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Alert: Thousands Undergo Surgery Partially Awake
Better understanding by health professionals can reduce risk
Oct. 6, 2004 - Tens of thousands of patients undergoing surgery each
year experience the helplessness of being partially awake while
under general anesthesia during surgery, but being unable to
communicate their distress to caregivers. Better understanding among
health care professionals of this frightening phenomenon could
reduce the risk of these events and assure appropriate support for
patients when they do occur, according to an Alert issued today by
the Joint Commission on Accreditation of Healthcare Organizations.
The phenomenon of anesthesia awareness affects an estimated 20,000
to 40,000 patients each year. While that figure represents only one
to two cases in every 1,000 general anesthetics administered, the
experience is traumatic for those patients who do become aware.
Patients undergoing cardiac, obstetric and major trauma surgeries
are at proportionately higher risk for anesthesia awareness,
according to the Joint Commission's Sentinel Event Alert patient
safety newsletter.
"Anesthesia awareness is under-recognized and under-treated in
health care organizations," says Dennis S. O'Leary, M.D., president,
Joint Commission. "The Joint Commission understands that anesthesia
professionals must balance the psychological risks of anesthesia
awareness against the physiological risks of excessive anesthesia.
This Alert is intended to help health care organizations address
this problem in an open and constructive fashion."
The Joint Commission Alert to more than 15,000 health care
organizations nationwide is designed to provide practical advice to
health care organization leaders and health care professionals to
help prevent or, when it occurs, manage anesthesia awareness. The
specific recommendations set forth in the Alert include:
1) Develop and implement an anesthesia awareness policy that
addresses the following:
-- Education of clinical staff about anesthesia awareness and how to
manage patients who have experienced awareness.
-- Identification of patients at proportionately higher risk for an
awareness experience, and discussion with such patients, before
surgery, of the potential for anesthesia awareness.
-- The effective application of available anesthesia monitoring
techniques, including the timely maintenance of anesthesia
equipment.
-- Appropriate post-operative follow-up of all patients who have
undergone general anesthesia, including children.
-- The identification, management and, if appropriate, referral of
patients who have experienced awareness.
2) Assure access to necessary counseling or other support for
patients who are experiencing post-traumatic stress syndrome or
other mental distress.
The Alert on anesthesia awareness is the latest in a series of
periodic Alerts issued by the Joint Commission. The content for most
but not all of these Alerts is drawn from the Joint Commission's
Sentinel Event Database, one of the nation's most comprehensive
voluntary reporting systems for adverse events in health care.
Previous Alerts have addressed wrong-site surgery, deadly medication
mix-ups, health care-acquired infections, patient suicides, infant
abductions, and fatal falls among the elderly. This Database
identifies the common underlying causes of sentinel events and
provides an informed basis for the Joint Commission to warn
facilities about dangers and share solutions for preventing these
occurrences. The complete list and text of past issues of Sentinel
Event Alert can be found on the Joint Commission website at
http://www.jcaho.org.
Founded in 1951, the Joint Commission on Accreditation of Healthcare
Organizations seeks to continuously improve the safety and quality
of care provided to the public through the provision of health care
accreditation and related services that support performance
improvement in health care organizations. The Joint Commission
evaluates and accredits more than 15,000 health care organizations
and programs in the United States, including more than 7,800
hospitals and home care organizations, and more than 7,300 other
health care organizations that provide long term care, assisted
living, behavioral health care, laboratory and ambulatory care
services. The Joint Commission also accredits health plans,
integrated delivery networks, and other managed care entities. In
addition, the Joint Commission provides certification of
disease-specific care programs and primary stroke centers. An
independent, not-for-profit organization, the Joint Commission is
the nation's oldest and largest standards- setting and accrediting
body in health care. Learn more about the Joint Commission at
http://www.jcaho.org.
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