To the Editor
With the coronavirus disease 2019 (COVID-19) pandemic still in progress, anesthesia providers have been searching for novel ways to manage patient care while minimizing staff and equipment exposure. COVID-19 is spread through physical contact and aerosols, and the airway management that anesthesiologists routinely perform creates opportunities for widespread equipment contamination and potential waste of supplies while using a standard anesthesia cart.1,2 To preserve supplies while maintaining patient safety, our institution elected to remove the anesthesia cart from the operating room (OR) when caring for patients requiring strict isolation precautions.3 Without an anesthesia cart, there is a risk of either missing critical supplies or being unable to locate them in a timely manner. With a team of anesthesiologists and anesthesia technicians, we sought to improve this process by creating a standardized “Mayo Mat” to improve efficiency, safety, and minimize staff exposures.
The “Mayo Mats” (Figure) are 48 × 33 cm and designed to fit on standard, large Mayo stands. One mat organizes medications and the other airway supplies. Following the mat’s layout, the anesthesia team can have the Mayo stands prepared in advance, with medications, equipment, and supplies, ready on demand to be wheeled into the OR for patients requiring strict isolation. It has already been demonstrated that implementation of an “Anesthesia Medication Template” (AMT), a standardized setup of essential medications, results in fewer medication errors, possibly by reducing cognitive load.4,5 The industrial engineering and physician team that created the AMT focused on use-based placement and outlined format to best display essential medications for safety. To recreate the anesthesia cart, we utilized the principles of this AMT: standardizing medication and equipment layout, exploiting blank spaces as cues for missing medications and equipment, diminishing search time, and reducing overall cognitive load on clinicians. Moreover, having all needed equipment in the OR before patient arrival reduces the need for midcase door openings to pass in additional equipment and further staff exposure. Utilization of the Mayo Mat also reduces potential delays in attaining essential equipment and minimizes personal protective equipment (PPE) use. For example, passage of a forgotten suction catheter requires staff to don appropriate PPE, obtain it from the anesthesia supply cart, and reopen the OR door to hand it to the anesthesia team.
The Mayo Mats may reduce additional cognitive stress, time, use of PPE, staff exposure, and possibly incidence of error by no longer having to recall from memory the usual supplies normally at the anesthesiologists’ fingertips in the cart. In addition, the 2 mats provide a visual checklist, helping to ensure emergency supplies and medications are in the OR before the start of the procedure. The Mayo Mats can be used for all cases requiring strict isolation from droplet and airborne disease transmission, even for out-of-OR intubations. Moving forward, we hope to adapt this design further, standardizing the anesthesia setup for intubations in the intensive care unit and emergency room. As with the intention of AMTs in standardizing anesthesia cart tops to decrease the rate of medication administration errors, provide visual cues, and standardize OR anesthesia setup, the Mayo Mats help cultivate a system of standardized, safe, and methodical anesthesia practices, even during this pandemic.
Shilpa Verma, MD, Fiona Patrao, MD, Eliot Grigg, MD.
We would like to thank the Seattle Children’s Hospital Anesthesia Technician Team for their aid, flexibility, and support in the implementation of this novel tool.
Alexa Lean, MD
Sarah Brown, MD
Department of Anesthesiology and Pain Medicine
University of Washington
1. Siegel JD, Rhinehart E, Jackson M, et al. Isolation Precautions. 2019Centers for Disease Control and PreventionAvailable at: https://www.cdc.gov/infectioncontrol/guidelines/isolation/
. Accessed April 18, 2020.
2. Centers for Disease Control and Prevention. Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
. Accessed April 18, 2020.
3. Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth. 2020;67:568–576.
4. Grigg EB, Martin LD, Ross FJ, et al. Assessing the impact of the anesthesia medication template on medication errors during anesthesia: a prospective study. Anesth Analg. 2017;124:1617–1625.
5. Roesler A, Grigg EB, Martin LD, et al. Practice-centered design of a medication template to reduce medication handling errors in the operating room. Int J Des. 2019;13:53–68.