Safety and quality update: June 2022
10 June 2022
New this month: bradycardia from oculocardiac reflex; new trauma model resource criteria; anticoagulation management error; reducing routine ICU coagulation tests; NZ advance care planning; safe healthcare for LGBTQIA+, asylum seeker and refugee communities; pain in newborns; and more.
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WebAIRS incident: Bradycardia due to the oculocardiac reflex
A recently reported incident to webAIRS describes bradycardia leading to asystole following the application and subsequent stimulus of the eye speculum and camera on the cornea.
Anaesthesia was maintained via total intravenous anaesthesia using propofol and remifentanil. Immediately removing the stimulus, stopping the remifentanil infusion, and giving glycopyrrolate 200 mcg was ineffective, whereas giving atropine 300mcg showed a good effect with a return of P-waves and a heart rate of 80/min.
The oculocardiac reflex (OCR) is well known by most anaesthetists and defined by a decrease in heart rate, most commonly resulting in sinus bradycardia, but it also has a reported association with reduced arterial pressure, arrhythmia, asystole, and even cardiac arrest.
For more information and recommendations for clinical practice, please refer to:
Visit the webAIRS website to register to report anaesthetic incidents or email email@example.com for more information.
RACS Trauma Verification Program – update to Model Resource Criteria for Trauma Services
The Royal Australasian College of Surgeons (RACS) Australian and Aotearoa New Zealand Trauma Verification Program: Model Resource Criteria for Trauma Services provides guidance to hospital trauma services on resourcing required for the care of injured patients. ANZCA participates in this program and endorses the Model Resource Criteria. A new update to the Criteria was published in April 2022.
ANZASM Case of the month May 2022: anticoagulation transition orders error
The Australian and New Zealand Audits of Surgical Mortality (ANZASM) Case of the Month, May 2022 edition, highlights the importance of coordinated management of anticoagulation in the perioperative period and for each patient to have a documented perioperative anticoagulation plan.
Read case report
Choosing Wisely Champion Health Services webinar: reducing routine ICU coagulation tests
Riley Hazard presented on a Choosing Wisely project focussed on reducing routine coagulation testing in the Intensive Care Unit (ICU) at Western Health. In a recent retrospective review, they found that the great majority of patients who were admitted to the ICU with normal coagulation profiles had these remain normal throughout their ICU stay.
This webinar took place on 1 June 2022, but is available to watch retrospectively as a recording.
HQSCNZ Advance Care Planning - Serious Illness Conversation Guide
The Health Quality and Safety Commission New Zealand (HQSCNZ) advance care planning team is happy to announce that more than 1000 people have attended the Serious Illness Conversation Guide (SICG) three-hour workshops being delivered in district health boards. The guide is a set of structured questions to help clinicians who do not come from a palliative care background have conversations with seriously ill people and their whānau about what is most important to them if time were limited and/or their functional abilities were to change.
HQSCNZ Quality improvement scientific symposium – videos
Videos are now available to watch from the Health Quality and Safety Commission New Zealand’s (HQSCNZ’s) Quality improvement scientific symposium virtual lunchtime sessions, which took place in February and March 2022. Topics include: consumer partnerships; QI in complex systems; cross-service discharge planning for elderly patients; system resilience; reducing waiting lists; and planned care equity for Māori and Pacific people.
Ahpra podcast 24 May: Providing safe healthcare for LGBTQIA+ communities
Providing safe healthcare for LGBTQIA+ communities as a practitioner is the focus of this Taking care episode, which features clinical neuropsychologist, Board member of the Victorian Pride Centre, and Commissioner at the Victorian Multicultural Commission, Dr Judy Tang; and clinical psychologist and Senior Research Fellow, Dr Lee Cubis.
Ahpra podcast 10 May: The asylum seeker and refugee healthcare experience
In this episode of Taking care, infectious diseases specialist Dr Nadia Chaves, counsellor Tigist Kebede, and lawyer Sahema Saberi detail their experiences of healthcare through the refugee and asylum seeker lens. They explain the importance of patient centred care for these communities and offer tips for practitioners on how to provide culturally safe and respectful support.
Safer Care Victoria – adverse events review, pain in newborns
Free online events from Safer Care Victoria (SCV) in July 2022:
- Training: Fundamentals of Adverse Patient Safety Event Reviews (for Vic clinicians) – 12–13 July
- Webinar: Reducing pain in newborns during painful procedures – 13 July
International Forum on Quality and Safety in Healthcare, Sydney, 24–26 July 2022
This inspiring conference is hosted by the Institute for Healthcare Improvement (IHI) and the British Medical Journal (BMJ) and is suited to all those passionate about improving outcomes for their patients and communities. Themed New horizons: Quality improvement shaping the future, the Sydney program will ask how to tackle the important post-pandemic challenges ahead of us and will invite action.