Vigilance is Key!

When we first got out of Anesthesia school we were always on high alert. We were so nervous that something could go wrong that we were hypervigilant in watching the monitors, the patient and looking over the curtain to see what the surgeon was doing. As time went on we became more comfortable. We became comfortable in our skills and ability to recognize when something was going wrong.

When I got out of school there was no iphone or any other seriously smart device. I had a palm 3xe which was very limited in its ability. 2007 changed all of that. We went from going to the phone on the wall if we needed to call someone to having it right there in our pocket. As the phones became more advanced and the internet progressed we now found ourselves with the ability to gather all sorts of information right at our fingertips.

We became distracted. We now find ourselves shopping on Amazon. We may be reading the latest news from our favorite media site. It is not uncommon to pass by an OR and see someone with their head buried in their phone. This is no attempt to pass judgment since I have also been guilty of this behavior. There is nothing wrong with the use of these devices in the OR as long as they are used for the right purpose. It has been great to look up diseases, drugs and other types of information that can be useful to the care of your patient. But when that goes into shopping, playing video games or any other activity that takes your vigilance away from the patient it then becomes a dangerous scenario. I have heard of a case where a patient bucked in pins. The provider was on his phone not paying attention to the case. There was significant damage to the patient.

We must remain vigilant at all times. Vigilance more than anything else prevents mishaps and unfortunate outcomes in the operating room. Your constant monitoring of the patient’s vitals, trends and general events going on in the OR goes a long way in preventing undesirable outcomes. There is more than one case of a bad outcome occurring due to lack of vigilance.

So what do you do? First, you have to remember and respect the great responsibility that the patient has placed in your hands. You may be the difference between life and death for that patient. Realizing this should make you more aware and feel the need to monitor more closely. Second, create rituals and systems so you are consistent in each case. If your patient is being administered a neuromuscular relaxant then consistently check the TOF every 15 minutes or even more often if needed. You should always be aware of where your patient currently stands in relation to neuromuscular blockade. My point is for you to create a system of rituals that work for you to constantly monitor all aspects of the patient. Look over the curtain and know where you are in the surgery. Anticipate events to occur such as blood pressure changes when the tourniquet is let down. Do not be caught off guard by routine events of a case that you should have known if you were being more vigilant.

In recent years I have realized that these “smart” devices distract me more than I would like to admit. I now try to place my phone in the Pyxis and only pull it out to briefly scan it if the situation allows. I may use the phone to look up a medicine or even reply to a quick text if I feel it is something important. With iPhones and other types of devices being used as primary forms of communication now in the OR, it can be difficult to completely eliminate the distraction. This is most likely never going away and I am not a fan of its removal from the OR environment. However it is a great tool that can be used in the wrong way. The next time you are in a case, think of how you would feel if the pilot of your plane was staring down at his laptop or phone during a flight. Would you be comfortable with that? Practice Vigilance!