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Anesthesia awareness is not just a problem for the anesthesia department. That was a key message of JCAHO when it issued its recent Sentinel Event Alert on the issue. Preventing this terrible outcome requires the interaction of many players within the health care organization, and the risk manager can be pivotal in making sure the problem is addressed vigorously. The Joint Commission, along with the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA), stresses that preventing anesthesia awareness, and dealing properly with patients do experience it, requires an organizationwide effort by top administrators.
That’s where the risk manager comes in. For starters, the Joint Commission urges you to develop and implement an anesthesia awareness policy that addresses these points:
For patients who have experienced anesthesia awareness, risk managers must assure access to necessary counseling or other support for patients who are experiencing post-traumatic stress syndrome or other mental distress.
Clinical advice available
Of course, much of the work in preventing anesthesia awareness will involve clinical decisions. The Joint Commission urges risk managers to refer anesthesia providers to their professional organizations for specific guidance, but the ASA and AANA offer these tips:
Unfortunately, anesthesia awareness may occur despite your best efforts to prevent it. When it does, the Joint Commission expects health care providers to respond in a compassionate way. (In addition to just being good practice, taking the report seriously might help decrease the chance of being sued, since your response to complaints always has a major impact on the patient’s decision to seek a lawyer.) It offers these suggestions for responding to a patient who reports awareness: