PMID- 28991115
OWN - NLM
STAT- MEDLINE
DCOM- 20190724
LR  - 20220321
IS  - 1526-7598 (Electronic)
IS  - 0003-2999 (Linking)
VI  - 126
IP  - 5
DP  - 2018 May
TI  - Preventing Adverse Events in Cataract Surgery: Recommendations From a 
      Massachusetts Expert Panel.
PG  - 1537-1547
LID - 10.1213/ANE.0000000000002529 [doi]
AB  - Massachusetts health care facilities reported a series of cataract 
      surgery-related adverse events (AEs) to the state in recent years, including 5 
      globe perforations during eye blocks performed by 1 anesthesiologist in a single 
      day. The Betsy Lehman Center for Patient Safety, a nonregulatory Massachusetts 
      state agency, responded by convening an expert panel of frontline providers, 
      patient safety experts, and patients to recommend strategies for mitigating 
      patient harm during cataract surgery. The purpose of this article is to identify 
      contributing factors to the cataract surgery AEs reported in Massachusetts and 
      present the panel's recommended strategies to prevent them. Data from 
      state-mandated serious reportable event reports were supplemented by online 
      surveys of Massachusetts cataract surgery providers and semistructured interviews 
      with key stakeholders and frontline staff. The panel identified 2 principal 
      categories of contributing factors to the state's cataract surgery-related AEs: 
      systems failures and choice of anesthesia technique. Systems failures included 
      inadequate safety protocols (48.7% of contributing factors), communication 
      challenges (18.4%), insufficient provider training (17.1%), and lack of 
      standardization (15.8%). Choice of anesthesia technique involved the increased 
      relative risk of needle-based eye blocks. The panel's surveys of Massachusetts 
      cataract surgery providers show wide variation in anesthesia practices. While 
      45.5% of surgeons and 69.6% of facilities reported increased use of topical 
      anesthesia compared to 10 years earlier, needle-based blocks were still used in 
      47.0% of cataract surgeries performed by surgeon respondents and 40.9% of those 
      performed at respondent facilities. Using a modified Delphi approach, the panel 
      recommended several strategies to prevent AEs during cataract surgery, including 
      performing a distinct time-out with at least 2 care-team members before block 
      administration; implementing standardized, facility-wide safety protocols, 
      including a uniform site-marking policy; strengthening the credentialing and 
      orientation of new, contracted and locum tenens anesthesia staff; ensuring 
      adequate and documented training in block administration for any provider who is 
      new to a facility, including at least 10 supervised blocks before practicing 
      independently; using the least invasive form of anesthesia appropriate to the 
      patient; and finally, adjusting anesthesia practices, including preferred 
      techniques, as evidence-based best practices evolve. Future research should focus 
      on evaluating the impact of these recommendations on patient outcomes.
FAU - Nanji, Karen C
AU  - Nanji KC
AD  - From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts 
      General Hospital, Harvard University, Boston, Massachusetts.
FAU - Roberto, Sarah A
AU  - Roberto SA
AD  - Betsy Lehman Center for Patient Safety, Boston, Massachusetts.
FAU - Morley, Michael G
AU  - Morley MG
AD  - Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
FAU - Bayes, Joseph
AU  - Bayes J
AD  - Department of Anesthesia, Massachusetts Eye & Ear, Harvard Medical School, 
      Boston, Massachusetts.
LA  - eng
GR  - K08 HS024764/HS/AHRQ HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Anesth Analg
JT  - Anesthesia and analgesia
JID - 1310650
CIN - Anesth Analg. 2018 May;126(5):1446-1447. PMID: 29672383
CIN - Anesth Analg. 2018 Oct;127(4):e69-e70. PMID: 30028348
CIN - Anesth Analg. 2018 Oct;127(4):e68-e69. PMID: 30028349
CIN - Anesth Analg. 2018 Oct;127(4):e67-e68. PMID: 30059401
CIN - Anesth Analg. 2018 Oct;127(4):e66. PMID: 30059403
CIN - Anesth Analg. 2019 Jan;128(1):e11. PMID: 30346357
CIN - Anesth Analg. 2019 Jan;128(1):e11-e12. PMID: 30346359
MH  - Cataract/*epidemiology
MH  - Cataract Extraction/adverse effects/*standards
MH  - Expert Testimony/*standards
MH  - Female
MH  - Health Personnel/*standards
MH  - Humans
MH  - Male
MH  - Massachusetts/epidemiology
MH  - Postoperative Complications/epidemiology/prevention & control
MH  - *Surveys and Questionnaires
EDAT- 2017/10/11 06:00
MHDA- 2019/07/25 06:00
CRDT- 2017/10/10 06:00
PHST- 2017/10/11 06:00 [pubmed]
PHST- 2019/07/25 06:00 [medline]
PHST- 2017/10/10 06:00 [entrez]
AID - 10.1213/ANE.0000000000002529 [doi]
PST - ppublish
SO  - Anesth Analg. 2018 May;126(5):1537-1547. doi: 10.1213/ANE.0000000000002529.