Improving Safety in Pediatric Anesthesia in Moldova
Markus Schily
Biel, Switzerland
Is more safety in anesthesia in Eastern Europe
needed?
Who is responsible for it?
Who is going to do it?
Moldova
3.3 mill. people
Anesthesia safety differs
in Europe
Different Standards:
Example1:
Children should have anesthesia for TE
Example2:
Children should have painfree CC
Example3:
Most ped.anesthesia should be combined
with a regional block
Motivation, technologies, knowledge
Intercultural learning
Progress
A project to improve anesthesia safety
2007: first activities with Moldovan doctors
2008: foundation of IATC
I
= Information
A
= Assistance
T
= Technologies
C
= Communication
Driving on the left side?
KEEP LEFT!
Wikipedia:
Promote empathy, role-play .
Supports students in making the shift in perspective:
own culture becomes a strange, looked at from the outside,
target culture becomes familiar.
Inter Cultural Learning
Gradual approach:
I. Identification and understanding of the fundamental values
of the host country
I. Acquisition of the keys needed to decode new situations
II. Adaptation of behaviour
Improving Safety - Projects obstacles
Funding?
Language & culture barrier
Ministry of Health: decision maker
Understanding - teaching in 2007 by IATC
Sterile surgery drapes
2012: Moldovan Anesthesia Machines
Who is going to listen to us?
German Ministry of Health
Z31 International Cooperation
Lawrence of Arabia: united the Beduin tribes…
Strategy:
Target governmental funding
introduction of modern drugs and technologies
Anesthesia equipment upgrade
Ministries of Health
Annual meetings in Moldova
Anesthesia
Safety
Strategy: Improve communication
Involving societies, find a name of activities
improved anesthesia training
Fundraising strategy
Private fundraising
improving means of teaching, humanitarian aid
Initial IATC project in Moldova:
Upgrade of anesthesia equipment
2007: First donated anesthesia machine
Bern 2008 – used anesthesia machines for Moldova
These machines went from Luzern to Moldova
IATC aid to Moldova included:
Budget of about 2 Mill. EUR
More than 80 anesthesia working stations
3 ultrasound machines, 55 syringe pumps
150 hospital beds
Ambulance car
All three children hospitals
fully equiped with new
anesthesia machines
First result
Reduced pediatric anesthesia mortality compared to 2007
ref: MoH Moldova, 2012
Improving communication between societies
WFSA
SARM
ESPA delegate from Moldova
2011 -2013, sponsored and supported by IATC
Commission SARM, MoH, ESA: Reform of anesthesia residency
2010 – 2011, sponsored and supported by IATC
Situation ahead of Anesthesia Reform (before 2011)
1. Pediatric Anesthesia Residency 4 years
(separate Residency)
2. Anesthesia Residency: 4 years
3. Moldovan Syllabus
4. Moldovan oral Exam
Plan of Reform , Anesthesia Residency Moldova, Nov. 2011:
1. Pediatric Anesthesia Residency integrated
2. Residency: 5 years
3. European Syllabus
4. EDAIC exam
What is wrong?
Moldovan anesthesia exam result 2012: 100% candidates passing
EDAIC exam Chisinau exam result 2012:
0 % candidates passing
Corruption
Extra fees to doctors
MC questions: known ahead of exam
Everything can be bought
2012: last 35 anesthesia machines / monitors delivered
New Teaching Concept:
Mobile
Simulation based & clinical teaching
OLA
Mobile Anesthesia Simulation Unit
Curriculum:
Recommendations, guidelines
Crisis management, crew resource management
Rare case management, patient transfer
Simulation cannot replace clinical teaching!
German GiZ funding till end of 2013
Sim baby, Sim 3G man, Sim junior
Ambulance car, transport car
Anesthesia working place
Simulation in Switzerland, 2013
No ECG leads!
Cardiac arrest after
aspiration
ESPA Safety Committee and Simulation:
Joint venture: spread guidelines and recommendations
Pediatric Anesthesia Simulation Course:
ESimPA
ESimPA:
1.
2.
3.
4.
5.
European network
Small mobile teaching teams
Inclusion of Eastern Europe
Coordinating simulation activities with ESPA
Certification of attendance (ESPA
First steps:
Moldovan project
ESPA safety project
TTC for ESimPA tutors
ESimPA tutors: Simulation stage in Swiss and German hospitals
Learning from others: Visitations
Conclusion:
6 yrs.IATC project proved that anesthesia safety differs significantly
in Europe
Technical upgrade must be followed by teaching activities
ESPA: key factor in making European pediatric anesthesia more safe
IATC supports ESPA…
It‘s all about anesthesia safety in Europe
2010
2011