AFTER THE CRISIS

IF THE PATIENT SURVIVES

Talk to the patient at the earliest opportunity
     Explain what has happened
     Keep it simple and stick to the facts
     Avoid guesswork
     Do not admit liability but do apologise for the mishap
For incidents with risk of psychiatric trauma/awareness/disability/pain,
     involve a psychiatrist/psychologist
If it was a minor mishap (eg. superficial corneal or dental damage)
     - arrange for the problem to be corrected as soon as possible, at no expense to the patient.

IF THE PATIENT DIES

Contact a senior colleague who will:
     Advise you to stop working that day/night
     Help you with the tasks ahead
     Liaise with medical/hospital administration
     Arrange cover of your duties
Make a factual account as soon as possible referring to the medical record
     Do not alter or erase any part of the anaesthetic record
     You may annotate the medical record with a separately timed, dated and signed postscript
Leave ETT, IV lines, catheters etc. in situ
If there is any doubt at all about what happened,
     isolate the theatre/equipment/drugs for future examination by an appropriate person,
     who can document the checks performed.
Contact the family personally as soon as possible
Arrange an interview in a suitable room
DO NOT let others (eg. surgeon) conduct the interview alone
Give the bad news first; show empathy
Explain the facts as known at the time
Do not offer opinions lightly
Make yourself available to the family (eg. contact numbers)
Debrief the staff involved
Seek a good friend/family member for support
Contact the Head of Department
Contact the relevant medical defence organisation

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AFTER THE CRISIS - THE POST-MISHAP PROTOCOL

(A two-page Action Card)

1. Contact a mentor/senior colleague: To come and assist in the protocol.

2.     The patient: Should be informed as soon as possible if he or she has survived and is conscious. The Coroner's office is
        responsible for the body of a dead patient; the surviving patient usually needs intensive care and the anaesthetist must be seen to
        be there and to be part of the team.

3.     The relatives: Need to be informed promptly and accurately of what has occurred.
        THE SURGEON MUST NEVER CONDUCT THE INTERVIEW ALONE.
        The interview should be unhurried, run as a team effort and may be divided into two parts:
           - first the bad news,
           - and then after a pause, the facts as known.
        Start with the need for the operation, what the plan was for the anaesthetic and build the basic medical history of the patient.
        If an opinion is to be offered, make it clear that it is an informed guess, not fact; the autopsy may prove you wrong.
        Ongoing support and communication channels of a surviving patient and of their friends and relatives should be established.

4. The next patient: Deserves a fresh team and equipment. The unthinkable sequel to an unexpected death is that the next patient
also dies because of an undetected equipment fault or overstressed personnel.

5. The equipment and drugs used: If implicated, must be isolated for examination.

6. The medical staff involved: Need a debriefing session to state what they think occurred, to ventilate their feelings and to learn
from the mishap. Critical Incident Stress Debriefing (CISD) may be appropriate after two or three days.

7.     The nursing and paramedical staff: Should attend an end-of-shift defusing session, to allow immediate reactions to be
        revealed, and a factual and concise "take away" statement to be given out, in order that the hospital staff have information that is
        appropriate and accurate. The situation may also require a formal CISD. Special consideration should be given to any
        anaesthesia nurse(s) involved.

8.     Administrative details: Check the medical record for accuracy and completeness, prepare formal statements, hospital or
        departmental incident reports, AIMS and TGA reports. The ICU record should be examined frequently. never alter or destroy
        the record, but you may annotate with a separate, timed, dated and signed postscript.

9. The anaesthetist, as well as the anaesthetist's family, should be supported and assisted in the immediate post-catastrophe
period.

10. The courts: Copy, review and understand all relevant records. Notify medical defence and hospital administration.
Prepare a personal statement of events for medical defence, even if no court action follows.

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