CAA Risk Management & Mitigation 2 — Questions and Answers
Question 1: A patient scheduled for elective surgery is found to have an INR of 3.8 on preoperative labs. What is the most appropriate risk mitigation step?
- Proceed with surgery using careful hemostasis
- Cancel surgery and reverse anticoagulation before rescheduling (Correct answer)
- Administer fresh frozen plasma intraoperatively as needed
- Reduce the planned anesthetic agent doses to compensate
Correct answer: Cancel surgery and reverse anticoagulation before rescheduling
An INR of 3.8 represents a significant bleeding risk; elective surgery should be postponed until anticoagulation is safely reversed and INR is within acceptable range.
Question 2: Which strategy BEST reduces the risk of wrong-site surgery in the perioperative setting?
- Relying on the surgeon's verbal confirmation in the OR
- Performing a time-out immediately before incision with all team members (Correct answer)
- Marking the site only when the patient is sedated for comfort
- Documenting the surgical site in the anesthesia record post-induction
Correct answer: Performing a time-out immediately before incision with all team members
The universal protocol requires a time-out with active participation of all team members immediately before incision to verify patient identity, procedure, and site.
Question 3: A CAA notices that the end-tidal CO2 waveform has suddenly disappeared during a case. What is the FIRST priority action?
- Increase the fresh gas flow rate
- Verify endotracheal tube position and ventilation immediately (Correct answer)
- Document the capnography malfunction in the record
- Switch to spontaneous ventilation mode
Correct answer: Verify endotracheal tube position and ventilation immediately
Sudden loss of ETCO2 waveform is a critical sign that may indicate esophageal intubation, circuit disconnection, or cardiac arrest and requires immediate verification of airway and ventilation.
Question 4: Which of the following is a key component of a root cause analysis (RCA) following an anesthesia-related adverse event?
- Identifying and disciplining the individual responsible
- Analyzing system and process failures that contributed to the event (Correct answer)
- Limiting the investigation to the anesthesia department only
- Completing the analysis within 24 hours regardless of complexity
Correct answer: Analyzing system and process failures that contributed to the event
RCA focuses on identifying underlying system and process failures rather than individual blame to prevent recurrence of adverse events.
Question 5: A patient with known latex allergy is scheduled for surgery. What is the MOST important risk mitigation measure?
- Have epinephrine available but proceed with standard supplies
- Ensure a latex-free environment is prepared prior to patient arrival (Correct answer)
- Premedicate with antihistamines and proceed with latex-containing products
- Schedule the patient last on the OR schedule only
Correct answer: Ensure a latex-free environment is prepared prior to patient arrival
A fully latex-free environment must be established before the patient enters the OR to prevent allergic and anaphylactic reactions.
Question 6: During a case, the CAA suspects a medication administration error has occurred. After treating the patient, what should be done next?
- Discuss the error only with the supervising anesthesiologist privately
- Complete an incident report and disclose the error through proper channels (Correct answer)
- Document the event using vague terminology to avoid liability
- Wait to see if the patient has an adverse outcome before reporting
Correct answer: Complete an incident report and disclose the error through proper channels
Incident reporting and transparent disclosure are ethical and legal obligations that support patient safety and system improvement.
Question 7: Which preoperative assessment finding most significantly increases the risk of pulmonary aspiration during anesthesia induction?
- BMI of 27 kg/m²
- Last oral intake of clear liquids 4 hours ago per NPO guidelines
- Symptomatic gastroesophageal reflux disease with full stomach (Correct answer)
- Mild anxiety about the procedure
Correct answer: Symptomatic gastroesophageal reflux disease with full stomach
Symptomatic GERD combined with a full stomach markedly increases aspiration risk, warranting rapid sequence induction and additional precautions.
CAA Risk Management & Mitigation 2
A patient scheduled for elective surgery is found to have an INR of 3.8 on preoperative labs.
What is the most appropriate risk mitigation step?