If you have any additions, changes, or suggestions for our list, please email Jerry Simons, PA-C (CornellSPA@aol.com).

Council on Surgical and Perioperative Safety
Dan Vetrosky and Dana Gray
AASPA CSPS Council Representatives 

Approximately two years ago a very important liaison was established between the American Association of Surgical Physician Assistants (AASPA) and the Council on Surgical and Perioperative Safety (CSPS). The CSPS is a multidisciplinary coalition of organizations whose members are directly involved in the care of patients undergoing surgery or surgically related therapeutic, or diagnostic procedures. The council was first conceived in February 2004 at a summit meeting on perioperative care cosponsored by the American College of Surgeons (ACS), the American Society of Anesthesiologists (ASA), and the Association of periOperative Registered Nurses (AORN). Other representatives present at the summit included the American Association of Nurse Anesthetists (AANA), the AASPA, the American Society of PeriAnesthesia Nurses (ASPAN), and the Association of Surgical Technologists (AST). The members agreed to form the Council on Surgical Patient Safety and later changed the name to the current Council on Surgical and Perioperative Safety.

The stated mission of the CSPS is “to promote a culture of patient safety and a collaborative work-place environment for and among the members of our participating organizations.” Among the goals of the council are the creation of opportunities for strategic, informed dialogue, the identification of areas where internal and external collaboration can improve surgical patient safety and perioperative work-place environments, and the initiative to raise the awareness of surgical patient safety and perioperative work-place environment issues among the public, healthcare leaders, and members of the perioperative team. Other goals include the establishment and facilitation of ongoing communications and educational opportunities among the member organizations and the perioperative/surgical team, and the coordination of advocacy efforts for patient safety and perioperative work-place environmental issues.

Each member organization is strongly encouraged to bring issues related to surgical and preoperative patient safety to the council for discussion and ultimately adoption as a statement endorsed by the Council. Publications of consensus statements from the Council have appeared in the Bulletin of The American College of Surgeons. Issue statements such as retained foreign bodies, the adoption of use of blunt suture needles in specific surgical applications, and a revised statement on health care industry representatives in the operating room have appeared in The Bulletin.

This February the 6 th meeting of the CSPS took place in Chicago . Dana Gray and Dan Vetrosky were the AASPA representatives present. Issues discussed during this meeting included processes for developing statements on perioperative issues, fire safety in the operating room, the mandatory use of audible monitoring alarms in the operating room, sedation outside the operating room, alcohol-based skin preparations: FDA requirements, the introduction of new technology and safety issues identified with it in the operating room, organizational models for safety, discussion regarding AAPA representation on the Council (it was not approved), and communications with the Joint Commission on Accreditation of Healthcare Organizations. New business discussed included the issue of awareness during anesthesia and the new film Hollywood is putting out on the subject.

As you can see, the meeting was quite interesting and the liaison with the member organizations was invaluable.

Statement of ASA Anesthesia Patient Safety Foundation Board of Directors Workshop

The AASPA BOD endorses the following statement from the American Society of Anesthesiologists recent meeting:

Friday, October 13, 2006 (1300-1700)
Hilton Hotel, Chicago , IL

Safety During Patient Controlled Analgesia (PCA)

APSF believes that opioid-induced depression of ventilation during patient-controlled analgesia (PCA) and neuraxial analgesia is a preventable cause of morbidity and mortality. A panel of experts discussed this topic and attendees at the conference contributed their views during the APSF Board of Directors Workshop on October 13, 2006 .

The conference attendees and participants agree there is a significant and underappreciated risk of injury from PCA and neuraxial opioids administered in the postoperative period. While some patient populations (notably those patients with obstructive sleep apnea) appear to be at higher risk, there is still a low but unpredictable incidence of life-threatening opioid-induced depression of ventilation in young healthy patients.

Based on the data presented at the October 13, 2006 conference and the comments of the participants, APSF endorses a goal that “no patient shall be harmed by opioid-induced ventilatory depression in the postoperative period.” To address this goal, APSF urges healthcare professionals to give consideration to the potential safety value of continuous monitoring of oxygenation (pulse oximetry) and ventilation in patients receiving PCA or neuraxial opioids in the postoperative period. Although pulse oximetry will monitor oxygenation, it is not a sensitive or specific monitor for hypoventilation when supplemental oxygen is being administered. When supplemental oxygen is indicated, monitoring of ventilation may warrant the use of technology designed to detect breathing or estimate arterial carbon dioxide concentrations.

Continuous monitoring is most important for at-risk patients, but depending on clinical judgment, could be applied to other patients. APSF also believes it is critical that any monitoring system be linked to a reliable process to summon a competent healthcare professional to the patient's bedside in a timely manner.

APSF recognizes that future developments may improve the ability to utilize continuous monitoring of oxygenation and ventilation in the postoperative period. In this regard, APSF encourages research and education in postoperative monitoring of patients receiving opioids. However, the status quo while awaiting the perfect monitor(s) is not acceptable and APSF urges consideration of continuous postoperative monitoring of oxygenation and ventilation in appropriate patients without delay.

A complete report of the conference presentations and an expanded description of APSF's goals and conclusions will be published in a future issue of the APSF Newsletter.

Robert K. Stoelting, MD

President, APSF