An audit of level two and level three checks of anaesthesia delivery systems performed at three hospitals in South Australia

Abstract

Anaesthetists may subject patients to unnecessary risk by not checking anaesthetic equipment thoroughly before use. Numerous adverse events have been associated with failure to check equipment. The Australian and New Zealand College of Anaesthetists and anaesthetic delivery system manufactures have made recommendations on how anaesthetic equipment should be maintained and checked before use and for the training required for staff who use such equipment. These recommendations are made to minimise the risk to patients undergoing anaesthesia. This prospective audit investigated the adherence of anaesthetic practitioners to a selection of those recommendations. Covert observations of anaesthetic practitioners were made while they were checking their designated anaesthetic machine, either at the beginning of a day's list or between cases. Structured interviews with staff who check the anaesthetic machine were carried out to determine the training they had received. The results indicated poor compliance with recommendations: significantly, the backup oxygen cylinders' pressure/contents were not checked in 45% of observations; the emergency ventilation device was not checked in 67% of observations; the breathing circuit was not tested between patients in 79% of observations; no documentation of the checks performed was done in any cases; and no assessment or accreditation of the staff who performed these checks was performed. It was concluded that the poor compliance was a system failing and that patient safety might be increased with training and accrediting staff responsible for checking equipment, documenting the checks performed, and the formulation and use of a checklist.