Anaesthetic chart report

Anaesthetic chart report

This report was commissioned to explore and develop a standard for the anaesthetic chart, recognising its integral role in patient safety within the perioperative pathway.

Overview

Anaesthetics is the single largest UK hospital specialty, over two-thirds of hospital in-patients will see an anaesthetist and sixteen per cent of all hospital consultants are anaesthetists. 

The anaesthetic chart:

  • Is integral to the real-time delivery of safe anaesthesia – acknowledgement of trends, variations, events, and actions is part of the process of giving an anaesthetic.
  • Provides instantaneous presentation of key data, when rapid decisions are needed at critical parts of an operation or in an emergency.
  • Acts as a prompt for best practice and safe care.

 

Scope

This scope of this report is limited to the anaesthetic record and the use of charts for adults in the operating theatre setting. Scope of this phase is restricted to: 

  • The development of the Discovery Phase Report.
  • The draft Information Standard.

 

Outcomes

The following recommendations have been made:

  • The NHS should commission the development of the Anaesthetic Chart Standard as a good first step but should consider commissioning the development of integrated information standards for the complete perioperative pathway. This will future-proof standards developed and deliver maximum benefit.
  • The full standard development cycle for the Anaesthetic Chart Standard should be commissioned to include full consultation, endorsement, piloting, and implementation support, together with the development of technical messaging standards.
  • Implementation support should include, where possible, definition of benefits which can be attributed to implementation of an electronic anaesthetic chart.
  • Due to the critical importance of the user interface design in the intraoperative operating theatre environment, detailed implementation guidance should be developed to cover this aspect. This should be led by clinicians to determine what good looks like, what mandatory information must be available and how this should be presented.
  • Simulation can be utilised to identify pathway touchpoints (where data is created, used, or changed) and prototype requirements. User interface design should be specifically addressed in the Safety Case and with system suppliers.
  • Conformance with the Anaesthetic Chart Standard should be mandated in the procurement process for Electronic Health Record (HER) systems.

Final Report

Publication date: July 2023

Anaesthetic chart report

surgery

CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests. 
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history. 

 

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning. 

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”