Special Focus: Staff Education and Safety Training
Staff training is critical for anesthetic safety. Although this is actually the first step in anesthesia, this section has been placed separately in order to emphasize its importance.
Providing quality patient care through scientific and knowledge based practice is the mission of veterinary medicine. A cornerstone of the implementation and success of this objective is the veterinary staff, from the veterinarians, technicians, and assistants to the receptionist/office personnel. Creating a cohesive team and providing the educational training resources for the staff is key to patient and personnel safety. Untrained staff can lead to unhappy, unproductive employees who are inefficient and could compromise patient care with procedural mistakes. This can lead to a decline in customer service, ultimately leading to a decrease in practice revenue as a result of the loss of clients.
A successful training program begins with the active participation of the employee. Taking the time to introduce staff to hospital policies and procedures will result in a more efficient workflow. Training can be performed by all members of the team in various capacities; for example, an experienced nurse can teach clinical skills, the veterinarian can teach science, and the patient care representative or receptionist can help with effective client communication. This allows for all practice team members to become engaged in the success of individual employees.
First, create a plan for training by determining the practice goals. Be specific in those expectations. A comprehensive staff training program is outlined here, organized into weekly training sessions over a 12 wk period. Assign each department into an individual training objective, an approach that minimizes the ambiguity of trying to “learn everything.” List the tasks you need each employee to learn weekly and monthly as well as the resources available to support these skills. Regularly test your new employees to ensure retention of material. Use the full spectrum of educational resources, including handouts, in-house presentations, checklists, and online courses.
Anesthesia-based training programs should start with the anesthesia machine. Employees should not attempt to use anesthetic equipment before being properly trained and qualified to troubleshoot problems.55 Checklists for daily anesthesia machine function, case preparation, and preventive maintenance should be readily available to the employee. A reliable way to prevent equipment failure is to inspect each part of the machine daily and before use.56 Once a technician has been trained how to set up, operate, and disassemble the anesthesia machine, the primary focus should center on the proper use of breathing circuits, rebreathing bags, and appropriate endotracheal tube selection. A properly working anesthesia machine is critical to not only patient safety but also operator safety. Exposure to volatile anesthetic agents, including nitrous oxide and halogenated gases, is hazardous. Although the full risks associated with anesthesia exposure are unknown, exposure should be minimized. Retrospective studies have indicated, although specific incidence is unknown, that exposure to these hazardous chemicals can result in headaches, nausea, early pregnancy loss, and reduced sperm count in humans.57 A properly sealed (i.e., not leaking) machine and ETT cuff, avoidance of mask and chamber inductions, and the proper use of the scavenging systems will limit exposure to anesthesia gases.
Once an employee is comfortable operating the anesthesia machine, training should shift to include anesthetic monitoring. Most patient complications will first be detected through use of an anesthetic monitor. For that reason, the anesthetist should be comfortable interpreting patient parameters such as ECG, ETCO2, BP, SpO2, and body temperature.
Anesthesia is pharmacologically based. Thus, specific training should be conducted on the various drug classes, along with a “what to expect” guideline. Emphasis can be placed on the medications used for sedation, pain management, and general anesthesia (see the sections on Anesthesia Protocol).
All clinical personnel should be trained in emergency resuscitation, with a review session repeated every 6–12 mo. The new Reassessment Campaign on Veterinary Resuscitation (RECOVER) initiative uses a combination of online and hands-on training.58 Studies show that cardiopulmonary resuscitation outcomes are affected, not only by the availability of emergency carts, drugs, and equipment but also by the level of training within the hospital. The recognition of an emergent situation is almost as critical as the response itself.