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Anaesthetists who care for children should have received appropriate training,³ and must ensure that their competency in anaesthesia and resuscitation is adequate for the management of the children in their care.^,3,4

An appropriately trained and experienced anaesthetist should be present throughout the conduct of anaesthesia for all procedures, including those procedures requiring intravenous sedation (where provision of this service has been agreed by the anaesthetic department). In exceptional circumstances, for example, where urgent treatment for another patient requires the anaesthetist to leave the patient, they should delegate responsibility to another appropriate...

Documentation and communication of information on preoperative preparation are essential. Electronic systems should be considered to enable the capture and sharing of information, support risk identification and allow data to be collected and available for audit and research purposes.^10,12

There should be an identified consultant anaesthetist with overall responsibility for supervision of anaesthetic trainees and, where necessary, anaesthetists who are neither consultants nor trainees.^3,7

There should be a locally agreed policy on the level of consultant supervision required, based on the age, complexity and co-morbidities of the patient.^3,8,9

When a child undergoes anaesthesia or an anaesthetic department provides sedation services, there should be a dedicated trained assistant, i.e. an operating department practitioner (ODP) or equivalent, who has had paediatric experience and maintained their paediatric competencies.¹⁰

In the period immediately after anaesthesia, the child should be managed in a recovery area, staffed on a one-to-one basis at least until the child can manage their own airway. The staff in this area should have paediatric experience and current paediatric competencies, including resuscitation.^10,11

A member of staff with advanced training in life support for children should always be available to assist where required.^12,13,14

In situ simulation training can help to identify system process gaps.⁹² Simulation-based learning techniques should be used to assist anaesthetists to resolve these issues and develop the necessary technical and non-technical skills.^{93,94,95,96,97,98,99,100,101,102,103}

There should be induction programmes for all new members of staff, including locums. Induction for a locum doctor should include familiarisation with the layout of the labour ward, the location of emergency equipment and drugs (e.g. MOH trolley/intralipid/dantrolene), access to guidelines and protocols, information on how to summon support/assistance, and assurance that the locum is capable of using the equipment...