Anaesthetic
Meeting
Tuesday, 3
October 2000
|
Venue: |
Anaesthetic
Room, North Tower OT |
|
Time: |
13:00
h to 13:35 h |
|
Date |
Tuesday,
3 October 2000 |
|
Present: |
Dr.
Bachan Singh |
|
|
Dr.
Charlie Chan |
|
|
Dr.
Robert Liew |
|
|
Dr.
Ngun Kok Wah |
|
|
Datuk
Dr. Radha Krishna |
|
|
Dr.
Tan Poh Hwa |
|
|
Dr.
Anne Wong |
|
Absent: |
Dr.
Dalina |
|
|
Dr.
Mary Samuel |
1)
Ability of Dr. Robert Liew to Provide Anaesthetic On-Call Service
Datuk Dr. Radha revealed that Dr. Fong Chee Kin had brought to his attention
of an incident whereby Dr. Robert Liew who was on 2nd call had asked Dr.
Dalina who was not on call to do a case for him at 03:00 h. Dr. Fong
questioned whether Dr. Robert Liew was medically fit to provide anaesthetic
on-call service so soon after his recent major illness. While Datuk Dr. Radha
and Dr. Fong had agreed that Datuk Dr. Radha would look into the matter
personally, Dr. Ramanathan who had heard of the incident as well, decided to
bring it up at the OT Subcommittee Meeting held last week on 25 October 2000.
Datuk Dr. Radha was asked to discuss with the anaesthetist to resolve the
matter.
Datuk Dr. Radha said that Dr. Fong claimed that in the case concerned, foetal
distress had been diagnosed and because of the change of anaesthetist, there
had been a delay. He further claimed that Dr. Dalina was rather unhappy at
being called to do the case.
Datuk Dr. Radha had asked Dr. Dalina who said that she had come quite
willingly and that there was no delay in responding to the call.
Dr. Tan Poh Hwa felt that as long as,
a)
Anaesthetic
coverage was not compromised,
b)
There
was no undue delay (Dr. Liew stayed in section 12 while Dr. Dalina stayed in
Kelana Jaya, both in PJ), and
c)
Patient's
safety and health was not at risk
the surgeons had no reason to
complain. Furthermore, as pointed out, Dr. Dalina had not objected to being
called in this instance.
Dr. Bachan Singh also pointed out that at times, when he had been called to
come for an emergency LSCS for foetal distress, Dr. Fong was still at home
when he arrived.
It was decided that,
a)
As
Dr. Robert Liew's physician had certified Dr. Liew to be medically fit to
work, we should respect his physician’s judgement.
b)
Being
fit and able, Dr. Liew will continue to do his full share of calls.
c)
The
anaesthetists will continue to arrange amongst themselves to cover one another
whenever the need arises.
2)
Coverage for Datuk Dr. Radha's Leave
Datuk Dr. Radha had applied for leave from 16 November 2000 to 2 December
2000, a period of 17 days, inclusive. Dr. Anne Wong presented her proposed
changes to the roster to accommodate his leave. Dr. Bachan Singh affirmed his
ability to help provide coverage except on Wednesdays and Thursdays. There
were no further objections and it was felt unnecessary to get locum coverage
for the period.
3)
Dr. Tan Poh Hwa's Proposed List Changes
a)
Dr.
Tan proposed starting from 15 December 2000 to drop his,
i)
alternate
Monday afternoon Emergency session, and
ii)
alternate
Tuesday morning session with Dr. Thambyrajah.
b)
Members
who were interested in taking up the lists are to contact Dr. Anne Wong.
a)
Dr.
Lee Chong Meng requested, and the OT Subcommittee agreed, that his Thursday
morning list be changed to an Open List while the Monday morning Open List
would be reserved for him instead.
b)
Dr.
Anuar Onah will be sharing Dr. Govindan's Tuesday afternoon list.
c)
Dr.
Lyou Yen Tian has been asked to give up one of his lists due to under-utilisation,
most probably the Wednesday afternoon one.
5)
Booking of Cases Into the Two Open Lists on Thursday Mornings
Due to the transfer of Dr. Lee Chong Meng’s list from Thursday morning to
Monday morning, there will be two Open Lists on Thursday morning. As each of
the open lists were serviced by different anaesthetists on alternate weeks, it
was decided that Dr. Ngun would device a system of booking cases that
would be fair to all concerned.
(P.S.: Dr. Ngun proposed that the two Open Lists be labeled as Open I and Open
II. Cases would be booked alternately into the lists with the first case being
booked into Open I on two consecutive weeks. On the third and fourth weeks,
cases would be booked into Open II first. The cycle will then repeat itself
once every four weeks. Ms. Yim and Ms. Loke were informed of the
system on 6 October 2000 and a letter to
confirm the system was sent to Ms. Loke on 10 October 2000.)
6)
Proposed Changes to Anaesthetic Vouchers
a)
Both
our proposals have been rejected. They were,
i)
For
the signing of a copy of our charge voucher by the OT staff (Nursing
Administration claims that this will entail too much work for the staff), and
ii)
For
a third copy of our charge voucher to be time stamped by IT and subsequently
to be returned to us.
b)
Dr.
Ngun suggested that when handing in our vouchers, we note down the name of the
staff receiving our voucher, and the time and date, and to keep this data for
our records.
The OT Subcommittee has however asked that surgeons write the name of the
anaesthetist involved in their vouchers and to indicate if there was no
anaesthetist involved in the procedure.
Also, the anaesthetists should write in the name of the surgeon if,
i)
The
surgeon is not the primary physician, or
ii)
There
are 2 or more surgeons.
7)
December Holiday Leave
Few surgeons responded to the request for leave information for the holiday
period at the end of the year. Therefore, Ms. Doreen Loh has been asked to
take a poll of all the surgeons to find out who will be going on leave.
8)
Stoppage of Pancuronium and Vallergan
There were no objections to the stoppage of pancuronium but Dr. Bachan Singh,
Dr. Chan and Dr. Ngun voiced their preference for Vallergan as a
premedication. Dr. Ngun suggested that he ask Mr. Yen, our pharmacist, to
try to get a generic version of the drug if possible. They also expressed a
preference for the "Forte" version of the syrup.
9)
Fasting Guideline Handouts
The OT Subcommittee asked that the handouts be simplified. Dr. Ngun proposed
and members agreed that two different handouts be produced, one for adult and
one for paediatric patients.
10)
Preoperative Investigations
The OT Subcommittee asked that for patients scheduled for an operation, a
Haemoglobin test be done for all patients and an ECG and CXR be done for those
above 40 years of age. However, due to the risk of radiation Dr. Chan and Dr.
Ngun both felt that the CXR should be reserved for those above 60 years of age
unless clinically indicated. Dr. Chan also suggested that we check up on any
guidelines from any of the national anaesthetic associations on the issue.
11)
Epidural Charges
Datuk Dr. Radha revealed that Dr. Fong Chee Kin had proposed that there be a
separate charge for epidurals. As this had already been proposed to the
patient Economics Committee, the group proposed that we ask the PEC to
expedite their review to resolve the issue.