Where possible, ophthalmic surgery should be postponed until after delivery. When this is not possible, guidelines on anaesthetising pregnant patients should be followed (e.g. use of left lateral tilt after 16 weeks of gestation).7Local anaesthesia, with or without anxiolytic sedation, is usually preferable to general anaesthesia.
There should be induction programmes for all new members of staff, including locums. Induction for a locum doctor should include familiarisation with the layout of the hospital and the location of emergency equipment and drugs, access to guidelines and protocols, information on how to summon support/assistance, and assurance that the locum is capable of using the equipment in that hospital...
The urgent need for more doctors to be able to train as anaesthetists is always the first thing I raise in conversations I have with the government, NHS England and other decision makers around the country. Last month I wrote to the new Secretary of State for Health and Social Care to set out the need to address the current shortage of anaesthestists and to outline the impact this is having on the elective care backlog, among other things.
In the last year we have secured some incremental improvements on this front, but there is a long way to go, and we will do all we can to maintain momentum in the year ahead.
Agreed local clinical guidelines should be in use, produced by an appropriately constituted multiprofessional team, comprising anaesthetists, specialist nurses, surgeons, critical care clinicians, pharmacists, specialty consultants and managers. These guidelines should cover at least the following:
Departments should develop and regularly review burn and plastic surgery referral guidelines and major incident plans.66
Guidelines should be developed for the prevention, recognition and management of common postoperative geriatric complications and/or syndromes, including delirium, falls, functional decline and pressure areas.
