Infusion errors in the administration of Total Intravenous Anaesthesia (TIVA) is a topical concern in perioperative care, particularly as TIVA grows in popularity. Errors in infusion delivery can lead to awareness or overdose, compromising patient safety and outcomes [1]. Recognizing the importance of mitigating such risks, the implementation of a Two Person Safety Check (TPC) protocol has become paramount in TIVA administration at our hospital.

Methods

A TPC tick-box with initials was introduced to our electronic anaesthetic charts in February 2023 to serve as a prompt and reliable documentation tool. As no current standard of practice exists, we set out to achieve a check rate of at least 80%. We conducted a teaching session on TIVA safety and how to perform a TPC as part of our implementation process, utilizing the ‘Peruse Before You Infuse’ [2] resource. Two months later, we analyzed 150 cases completed in a week, excluding those done solely under local anaesthesia or sedation.

Results

Of the 150 cases analyzed, 55% were performed with TIVA (n = 82) and 21% involved the use of a single agent Target Controlled Infusion (TCI) (n = 31). The rate of TPC performed in the TIVA/TCI subset was 74% (n = 84/113). We found that checks were performed in 85% of TIVA cases (n = 70/82) as opposed to 45% in TCI cases (n = 14/31). Further analysis revealed that of all TPC performed, 24% were not initialled (n = 20/84).

Discussion

Despite falling short of the 80% target, our intervention has proven to be a reliable and standardized approach to performing checks. The large difference in TPC rates between TIVA and TCI (85% vs 45%) were surprising. A theory being that the TCI agents (mostly Remifentanil, sometimes Propofol as sedation during regional anaesthesia), were usually supplementary to the main form of anaesthesia. A somewhat perceived lower risk of error for single agent use. Regardless, the practice of TPC should be routine for all TIVA/TCI practitioners as infusion errors should be never events. Therefore, the next cycle will focus on two steps, education, and additional external prompts. Both focusing on empowering our Operating Department Practitioners and Anaesthetic Nurses to prompt and perform these checks with us.