ANAESTHESIA CAPACITY TOOL

This questionnaire is based on multiple priorefforts including: The Harvard Humanitarian Initiative Tool[1], the “International Standards for a Safe Practice of Anaesthesia” most recently revised by the World Federation of Societies of Anaesthesiologists (WFSA) in 2010 [2], the World Health Organisation Tool for Situational Analysis to Assess Emergency and Essential Surgical Care [3], the Surgeons Overseas (SOS) PIPES Surgical Capacity Assessment tool[4], the Lancet Commission on Global Surgery[5],the WHO-WFSA International Standards for a Safe Practice of Anaesthesia 2017, and multiple national anaesthesia capacity assessment projects using other tools [6,7].

The purpose of this questionnaire is to create a minimum data set that can be modified at a country-level to help determine the national anaesthetic capacity, and provide guidance for improving or maintaining standards for the safe practice of anaesthesia.

Data collection must be done in accordance with local protocols and laws. All data must not include any patient health information. All answers are optional and will be aggregated and kept anonymous.

If you are unsure of the answers to any question, please leave it blank.

Healthcare facility name:

Healthcare facility country:

Healthcare facility region/district:

Healthcare facility city/town:

Profession of person providing information to complete questionnaire:

Anaesthesiologist (Physician)

Anaesthesia resident/trainee (Physician)

Non-physiciananaesthetist

Non-physician anaesthetist (no nursing degree)

Surgeon (Physician)

Other Surgery provider (non-Physician)

Obstetrician/Gynecologists

Other:______

Facility Level

  1. Which of the following terms best describe this healthcare facility (select all that apply):

Small Hospital/Health Centre

District/Rural/Community Hospital

Provincial/Regional Referral Hospital

National Referral Hospital

Public Hospital

Private Hospital

NGO/Mission/Charity Hospital

  1. How many inpatient beds does this healthcare facility have?

<100 100-300 300-1000+

  1. How many functionaloperating rooms/theatres does this facility have? ______
  1. How many non functional operating rooms/theatres does this facility have?______
  1. How many operating room cases are done per year?______
  1. Are operating room deaths tracked in your facility?

YesNoSometimes

  1. Are caesarean sections performed at your facility?

YesNoSometimes

  1. Are laparotomies (e.g. uterine rupture, ectopic pregnancy, acute abdomen, intestinal perforation, injuries) performed at your hospital?

YesNoSometimes

  1. Are open fractures surgically repaired at your hospital?

YesNoSometimes

  1. Is Internet available at this health facility?

YesNoSometimes

  1. Does the facility have a designated area (not including the operating theatre or the post-operative recovery area) that can manage critically-ill patients who require continuous monitoring or mechanical ventilation, such as an intensive care unit (ICU)?

YesNoSometimes

  1. Not including the operating theatre, how many mechanical ventilators are present and functional in the facility?

______

Personnel/Workforce

  1. How many of the following providers are employed at your health facility?

Number of Anaesthesiologists (Physicians) ______

Number of Anaesthesia resident/trainees (Physicians)______

Number of Non-physiciananaesthetists ______

Number of Non-physician anaesthetists (no nursing degree)______

Number of Surgeons (Physicians)______

Number of Non-physician Surgery Providers ______

Number of Obstetrician/Gynecologists (Physicians)______

  1. How often are the following providers available at your health facility?

Always
(24hours/day, everyday) / Often
(available most of the time) / Rarely
(not available mostof the time) / Never
Anaesthesiologist (Physician)
Anaesthesia resident/trainee (Physician)
Non-physician anaesthetist
Surgeon (Physician)
Non-physicianSurgeryProvider
Obstetrician/Gynecologist
  1. Do you believe there are enough anaesthesia providers in your facility for the safe practice of anaesthesia?

Yes NoSometimes

  1. If anaesthesia is provided by non-medical personnel, are these providers supervised on site by medically qualified specialist anaesthesia professionals?

Yes NoSometimes N/A

Organisation/Training

  1. Is there an available anaesthesiaorganisation setting standards of practice, supervision of anaesthesia training, and providing continuing education/professional development?

Yes NoSometimes

(If yes, then at what level? National Regional Local )

  1. Is there a process of certification and accreditation for the practice of anaesthesia for physician anaesthesiologists?

Yes No

  1. Is there a process of certification and accreditation for the practice of anaesthesia for non-physiciananaesthesiologists?

Yes NoN/A

  1. Do you believe you wereadequately trained to usethe available anaesthesia equipment at this facility?

Yes NoSometimes

  1. In the pastone year, have you participated inreviews of current anaesthesia practice (CME/CPD)?

Yes No

  1. Does your health facility conduct reviews of unfavorable outcomes (morbidity and mortality conference/review) at least once a year?

Yes No

Clinical Practice

  1. Are patients formally evaluated by an anaesthesia professional prior to administration of anaesthesia?

Yes NoSometimes

  1. Is an anaesthesia professional immediately present with the patientthroughoutthe anaesthetic?

Yes NoSometimes

  1. Do you utilise a checklist to confirmproperly functioning equipment is available before starting each anaesthetic?

Yes NoSometimes

  1. Is the WHO Safe Surgery Checklist (locally modified if appropriate) used for all surgical procedures?

Yes NoSometimes

  1. Do you utilise a pre-anaesthetic patient checklist prior to delivery of anaesthesia?

Yes NoSometimes

  1. Are the details of each anaesthetic, including: preop assessment, anaesthetic plan, intraoperative and postoperative management,documented in an anaesthesia record?

Yes NoSometimes

  1. Is supplemental oxygen available to patients undergoing general anaesthesia?

Yes NoSometimes

  1. Is continuous pulse oximetry used for intraoperative anaesthesia care?

Yes NoSometimes

  1. Arethe airway and ventilation continuously monitored while providing anaesthesia?

Yes NoSometimes

  1. Is adequacy of ventilation monitored with capnography?

Yes NoSometimes

  1. Is a “disconnect alarm” utilised during mechanical ventilation?

Yes NoSometimes

  1. Is circulation continuously monitored by either palpation, auscultation, or display of the heart rate while providing anaesthesia?

Yes NoSometimes

  1. Is arterial blood pressure measured at least every 5 minutes while providing anaesthesia?

Yes NoSometimes

  1. Is a designated anaesthesia provider (not the surgeon) present insideeach operating theatre with the patient at all times during cases requiring general or neuraxial anaesthesia?

Yes NoSometimes

  1. Are audible monitor signals and alarms available AND activated at all times in the operating room?

Yes NoSometimes

  1. Is there the capability for continuous measurement of inspired/expired gas volumes in the operating room?

Yes NoSometimes

  1. Is there capability for measurement of inspired/expired volatile gas concentration in the operating room?

Yes NoSometimes

  1. Is your facility able to provide prolonged mechanical ventilation in the operating rooms or intensive care unit?

Yes NoSometimes

  1. Is regional anaesthesia (nerve blocks) performed at this facility?

Yes NoSometimes

  1. Is spinal anaesthesia performed at this facility?

Yes NoSometimes

  1. Is epidural anaesthesia performed at this facility?

Yes NoSometimes

  1. What is the most common anaesthetic used for maintenance of general anaesthesia?

Yes NoSometimes

  1. Is there a designated area available for post- anaesthesia care?

Yes NoSometimes

  1. Is post-anaesthesia patient care transferred to personnel trained to administer analgesic medications AND recognize airway or hemodynamic compromise?

Yes NoSometimes

  1. Is a “handover protocol” followed for transfer of care from one anaesthesia provider to another?

Yes NoSometimes

  1. Is non-invasive blood pressure (NIBP) measurement available for all patients in the post-anaesthesia care area?

Yes NoSometimes

  1. Is pulse oximetry available for all patients in the post-anaesthesia care area?

Yes NoSometimes

  1. Are there staff assigned to the post-anaesthesia care area who are readily available?

Yes NoSometimes

  1. Are oxygen, suction, and a means of ventilation (e.g. self-inflating bag-mask system) immediately available in the post-anaesthesia care area?

Yes NoSometimes

  1. How often are pain scores assessed by a healthcare provider in the first 24-hours post-operation?

Hourly Once every 2-4hours Once every 4-6 hours Once every 12 hours or less

  1. Can non-functioning equipment (suction machines, vitals monitors, autoclaves) be repaired locally?

Yes NoSometimes

  1. Is a blood bank available at this facility?

Yes NoSometimes

  1. How long does it take to receive blood products in an emergency:

15 minutes <1hour 1-5 hours 5-10h 10-24h >24hours or more

  1. Please select which blood products are available at your facility (may select multiple):

Whole bloodPacked Red Blood CellsPlasmaPlatelets

  1. Are patients required to procure their own medications for anaesthesia?

In house Pharmacy No they are provided Other

------

  1. Are patients required to procure their own medications for post-operative pain control?

Yes NoSometimes

  1. Are personnel required to change shoes before entering the operating theatre complex?

Yes NoSometimes

  1. How often are prophylactic antibiotics given prior to skin incision in the operating theatre?

Yes NoSometimes

  1. How many functioning anaesthesia machines are available at this health facility? ------

Bottom of Form

Medications

Are the following medications regularly available? Write additional comments below:

Always
(24hours/day, everyday) / Often
(available mostof the time) / Rarely
(not available mostof the time) / Never

Ketamine injection Always OftenRarely Never

Lidocaine 1% or 2% injectionAlways OftenRarely Never

Diazepam injectionAlways OftenRarely Never

Midazolam injectionAlways OftenRarely Never

Meperidine (pethidine) injectionAlways OftenRarely Never

Morphine injectionAlways OftenRarely Never

Epinephrine injectionAlways OftenRarely Never

Atropine injectionAlways OftenRarely Never

Atracurium injectionAlways OftenRarely Never

Pyridostigmine injectionAlways OftenRarely Never

NaloxoneAlways OftenRarely Never

Nitrous OxideAlways OftenRarely Never

IsofluraneAlways OftenRarely Never

HalothaneAlways OftenRarely Never

Sevoflurane Always OftenRarely Never

EtherAlways OftenRarely Never

Thiopental injectionAlways OftenRarely Never

Succinylcholine (Suxamethonium) injAlways OftenRarely Never

Pancuronium injectionAlways OftenRarely Never

Neostigmine injectionAlways OftenRarely Never

Lidocaine 5% intrathecalAlways OftenRarely Never

Bupivacaine 0.5% intrathecalAlways OftenRarely Never

Hydralazine injectionAlways OftenRarely Never

Furosemide injectionAlways OftenRarely Never

Dextrose 50% injectionAlways OftenRarely Never

Aminophylline injectionAlways OftenRarely Never

Ephedrine injectionAlways OftenRarely Never

Hydrocortisone injectionAlways OftenRarely Never

ErgometrineAlways OftenRarely Never

MetaraminolAlways OftenRarely Never

Propofol injectionAlways OftenRarely Never

Rocuronium injectionAlways OftenRarely Never

Vecuronium injectionAlways OftenRarely Never

Cisatracurium injectionAlways OftenRarely Never

Phenylephrine injectionAlways OftenRarely Never

Norepinephrine injectionAlways OftenRarely Never

Dopamine injectionAlways OftenRarely Never

Dobutamine injectionAlways OftenRarely Never

Milrinone injectionAlways OftenRarely Never

Amiodarone injectionAlways OftenRarely Never

Magnesium injectionAlways OftenRarely Never

Nitroglycerine injectionAlways OftenRarely Never

Calcium chloride injectionAlways OftenRarely Never

Potassium chloride injectionAlways OftenRarely Never

OxytocinAlways OftenRarely Never

Paracetamol (acetaminophen)Always OftenRarely Never

NSAIDsAlways OftenRarely Never

FentanylAlways OftenRarely Never

Dantrolene for malignant hyperthermia Always OftenRarely Never

Intralipid for local anaesthetic toxicityAlways OftenRarely Never

MannitolAlways OftenRarely Never

TramadolAlways OftenRarely Never

OxycodoneAlways OftenRarely Never

GabapentinAlways OftenRarely Never

Comments (Please provide any additional comments or concerns below):

Equipment

Are the following equipment availableandin functional condition? Write additional comments below:

Always
(24hours/day, everyday) / Often
(available mostof the time) / Rarely
(not available mostof the time) / Never

Adult self-inflating breathing bag/maskAlways OftenRarely Never

Paed self-inflating breathing bag/maskAlways OftenRarely Never

Manual or electric suction pumpAlways OftenRarely Never

StethoscopeAlways OftenRarely Never

SphygmomanometerAlways OftenRarely Never

ThermometerAlways OftenRarely Never

Pulse oximeter (adult probes)Always OftenRarely Never

Pulse oximeter (paeds probes)Always OftenRarely Never

Oxygen concentratorAlways OftenRarely Never

Central/piped oxygenAlways OftenRarely Never

Oxygen tankswith tubingAlways OftenRarely Never

Laryngoscope (adults blade:size 3-4) Always OftenRarely Never

Laryngoscope (paeds blades: size 1-2) Always OftenRarely Never

BougiesAlways OftenRarely Never

Provider eye protection equipment Always OftenRarely Never

IV infusion/drug injection equipmentAlways OftenRarely Never

Suction catheters (16F)Always OftenRarely Never

Endotracheal tubes (adult size: 6.0-8.0)Always OftenRarely Never

Endotracheal tubes (Paed size: 3.0-5.0)Always OftenRarely Never

Oral airwaysadult size Always OftenRarely Never

Oral airways paeds size Always OftenRarely Never

Nasal airwaysAlways OftenRarely Never

ElectricityAlways OftenRarely Never

Operational power generatorAlways OftenRarely Never

Running waterAlways OftenRarely Never

Functioning AutoclaveAlways OftenRarely Never

Hand sanitizer or soapAlways OftenRarely Never

Glucose measurement deviceAlways OftenRarely Never

Haemoglobin measurement deviceAlways OftenRarely Never

Cricothyroidotomy/tracheostomy equip.Always OftenRarely Never

Functioning ultrasound machineAlways OftenRarely Never

Refrigerator for medicationsAlways OftenRarely Never

Air conditioning in operating theatreAlways OftenRarely Never

Tippable operating tableAlways OftenRarely Never

Work surface for meds in theatreAlways OftenRarely Never

Intra-arterial blood pressure monitorAlways OftenRarely Never

Neuromuscular transmission monitor Always OftenRarely Never

Adequate operating room lightingAlways OftenRarely Never

Pediatric anaesthesia system Always OftenRarely Never

VaporizersAlways OftenRarely Never

Bellows or bag to inflate lungsAlways OftenRarely Never

Face masks of various sizesAlways OftenRarely Never

Adult and pediatric resuscitator setsAlways OftenRarely Never

O2 supply failure alarm; inspired oxygen analyzerAlways OftenRarely Never

Continuous waveform capnography Always OftenRarely Never

Spot check capnographyAlways OftenRarely Never

Defibrillator (one per operating room suite)Always OftenRarely Never

Electrocardiograph monitor Always OftenRarely Never

Electrocardiograph electrodesAlways OftenRarely Never

IV pressure infuser bagAlways OftenRarely Never

IV fluids (NS, LR, D5W) Always OftenRarely Never

IV Cannulas (18g 22g & 24g)Always OftenRarely Never

Magill forcepsAlways OftenRarely Never

Nasogastric tubes (10-16F)Always OftenRarely Never

Catheter for bladder catheterizationAlways OftenRarely Never

Spinal needles (22g, 25g)Always OftenRarely Never

Peripheral nerve stimulatorAlways OftenRarely Never

Epidural placement suppliesAlways OftenRarely Never

Automatic non-invasive blood pressure monitor Always OftenRarely Never

Sterile gloves Always OftenRarely Never

Examination gloves (non sterile)Always OftenRarely Never

Batteries size CAlways OftenRarely Never

SyringesAlways OftenRarely Never

Infusion pumps (2 per OR/ICU room)Always OftenRarely Never

Electric warming blanketAlways OftenRarely Never

Infant incubatorAlways OftenRarely Never

Laryngeal mask airways (sizes 2,3,4)Always OftenRarely Never

Adult ventilator circuitsAlways OftenRarely Never

Paediatric ventilator circuitsAlways OftenRarely Never

Yankauer suckersAlways OftenRarely Never

Water trapsAlways OftenRarely Never

Comments (Please provide any additional comments or concerns below):

Works Cited

1. Chao TE, Burdic M, Ganjawalla K, Derbew M, Keshian C, et al. (2012) Survey of Surgery and Anesthesia Infrastructure in Ethiopia. World J Surg. Available: Accessed 12 September 2012.

2. Merry AF, Cooper JB, Soyannwo O, Wilson IH, Eichhorn JH (2010) International Standards for a Safe Practice of Anesthesia 2010. Can J Anaesth 57: 1027–1034. doi:10.1007/s12630-010-9381-6.

3. World Health Organisation (n.d.) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. Available: Accessed 4 April 2017.

4. SOS PIPES Surgical Capacity Assessment tool (n.d.). Surg Overseas. Available: Accessed 4 April 2017.

5. Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, et al. (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. doi:10.1016/S0140-6736(15)60160-X.

6. Hodges SC, Mijumbi C, Okello M, McCormick BA, Walker IA, et al. (2007) Anaesthesia services in developing countries: defining the problems. Anaesthesia 62: 4–11. doi:10.1111/j.1365-2044.2006.04907.x.

7. Evans FM, Nelson C, Lagoo J, Enright A, Paige C, Guzman P, Gelb AW. (2017) Availability of Essential Anesthetic Medicines in Resource-Poor Countries in Africa and Central America. ASA abstracts

Prepared of WFSA by Gelb AW, Lipnick M, Ttendo S, Bulamba F, Kiwanuka J, Evans FM