org.uk) is seeking an Anaesthetist Volunteer to provide anaesthesia during a surgical mission to Mongolia from 1-14 May 2010 lead by Professor Andrew Kingsnorth (Andrew.kingsnorth@phnt.swest.nhs.uk) .  Operation Hernia is a surgical programme intended to treat and teach groin hernia surgery in rural hospitals worldwide.  To date, the organization has completed over 30 missions and more than 1700 patients have received a potentially life-saving operation.  We have upgraded surgical facilities in participating rural hospitals so that quality surgery can be taught and delivered. Currently about 10 missions are carried out per year.  In addition to our surgical work, the missions usually take time to enjoy cultural opportunities and build lasting relationships in the locations where they work, in order to effect sustainability.

The MHRA Medical Device Alert

The MHRA has issued a Medical Device Alert about the TEC6 Plus Desflurane Vapouriser, manufactured by GE Healthcare.  An unexpected age related failure may result in over or under delivery of anaesthetic agent, and in some cases this may have been interpreted by anaesthetists as a monitoring failure rather than a problem with agent delivery.  More details can be found at: http://www.mhra.gov.uk/Publications/Safetywarnings/MedicalDeviceAlerts/CON062635.

Andrew Hartle
Chairman, AAGBI Safety Committee

First notice from the Safe Anaesthesia Liaison Group

The first notice from the Safe Anaesthesia Liaison Group, a collaboration of the Association of Anaesthetists, Royal College of Anaesthetists and the NPSA is now available to download.  You may also receive a copy via your College Tutor; one of the main aims of SALG is to ensure that safety notices receive the widest distribution. Safety notices are based on themes arising from the NPSA's NRLS, and we will shortly also be publishing quarterly reports on all anaesthetic reports to NPSA. These publications will hopefully help "close the loop" between reporting and feedback.

As ever, any comments on this report would be appreciated: please send to secretariat@aagbi.org marked for my attention.

>Download a copy of the notice from the Safe Anaesthesia Liaison Group

Andrew Hartle
Chairman, AAGBI Safety Committee

ACCEA 2010 round presentation and guide to the Employer Based Awards (England)

Available to download are a presentation on the 2010 ACCEA round and a guide to the Employer Based Awards (England).

> Download the presentation

> Download the guide



Two new AAGBI Safety Guidelines available for download

The Association is pleased to announce that two new Safety Guidelines are available for download. They are 'Blood Transfusion and the Anaesthetist: Intra-operative Cell Salvage' and 'Safe Management of Anaesthetic Related Equipment'. Below is a summary of recommendations for both guidelines:


Blood Transfusion and the Anaesthetist: Intra-operative Cell Salvage

The use of Intra-operative Cell Salvage (ICS) reduces the demand on allogeneic (donor) red cells and is a cost effective measure.

Trusts should provide the resources required to set up and maintain an ICS service in a safe, appropriate and cost effective manner.

Each Trust needs to ensure there is a clinical lead for ICS.

A member of the theatre management team is responsible for ensuring overall management and facilitation of the ICS service.

All personnel using ICS must be adequately trained and competent in its use.

Pre-operative assessment clinics should provide information on ICS to patients.

All ICS cases undertaken require documentation and audit of use to enable future service planning and quality assurance.

Safe Management of Anaesthetic Related Equipment

Safety, quality and performance considerations must be included in all equipment acquisition decisions.

Each directorate should nominate one consultant with responsibility for equipment management. This Nominated Consultant should be a member of a Medical Devices Management Group, which reports directly to the Trust Board, and he or she should liaise closely with the Technical Servicing Manager.

An inventory of all equipment, including donated equipment, must be held by the technical department for maintenance and replacement purposes.

A planned preventative maintenance programme must be in place.

There should be a policy to cope with equipment breakdown.

A replacement programme which defines equipment life and correct disposal procedures should be in place.

Purchase of new equipment should include wide consultation (especially involving users), and technical
advice to ensure practicality, cost effectiveness and suitability for purpose.

There must be a commissioning or acceptance procedure before any new equipment is put into use.

All users must be trained in the use of all equipment that they may use.

All adverse incidents arising from the use of equipment must be reported.

>Download a full version of the Intra-operative Cell Salvage guideline (PDF)

>Download a full version of the Safe Management of Anaesthetic Related Equipment guideline (PDF)

AAGBI Annual Report 2008/09 and Annual Members Meeting 2009

Although no longer obliged by company law to produce and distribute an Annual Report to all members, Council of the AAGBI decided to continue this practice in order to ensure that members receive full information about the activities of the Association and its charity. This document contains, as usual, written reports from the President, senior Officers and Committee Chairman. Importantly, it also includes summary accounts for the AAGBI and AAGBI Foundation for the financial year 2008/9.

The latest Annual Report and detailed accounts of the AAGBI and its charity, the AAGBI Foundation, is now available for download. Members attending the Annual Members’ Meeting on Thursday 24 September at 14:45 at the forthcoming Annual Congress in Liverpool will be given the opportunity to ask the President and senior Officers of the AAGBI questions about the Annual Report. Members who would like to ask questions about the Report but who cannot attend the Annual Members’ Meeting should email the Honorary Secretary on HonSecretary@aagbi.org

Council also decided that, for environmental and economical reasons, it would not send a paper copy of the 44-page report to every member. However if members would like a paper copy of the report to be mailed to them, they should write to the Honorary Secretary requesting one.

> Download a copy of the Annual Report & Audited Accounts

Patient Safety First Campaign

Patient Safety First was launched in 2008 by clinicians and managers to highlight the importance of patient safety in the NHS.   Their campaign for patient safety is highlighted on their website and the AAGBI is delighted to support their initiative 'Patient Safety First Week'.  This  will focus on implementation of the Surgical Safety Checklist, in particular to encourage trainees to get involved in leading the checklist.  www.patientsafetyfirst.nhs.uk

Update on Clinical Excellence Awards (ACCEA) from the AAGBI Honorary Secretary

The AAGBI is recognised by the Advisory Committee for Clinical Excellence Awards (ACCEA) as one of the professional organisations that can nominate anaesthetists, intensivists and pain physicians for national Clinical Excellence Awards (Bronze, Silver, Gold and Platinum levels), and can also support applications for higher awards in Scotland and Northern Ireland. The AAGBI has established an objective assessment and ranking process in accordance with strict ACCEA guidelines. The AAGBI will convene a group that will assess and rank the submissions for each award level. The group will include senior national award holders, local award holders and lay representation. The ranked list of nominations will be formally submitted to the ACCEA or equivalent body for applicants from Scotland or Northern Ireland. Any anaesthetist wishing support from the AAGBI should follow the instructions and timetables detailed in the document below.

>Download ACCEA Information Document

> CEA Letter from David Nicholson CBE (Chair National Quality Board & National Leadership Council)

The NHS Supply Chain is seeking Clinicians’ involvement in advising on the contracting process, including technical specifications. 

The NHS Supply Chain is seeking Clinicians’ involvement in advising on the contracting process, including technical specifications.  Task Forces responsible for “Breathing Filters, Systems and Accessories”, and “Anaesthetic and Resuscitation Consumables” are currently being recruited.  If you’d like the opportunity to influence the equipment available in your hospital you can obtain further information at http://www.supplychain.nhs.uk/portal/

Anaphylaxis safety guideline and laminate available for download

The Association is pleased to announce that 'Suspected Anaphylactic Reactions Associated with Anaesthesia 4' and the associated laminated card are available for download. Below is a summary of recommendations.

(1) The AAGBI has published guidance on management of anaphylaxis during anaesthesia in 1990, 1995 and 2003. This 2009 update was necessary to disseminate new information.

(2) Death or permanent disability from anaphylaxis in anaesthesia may be avoidable if the reaction is recognised early and managed optimally.

(3) Recognition of anaphylaxis during anaesthesia is usually delayed because key features such as hypotension and bronchospasm more commonly have a different cause.

(4) Initial management of anaphylaxis should follow the ABC approach. Adrenaline (epinephrine) is the most effective drug in anaphylaxis and should be given as early as possible.

(5) If anaphylaxis is suspected during anaesthesia, it is the anaesthetist’s responsibility to ensure the patient is referred for investigation.

(6) Serum mast cell tryptase levels may help the retrospective diagnosis of anaphylaxis: appropriate blood samples should be sent for analysis.

(7) Specialist (allergist) knowledge is needed to interpret investigations for anaesthetic anaphylaxis, including sensitivity and specificity of each test used. Specialist (anaesthetist) knowledge is needed to recognise possible non-allergic causes for the ‘reaction’. Optimal investigation of suspected reactions is therefore more likely with the collaboration of both specialties.

(8) Details of specialist centres for the investigation of suspected anaphylaxis during anaesthesia may be found on the AAGBI website http://www.aagbi.org.

(9) Cases of anaphylaxis occurring during anaesthesia should be reported to the Medicines Control Agency and the AAGBI National Anaesthetic Anaphylaxis Database. Reports are more valuable if the diagnosis is recorded following specialist investigation of the reaction.

(10) This guidance recommends that all Departments of Anaesthesia should identify a Consultant Anaesthetist who is Clinical Lead for anaesthetic anaphylaxis.

>Download a full version of the safety guideline (PDF)

>Download a full version of the laminate (PDF)

Clinical Excellence Awards (ACCEA) - AAGBI support for higher award applicants

ACCEA's 2010 national Guide for Applicants has now been published at this link: www.dh.gov.uk/ab/ACCEA/index.htm. A summary of the changes is also available at the above link and the online application form is likely to be available at the start of September. The deadline for requesting AAGBI support (with a copy of your ACCEA form) is midnight on Friday 16th October 2009. Please email your completed form to president@aagbi.org by this date.

Dr Judith Hulf awarded a CBE

The Association of Anaesthetists of Great Britain & Ireland is delighted to congratulate Dr Judith Hulf, Member and Council Member of the Association, President of the Royal College of Anaesthetists and Consultant Anaesthetist at University College London Hospitals NHS Foundation Trust on being awarded a CBE in the 2009 Queen's Birthday Honours List.

AAGBI GAT Elections 2009 – Results

The AAGBI GAT Committee is pleased to announce the election of six new members who will take up their posts after the GAT Annual General Meeting in Cambridge on 2nd July 2009:

Dr Emma Anderson (ST4, St John’s Hospital, Livingston)
Dr Hannah Gill (SpR, Barts and The London School of Anaesthesia)
Dr Mike MacMahon (ST3, Royal Infirmary of Edinburgh)
Dr Kate McCombe (SpR3, Poole and Bournemouth Hospitals, Dorset)
Dr Simran Minhas (StR4, Hull Royal Infirmary)
Dr Claire Williams (SpR, Addenbrooke’s Hospital, Cambridge)

AAGBI Council Elections 2009 – Results

Council of the Association is pleased to announce the election of three Council members who will take up their posts after the Annual Members Meeting in Liverpool on 24th September 2009:

Dr Barry Nicholls (Consultant Anaesthetist, Musgrove Park Hospital, Taunton)
Dr Felicity Plaat (Consultant Anaesthetist, Queen Charlotte’s & Hammersmith Hospitals, London)
Dr Mansukh Popat (Consultant Anaesthetist, Oxford Radcliffe Hospitals NHS Trust)


There were 12 candidates in total.

EUROPEAN WORKING TIME DIRECTIVE STATEMENT

The AAGBI endorses the following statement from the RCoA regarding new appointments. This is an important patient safety issue and should be brought to the attention of those involved in appointing new anaesthetic doctors and locums within Trusts.

>Download the statement (PDF)

NEW DNAR GUIDELINE AVAILABLE TO DOWNLOAD

The Association would like to announce the release of a new guideline: 'Do Not Attempt Resuscitation (DNAR) Decisions in the Perioperative Period'. Below is a summary of recommendations.

1. Management of patients with DNAR decisions in the perioperative period should focus on what resuscitative measures will be embarked on rather than on what will not be done.

2. It is essential that patients who may require surgical procedures with DNAR decisions in place are referred as early as possible to the anaesthetic and surgical teams.

3.  A review of the DNAR decision by the anaesthetist and surgeon with the patient, proxy decision maker, other doctor in charge of the patient’s care, and relatives or carers, if indicated, is essential before proceeding with surgery and anaesthesia.

4.  There are three options for managing the DNAR decision:
Option one: the DNAR decision is to be discontinued.  Surgery and anaesthesia are to proceed with cardiopulmonary resuscitation (CPR) to be used if cardiopulmonary arrest occurs. 
Option two: the DNAR decision is to be modified to permit the use of drugs and techniques commensurate with the provision of anaesthesia.
Option three: no changes are to be made to the DNAR decision.  Under most circumstances this option is not compatible with the provision of general anaesthesia for any type of surgical intervention. 

5.  The agreed DNAR management option should be documented in the patient’s notes.

6.  The DNAR management option should be communicated to all the healthcare staff managing the patient in the operating theatre and recovery areas.

7.  The law provides a clear hierarchy in terms of legal standing to make DNAR decisions:
a. The competent patient’s direct instructions.
b. The patient’s advance decision or proxy decision maker if competence is lacking.
c. The senior clinician in charge of the patient’s care, acting in the patient’s best interests, if there is not a legally valid advance decision or proxy decision maker for a patient lacking competence.

8. If, after discussion, there is no agreement on which DNAR decision option should be adopted, the decision of the person with the legal right or responsibility for making the decision should be accepted.

9. If an anaesthetist or other health care provider cannot agree with the outcome of the review of the DNAR decision, they must ensure that arrangements are made for another suitably qualified colleague to take over the role in accordance with GMC guidelines.

10. If it is unclear who has the right or responsibility to make the decision, or if there is doubt over the legal validity of an advance decision or proxy decision maker, or doubt as to what is in the best interests of the patient, then seek legal advice immediately.

11. In an emergency, the doctor must make decisions that they view to be in the best interests of the patient using whatever information is available.

12. The DNAR management option should, under most circumstances, apply for the period when the patient is in the operating theatre and recovery areas.  The DNAR decision should be reinstated when the patient returns to the ward, unless in exceptional circumstances.

>Download a full version (PDF)

PANDEMIC FLU STATEMENT

The World Health Organization has now raised its Pandemic Alert to Level 5.  Hospitals, departments and individuals should already have plans in place to respond to a pandemic; now is the time to review and update them.

AAGBI does not intend to give specific advice, but the following resources may be useful.

The General Medical Council has prepared a revised version of Good Medical Practice for use when the UK has declared a Level 3 pandemic.  It covers issues such as working outside your normal area of practice, participation in appraisal, safety concerns, limited resources and the degree to which you have to put yourself at risk.

http://www.gmc-uk.org/guidance/news_consultation/GMP_in_pandemic_draft_24_Feb_09.pdf

More specific guidance on planning, ethical considerations and human resource implications may be found at the various websites of the four Health Departments;

http://www.dh.gov.uk/en/Publichealth/Flu/PandemicFlu/index.htm

http://www.dhsspsni.gov.uk/pandemicflu

http://www.scotland.gov.uk/Topics/Health/health/AvianInfluenza/PandemicFlu

http://wales.gov.uk/topics/health/protection/communicabledisease/flu/?lang=en

AAGBI will continue to monitor the situation and issue further statements as appropriate.

Andrew Hartle
Chairman, AAGBI Safety Committee