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Biomedical subjects

D A Yee

Publications and source records attributed to D A Yee.

6 recordsLinked to original sources
PubMed2001

Medication errors in anesthetic practice: a survey of 687 practitioners.

PURPOSE: The objectives of this study were to determine: 1) if anesthesiologists had experienced a medication error and 2) to identify causal factors. The perceived value of a Canadian reporting agency for medication errors and improved standards for labels on drug ampoules was also investigated. METHODS: A self-reporting survey was mailed to members of the Canadian Anesthesiologists' Society (n = 2,266). Respondents provided free-text descriptions of medication errors and answered fixed response questions. RESULTS: Surveys from 687 anesthesiologists (30% response rate) revealed that 85% of the participants had experienced at least one drug error or "near miss". Although most errors (1,038) were of minor consequence (98%), four deaths were reported. The commonest error involved the administration of muscle relaxants instead of a reversal agent. "Syringe swaps" (70.4%) and the misidentification of the label (46.8%) were common contributing factors. Anesthesiologists (97.9%) reported that they read the ampoule label "most of the time" although the label colour was an important secondary cue. Approximately half of the participants would report the error if a reporting program existed and 84% agreed that improved standards for drug labels would reduce the incidence of error. CONCLUSIONS: Most anesthesiologists experienced at least one drug error. The commonest error was a "syringe swap" that involved a muscle relaxant. Most errors were of minor consequence, however, serious morbidity and mortality resulted from clearly preventable events. These results support the development of improved standards for drug labels and the establishment of a Canadian reporting program for medication errors.

Anesthesiology↗
PubMed1997

Changing the practice of pain management.

Since postoperative pain is associated with morbidity and increased hospital resources, reducing pain should improve patient care. Enhanced education and individualized feedback were introduced at the study hospital to promote anesthesiologists' use of patient-controlled analgesia, nonsteroidal antiinflammatory drugs, epidural morphine, and nerve blocks. After 6-mo baseline, anesthesiologists at the study hospital attended educational seminars and received literature about pain management. Personalized feedback forms were then distributed to each anesthesiologist showing the management and rates of pain for their patients. Practice was as usual at a control hospital. Pain in the postanesthesia care unit (PACU) and for 6-h post-PACU discharge was assessed using PACU records and interviews for 3413 patients at the study hospital and 1753 at the control hospital. From the baseline to the feedback period, the absolute increase in the proportion of patients receiving at least one promoted strategy was greater at the study hospital than at the control hospital (44.9% vs 22.8% P < 0.0001). Mean pain scores with activity decreased at both hospitals; study hospital 7.6 (7.3-7.8, 99% confidence interval) to 6.2 (5.9-6.5); control hospital 7.3 (6.9-7.6) to 6.1 (5.7-6.4). Education and feedback increased the use of pain management strategies at the study hospital. The modest change in patient outcome was unlikely related to directed interventions.

Analgesia, Patient-Controlled↗
PubMed1996

Changing anesthesiologists' practice patterns. Can it be done?

BACKGROUND: Because the ultimate purpose of new medical knowledge is to achieve improved health outcomes, physicians need to possess and use this knowledge in their practice. The authors introduced enhanced education and individualized feedback to reduce postoperative nausea and vomiting (PONV). The primary objective was to increase anesthesiologists' use of preventive measures to reduce PONV, and the secondary objective was to determine whether patient outcomes were improved. METHODS: After obtaining hospital ethics committee approval, the effect of education and feedback on anesthesiologist performance and the rate of PONV in major surgery elective inpatients during a 2-yr period was assessed. After baseline data collection (6 months), anesthesiologists at the study hospital received enhanced education (8 months) and individualized feedback (10 months). Parallel data collection was performed at a control hospital at which practice was continued as usual. The education promoted preventive measures (antiemetic premedication, nasogastric tubes, droperidol, metoclopramide). Individualized feedback provided the number of patients receiving promoted measures and the rate of PONV. The mean percentage of anesthesiologists' patients receiving at least one promoted measure and the rate of PONV were compared with baseline levels. RESULTS: At the study hospital, there was a significant increase in the mean percentage of the anesthesiologists' female patients receiving a preventive measure as well as a significant increase in the use of droperidol > or = 1 mg (P < 0.05) for all patients. The use of other promoted measures was unaffected. Absolute rates of PONV were unaffected at the study hospital until the post-feedback period (decrease of 8.8% between baseline and post-feedback (P = 0.015)). CONCLUSION: It was demonstrated that enhanced education and individualized feedback can change anesthesiologists' practice patterns. The actual benefit to patients from use of preventive measures was limited when used in the everyday clinical situation. Therefore, only modest decreases in PONV were achieved, despite the use of preventive measures.

Anesthesiology↗
PubMed1992

Development of a computerized database for the study of anaesthesia care.

To record, tabulate and report problems associated with anaesthesia, we have developed an information collection system and computer software to follow all patients attended by an anaesthetist at a teaching hospital in Canada. For the last 15 mo, data for 17,000 patients have been collected and the system is ongoing. Data collection is from three sources: carbonless copies of the handwritten Operating Room (OR) and Post Anaesthetic Care Unit (PACU) records, other hospital databases, and postoperative visits. Adverse events (observations which differ from specific physiological variables, or require an intervention and do not normally occur during the routine conduct of anaesthesia), are defined directly on each OR and PACU record. These events are recorded when they occur by the attending anaesthetist or the PACU nurse. All data are verified by a research nurse and an anaesthetist. Computer software, developed from DBase IV, is used to track 95 individual items on preoperative status and anaesthetic technique and another possible 1,450 selections for drugs, physicians, airways, surgical procedures and events for each patient. Data are analyzed with SAS software and reports generated to link the casemix and process with outcome. Comparison of data entered into the computer programme to a retrospective chart review revealed discrepancies of less than 0.5%. Collection, verification and computer entry takes five minutes per patient and the on-going cost is estimated at $4 per patient record. Analysis of the information collected in this database has been useful for research of adverse outcome following anaesthesia, resident expertise profiles, and the administrative management of an anaesthesia department.

Anesthesia Department, Hospital↗