Anesthesia — Core of Discipline

C12 Diagnosing and providing management for patients with complications of regional anesthesia

- This EPA focuses on diagnosis, assessment and management of complications relatedto regional anesthesia including history, physical exam, investigations, appropriate consultation, and follow up.
- Examples of common issues/complications include: failed or partial regional block; hypotension; phrenic nerve block.
- Examples of serious or life-threatening complications include block related hematoma or abscess; post-procedure neuropathy or pain; hypoxemia; local anesthetic toxicity; cardiac arrest.
- The EPA includes appropriate documentation as well as relevant communication and disclosure with patients and families as appropriate.
- This EPA does not include neuraxial anesthesia

Form

F1: Observation

Milestones

• ME 1.1. Demonstrate commitment and accountability for patients in their care

• ME 1.6. Seek assistance in situations that are complex or new

• ME 2.2. Elicit a history, perform a physical exam, use appropriate information from ongoing monitoring, select appropriate investigations and interpret their results for the purpose of diagnosis and management of an unexpected perioperative event

• ME 2.2. Identify and diagnose anesthesia complications encountered during the perioperative period

• ME 2.4. Manage the encountered complications of regional anesthesia and consider the risk factors, presentation, diagnosis and treatment.

• ME 3.1. Determine and implement the most appropriate procedures or therapies for the purpose of management of unexpected perioperative events

• ME 3.4. Competently perform resuscitation protocols

• ME 3.4. Perform the management and all related technical procedures in a skillful and safe manner

• ME 3.4. Establish and implement a plan for post-anesthesia care

• ME 4.1. Implement a patient-centred care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation

• ME 5.1. Report patient safety incidents to appropriate institutional representatives

• ME 5.1. Recognize near-misses in real time and respond to correct them, preventing them from reaching the patient

• ME 5.1. Identify potential improvement opportunities arising from harmful patient safety incidents and near misses

• ME 5.1. Participate in an analysis of patient safety incidents

• ME 5.2. Apply the principles of situational awareness to clinical practice

• COM 3.1. Share information and explanations that are clear, accurate and timely while checking for patient and family understanding

• COM 3.2. Communicate the reasons for unanticipated clinical outcomes to patients and disclose patient safety incidents

• COM 3.2. Apologize appropriately for a harmful patient safety incident

• COM 5.1. Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements

• COL 1.1. Anticipate, identify, and respond to patient safety issues related to the function of a team

• COL 1.3. Communicate effectively with physicians and other colleagues in the health care professions

• COL 1.3. Engage in respectful shared decision-making with physician and other colleagues in the health care professions

• COL 2.1. Delegate tasks and responsibilities in an appropriate and respectful manner

• L 1.2. Actively encourage all involved in health care, regardless of their role, to report and respond to unsafe situations

• L 4.2. Apply the principles of crisis resource management

• P 2.2. Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures

• P 3.1. Describe how to respond to, cope with, and constructively learn from a complaint or legal action

Context Variables

No context variables defined.

Requirements

• Direct observation or case and/or chart review with debrief by supervisor
• Type of regional anesthesia: upper limb nerve block; lower limb nerve block; trunk block; Bier block
• Category of event: failed block; cardiac; respiratory; neurologic; other event
• Timing of event: preoperative; intraoperative; postoperative
• Collect observations from a large breadth of training experience and issues with the expectations not all will be achieved, with a minimum of 5 observations of achievement