| President
Addresses Locked Carts and Audible Alarm
Eugene P. Sinclair, M.D.
he President has the prerogative to publish an article
in this NEWSLETTER whenever there are special
newsworthy items of interest to the membership. I
am writing this article to bring two significant events
to your attention.
First, on Friday, March 25, 2005, the Center for Medicare
& Medicaid Services (CMS) published proposed rule
changes for the Medicare Conditions of Participation
in the Federal Register. One of the proposed changes
states that “All drugs and biologicals must
be kept in a secure area, and locked when appropriate.”
“Secure area” is defined in the narrative
accompanying the proposed rule change as one to which
only authorized personnel have access. Although
an operating suite is not specifically mentioned in
the narrative, in light of the explanatory wording,
I believe that most reasonable observers would regard
it as a “secure area.”
The publication of this proposed rule successfully
concludes an ASA initiative on “Locked Carts”
that began with a 2003 House of Delegates Resolution
and an Executive Committee policy statement on “Security
of Medications in the Operating Room.” A detailed
account of the new rule and activities leading to
its publication can be found in Karin Bierstein’s
“Practice Management” column in this NEWSLETTER
issue.
Next, I would like to report on a proposal that originated
with the Anesthesia Patient Safety Foundation (APSF)
and is under consideration by the Committee on Standards
of Care. Based on information regarding adverse anesthesia-related
outcomes, APSF proposed that the wording of the Standards
for Basic Anesthetic Monitoring be amended by adding
the following language::
STANDARDS FOR BASIC ANESTHETIC
MONITORING — PROPOSED CHANGES
(Approved by ASA House of Delegates on October
21, 1986, and last amended on October 27, 2004)
STANDARD II (Excerpted)
OXYGENATION METHODS
2) Blood oxygenation: During all anesthetics,
a quantitative method of assessing oxygenation
such as pulse oximetry shall be employed.* When
the pulse oximeter is utilized, the variable pitch
pulse tone and the low threshold alarm must be
audible .** Adequate illumination and exposure
of the patient are necessary to assess color.*
VENTILATION METHODS
2) When an endotracheal tube or laryngeal mask
is inserted, its correct positioning must be verified
by clinical assessment and by identification of
carbon dioxide in the expired gas. Continual end-tidal
carbon dioxide analysis, in use from the time
of endotracheal tube/laryngeal mask placement,
until extubation/removal or initiating transfer
to a postoperative care location, shall be performed
using a quantitative method such as capnography,
capnometry or mass spectroscopy.* When capnography
is utilized, the capnograph alarms must be audible
.**
**Under extenuating circumstances the responsible
anesthesiologist may waive the requirements marked
with an asterisk (*); it is recommended that when
this is done, it should be so stated (including
the reasons) in a note in the patient’s
medical record. |
The proposal is posted on the “Members Only”
page of the ASA Web site with a request for comments
at <www.asawebapps.org/docs/audiblealarms.htm>.
The Committee on Standards of Care will consider the
APSF proposal and report its recommendations to the
Board of Directors and House of Delegates. The House
will make the final determination whether to add the
APSF suggested wording to the Basic Standards for Anesthetic
Monitoring.
The Executive Committee, consisting of Orin F. Guidry,
M.D., Mark J. Lema, M.D., Ph.D., and me, has carefully
followed the development of the APSF proposal. We regard
it as a common-sense action that will help to avoid
preventable patient injury, and is easily implemented,
and we encourage all members to incorporate the APSF
proposal into their practices without waiting for formal
adoption of the standard.
AMA Meeting to Include Issues
for Section Council
fficials from the Society’s Section Council
on Anesthesiology of the American Medical Association
(AMA) would like to know the names of the ASA members
planning to attend the AMA’s House of Delegates
on June 18-22, 2005, in Chicago, Illinois.
The Section Council is open to all anesthesiologists
who attend the AMA House of Delegates meeting as representatives
of their state or county medical society. The Section
Council meets to discuss resolutions and other issues
of importance to anesthesiologists. Meetings usually
take place on Saturday and Monday of the AMA House
of Delegates meeting. If you are attending the House
of Delegates meeting, the Society welcomes your participation.
To be placed on the mailing list to receive information
on the Society’s AMA Section Council meetings,
please send your name, address, telephone number,
fax number and reason for attendance to Denise M.
Jones at the ASA Executive Office, 520 N. Northwest
Highway, Park Ridge, IL 60068; or fax (847) 825-2085.
The
Big One
SA turns 100 this year. This is a milestone that should
not be missed! It is a time to recognize and to reflect
on the achievements of the Society and its members
and the changes that have come about over the course
of a century. It also is an opportunity to capture
that history and ensure that it will be permanently
retained for the future.
The Wood Library-Museum of Anesthesiology (WLM) collects
the archives of many professional societies, including
those of ASA. These records document the growth of
an important branch of medical knowledge and the development
of a uniquely modern specialty. But the record of
ASA’s first 100 years is incomplete.
Many common hazards can lead to a gap in the official
records. Fortunately these losses can often be remedied
by the membership. ASA materials in your own files
just might fill some of these gaps. Minutes, correspondence,
meeting programs and other publications, photographs
and souvenirs all have archival value. If you have
these or other ASA records, please consider donating
them to the ASA archives.
For more information, contact Judith Robins by e-mail
at <j.robins@ASAhq.org>
or by telephone at (847) 825-5586, ext. 168.
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