Transcript Slide 1

CPSO – Anesthesia Peer Assessment Form
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CPSO Peer Assessment Form
History & Physical
(Items 2 - 8)
Covered by PAU visit and you
need to indicate you reviewed
OR – you need to complete in
Preop Manager in OR corridor
(#8 – VS done in SDCU)
Airway Exam & ASA
(Items 9 - 11)
Although covered by PAU
visit, as attending Anesthetist
you need to record your own
A/W & ASA assessments.
CPSO – Anesthesia Peer Assessment Form
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Medications
(Item 12)
Covered by Medication
Reconciliation List and you
need to indicate you reviewed
Premedication
(Item 13)
Documented in SDCU notes
NPO Status
(Item 14)
Indicate that you confirmed
this yourself
Investigations
(Item 15)
Review in Preop Manager or
in vOacis – need to say you
did it.
CPSO – Anesthesia Peer Assessment Form
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Anesthetic Plan
(Item 16)
You need to document what
the Anesthetic Plan is that
you have recommended
Anesthetic Problems
(Item 17)
List problems identified
Patient Discussion
- Risks/Benefits & Options
(Item 18)
Indicate that you have
discussed these issues with
the patient
CPSO – Anesthesia Peer Assessment Form
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Equipment Check
(Item 2)
Needs to be documented,
including Gas Machine ID#
GA Induction
(Item 3)
Technique, drugs, etc
Airway Management
(Items 4 & 5)
Documenting routine and
difficult airway management
Mechanical Ventilation
(Item 6)
Ventilator Mode and physiologic parameters associated
CPSO – Anesthesia Peer Assessment Form
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Invasive Monitoring
(Item 7a)
Needs to be documented:
insertion, data
Capnography
Inhalational Agents
(Items 7b & 7d)
Evidence of use
Temperature / Urine Output
(Items 7c &7e)
Needs to be documented
Depth of Anesthesia
(Item 7f)
Unclear how this is to be
done
CPSO – Anesthesia Peer Assessment Form
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Patient Position
(Item 8)
Documented; possible injury
risks addressed
Eye Care
(Item 9)
Documented
IV Lines: Sites & Sizes
(Item 10)
Documented
IV Fluids / Fluid Plan
(Items 11 & 12)
Documented
Blood Loss / Replacement
(Item 13)
Documented
CPSO – Anesthesia Peer Assessment Form
Neuraxial & Peripheral Blocks
(Items 15 & 16)
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Documented in detail – with
technique, equipment and
adequacy of block;
Include complications, if
present
Monitoring after Blocks
(Item 17)
Documented in PACU
Drug Administration
(including Narcotics)
(Items 18 & 19)
Fully documented
Operative / Emergent Events
(Item 20)
Fully documented