Risk containment during cardiopulmonary bypass.

Abstract

It is evident that positive attitudes towards patient care are the cornerstone of risk containment during CPB. Positive attitudes are shaped by education and training, including continuing education. Mutual respect among team members can foster positive attitudes that are manifested in an orderly, quiet operating room, with those present always mindful of the patient's welfare. Vigilance is the key in preventing complacency during CPB procedures that have now become routine. Collins writes that the best airplane pilots develop a curious and suspicious attitude in the cockpit and, again, the applicability of the aviation and perfusion analogy is apparent. Monitors, standards, protocols, and safety devices can never fully replace vigilance in overcoming human frailty or error. Vigilance has been defined as "a state of clinical awareness whereby dangerous conditions are anticipated or recognized and promptly treated." Stoelting further writes that levels of vigilance may be reduced by extraneous distractions, fatigue, and stress. Gaba et al have studied anesthetic mishaps in the context of accident investigations in unrelated fields and have suggested two responsibilities in breaking the chain of accident evolution. The first is to scrutinize our own abilities and limitations ... and implement the procedures and training that can be shown to optimize patient safety, and second ... to reexamine the entire structure of our industry, attempting to steer the interacting sources of incentive and constraint towards a system that promotes patient safety. Guides to acceptability of risk include the twin tenets of reasonableness and custom of usage, prevailing professional practice, the best available practice, and the degree of necessity or benefit.(ABSTRACT TRUNCATED AT 250 WORDS)