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Anesthesia Education Anesthesia Equipment and Technology Clinical Tips Leadership in Emergencies Preparing for Grad School/Residency

#97 – Safety is a capacity

What up folks! This is another short podcast on the idea that safety is a capacity, not an outcome. This idea comes out of Todd Conklin & Sidney Dekker’s work on organizational safety where they discuss two ways of looking at safety:

The Safety 1 Perspective or the old way of thinking is that safety is about minimizing errors.  It’s about identifying risks, including human behaviors, and implementing steps to prevent errors from happening.  Success is often measured in low to zero error rates and errors are punishable offenses.  

The Safety 2 Perspective doesn’t overlook the need to minimize errors.  But it focuses on building the capacity for the right thing to happen versus a feverish focus on whack-a-moling potential risk and, frankly, whack-a-moling the people who make mistakes.

The idea is that safety is not an outcome but rather a capacity that’s built up over time through thoughtful design of systems and careful handling of people and systems both when things go right as well as when errors happen.  It’s about figuring out how humans are doing the work – including all of their workarounds – in order to generate successful outcomes and finding ways to support and foster positive outcomes on a consistent basis.  And when things go wrong, people aren’t punished.  While egregious error or outright negligence is always possible, Safety 2 presumes people are smart and are trying to do the right thing.  So if something goes wrong, there is likely a system input, factor or design that created a high probability that something would in fact go wrong.  So the focus is on understanding how the worker performed in a faulty system and trying to improve that system so there’s a higher likelihood that the right thing happens the next time around.

Check out the short podcast for a couple of illuminating stories to bring these principles to life. As always, drop me an email or message on social media if you’d like to connect!

Resources:

Todd Conklin’s Pre-Accident Investigation podcast

Sidney Dekker’s professional website

Upcoming conferences I’m speaking at:

Maine Association of Nurse Anesthesiology: https://meana.org MEANA Fall Conference in Portland, Maine (virtual option available)

Encore Symposium’s New England at the Cliff House, Cape Neddick, Maine October 16-19, 2023

Encore Symposium’s Autumn in Bar Harbor & Acadia National Park, October 14-17, 2024

Categories
Airway Anesthesia Education Anesthesia Equipment and Technology Case Studies Clinical Tips Leadership in Emergencies Preparing for Grad School/Residency

#93 – OR Fires with April Bourgoin, DNAP, CRNA

In this episode, I speak with Dr April Bourgoin, DNAP, CRNA about operating room fires – how they can start and how we can respond to them as anesthesia providers. This show was originally released in 4 years ago in February of 2019 on the podcast From the Head of the Bed and was recorded with a table top microphone so the audio is a little suboptimal, but I’m sure you’ll still find this to be a very hot topic that will smolder in your memory for years to come after they key details become seared into your clinical practice. Hopefully, this podcast will really help you turn up the heat on your OR fire prevention practices… and now that we have almost all of the puns put out, let me tell you about Dr Bougoin.

Dr Bourgoin completed her Master of Nursing Science (MSN) and Doctorate of Nurse Anesthesia Practice at Virginia Commonwealth University. Prior to becoming a CRNA, she served for eight years as an active duty commissioned officer in the Army with experience as a critical care Registered Nurse and flight nurse with the 82nd Airborne Dustoff medevac team. She served two combat tours prior to transferring to the Army Reserves at the rank of Major and then returned to school for her master’s and doctorate degrees in anesthesia.

Dr Bourgoin had a case in which there was an OR fire and we discuss that story in detail in this podcast. She then unpacks OR and airway fires for us, including contributing factors, prevention, crisis management and the importance of critical incident debriefing.

Currently, I have the incredible privilege in working closely with April to support our CRNA group at Maine Medical Center in Portland, Maine. April is one of our 2 CRNA Supervisors and an invaluable part of our CRNA leadership team. I think you’re really going to enjoy hearing from her on this topic and in an upcoming episode on the pathophysiology of vaping associated lung injury.

In the show notes to this episode we have links to the Anesthesia Patient Safety Foundation’s infographics and video on OR fire prevention and safety, which are excellent resources to share with colleagues & classmates. We also link to a resource called Anesthesia eNonymous, which is a website hosted by faculty from Virginia Commonwealth University’s Nurse Anesthesia program where providers and anesthesia learners can anonymously share and read real stories of near misses, medical errors & other clinical experiences. As it’s been said: good judgment comes from bad judgment and it’s better to learn from others mistakes & bad judgement calls than having to make your own along the way. So be sure to check out the links in the show notes to this podcast that Dr Bourgoin has shared and with that, let’s get to the show!

Anesthesia Patient Safety Foundation Fire Safety Video

Anesthesia e-Nonymous – Virginia Commonwealth University

APSF Fire Safety Video Contributes to 44% Decrease in Intraoperative Fires Since 2011

Categories
Anesthesia Equipment and Technology Clinical Tips Pharmacology Preparing for Grad School/Residency

#45 – The Anesthesia Machine with Ashley Scheil, BSN, SRNA

In this episode, which was originally released in April of 2019 on From the Head of the Bed… a podcast for the anesthesia community, Ashley provides an incredibly detailed run down of the anesthesia machine: the flow of gas through the machine, high, intermediate and low pressure system components in the machine, variable bypass vaporizer structure & function, relevant gas laws, safety systems & features and more! If you’re an anesthesia learner just hitting the ORs, this show will give you a detailed run down on what you need to know to use the anesthesia machine. If you’re a seasoned provider and clinical educator/preceptor, this show provides a wonderful reminder of core information on the machine so you can best support your learners.

Ashley Scheil earned her BSN from Purdue University in 2012. She worked as a critical care Registered Nurse in the surgical ICU at the Roudebush VA Medical Center in Indianapolis for 6 years before going back to anesthesia school to earn her DNP at Marian University in May of 2020. Dr Scheil, DNP, CRNA practices at IU Health Arnett Hospital as of September 2021.

Resources

E – Cylinder Calculation

Amount of oxygen in cylinder in liters divided by liters of flow:

At full pressure (1900 PSI): 660 liters / 3 lpm = 220 minutes of O2.

At half pressure (950 PSI): 330 liters / 10 lpm = 33 minutes of O2.

Butterworth, J. F., Mackey, D. C., & Wasnick, J. D. (2018). Morgan and Mikhail’s clinical anesthesiology. McGraw-Hill Education.

Miller, R. D. (2014). Miller’s anesthesia. Philadelphia, PA: Elsevier. 

Nagelhout, J. J., Elisha, S., & Plaus, K. (2017). Nurse anesthesia. Elsevier Health Sciences.