This article continues the series on cardiac monitoring in the peri-operative area by reviewing those arrhythmias that are classified as atrial or supraventricular. Whilst these arrhythmias are rarely life threatening, their haemodynamic effects can be significant and may not be tolerated in conjunction with the concurrent operative procedures. These arrhythmias are however, very commonly seen in perioperative practice and may be associated with anaesthetic procedures, surgical techniques and the recovery phase. In this increasingly technological age, it is imperative that perioperative practitioners can recognise and respond appropriately to the rhythms observed on the cardiac monitor.

Britains older population is on the increase. Anecdotal evidence suggests that the perioperative care of older patients does not take into consideration the physiological changes that come with ageing and their implications for care. Active consideration of physiological changes can contribute to the reduction in morbid events and achieves a better outcome for the older surgical patient.

The shift in the philosophy of care for people with learning disabilities from institutional care to living in the community has placed greater demands on generic health services. Alack of training and appropriate skills have been identified as problem areas for health care providers who may be required to care for this group of people. The dental health of people with learning disabilities has shown no improvement over the last fifty years despite advances in dental treatment. Requests for dental care present practitioners with ethical and legal problems due to a reduced capacity to give informed consent. The provision of dental care for patients with learning disabilities in the day surgery unit of a local hospital is critically evaluated and recommendations are then made as to how current practice may be improved with reference to the findings of current literature.

A lack of clarity in role definition can pose a risk to the care of patients in the peri-operative phase. Health care teams are often made up of multi-skilled-nursing-care-providers that are not statutorily registered professionals. This may undermine who is actually responsible and accountable in practice. This delegation dilemma is due to certain market forces, like changes and reforms in health service provision, shortages of doctors and nurses, and ever rising costs. Change and development in practitioners' scope of practice has been encouraged with training to enable practitioners to take on certain specific aspects of health care provision that were traditionally part of a doctor and, or a nurse's role. These changes should be monitored and considered by risk managers or those responsible for clinical governance, as they raise important legal and professional issues. In short, there is confusion over accountability driven by issues of role expansion. The respective professional bodies, both medical and nursing and the Department of Health need to come together and find a consensus of opinion in resolving the confusion over accountability and role delineation.