Checking anaesthetic equipment: AAGBI 2012 guidelines

The modern anaesthetic machine is a complex device. It has evolved from a ‘trolley’ that did little more than deliver gas to the patient, into a ‘workstation’ with multiple delivery modalities, multiple safety features and multiple integrated monitoring devices. In addition, we have at our disposal many more pieces of complex equipment, separate from the anaesthesia workstation itself, to help ensure our patients’ safety while in our care. Yet patients still can, and do, come to significant harm due to failure of any part of the anaesthetic equipment, whose function has not been adequately checked before use. With such complexity it may be tempting for some users to abrogate responsibility for understanding the function of components, or what constitutes their safe conditions of use. The anaesthetic machine is treated as a ‘black box’, whose internal workings are a technical mystery; after all, we are clinicians not engineers. However, as intelligent and learned users of our equipment, and more importantly, as professionals who have our patients’ safety as our highest priority, we have a responsibility to do a great deal better than that. We have well-trained operating department assistants who check equipment for us, but we are responsible to the patient for ensuring our own knowledge and training and for doing our own checks. In the relentless drive for efficiency in the National Health Service (NHS), it is important that anaesthetists do not allow the equipment check to be omitted or abbreviated. The Association of Anaesthetists of Great Britain & Ireland (AAGBI) exhorts us to be vigilant towards patient safety in the use of equipment, even if the pace of equipment development outstrips safe recommendations in its use, or if written standards become inappropriate [1]. Knowledge of equipment and safety is an integral part of the FRCA Primary Examination, and includes testing, at an early stage of a career, the candidate’s ability to check the safe function of an anaesthetic machine. Additionally, in order to reduce their own vicarious liability for our actions, our NHS employers require us to adhere to protocols that demonstrably enhance patient safety. As a result, checklists for many procedures have become routine in our working lives, in order that important details are not omitted in a long list of complex functions and processes [2]. Other industries have used checklists for years to improve user competence and customer safety, notably the aviation [3] and nuclear power industries [4]. The modern anaesthetic machine is a complex hybrid of mechanical engineering and electromedical equipment, and both the International Standards Organization [5] and the International Electrotechnical Commission [6] continue to evolve standards to ensure the safe design and implementation of anaesthetic workstations and electromedical equipment. The critical importance of the safe use and checking of anaesthetic equipment is recognised by our colleagues internationally, although some recommendations have been updated more recently than others [7–13]. Hence the AAGBI has produced a timely UK update of its 1997 and 2004 checklists for enhancing the safe function of the anaesthetic machine and its associated equipment before use [14], although it is noted that this update was intended as long ago as 2009 [15]. It is an art to develop a checklist that is not so simplistic as to be functionally useless to users of many different types of workstations, yet not so complex as to tempt the user to bypass it, in the belief that the integral self-test carried out by modern machines on powering up will suffice. The checklist emphasises the requirement to check all the equipment we use, not just the gas delivery system of the anaesthetic machine and its integrated monitoring. The detailed guideline document tells us what to do and why, but if the machine check is part of our daily routine, this can be done very quickly; anomalies are rapidly detected by pattern recognition, so the checks Anaesthesia 2012, 67, 571–583