title: Crisis management during anaesthesia: problems associated with drug administration during anaesthesia.
abstract: BACKGROUND
  Modern anaesthetic practice relies upon the administration of a wide range of potent drugs given by a variety of routes, at times in haste or under conditions of stress. Problems associated with drug administration make up the largest group of incidents reported during anaesthesia, with outcomes including major morbidity and death. It was decided to examine the role of a structured approach to the diagnosis and management of drug problems under anaesthesia.
  
  
  OBJECTIVE
  To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for drug problems, in the detection and management of drug problems occurring in association with anaesthesia.
  
  
  METHODS
  The potential performance of this structured approach for the relevant incidents among the first 4000 incidents reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual performances as reported by the anaesthetists involved.
  
  
  RESULTS
  Among the first 4000 reports received by AIMS there were 1199 reports which detailed 1361 incidents involving the use of drugs. Contributing factors named included errors of judgement (20%), lack of attention (17%), and drugs deemed to have been given in haste. Major morbidity or prolonged stay ensued in over one quarter of reports and 15 patients (1.25%) died. Drug overdose, side effects, and allergic reactions accounted for the majority of serious outcomes.
  
  
  CONCLUSIONS
  It was judged that the use of the COVER-ABCD algorithm during the course of an anaesthetic, properly applied, would prevent many drug related incidents from occurring. The sub-algorithm presented here provides a systematic framework for detecting the causes of drug related incidents.
authors.affiliation: Princess Royal University Hospital, Orpington, Kent, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Paix
authors.forename: M F
authors.initials: MF
authors.lastname: Bullock
authors.forename: W B
authors.initials: WB
authors.lastname: Runciman
authors.forename: J A
authors.initials: JA
authors.lastname: Williamson
mesh_terms: D000465:Algorithms; D000758:Anesthesia / Q000009:adverse effects*; D000776:Anesthesiology / Q000379:methods* / Q000592:standards; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D001315:Australia; D004630:Emergencies; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D008370:Manuals as Topic; D008508:Medication Errors; D016343:Monitoring, Intraoperative; D012308:Risk Management; D013647:Task Performance and Analysis
chemical_list: D018686:Anesthetics, Intravenous