Value sets – OAS Anaesthesia complication

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Anaesthesia complication

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Concept IDDescription
427787004Abscess in epidural space of cervical spine
429437003Abscess in epidural space of lumbar spine
427916006Abscess in epidural space of thoracic spine
737614006Accidental awareness during maintenance of general anaesthesia
768804008Accidental awareness under general anaesthesia
737615007Accidental awareness under general anaesthesia during emergence or extubation
737613000Accidental awareness under general anaesthesia during induction or intubation
305352006Admission to adult intensive care unit
84901000000108Admission to high dependency unit or intensive therapy unit following anaesthetic adverse event
218727000Adverse reaction to spinal anaesthetic
735173007Anaphylactic shock
79337003Anaphylactic transfusion reaction
39579001Anaphylaxis
15919521000119106Anaphylaxis caused by anaesthetic
15919481000119106Anaphylaxis caused by analgesic
8217007Arachnoiditis
744853008Aspiration of foreign body into lung
35144003Aspiration of tooth or dental material
129571008Aspiration syndrome in the adult
397829000Asystole
703162001Bradycardic cardiac arrest
410429000Cardiac arrest
410430005Cardiorespiratory arrest
699748007Cardiorespiratory arrest with successful resuscitation
261195002Circulatory arrest
310481001Complaining of paraesthesia
718447001Difficult intubation
241937000Drug-induced anaphylaxis
405600004Endobronchial tube wrongly placed during anaesthetic procedure
61974008Epidural abscess
192743008Epidural intracranial abscess
230204001Epidural supratentorial pyogenic abscess
405361005Excessive spread of local anaesthetic
359844001Extradural infratentorial pyogenic abscess
698826004Failed epidural anaesthesia
1263713000Failed intubation of larynx
1263712005Failed intubation of trachea
763327008Failed mask ventilation
698825000Failed spinal anaesthesia
766780003Failed supraglottic airway ventilation
1264229001Fetal cardiac arrest
1163490004Fungal spinal epidural abscess
398987004Headache following lumbar puncture
428900007History of headache after dural puncture
723866006Idiopathic ventricular fibrillation not Brugada type
714107007Inability to reverse neuromuscular block
830275007Inadvertent dural tap
781129002Inadvertent dural tap during anaesthesia
397871004Incomplete reversal of neuromuscular block
312216007Infective meningitis
713419002Intraoperative cardiorespiratory arrest
295549004Local anaesthetic agent overdose
405501007Malignant hyperthermia
288264001Maternal anaesthetic/analgesic problem
180906006Neonatal cardiac arrest
181869007Neonatal cardiorespiratory arrest
57182000Nerve injury
448584000Neuraxial haematoma
264552009Neurological deficit
200071001Obstetric spinal and epidural anaesthesia-induced headache
200068009Obstetric toxic reaction to local anaesthesia
10756061000119109Pain during postpartum period due to and following caesarean section
398058003Pain during regional anaesthesia for caesarean section
233915000Paroxysmal familial ventricular fibrillation
764873005Perioperative pulmonary aspiration
230479008Post dural puncture headache
1268344005Postoperative anaphylaxis
698504006Postoperative cardiopulmonary failure
68052005Pulmonary aspiration
25797006Pulmonary aspiration of blood
30227006Pulmonary aspiration of gastric contents
234172002Pulseless electrical activity
309809007Pulseless electrical activity with successful resuscitation
405368004Regional blockade – excessive cephalad spread of local anaesthesia
200076006Spinal and epidural anaesthesia-induced headache during labour and delivery
200072008Spinal and epidural anaesthesia-induced headache during pregnancy
200073003Spinal and epidural anaesthesia-induced headache during the puerperium
63627007Spinal epidural abscess
703861005Spinal epidural haematoma
231255000Spinal subdural local anaesthetic block
54602006Suxamethonium apnoea
277362007Total spinal blockade
405363008Total spinal nerve blockade following local anaesthetic injection
200069001Toxic reaction to local anaesthesia during pregnancy
200070000Toxic reaction to local anaesthesia during the puerperium
200075005Toxic reaction to local anaesthetic during labour and delivery
397945004Unexpected admission to intensive care unit
718446005Unexpected difficult airway
718448006Unexpected difficult intubation
1263661003Unintended oesophageal intubation
71908006Ventricular fibrillation
195083004Ventricular fibrillation and flutter
398231003Wrong route of administration

Personalised care and support planning for people with severe mental illness

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides more detailed explanations about each element of the plan, including advice on how the planning process might be best conducted.
These questions might form a checklist for current plans to be compared with. 

1. Does the plan include an About Me section in which the service user, in their own words, can indicate the information they want to be available about their lives, their values, their interests, and priorities, available for all those who may care for them?
2. Is the approach to developing a care plan patient centred and engaging, allowing plans to be based on patient priorities goals, and aspirations, along with the actions they plan to take and the support that they will receive?
3. Is there space for a “formulation” to be recorded in which the person receiving care and the professionals who provide it, share and record the personal meaning and the origins of the person’s difficulties?
4. Are relevant procedures and therapies recorded?
5. Where relevant, are one or more contingency plans included for anticipatable disruptions, exacerbations, or deterioration, and do they include advice on what to do and points of contact for those called upon to respond?
6. Where relevant are additional supporting plans incorporated, (an example being an “educational and health plan” for someone with a neurodevelopment disorder)
7. Is a version of the plan available to a service user (if they wish to have it) in a form and format that they can understand and find to be of value?
8. How is a version of the plan available to the GP and other key parts of the health and care system?

Work conducted by PRSB and partners recently has looked specifically at the suitability of this approach to the development and documentation of care and support plans for people with Severe Mental Illness. This resulted in an updated version of the standard (v1.4), for use by any service and for any group of service users, but with some modifications to ensure that it meets the needs of this community. The approach to a patient centred process of identifying goals, hopes, and values, and the support needed to achieve them, is fully compatible with and can be conducted using, specific tools in use in mental health, such as DIALOG, DIALOG+, and ReQoL, for example. 

Where analysis indicates the need for improvement in the content and process of personalised care and support planning for patients with Severe Mental Illness, specific improvement projects should be instituted to co-design with service users and their representatives, and the relevant staff groups, new approaches, and documentation that would be of value in delivering improvement. The toolkit includes a range of existing resources that could be used to engage in this improvement work, including signposting to relevant existing approaches informed by patient experience-based design.

Moving to a single holistic plan

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides A key development, consistent with national policy on support for Personalised Care across all health and care sectors, is the move towards an individual with complex needs having a single, integrated, care plan, rather than a series of plans developed by different parts of the health and social care system in isolation of one another. For a patient with severe mental illness, the related concerns and challenges might form a very prominent part of such an integrated plan; many will also have concurrent health challenges and needs. The intention is that the relevant services work together to plan and wrap support around the patient and their family in an integrated way, rather than as a series of sequential or disconnected encounters in which the service user or their friends and family have to adopt the role of the integrator.

A starting point would be to agree priority groups of service users who may already have more than one care plan because they need care from more than one part of the system of health and social care. This could be initiated by looking at service users registered with some sentinel practices or PCNs. Alternatively, the approach might focus initially on people with defined co-morbidity or risk that entails collaborative care with agencies beyond specialist mental health services.

The focus here is on the process of care planning and agreement on what should be shared, rather than solely on the technology used;

1. What is the process to agree which professional will initiate care planning and act as the “lead point of contact” for the service user?
2. Will initial plans be agreed with the service user in joint consultations or sequentially? Where and how will they be conducted?
3. What will be the process to agree the elements of the plans which should be available to professionals and potential authorised users beyond the immediate care teams, (A&E services, Ambulance Services, Social services, etc.) with the service user’s consent?
4. How will elements of the plan be updated following consultations in a way which is proportionate, to allow contact and progress notes to be maintained by the service conducting the consultation, whilst avoiding unnecessary work for partners in care if there is no significant change to the personalised care and support plan?
5. What are the implications for workload, logistics, and administration arising out of these decisions?

The answers to these questions and others will best be elicited through focused joint working, grounded in real, or at least realistic examples. This will entail process mapping, and co-design with a range of professionals, service users, and families. Resources from the toolkit and outputs from the Simulation element of this project will be valuable. Some organisations would adopt an approach such as a Rapid Process Improvement Workshop, planned over several weeks and conducted over a number of sequential days, to develop prototype ways of working that could be tested in the field.