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October 16-20, 2010 San Diego, CA Home Abstract Archive Search Abstracts 2010 Session Grid 2010 Meeting Website Policy Statements ASA Website Feedback 
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A766
October 19, 2008 2:00 PM - 4:00 PM Room Hall E2-Area N, |
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| Vasoactive Medication Preparation during Pediatric Cardiac Surgery | ||||||||||||||||||||||||
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Igal Nevo, M.D., Gayatry Siram, M.D., Steve R. Scheinman, M.D., FACP, Michael G. Rossi, D.O., FAAP, David J. Birnbach, M.D., M.P.H. UM-JMH Center for Patient Safety and Department of Anesthesiology, University of Miami - Miller School of Medicine, Miami, Florida |
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Introduction: The potential for human error and near misses is high during pediatric cardiac anesthesia (PCA). Heightened awareness to these conditions led some departments to assign the preparation of vasoactive drips (VAD) to pharmacy services[i]. We conducted a nationwide survey to determine the extent this policy has been adopted. Methods: A phone survey was conducted to all children's hospitals in all 50 states including DC from 1/2008 to 3/2008. The survey included 6 questions: Is it a teaching department; who prepares the VAD during PCA; are those services provided 24/7; what is the process in emergency cases; level of satisfaction using the 1-5 Leickert scale. The survey was conducted with either the chief or an attending on the PCA team. Results: All 223 children's hospitals were surveyed; 208 (93%) responded, of which 2 (1%) refused to take the survey. Of the responders, 112 (54%) perform PCA. Table 1 depicts the detailed results:[table1]Satisfaction level was 4.8±6.4 (mean±std) and was rated by 32% of responders; one non-teaching responder rated the service at 2/5 (low). Discussion: Preparation of VAD for PCA is a new paradigm that has been adopted by the majority of teaching and some non-teaching children's hospitals in the USA that responded to the survey. Over 80% of the responding teaching hospitals have pharmacy services available 24/7. Several operational models emerged. Services are available 24/7 from the main or satellite pharmacy, which prepares patient specific VAD. Others have services for elective surgery, but stocks of VAD are batch-prepared based on weight ranges. Some hospitals have an on-call pharmacist for emergency cases. A small number of PCA services have either an ICU or an OR circulating nurse that prepares VAD. The high satisfaction rating should be cautiously considered, because of the low number of raters. Conclusion: The new paradigm has the potential to reduce human error, especially during very intensive situations. Repetition of the study in 1 year that encompasses other anesthesiology departments may provide long term perspective about the clinical and economical advantages and disadvantages of this paradigm. It will provide a better perspective about the preferred operational model. The new model should be considered for implementation in other types of surgeries of similar intensity (e.g., liver transplantation). [i] Ginsberg SH, at al. Vasoactive medication preparation Aneth Analg 2003;96,SCA85. Anesthesiology 2008; 109 A766 |
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