Improving Safety in Pediatric Anesthesia in Moldova

Markus SchilyBiel, Switzerland

Is more safety in anesthesia in Eastern Europeneeded?

Who is responsible for it?

Who is going to do it?

Moldova

3.3 mill. people

Anesthesia safety differs in Europe

Motivation, technologies, knowledge

Example1: Children should have anesthesia for TE

Example2: Children should have painfree CC

Example3: Most ped.anesthesia should be combined with a regional block

Intercultural learning

Different Standards:

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!

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.

Wikipedia:

Gradual approach:

I. Identification and understanding of the fundamental values

of the host country

II. Acquisition of the keys needed to decode new situations

III. Adaptation of behaviour

Inter Cultural Learning

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 HealthZ31 International Cooperation

Lawrence of Arabia: united the Beduin tribes…

Target governmental funding

introduction of modern drugs and technologies

Strategy:

Ministries of Health

Annual meetings in Moldova Anesthesia Safety

Anesthesia equipment upgrade

Involving societies, find a name of activities

improved anesthesia training

Strategy: Improve communication

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

Reduced pediatric anesthesia mortality compared to 2007

ref: MoH Moldova, 2012

First result

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

Moldovan anesthesia exam result 2012: 100% candidates passing

EDAIC exam Chisinau exam result 2012: 0 % candidates passing

What is wrong?

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

Cardiac arrest afteraspiration

No ECG leads!

ESPA Safety Committee and Simulation:

Joint venture: spread guidelines and recommendations

Pediatric Anesthesia Simulation Course: ESimPA

ESimPA:

1. European network 2. Small mobile teaching teams 3. Inclusion of Eastern Europe4. Coordinating simulation activities with ESPA5. 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