EditordDrug errors are defined as any unintended patient safety incident relating to the handling of drugs that could have led, or did lead, to harm. They are the most frequent critical incidents in anaesthesia. 1 Whilst in adults approximately one-third of errors lead to harm, life-threatening errors are even more likely in paediatric anaesthesia. This is because of variable exposure of some anaesthetists to paediatric patients, age and weight variations, and the potential for large-scale errors. 2 The Paediatric Anaesthesia Trainee Research Network conducted a tablet device survey amongst anaesthetists attending the 2017 Association of Paediatric Anaesthetists of Great Britain and Ireland Annual Scientific Meeting. This evaluated the frequency of drug errors, reporting attitudes, and potential avenues for improvement. Of 354 delegates, there were 162 respondents (46%). They ranged in grade from core trainee (n¼4) to consultant (n¼99; 61%) with an approximate 50:50 split amongst those with more or less than five years of paediatric anaesthetic experience. A total of 60% of anaesthetists experienced paediatric drug errors at least once every year, 15% of whom reported experiencing an error at least once every month. These frequencies are likely to underestimate true frequencies because of reluctance to self-report errors and failure of error recognition. Calculation and dilution errors accounted for half of all errors. This was followed by the i.v. cannula not being flushed (16%) and wrong drug administration (11%). In order of frequency, antibiotics, opioids, paracetamol, and neuromuscular blocking agents were the most commonly involved drugs. The most common causative factors were distractions and interruptions whilst handling drugs, dose or dilution miscalculations, and anaesthetist fatigue. Amongst reporting attitudes, 36% of respondents stated that they would only report errors resulting in actual patient 4. Kaufmann J, Roth B, Engelhardt T, et al. Development and prospective federal statewide evaluation of a device for height-based dose recommendations in prehospital pediatric emergencies: a simple tool to prevent most severe drug errors.
Background: Failure to discharge home following day case procedures has a negative impact on patients, families and hospital finances. There are currently no national paediatric data on the incidence and causes of unplanned admission. We determined the incidence of unplanned admissions after paediatric day case anaesthesia and identified risk factors leading to unplanned admission. Methods: During a 6-week period (October and November 2017), all children aged 16 years or under, receiving general anaesthesia, without an inpatient bed on arrival, were included. Hospital, surgical and procedural details, anonymised demographic data, plus anaesthetic and surgical experience were collected by local Paediatric Anaesthesia Trainee Research Network (PATRN) coordinators. A mixed effects binary logistic regression model with backward selection was used to determine variables associated with unplanned admission. Results: 93 hospitals across the United Kingdom and Ireland participated. There were 25,986 cases, of which 640 were unplanned admissions. Independent risk factors for unplanned admission were ASA-PS (ASA-PS III/IV vs ASA-PS I OR (95% CI) 2.80 (2.07, 3.77)), duration of procedure (1.04 (1.03-1.05)) and surgical specialty (vs ENT (highest caseload specialty): Cardiology 1.89 (1.15, 3.06), Orthopaedics/Trauma 0.91 (0.69, 1.18), General Surgery 0.59 (0.46, 0.77)). The commonest reasons for admission were unexpected surgical complexity, pain, postoperative nausea and vomiting and late finish. Conclusions: This is the first large paediatric multicentre observational study investigating unplanned admissions following day case procedures under general anaesthesia in the UK and Ireland. This study provides baseline figures for focused quality improvement projects to reduce unplanned day surgery admissions.
We report university student perspectives on COVID-19 impact on education, general health and well-being, one year into the pandemic. A ‘low risk’ questionnaire with modified General Health (GHQ-28) and Anxiety Disorder (GAD-7) instruments was shared with students via an email link over a 4-week period. 725 students responded from five countries. Half of the students reported significant general health difficulties and more than ten per cent experienced a severe state of generalised anxiety disorder. The virtual learning techniques adopted during the pandemic were welcomed by students but many were frustrated by the poor quality teaching material, poor scheduling of virtual sessions with inadequate spacing and assessments not being truly representative of what was taught. Digital poverty due to inadequacies in hardware, software compatibility and connectivity were major hindrances to virtual learning. Universities should urgently modify the virtual training methods and enhance mental health and wellbeing support before disaster strikes.
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