Cardiopulmonary bypass (CPB) is highly technical and complex and accident and error can occur due to malfunction of equipment and/or human factors.Since its first successful clinical use in 1953, incremental improvements in the heart lung machine have resulted in a decline of perfusion related accidents. Safety practices have been demonstrated to reduce the incidence of error and equipment fault and need to be constantly reviewed and their implementation should be regularly rehearsed by all members of the intraoperative team and not only by the perfusion team. Institutional protocols, compliance with instructions for use of equipment and step-by-step processes to deal with error and unforeseen events will minimize their impact.

Medication errors are believed to be a leading cause of avoidable harm to patients around the world, with an estimated cost of US$42 billion per year, worldwide. It has been estimated that 5% of all patients who are admitted to a hospital experience a medication error, and that an average hospital will have one medication error every 22.7 hours or every 19.7 admissions. Human error is inevitable, but many of these errors actually reflect failures in the design and resourcing of the system within which medications are administered to patients, and some reflect violations of safe medication practices. Medication errors are the most common of all medical errors and pose a tremendous emotional and physical cost to patients and economic burden to our health system. Clearly medication error is a major source of risk and adverse events for our patients. This chapter presents a roadmap for the rest of the book, and definitions that will be used throughout. We also discuss how medication error is measured, the methods by which it is studied, the techniques used to capture incident reports, and some of the metrics and statistics to report these errors and incidents.

Although an individual anaesthesia provider secures the patient’s airway, upstream organisational events will influence how airway management is actually performed in any institution. Decisions around equipment purchases, staff training, post-operative care arrangements and even departmental staffing will all influence how an anaesthetic is administered. While standardised equipment, and high quality protocols, guidelines and behaviours ensure better patient outcomes in the event of an airway emergency, this cannot be achieved without input from the institution to facilitate education and training for all airway team members. Organisations should learn from both critical incidents and examples of excellent practice, and have mechanisms to record airway events. Human factors (ergonomics) are a vital component of successful airway management and organisations should incorporate human factors education in their airway training programmes. Communication about patients known to have a difficult airway is vital and must be done effectively, especially when this involves communication between hospitals or even countries.