One of this year’s Honorary Membership awards has been given to Dr David Whitaker, who has recently retired from clinical practice at Manchester Royal Infirmary, UK. Dr Whitaker has placed patient safety at the centre of his long and successful career, including his work with this year’s other Honorary Member, Dr Jannicke Mellin-Olsen, on the Helsinki Declaration on Patient Safety.
Q: David, congratulations on your award. Tell us how you felt when ESA informed you that you had been awarded an Honorary Membership?
I was actually quite surprised at such an unexpected pleasure. For me it is a real honour and privilege to be given an ESA Honorary membership when I think of the list of previous holders, many of the great names of European Anaesthesiology who have worked so hard for the specialty and developed the ESA over the years. I was equally pleased to see my longstanding friend Jannicke Mellin-Olsen deservedly becoming an Honorary Member as well. Jannicke has tirelessly travelled around the world as a roving ambassador for patient safety and the Helsinki Declaration.
Q: What made you become an anaesthetist, was it a particular mentor, a specific period of training, or a mixture of factors?
I became interested in physiology as a medical student doing a B Med Sci in physiology. There is a lot of applied physiology and pharmacology involved in anaesthesia and I get satisfaction from trying to perfect any clinical hands-on techniques. I was fortunate to have a number of inspiring teachers for example Dr Michael Johnstone who first introduced routine ECG monitoring into the operating theatre as result of which he was then chosen to give the first halothane anaesthetics to patients. Less well known are the battles he fought to get dedicated trained assistants for anaesthetists and set up teaching courses and recognised qualifications for them.
Q: when did you first become involved in projects to improve patient safety?
There was a culture of safety in anaesthesia right from day one when I started training. There had been some high-profile fatal oxygen and nitrous oxide mix-ups and we were all taught to check our machines systematically. Also, at that time, there were no labels for our syringes and we used to identify their drug contents by the syringe size and the colour of the needles e.g. blue for muscle relaxants. Looking back on it this was crazy and the first major safety project I was involved at the Association of Anaesthetists of Great Britain and Ireland (AAGBI) was introducing the recommendation for using the ISO colour coded syringe labels in 2003.
I had given anaesthetics for number of years before pulse oximetry arrived in the 1980s. I immediately recognised its value and so I was happy to be involved with the Global Oximetry (GO) project which started in 2004 to develop oximetry for low- and middle-income countries. This work has now successfully been progressed by Lifebox. Since then I have similarly become an advocate of for global capnography and I am now working with a team on this.
Q: What would you say have been some of the most significant improvements to patient safety in anaesthesiology and medicine more generally throughout your career?
The introduction of minimal monitoring standards in the 1980s brought about the most significant improvement in patient safety during my career. The laryngeal mask invented by Archie Brain also made a very significant improvement in airway safety and it has not only saved lives in anaesthesia but also during resuscitation and prehospital care. There have been many improvements in medicine generally, but a couple of things strike me. When I was a trainee we spent a lot of time on the emergency list anaesthetising patients with bleeding perforated peptic ulcers but this has now been virtually eliminated with the discovery of H2-blockers by Sir James Black and subsequent pharmacological developments. Another thing we did was spend a very long time anaesthetising patients having their faces repaired and numerous pieces small pieces of glass painstakingly removed from their face after car crashes. Safety belts and changes to windscreen glass again eliminated this. The other excellent improvement I would mention is the awareness now in the medical profession of the importance of human factors in patient safety and the related training that takes place.
Q: How did you first become involved with the ESA?
The first European anaesthesiology meeting I went to was in Vienna in the 1980s. I attended some of the early ESA meetings and then became closely involved when there was a joint meeting with the AAGBI in Glasgow in 2003. Later on, I became a member of the European Board Anaesthesiology of the UEMS. As a result of this, I took part in the drawing up of the Helsinki Declaration on Patient Safety in Anaesthesiology which the EBA and ESA have successfully promoted around the globe. I currently am a member of the ESA Patient Safety and Quality Committee.
Q: Tell us about the work put into the Helsinki Declaration, and the impact it is having around the world.
The Helsinki Declaration is a consensus of what was thought appropriate to have in place to improve patient safety in anaesthesiology in Europe. It has two sections initially: the Heads of Agreement which set out the context for patient safety and then the Principal Requirements which were thought to be easily achievable and deliverable by anaesthetic departments to improve patient safety to a minimally acceptable standard. This was the first time anyone had brought all this together internationally and it caught the imagination of many other countries around the world who had probably also been deliberating about these things but now wished to join in and sign up to the consensus. Many countries around the world have incorporated the Declaration into the local arrangements. Brazil, for example produced its own detailed safety document and Morocco has produced a similar document in French. In summary the Helsinki Declaration has made a very positive contribution to raising the profile of patient safety issues amongst the anaesthetic community worldwide.
Q: You recently said that medication safety is the number one factor affecting overall patient safety. Can you see anaesthesiologists and doctors worldwide adopting a safe medication checklist, just as they have adopted the safe surgery checklist?
Unsafe medication practices medication errors are a leading cause of injury and avoidable harm in health care systems across the world. Globally the cost medication errors have been estimated at $42 billion annually. The WHO have recognised this and made it their third of Global Patient Safety Challenge — ‘Medication without harm’ — which aims to reduce the global burden of iatrogenic medication-related harm by 50% within five years. WHO hopes to match the global reach and impact of its first two Global Patient Safety Challenges: Clean care is safer care, 2005 and Safe surgery saves lives, 2008
‘Medication without harm’ will focus on three priority areas of medication safety, 1. High-risk situations, all anaesthetic drugs are termed high risk, 2. Polypharmacy, which is what anaesthesiologists do with a minimum of say 6 drugs per anaesthetic, and 3. Transitions of care, again our patients transition from preop, to theatre to recovery to the ITU /HDU/ ward then home.
‘Medication Without Harm’ is not going to reinvent the wheel. The WHO recognises that multiple interventions to address the frequency and impact of medication errors have already been developed, yet their implementation is varied. For example, one of the most recent guidance documents is The European Board of Anaesthesiology recommendations for safe medication practice: first update published in the EJA las year. This is in the new format of recommendations succinctly providing the working knowledge that clinical anaesthetists require in two pages with a 13-point checklist at the end. The purpose of this checklist is to help departments of anaesthesia with the implementation of these medication recommendations and monitor their progress as they achieve them locally. The majority of the recommendations are simple, not costly and relatively easily to put in place.
Q: What are some of the sessions that interest you most at this year’s Euroanaesthesia?
I enjoyed immensely Claude Martin giving the Sir Robert Mackintosh lecture on ‘Anaesthesia in the 21st-century’. I also enjoyed the session with Mark Warner talking about the ‘Anaesthesia Patient Safety Foundation (APSF) current perspective on perioperative medication safety’ on Sunday, and Adrian Gelb’s talk about ‘Intraoperative hypotension – just a monitoring challenge or a real safety threat?’
We have also, on Saturday, heard the patients’ perspective on patient safety and in today’s session on the Helsinki Declaration follow-up session I will be talking about ‘the value of Annual Safety Reports’.
Also today, the European Board of Anaesthesiology (EBA/UEMS) have an important Symposium on the welfare of anaesthetists and it will be good to hear some ‘Practical steps to help our wellbeing’ from an expert on this Nancy Redfern.
If time permits, I also enjoy visiting the abstract and post sessions where I can often learn some interesting facts on unusual topics during the presentations or discussions.
Q: Thank you David, and enjoy the congress.