Perfusionists work in various fields and they have improved quality-Nusrat Rizvi

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CardioThoracic Surgeons Conference
Perfusionists work in various fields and
they have improved quality - Nusrat Rizvi
We need guidance, encouragement, support so that we
can work as a team with cardiothoracic surgeons

KARACHI: Anesthesia and role of perfusionists was discussed in detail during the last session of the 9th annual conference of PSCTS. This session was chaired by Dr. Aqeel Naqvi along with Mr. Pervez Ahmed. Dr. Shahab Naqvi was the first speaker who talked about Perioperative Monitoring: Standard of Care. He pointed out that we do hematology, neuro and pressure monitoring. He then talked abut cardiac anesthesia, limitations of CVP, modification of old equipment, Echocardiogram, Esophageal continuous cardiac monitoring, Esophageal Aortic Doppler Ultrasound, Doppler ultrasound, cardiac output monitoring, neurological monitoring and warned that one should be careful of stroke.

Prof. Col. M. A. Cheema presenting certificates to Dr. Tariq Azam, Dr. Hasnat Shareef and
Prof. Shahid Sami during the PSCTS Conference held at AKU recently.

Dr. Fazal Hameed talked about Quality Improvement Tools in cardiac anesthesia and said that we have to modify the tools as per our requirements. There is a need for continuous quality improvement as a means to develop clinical practice. We must identify the problems first only then we can improve our practices. If there is a faulty system only then errors occurs. One must analyze the system carefully, what are the defects and how to address them. We cannot do risk factor modification but we can modify the process which will alter the final outcome of the patient. No suggestion should be accepted which is in clash with the evidence based medicine. Our every action is likely to cause problem to the patient hence we should not do anything which is against evidence based medicine. We should monitor our standards, practice fast track extubation. Use of antibiotics within one hour of cardiac surgery, is it good what we are doing. We have to study, analyze the data, plan and act and implement which leads to beneficial outcome. He then talked about SMART initiative, specific, measurable, actionable and relevant technology. Decisions should be taken like this to collect data, acknowledge and implement the quality improvement plan, monitor people to change, document your success, audit current practice. Look for evidence and expert’s opinion, identify areas of improvement. However, he admitted that to motivate people to change is very difficult. Dr. Aqil Naqvi remarked that we can achieve best results if we work as a team. Dr. Shahid Sami said that we have found that stopping clopidogrel five days before cardiac surgery is good and we continue with Aspirin. Dr.Saeed Ashraf remarked that it is important to improve haemoglobin before taking the patient to the OT for surgery. Dr.Shahid Sami said that we know about cell saves but it cannot be used routinely. We know many other things but at times patients cannot afford all that. It was also pointed out that one third of the patients at AKU do get away without blood transfusion, blood should not be given if not necessary and these results are published. In fact it is criminal to do blood transfusion if it can be avoided.
Mr. Nusrat Rizvi from Sultan Qaboos University Hospital Oman was the next speaker who talked about quality assurance in perfusion. He opined that one must do it right first time and when you do it again risk increases. Late Dr. Abdul Haque, he said, was the first foreign trained cardiac perfusionists and it was Surgeon M.Rehman who for the first time invited the perfusionists to the cardiac surgery meeting and we decided to work as a team. Blood cell saver technique developed in 1992 reduced blood transfusion in AKU, intra and post operatively. Work done by perfusionists in different centers was discussed in detail. Continuing he said, we care, we learn and we share. Perfusionists work in various fields and they have improved quality. We need guidance, encouragement and support. ECMO in Cath lab are challenges.
Mr. Ijaz Hidayat talking about perfusion education and training said that now perfusionists have a society to solve their problems. It took us thirty years to form the society and now DUHS has started a certification course. We started a two years special training programme in 1996.We have started four years BS degree programme, we introduce latest perfusion technology. He then highlighted the role played by AKU which has been training people for Pakistan and overseas. We have introduced many new perfusion techniques. He then talked about IABP, cell saver, centrifugal pump, blood cardioplegia ECMO. We have performed three ECMO of which one was successful. We have started Journal of Perfusion Sciences and many of our members have had publications in international journals. The present role of perfusionists has improved a lot in all spheres. We should have a policy of listen to every one, no body knows everything but every body knows some thing, he added.
Mr. Tariq Nawaz talked about quality assurance in critical nursing and pointed out that medical error has emerged as the leading cause of death. If the staff has fatigue, work for long hours, they cannot give their best. He also talked about lack of communication and said that better communication can avoid errors. He emphasized the importance of no harm, no blame culture; see what has gone wrong and how it can be avoided. Do not blame doctors or nurses. All these mistakes should be reported. He also talked about lack of resources, nursing leaders, incentives and motivation. We have too many nursing schools but not many of them have proper training and nurses are not prepared to work in critical areas. Give them incentives, motivation, put the client first as they are the expert on their disease. Giving details of errors they had noted, he mentioned nine incidents of which two were pressure ulcers. We do our audit regularly which shows improvement in quality. He concluded his presentation by stating that we must propagate that every body should wash hands.
Dr. Hasnat Shareef in his concluding remakes said that we had some pre conference workshops including ECMO, Web conference with Bangalore on mitral valve repair. During the conference quality issues were discussed and we must ensure that all children who need treatment should get it. We had our PSCTS meeting which of course was not very well attended. Problems of Data base were discussed in detail during the conference. Perfusionists have done much better than us while we the cardiac surgeons were still struggling. He specially thanked Dr.Saeed Ashraf who came for the Society from UK who though does not live in Pakistan but is Pakistani. He has the quality of speaking his mind out and he also gets away with that. We thank him for his participation, he added.