Royal College of Anaesthetists

“We will ask the trust for the action they intend to take because of this Prevention of Future Deaths Report and monitor those actions as part of our ongoing monitoring and engagement with them.”

“NHS England has published a summary of existing guidance on the deployment of medical associate professions for NHS organisations. This guidance makes it clear that all staff should introduce themselves and their role clearly and be supported by their employer to do so.”

“RCEM issued a position statement in October 2024 regarding patients who may require a laparotomy [7]; this statement highlights that some patients are at greater risk of requiring surgery and part of this group includes the older person and those with cognitive impairment.”

“the Department notes that the report has been sent to a number of medical Royal Colleges and professional bodies relating to anaesthesia. We think these organisations are best placed to respond to points 6, 7 and 8 of your report which relate specifically to guidelines around anaesthesia therefore our response focuses on points 1 - 5 only.”

“We recommend that local anaesthetic prescriptions are recorded as 'the volume in ml of a solution containing a specified number of mg/ml of a named local anaesthetic' to simplify any calculations of the total dose of local anesthetic received.”

“We will ensure these issues are brought to the attention of all trainees in anaesthesia and all Fellows and Members of the RCoA and AAGBI by publishing information in the Patient Safety Update, which is published quarterly by the RCoA on behalf of the Safe Anaesthesia Liaison Group (SALG - https://www.rcoa.ac.uk/salg), and is distributed to practising anaesthetists throughout the UK.”

“we will ensure particular attention is attached to correct site location at the next review.”