Anaesthetic agent usage and wastage during caesarean deliveries done with spinal anaesthesia in a labour ward theatre: a concern for the financial implication

Background: Local anaesthesia usage and wastage are common in the operation rooms. The wastage is often not given due considerations. Budgetary allocation for drugs is an identifiable area for cost-cutting and savings. Hence, the need to minimize wastage Objectives: To assess and estimate the amount of local anaesthesia usage and wastage in the labour ward theatre. Also, to analyze the financial implications of the wastages and suggest appropriate steps to reduce the wastages. Methodology: A prospective observational study conducted in the labour ward theatre of a tertiary care hospital. The amount of local anaesthesia administered to the patient during spinal anaesthesia prior to caesarean section was considered the dose used. The wastage was considered as the amount of local anaesthetic agents left unutilized in the syringes, ampules or vials after completion of each caesarean delivery. An estimation of the cost of wasted local anaesthetic agents was made. Result: The local anaesthetic agents being used in significant quantities were hyperbaric bupivacaine, plain lidocaine and lidocaine with adrenaline. The wastage was found more during the use of hyperbaric bupivacaine as the cost of its wastage formed the bulk (N75,000.00/ $210.10) of the estimated total cost of wasted local anaesthetic agents during the study period which was N88, 100.00 ($246.77). Conclusion: There were appropriate uses of the local anaesthesia with respect to the choice and doses for caesarean deliveries but there were wastages often ignored as infinitesimal. In the long run, the wastages become significant and the financial implication scale up the burden of health bills. Effective waste reduction strategies have input in the overall reduction of financial burden associated with health care. Emphasis should be t ailored towards awareness of these wastages among resident doctors and their prudent use of local anaesthesia

Preventative measures taken against hypothermia in selected Durban hospitals' emergency centres and operating theatres

Introduction:Hypothermia is common in emergency general surgical patients. It is known to be associated with major complications in multiple organ systems. It is also easily preventable with the use of safe and cost-effective equipment. However, by observation, it appears that this equipment is used too infrequently thus resulting in unnecessary harm to patients.Methods:This descriptive, observational, cross-sectional study was conducted in two arms to evaluate both emergency centres and operating theatres in the major state hospitals in Durban. It was conducted as an audit as well as a questionnaire-based study, to ascertain the availability of equipment used to prevent hypothermia and also how appropriately the equipment was being used.Results:There was good availability of equipment in both the operating theatres and the emergency centres. However it was being used very poorly, particularly in emergency centres (41% of responses deemed not beneficial to patients versus 29% from operating theatres; 39% of answers beneficial versus 54% from operating theatres.Institutions with hypothermia-prevention protocols scored significantly better than those without a protocol (59% versus 25% beneficial; p = 0.01.Conclusion: In the field of hypothermia prevention, there was sufficient equipment to result in optimal patient care. However there appears to be a lack of knowledge amongst health care providers, resulting in suboptimal use of this equipment.Protocolised management may provide a solution to this problem and improve patient outcomes

Mobile Hearing Testing - The Challenge to Stay SABS Compliant. Part 2 of 3- Part Series

How to ensure that your mobile audiometer is always calibrated according to SABS standards

Staff and Patient Perceptions of Noise in SA Hospitals - a Pilot Study

Background: Noise in hospitals can negatively affect users. Guideline noise levels for hospital wards are stipulated by the World Health Organization (WHO) and a South African National Standard (SANS). Studies show that few hospitals comply with the guidelines but limited research in South Africa means that conditions in local hospitals are unknown. The objective of this pilot study was to compare measured noise levels with guideline and perceived noise levels in general hospital wards. Methods: Measured and perceived noise levels were assessed; using data obtained from sound level meter readings and questionnaires; respectively; in four hospitals.Results: None of the hospitals complied with the guidelines; with an average Leq;24hr of 53.4 dBA. Yet; most users did not perceive the environment to be excessively noisy. At two of the hospitals it emerged that noise is more disturbing for staff than for patients.Conclusions: The results did not yield the predicted perceptions of noise in hospitals. Further research on a larger sample is required to confirm findings; particularly pertaining to the difference in perceptions between staff and patients