Quality of clinical practice guidelines in delirium

Bush, S.H. et al. (2017) BMJ Open. 7:e013809

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Objective: To determine the accessibility and currency of delirium guidelines, guideline summary papers and evaluation studies, and critically appraise guideline quality.

 

Conclusions: Delirium guidelines are best sourced by a systematic grey literature search. Delirium guideline quality varied across all six AGREE II domains, demonstrating the importance of using a formal appraisal tool prior to guideline adaptation and implementation into clinical settings. Adding more knowledge translation resources to guidelines may improve their practical application and effective monitoring. More delirium guideline evaluation studies are needed to determine their effect on clinical practice.

Read the full review here

European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium

Aldecoa, C. et al. (2017) European Journal of Anaesthesiology. 34(4) pp. 192-214

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Postoperative delirium (POD) is an adverse postoperative complication that can occur in patients of any age, from children to the elderly. Its incidence varies in the various age groups and is substantially influenced by patient-related risk factors that are variably distributed and differentially accumulate in the different age groups. Elderly patients are generally thought to be at higher risk because predisposing risk factors such as cognitive impairment, comorbidity, sensorial deficits, malnutrition, polymedication, impaired functional status and frailty (a condition that can only be observed among aged patients) accumulate and overlap with ageing.

Moreover, POD (refer to the specific definition in the ‘Paediatric patients’ section) is a common complication in children of pre-school age (5 to 7 years): whether this is due to age-related psychological issues or to additional inflammatory effects on the brain cannot currently be determined. There is a limited number of studies on cognitive outcomes in children. For the USA, the Food and Drug Administration (FDA) recently recommended cautious indications for anaesthesia and surgery in children aged less than 3 years. In Europe, the ESA launched an initiative, the EUROpean Safe Tots Anaesthesia Research (Eurostar) Initiative Task Force to promote translational research on anaesthesia neurotoxicity and long-term outcomes after paediatric anaesthesia and surgery.

Read the abstract here

ACP Guideline: Nondrug Treatments Should Be First-Line Therapy for Low Back Pain

Nondrug treatment alternatives should be considered as first-line therapy for patients with low back pain according to an updated clinical practice guideline from the American College of Physicians | Anesthesiology News

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The new guideline offered three main recommendations for treating acute (less than four weeks), subacute (four to 12 weeks) and chronic (>12 weeks) LBP:

  •  Nonpharmacologic treatments such as acupuncture, heat packs and massage are strongly recommended because acute or subacute LBP is expected to improve over time regardless of treatment.
  •  Nonpharmacologic treatment such as exercise, multidisciplinary rehabilitation, yoga and tai chi should be initially used for patient with chronic LBP.
  •  Only after these treatments are deemed ineffective should nonsteroidal anti-inflammatory drugs be considered as first-line therapy.

Read the full article here

Service pressures and the role of anaesthetists in training – joint RCoA & AAGBI statement

Service pressures and the role of anaesthetists in training – joint RCoA & AAGBI statement
The Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists of Great Britain & Ireland (AAGBI) have issued the following statement in light of some anaesthetists in training being asked to work outside of their usual scope of practice due to recent unprecedented demands on clinical services:

Patient safety should be the first priority of all NHS staff at all times. To support the needs of patients, and their safety, we believe the following principles are important when redeployment of trainees in our specialty is being considered although some of the points made would be equally applicable to non-trainee colleagues:

  • Trainee anaesthetists should be redeployed from their normal duties only in exceptional circumstances, and for the shortest possible length of time. The decision to do so should be made only by the Medical Director or deputy taking account of all service pressures and the clinical environment pertaining at that time.
  • Trainee anaesthetists should never practice beyond their competence. Trainees working in unfamiliar environments must have clear lines of supervision and responsibility established, and they must always receive adequate induction and be familiar with local governance arrangements.
  • It is important that those trainees asked to help support a part of the service under pressure are selected equitably from all of the medical staff competent to contribute to that aspect of the hospital’s clinical activity and that the number of sessions each redeployed trainee spends in another clinical service is closely monitored. 
  • If as a result of a change in duties an anaesthetic trainee misses an important training opportunity, it should be clearly outlined how this training will be accessed in a timely manner once the crisis has passed. We would encourage trainees to reflect on their experiences of working under these circumstances with their educational supervisors so that trainers can fully understand the problems trainees face and the potential for learning in these unfamiliar environments.

The decision to alter a trainee anaesthetist’s duties should be communicated by the Medical Director to the local Guardian of safe working, the trainee’s educational supervisor, RCoA Tutor (who should inform the relevant RCoA Regional Advisor) and Postgraduate Dean at the earliest opportunity. This should outline the circumstances that led to the redeployment being necessary; how long it will last for and the actions that will be put in place to avoid a recurrence in the future”.

 

 

 

New Guidelines: Consent for Anaesthesia 2017

This is a consensus document produced by expert members of a Working Party established by the AAGBI. 

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Previous guidelines on consent for anaesthesia were issued by the Association of Anaesthetists of Great Britain and Ireland in 1999 and revised in 2006. The following guidelines have been produced in response to the changing ethical and legal background against which anaesthetists, and also intensivists and pain specialists, currently work, while retaining the key principles of respect for patients’ autonomy and the need to provide adequate information. The main points of difference between the relevant legal frameworks in England and Wales and Scotland, Northern Ireland and the Republic of Ireland are also highlighted.

Read the full guidance here

 

The European Board of Anaesthesiology recommendations for safe medication practice

These European Board of Anaesthesiology (EBA) recommendations for safe medication practice replace the first edition of the EBA recommendations published in 2011 | (2017) European Journal of Anaesthesiology .34(1) pp.4-7

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They were updated because evidence from critical incident reporting systems continues to show that medication errors remain a major safety issue in anaesthesia, intensive care, emergency medicine and pain medicine, and there is an ongoing need for relevant up-to-date clinical guidance for practising anaesthesiologists.

The recommendations are based on evidence wherever possible, with a focus on patient safety, and are primarily aimed at anaesthesiologists practising in Europe, although many will be applicable elsewhere. They emphasise the importance of correct labelling practice and the value of incident reporting so that lessons can be learned, risks reduced and a safety culture developed.

Read the full article here

Evidence-Based Guidelines for Management of Post-Op Pain Issued Jointly by APS, ASA and ASRA

Holzman, D.C. Anesthesiology News. Published online: 18 April 2016.

The American Pain Society, for the first time, has released a clinical practice guideline on managing postoperative pain.

The guideline was created with input from the American Society of Anesthesiologists (ASA) and was subsequently approved by the American Society for Regional Anesthesia and Pain Medicine (ASRA), and was based on the 23-member panel’s review of 6,500 scientific abstracts and primary studies.

Read the full news story here