1. Professional status
Anesthesia services are a vital component of basic healthcare requiring appropriate resources. The WFSA views anesthesia as a medical practice. Medically trained anesthesia specialists should be trained and accredited with clinical and administrative autonomy. When anesthesia is provided by non-medical personnel, these providers should be appropriately trained and accredited as well as directed and supervised by medically qualified specialist anesthesia professionals.
2. Professional organizations
Anesthesia professionals should form appropriate organizations at local, regional, and national levels for the setting of standards of practice, supervision of training and continuing education/continuing professional development with appropriate certification and accreditation, and general promotion of anesthesia as an independent professional specialty. These organizations should form links with appropriate groups within the region and/or country and internationally.
3. Training, certification, and accreditation
Adequate time, facilities, and financial support should be available for professional training, both initial and continuing, to ensure that an adequate standard of knowledge, expertise, and practice is attained and maintained. Formal certification of training and accreditation to practice is RECOMMENDED.
4. Records and statistics
A record of the details of each anesthetic should be made and preserved with the patient’s medical record. This should include details of the pre-operative assessment and the post-operative course. It is RECOMMENDED that individuals, departments, and regional and national groups collect cumulative data to facilitate the progressive enhancement of the safety, efficiency, effectiveness, and appropriateness of anesthesia care.
5. Peer review and incident reporting
Institutional, regional, and/or national mechanisms to provide a continuing review of anesthetic practice should be instituted. Regular confidential discussion of appropriate topics and cases with multidisciplinary professional colleagues should take place. Protocols should be developed to ensure that deficiencies in individual and collective practice are identified and rectified. An anonymous incident reporting system with case analysis and resulting suggested remedies is RECOMMENDED.
A sufficient number of trained anesthesia professionals should be available so that individuals may practice to a high standard without undue fatigue or physical demands. Time should be allocated for education, professional development, administration, research, and teaching.
An anesthesia professional should be dedicated to each patient and be immediately present throughout each anesthetic (general, regional, or monitored sedation), and should be responsible for the transport of the patient to the post-anesthesia recovery facility and the transfer of care to appropriately trained personnel. An anesthesia professional should retain overall responsibility for the patient during the recovery period and should be readily available for consultation until the patient has made an adequate recovery. If responsibility for care is transferred from one anesthesia professional to another, a “handover protocol” should be followed, during which all relevant information about the patient’s history, medical condition, anesthetic status, and plan should be communicated. An anesthesia professional should ensure, if aspects of direct care are delegated before, during, or after an anesthetic, that the person to whom responsibility is delegated is both suitably qualified and conversant with relevant information regarding the anesthetic and the patient. Where it is impossible for this standard to be attained and the surgeon or other individual assumes responsibility for the anesthetic, these arrangements should be reviewed and audited by an appropriately trained anesthesia professional.
8. Facilities, equipment, and medications
Appropriate equipment and facilities, adequate both in quantity and quality, should be present wherever anesthesia and recovery from it is undertaken, including outside traditional hospital operating room suites, such as procedure or imaging suites and outpatient facilities or offices. In-service training and verification of an individual’s ability to use a specific piece of equipment correctly and safely is required. Formal certification as documentation of this process is Suggested. A list of facilities, infrastructure elements and supplies at the three levels and suggestions as to the order in which additions should be made when possible as resources permit is presented in Table 1. Anesthesia equipment should conform to relevant national and international standards. Appropriate anesthetic, resuscitative, and adjuvant medications are required at each level.
9. World Health Organization 2009 Safe Surgery Checklist
The 2009 Safe Surgery Checklist (http://www.who.int/patientsafety/information_centre/documents/en/index.html) consists of evidence based vital checks in 3 phases: before starting anesthesia, before starting surgery and at the end of surgery. The use of the checklist (locally modified if appropriate) in anesthesia care is HIGHLY RECOMMENDED.
Peri-anesthetic care and monitoring standards
The first and most important component of peri-anesthetic care, including monitoring of the anesthesia delivery system and the patient, is the continuous presence of a vigilant anesthesia professional during anesthesia. In addition to use of monitoring technology, careful continuous clinical observation is required because equipment may not detect clinical deterioration as rapidly as the skilled professional. If an emergency requires the brief temporary absence of the primary anesthesia professional, judgment must be exercised comparing the emergency with the anesthetized patient’s condition and in the selection of the person left responsible for the anesthetic during the temporary absence.
1. Pre-anesthetic care
The patient must be evaluated by an anesthesia professional prior to administration of anesthesia and an appropriate anesthetic plan formulated. The anesthesia professional must ensure that all necessary equipment is present and functions correctly prior to initiation of anesthesia care. The anesthesia professional should ensure that assistance is available as needed and that the assistant is competent at, or has been instructed in, the necessary tasks. The development of protocols and check-lists to facilitate such verification is RECOMMENDED.
2. Pre-anesthesia checks
An appropriate “pre-list check,” which has been established in each health care institution providing anesthesia services, of the anesthesia system, facilities, equipment, and supplies should be performed prior to the start of each operating list.
The relevant components of the World Health Organization Safe Surgery Checklist should be performed.
An appropriate “pre-patient check” (such as presented in the attached Pre-anesthetic check list) which has been established in each health care institution providing anesthesia services, of the anesthesia system and anesthetizing location should be executed prior to each anesthetic.