JCAHO Issues Alert

The alert advises the development and implementation of an anesthesia awareness policy that addresses: 1) clinical staff education on the phenomenon; 2) identification of patients at high risk for anesthesia awareness; 3) effective application of available anesthesia monitoring techniques, to include proper maintenance of equipment; 4) post-operative follow-up of all patients who have undergone anesthesia, including children; 5) identification of those patients who have experienced anesthesia awareness, and systems for referring them to counseling or other support networks if they are experiencing post-traumatic stress disorders or other mental distress.

When it is clear that anesthesia awareness took place during a particular procedure, the Joint Commission recommends that representatives of the treating facility: 1) interview the patient after the procedure, taking a detailed account of his or her experience and include it in the patient's chart; 2) apologize to the patient if anesthesia awareness has occurred; 3) assure the patient of the credibility of his or her account and sympathize with the patient's suffering: 4) explain what happened and its reasons, eg, the necessity to administer light anesthesia in the presence of significant cardiovascular instability; 5) offer the patient psychological or psychiatric support, including referral of the patient to a psychiatrist or psychologist; and 6) notify the patient's surgeon, nurse and other key personnel about the incident and the subsequent interview with the patient.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued an alert on Oct. 6 cautioning health care providers about the dangers of “anesthesia awareness.” The organization asserts that tens of thousands of patients undergoing surgery each year remain partially awake while under general anesthesia during surgery, but are unable to communicate this problem to their caregivers. JCAHO's alert aims to make health care providers more aware of this phenomenon so that they can reduce the risks of its occurrence and better support patients when it does happen.

The problem of anesthesia awareness affects an estimated 20,000 to 40,000 patients each year, with cardiac, obstetric and major trauma patients being at higher risk, according to the JCAHO. “Anesthesia awareness is under-recognized and under-treated in health care organizations,” says Dennis S. O'Leary, MD, president, Joint Commission. “The Joint Commission understands that anesthesia professionals must balance the psychological risks of anesthesia awareness against the physiological risks of excessive anesthesia. This alert is intended to help health care organizations address this problem in an open and constructive fashion.”

What the Alert Says

The alert advises the development and implementation of an anesthesia awareness policy that addresses: 1) clinical staff education on the phenomenon; 2) identification of patients at high risk for anesthesia awareness; 3) effective application of available anesthesia monitoring techniques, to include proper maintenance of equipment; 4) post-operative follow-up of all patients who have undergone anesthesia, including children; 5) identification of those patients who have experienced anesthesia awareness, and systems for referring them to counseling or other support networks if they are experiencing post-traumatic stress disorders or other mental distress.

When it is clear that anesthesia awareness took place during a particular procedure, the Joint Commission recommends that representatives of the treating facility: 1) interview the patient after the procedure, taking a detailed account of his or her experience and include it in the patient's chart; 2) apologize to the patient if anesthesia awareness has occurred; 3) assure the patient of the credibility of his or her account and sympathize with the patient's suffering: 4) explain what happened and its reasons, eg, the necessity to administer light anesthesia in the presence of significant cardiovascular instability; 5) offer the patient psychological or psychiatric support, including referral of the patient to a psychiatrist or psychologist; and 6) notify the patient's surgeon, nurse and other key personnel about the incident and the subsequent interview with the patient.