The emotional health of caregivers should be taken into consideration in incident investigation with advice and support available for dealing with hospital investigations, coroners’ inquests and possible legal proceedings. Resulting action and further psychological support should be available to individuals to enable recovery.98
If a member of staff is excluded from work, the department should ensure that the staff member continues to receive all appropriate emotional support including contact from colleagues and members of the department if requested.
The anaesthetic department should encourage and focus on learning through positives including what goes well. One key area for doing this on a daily basis is through the end of list debrief. There should be allocated time for the debrief to take place and this should be attended by all members of the theatre team.99
Anaesthetic departments should consider a system for documenting and sharing success with colleagues or the department as a whole.
There should be mechanisms to disseminate and use national safety alerts from groups such as the Safe Anaesthesia Liaison Group.
The anaesthetic department should engage with national safety initiatives such as ‘Stop Before You Block’ and audit practice, and should measure effectiveness against these initiatives.100
Decision support systems for crisis scenarios should be available, for example the Association of Anaesthetists Quick Reference Handbook.101
The anaesthetic department should develop and document a quality improvement (QI) plan in accordance with operational aims and objectives and in consultation with staff members. The QI plan should include all potential areas for improvement and adoption of innovation.43
The anaesthetic department should have a comprehensive and collaborative programme of engagement with QI initiatives locally, including audit of local guidelines and SOPs and improvements made following learning from incidents or near misses.102
The anaesthetic department should have a comprehensive and collaborative programme of engagement with QI initiatives at national level,103 for example ACSA, the RCoA Raising the standards : QI Compendium,43 national audit projects such as NELA, PQIP, SNAP and GIRFT. This should include embedding learning and improvement from these national initiatives.
