Multimodal, clinical assessment of a system to reduce error during anaesthesia.

INTERVENTION: A multimodal integrated system for the safe administration of drugs and compilation of an accurate automated record during anaesthesia This System has now been used in 170,000 anaesthetics. It is multifaceted and includes novel equipment, consumables and procedures. It was designed on the basis of lessons from empirical incident reporting, the psychological mechanisms underlying human error and the principles of system safety developed in the high‐risk chemical, nuclear and aviation industries. It includes specialised trays (which support aseptic technique and promote a well‐organised anaesthetic workspace), colour‐ and bar‐coded labelling of syringes (which facilitate the selection and tracking of drugs), pre‐filled syringes for the most commonly used anaesthetic drugs (to remove a key error‐prone step in drug administration and to save time), and automatic visual and auditory verification of syringes using a computer and bar‐codes just prior to each drug administration. The System also compiles an automated anaesthetic record, with the intention of improving comprehensiveness and accuracy, and of freeing the anaesthetist to spend more time caring for and monitoring the patient. The duration of the intervention will be up to 12 months in one or more designated operating rooms at Auckland City Hospital CONDITION: Drug administration error and failures in vigilance in anaesthesia PRIMARY OUTCOME: Failures in the accuracy and completeness of anaesthetic records Lapses in vigilance tested with a vigilance ; probe. To be reported as a co‐primary outcome with outcome 1. The composite of 1) rates of error related to iv drug administration; 2) failures in the accuracy and completeness of the anaesthetic iv drug records SECONDARY OUTCOME: Cost of procedures (in terms of money and time) Evaluation of safety assessment code (SAC) for each error ? see below Legibility of records Quantitative and qualitative measures of workflow Rate of actual harm from error The difference between Maori and other groups of patients combined in the primary outcome variable INCLUSION CRITERIA: All patients undergoing anaesthesia in designated operating rooms in Auckland City Hospital during the study period.