When it is considered appropriate for a do not to attempt cardiopulmonary resuscitation in the event of a cardiopulmonary arrest (DNACPR) order, this should be discussed with capacitous patients, including those who have expressed their own wish not to be resuscitated.120 In patients not without capacity to consent, every attempt should be made to discuss this with next of...
The paediatric anaesthetist should consider the patient’s age and physical capacity, the complexity of the procedure and the status of the surgical facility before administering anaesthesia. Children with learning and/or communication difficulties requiring sedation or anaesthesia should be cared for as per the recommendations of GPAS Chapter 10: Guidelines for the Provision of Paediatric Services.39
All patients (and relatives where appropriate and relevant) should be fully informed about the planned procedure and should be encouraged to be active participants in decisions about their care. Recommendations about the provision of information and consent processes outlined in Guidelines for the Provision of Anaesthesia Services for the Perioperative Care of Elective and Urgent Care Patients should be followed.24
Audit programmes should be developed locally but should include continuous audit of transfer of neuroscience patients, neurocritical care capacity and demand, rates of unplanned admission and readmission to the intensive care unit, and the caseload of anaesthetists in training, among others. In general, local practice should be audited against compliance rates with national and expert consensus guidelines.5,41,53
A support system and guidelines developed in conjunction with occupational health professionals should be in place to help anaesthetists returning to clinical work after a period of absence from clinical practice.21, 22 These could include, but are not limited to, returning after parental leave, or returning following long-term illness.23
The risk of postoperative functional decline and complex discharge related issues should be considered. Procedures should be in place to identify complex patients at pre-assessment and complex discharge planning should begin then. This will require a multi-disciplinary team approach. Guidelines should be developed for the prevention, recognition and management of common postoperative geriatric complications and/or syndromes, including delirium, falls, functional...
