Anesthesia Guidebook Jon Lowrance

What up folks! This is another short podcast on the idea that safety is a capacity, not an outcome. This idea comes out of Todd Conklin & Sidney Dekker’s work on organizational safety where they discuss two ways of looking at safety:







The Safety 1 Perspective or the old way of thinking is that safety is about minimizing errors.  It’s about identifying risks, including human behaviors, and implementing steps to prevent errors from happening.  Success is often measured in low to zero error rates and errors are punishable offenses.  







The Safety 2 Perspective doesn’t overlook the need to minimize errors.  But it focuses on building the capacity for the right thing to happen versus a feverish focus on whack-a-moling potential risk and, frankly, whack-a-moling the people who make mistakes.







The idea is that safety is not an outcome but rather a capacity that’s built up over time through thoughtful design of systems and careful handling of people and systems both when things go right as well as when errors happen.  It’s about figuring out how humans are doing the work – including all of their workarounds – in order to generate successful outcomes and finding ways to support and foster positive outcomes on a consistent basis.  And when things go wrong, people aren’t punished.  While egregious error or outright negligence is always possible, Safety 2 presumes people are smart and are trying to do the right thing.  So if something goes wrong, there is likely a system input, factor or design that created a high probability that something would in fact go wrong.  So the focus is on understanding how the worker performed in a faulty system and trying to improve that system so there’s a higher likelihood that the right thing happens the next time around.







Check out the short podcast for a couple of illuminating stories to bring these principles to life. As always, drop me an email or message on social media if you’d like to connect!







Resources:







Todd Conklin’s Pre-Accident Investigation podcast







Sidney Dekker’s professional website







Upcoming conferences I’m speaking at:







Maine Association of Nurse Anesthesiology: https://meana.org MEANA Fall Conference in Portland, Maine (virtual option available)







Encore Symposium’s New England at the Cliff House, Cape Neddick, Maine October 16-19, 2023







Encore Symposium’s Autumn in Bar Harbor & Acadia National Park, October 14-17, 2024

What up yall this is Jon Lowrance and this is episode 96 – virtual reality in anesthesia education: SIMVANA with Peter Stallo.  







This show is coming out in early August of 2023.







First up: I want to give a quick heads up that our team from Maine Medical Center where I currently serve as chief CRNA will be at the American Association of Nurse Anesthesiology Annual Congress in a couple of weeks in Seattle.  If you’re headed to AANA’s Annual Congress this year, be sure to swing by the exhibit hall and check out the MaineHealth booth.  My friends & colleagues April Bourgoin, Cat Godfrey & Steve Breznyak will be there to tell you all about career opportunities at our level 1 trauma hospital, Maine Medical Center, and other MaineHealth hospitals.  We have everything from independent, CRNA-only practices to a high acuity level 1 trauma center within MaineHealth, so if you’re interested in finding out more about what life looks like in the upper right hand corner pocket of the US, come chat with us!  I believe Peter Stallo with SIMVANA – who we’re talking with today on the show – will also be at Annual Congress, so be sure to swing by and tell him you listened to this episode and see what SIMVANA is about in person!  







This show is very interesting for a couple of reasons:









* I’m stoked to talk with Peter Stallo.  Peter created Prodigy Anesthesia back in 2004.  This was probably the very first computer-based anesthesia educational & board preparation study tool.  Kids these days can’t imagine getting through anesthesia training without programs like this.  And Prodigy is what Kristin & I exclusively used to study for boards back in 2015… so I’m personally very grateful for Peter’s development of that program.  (side note… I have no financial ties with Peter, Prodigy or SIMVANA to disclose… this just pure gratitude I’m working with here).







* I’m also stoked about what we’re going to chat about.  Virtual reality simulation will likely become a central aspect of anesthesia training in the future.  As the technology becomes more widely available and the user experience further developed and refined, programs like SIMVANA will likely become ubiquitous… just like with Prodigy over the last 20 years.









I’m reminded of something Elon Musk stated in a documentary about SpaceX.  Now, I don’t know how you feel about Twitter becoming X & how Elon is reshaping that organization or many of his other decisions.  But I think we can agree on the fact that the man has created & lead some remarkable organizations built on tenacious visions of what’s possible for the future.  In this documentary on SpaceX, Elon talked about how progress isn’t inevitable.  Some people just assume that the future will be better… that space travel will become routine or that will we become a multi planetary species or that we’ll solve for global warming & climate change.  But these things won’t actually happen unless individuals first imagine that they’re possible and then 2) put the work in to bring them into fruition.  Elon is someone who has devoted himself into putting the work into creating paths to a better future.

Quick 5-Question Post Podcast Survey HERE







Today I’m joined by John Fratianni who created the content for this episode as part of his Doctorate in Nurse Anesthesia Practice at Virginia Commonwealth University in Richmond, Virginia.  John earned a Bachelor of Science in Nursing at the University of North Carolina at Chapel Hill, a Master of Science in Nursing at the University of Alaska Anchorage, and completed his critical care nursing training with the United States Air Force where he served 7 years on active duty. John conducted a study to determine if ChatGPT, an artificial intelligence (AI) program, can assist us in providing anesthesia care to our patients.  







I want to give a special shout out to Peter Stallo who founded Prodigy Anesthesia and SIMVANA, both of which are digital educational tools for anesthesia trainees. Peter worked closely with John to grant access to Prodigy’s vast database of board-style anesthesia questions. If you haven’t checked out Prodigy or SIMVANA – which is a virtual reality based anesthesia education platform, links are in the show notes. I also want to personally thank Peter for creating a great board prep program in Prodigy… it’s all my wife and I and several of our classmates used to study for boards and we passed on the first try. Nice job, Peter and thank you!







Since this episode is part of John’s doctoral work with Virginia Commonwealth University, he kindly requests that you take a quick survey that’s embedded in the show notes. It’s 5 questions and will literally take you 30 seconds… click the link and give John & me some feedback on how we did with this.







With that, let’s get to the show.  







Quick 5-Question Post Podcast Survey HERE

All right what’s up folks this is Jon Lowrance and it’s May 16, 2023.







This is episode 94 – and I’m calling it “shorts: cue ball.” 







And I don’t mean shorts like the things you wear but shorts like, this will be brief and there will be more episodes like this to come… you know, shorts.







But first… updates!  







Maine Medical Center will the at the AANA Annual Congress in Seattle this August. We’ll have a table in the exhibition hall and a couple of our CRNAs will be there to tell yall about our sweet gig and you can ask questions and see if where we’re headed is similar to where you want to head. Maybe you can join us. And we’ll join you. And we’ll move in the same direction. If you want practice a wide range of case types as part of a clinically excellent and supportive team while living in a super cool town that’s just big enough but doesn’t come with the downsides of huge metro areas, come check us out!







In other news, this fall I’m back on the teaching circuit… well, circuit might be a little generous – I’m teaching at 1 conference this year which is the New England at the Cliff House 2023 Encore Symposium in Cape Neddick, Maine.  The dates are October 16 – 19.  You can check out the other folks who will be presenting at the conference and register at Encore’s website, which is e-s-crnas.com.  Look for “New England at the Cliff House 2023 Encore Symposium” and again the dates are October 16-19.  This conference usually sells out by July.  Part of the reason is the location… the Cliff House is an iconic resort built in 1872 on a 70-foot cliff overlooking the Atlantic Ocean.  So if a fresh cool ocean air, granite cliffs and near by sandy beaches are your thing, this might be a great get-away to come get your learn on.  If you come, we’ll get the chance to talk about practical pharmacology for anesthesia providers, leadership in emergencies, best practices in neuromuscular blockage, monitoring & reversal, ERAS, airway management & a run down on what’s new in anesthesia… so much!  It’s going to be fantastic.  Encore Symposiums – October 16 – 19 – Cliff House.  I hope to see you there!   







All right, with that let me tell you about Neil deGrasse Tyson, the famed astrophysicist, and his take on cue balls. This will blow your mind…

In this episode, I speak with Dr April Bourgoin, DNAP, CRNA about operating room fires – how they can start and how we can respond to them as anesthesia providers. This show was originally released in 4 years ago in February of 2019 on the podcast From the Head of the Bed and was recorded with a table top microphone so the audio is a little suboptimal, but I’m sure you’ll still find this to be a very hot topic that will smolder in your memory for years to come after they key details become seared into your clinical practice. Hopefully, this podcast will really help you turn up the heat on your OR fire prevention practices… and now that we have almost all of the puns put out, let me tell you about Dr Bougoin.







Dr Bourgoin completed her Master of Nursing Science (MSN) and Doctorate of Nurse Anesthesia Practice at Virginia Commonwealth University. Prior to becoming a CRNA, she served for eight years as an active duty commissioned officer in the Army with experience as a critical care Registered Nurse and flight nurse with the 82nd Airborne Dustoff medevac team. She served two combat tours prior to transferring to the Army Reserves at the rank of Major and then returned to school for her master’s and doctorate degrees in anesthesia.







Dr Bourgoin had a case in which there was an OR fire and we discuss that story in detail in this podcast. She then unpacks OR and airway fires for us, including contributing factors, prevention, crisis management and the importance of critical incident debriefing.







Currently, I have the incredible privilege in working closely with April to support our CRNA group at Maine Medical Center in Portland, Maine. April is one of our 2 CRNA Supervisors and an invaluable part of our CRNA leadership team. I think you’re really going to enjoy hearing from her on this topic and in an upcoming episode on the pathophysiology of vaping associated lung injury.







In the show notes to this episode we have links to the Anesthesia Patient Safety Foundation’s infographics and video on OR fire prevention and safety, which are excellent resources to share with colleagues & classmates. We also link to a resource called Anesthesia eNonymous, which is a website hosted by faculty from Virginia Commonwealth University’s Nurse Anesthesia program where providers and anesthesia learners can anonymously share and read real stories of near misses, medical errors & other clinical experiences. As it’s been said: good judgment comes from bad judgment and it’s better to learn from others mistakes & bad judgement calls than having to make your own along the way. So be sure to check out the links in the show notes to this podcast that Dr Bourgoin has shared and with that, let’s get to the show!























Anesthesia Patient Safety Foundation Fire Safety Video







Anesthesia e-Nonymous – Virginia Commonwealth University







APSF Fire Safety Video Contributes to 44% Decrease in Intraoperative Fires Since 2011

If you get this post by email: THANK YOU! You’re in a select group of supporters of the show who have followed the posts on the website and I can’t thank you enough. Your interest, feedback and willingness to share these episodes with your friends & colleagues is much appreciated. Shoot me a reply, social media message or email any time… I’d love to hear from you and again, thank you for your support! – Jon







My guest today is Dr Brian McGrory, MD.  His is an orthopedic joint replacement surgeon at Maine Medical Center in Portland, Maine.   







This is the second time Dr McGrory has joined me on the podcast, the first being way back in episode 25 when we discussed how to prevent hypothermia during joint replacement surgeries.  That episode included a special look at the controversy around various warming devices that are used in the OR and whether any of them are linked to surgical site infections.







In this episode, Dr McGrory and I take a more detailed look at how to prevent surgical site infections in periprosthetic joint replacement surgery.  The significance of these infections for patients cannot be overstated.  We discuss the particulars around why a joint infection is often considered a devastating outcome for patients that, at best, results in months of continued, aggressive therapy and at worst, can lead to amputation of the limb or even death.  I’m incredibly grateful for Dr McGrory’s continued focus on improving the quality of care that surgical teams can provide and his willingness to come on this show to speak directly to anesthesia providers concerning our role in helping create great outcomes for surgical patients.







Dr McGrory earned his bachelor’s degree in chemistry biology at Cornell, attended medical school at Columbia University, followed by residency in orthopedic surgery at the Mayo Clinic Graduate School where he also earned a Master’s degree in orthopedic research.  He then completed a fellowship through Harvard University at Massachusetts General Hospital in adult hip & knee reconstruction.  He has served as the research director for orthopedics at Maine Medical Center and the founding editor-in-chief of Arthroplasty Today, which is a publication of the American Association of Hip and Knee Surgeons.







References







Chaudhry, S. B., Veve, M. P., & Wagner, J. L. (2019). Cephalosporins: a focus on side chains and β-lactam cross-reactivity. Pharmacy, 7(3), 103. Retrieved from https://www.mdpi.com/505180







Hamilton, W. G., Balkam, C. B., Purcell, R. L., Parks, N. L., & Holdsworth, J. E. (2018). Operating room traffic in total joint arthroplasty: identifying patterns and training the team to keep the door shut. American Journal of Infection Control, 46(6), 633-636. Retrieved from https://www.ajicjournal.org/article/S0196-6553(18)30007-5/fulltext







McGrory, B. J. (2018). Letter to the Editor on “Hypothermia in Total Joint Arthroplasty: A Wake-Up Call”. The Journal of arthroplasty, 33(9), 3056-3057. Retrieved from https://www.arthroplastyjournal.org/article/S0883-5403(18)30506-0/fulltext







Wyles, C. C., Hevesi, M., Osmon, D. R., Park, M. A., Habermann, E. B., Lewallen, D. G., … & Sierra, R. J. (2019). 2019 John Charnley Award: increased risk of prosthetic joint infection following primary total k...