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Standards and Audit provide the essential foundation & framework to the delivery of safe, effective care to all patients undergoing anaesthesia in any setting. Since the 1990’s Standard Setting and audit has been practised within the NHS Trust network which introduced the marketing ethos into the National Health Service. This Quality Agenda was further developed by the Labour government’s NHS Modernisation Programme in the early noughties. There are now a plethora of government agencies & professional organisations, both private and public, that contribute to the Quality & Standards Framework that now governs health care practice. This presentation provides more detail.
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Nursing and Midwifery Council : The Code [2018]
The Nursing and Midwifery Council : The Code [2018] defines the professional standards of practice for Registered Nurses, Midwives and Nursing Associates. |
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BARNA Standards of Practice
BARNA Standards of Practice was developed in 2003, revised in 2011 and 2021. Based on the NMC Code [2018], this document contains the following sections:
BARNA Standards of Practice document will be updated soon. |
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Standards, Guidelines, Policies, Protocols : a glossary of terms
Standard : An accepted or approved example of something against which others are judged or measured.
Guideline : A principle put forward to set standards or determine a course of action.
Policy : A document containing a plan of action adopted or pursued by a specific group.
Protocol : A formal etiquette and code of behaviour, precedence.
The following lists major documents [guidelines, standards] developed by the leading perioperative professional associations which inform and guide our practice in anaesthetics and recovery.
National Guidelines & Standards Documents for use in Anaesthetics and Recovery practice:
International Guidelines & Standards for use in anaesthetics and recovery:
Standard : An accepted or approved example of something against which others are judged or measured.
Guideline : A principle put forward to set standards or determine a course of action.
Policy : A document containing a plan of action adopted or pursued by a specific group.
Protocol : A formal etiquette and code of behaviour, precedence.
The following lists major documents [guidelines, standards] developed by the leading perioperative professional associations which inform and guide our practice in anaesthetics and recovery.
National Guidelines & Standards Documents for use in Anaesthetics and Recovery practice:
- Association of Anaesthetists of Great Britain and Ireland [2013] Immediate Post Anaesthetic Recovery, London: Association of Anaesthetists of Great Britain and Ireland.
- Association for Perioperative Practice [2014] Staffing for Patients in the Perioperative setting, Harrogate: Association for Perioperative Practice
- National Institute for Health & Care Excellence [NICE] :
- Perioperative Care in Adults [2020]
- Hypothermia: prevention and management in adults having surgery [2016]
- Royal College of Anaesthetists [2020] Raising the Standard, 4th Edn. London: Royal College of Anaesthetists.
- Royal College of Anaesthetists [2013] Raising the Standard : a compendium of audit recipes 3rd edn. 2012 [includes Section 3 : Post-operative care]
- Royal College of Anaesthetists [2021] Guidelines for the Provision of Anaesthesia Services for the Perioperative Care of Elective and Urgent Care Patients. London, Royal College of Anaesthetists
- Royal College of Anaesthetists : National Audit Projects [NAPS] 1-7 nationalauditprojects.org.uk
International Guidelines & Standards for use in anaesthetics and recovery:
- American Society of PeriAnesthesia Nurses: Standards of PeriAnesthesia Nursing Practice 2021-2022, New Jersey: American Society of PeriAnesthesia Nurses.
- International Federation of Nurse Anaesthetists [revised 2012] Standards of Education, Practice, Monitoring and Code of Ethics, International Federation of Nurses Anaesthetists.
Audit : The Audit Cycle
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Clinical Audit is now part of everyday life and work and everyone working in clinical practice will be familiar with the Audit Cycle shown above. Recording key quality and outcome data from all patients passing through PACU should be routine for all hospitals [1].
[1] Royal College of Anaesthetists. Audit Recipe Book, Section 3 : Post-operative Care Audit is the method by which you bring about innovation in practice. First identify a problem or a new situation in practice that requires correction or rationalisation : compare it to a known standard or guideline, or create a standard for it. Collect data of what is actually happening and compare it to the accepted standard. Analyse the data collected to determine to what extent it falls short of the standard. Rationalise what needs to happen to bring up the standard. Implement change and after a period re-audit. Auditing removes the ‘personal’ from problems and brings in objectivity and evidence that something needs to change. |
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Audit is a key objective in BARNA. Gathering data about what is happening in practice in units around the country and applying this to BARNA Standards is essential. Without knowledge of current practice we cannot advocate for change.
BARNA Audit on Staffing the PACU [2012]
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BARNA National Audit Form on Staffing [2012]
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BARNA National Audit on Staffing in the Post Anaesthetic Care Unit : Results
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