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When members of the healthcare team are involved in a critical incident, they can be profoundly affected. A team debriefing should take place after a significant critical incident. Critical incident stress debriefing by trained facilitators, with further psychological support, may assist individuals to recover from a traumatic event. After a significant critical incident, the lead clinician should review the clinical...

Hospitals should have a clear and explicit strategy for developing a strong safety culture that includes the following characteristics: recognition of the inevitability of errors, commitment to discuss and learn from errors, proactive identification of latent threats, and the incorporation of non-punitive systems for reporting and analysing adverse events.^56,57

The organisational culture should seek to empower health professionals to implement patients’ preferences, informed by discussions around risk and benefit. Healthcare should be run from the bottom up, with ownership and decision making in the hands of professionals and patients.^59,60,61

Patients from non-English speaking groups may need interpreters. Hospitals should have arrangements in place to provide language support, including interpretation and translation (including sign language and Braille). This information should comply with the NHS England Accessible Information Standard.⁶⁹ Patients with learning and other difficulties may need special assistance and consideration.

Training for anaesthetists to attain stage 1, stage 2 and stage 3 competencies in pain medicine, as specified within the Royal College of Anaesthetists (RCoA) 2021 curriculum should be provided.³ Training opportunities can include allied health professional led reviews with appropriate education supervision from a recognised RCoA trainer. Where stage 3 training including Specialist Interest Areas in acute inpatient...

There should be ready access to evidence based guidelines that are appropriate for children on the following topics:

management of pain, nausea and vomiting

• fluid fasting⁶⁷
• intravenous fluid management¹⁸
• prevention of perioperative venous thromboembolism⁶⁸
• death of the child in theatre
• protocols for anaesthetic emergencies, including:
  • anaphylaxis⁶⁹
  • malignant hyperthermia
  • difficult airway management
  • airway obstruction...

There should be ready access to evidence-based guidelines that are appropriate for children on the following topics:

• management of pain, nausea and vomiting
• fluid fasting⁷²
• intravenous fluid management²⁰
• prevention of perioperative venous thromboembolism⁷³
• death of the child in theatre
• protocols for anaesthetic emergencies, including:
  • anaphylaxis⁷⁴
  • malignant hyperthermia
  • difficult airway management
  • airway obstruction
  • resuscitation
  • local anaesthetic toxicity...