Patient safety spotlight interview with Kathy Nabbie, Theatre Scrub Nurse Practitioner and Non-medical Surgical First Assistant

Summary

This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Kathy tells us about the importance of breaking down barriers to share patient safety tools, and talks about changes she has implemented to make surgery safer.

About the Author

Kathy Nabbie is a registered nurse and Non-medical Surgical First Assistant with over 40 years’ experience working in operating theatres. She trained at Whittington University Hospital, Broomfield University Hospital and the University of Greenwich. Kathy previously worked at HCA Princess Grace Hospital and King Edward VII Hospital. She is now employed by HBSUK, an insourcing service and her work involves assisting with the backlog of NHS dermatology patients.

Questions & Answers

Hello Kathy. Please can you tell us who you are and what you do?

My name Is Kathy Nabbie and I am a Theatre Scrub Nurse Practitioner and Non-Medical Surgical First Assistant specialising in breast oncology and reconstructive surgery, cosmetic and plastic reconstructive surgery, and dermatology. I currently work for an insourcing company at weekends, helping to reduce the backlog of NHS patients in dermatology. 

I am interested in evidence-based interventions for patient safety and spend time researching approaches and tools that will help make surgery safer for patients and staff.

How did you first become interested in patient safety?

I became interested in patient safety during my first role in an operating theatre in 1990. Other staff were calling patients “the next patient” or “the patient in room 2” rather than by their names. I saw how this was a patient safety issue and my motto became, “Always refer to patients by their name!” It allows us to be sure about their identity, and importantly, makes patients feel valued as real people.

My interest grew in 2012 when I was the coordinator at a breast surgery service and a Raytec swab was retained in a patient’s wound after surgery. It was the first time I had seen a retained swab on a x-ray, and I decided I never wanted to see it again. The scrub nurse, who was tired and trying to carry out multiple tasks, hadn’t done a second count and that was how she had missed the swab.

I realised that the processes we were using weren’t safe and wanted to find a way of making sure we didn’t repeat the error. Over the weekend, I researched a method I had heard of when working at another hospital, and on Monday morning presented the Swabsafe Management System to the theatre manager. They agreed to implement it and I carried out an audit of its use in theatres over the next few weeks. The change met some resistance from staff at first, but eventually people understood the difference it could make and the hospital integrated Swabsafe into their policies. It was so successful that it was implemented right across the group of six hospitals.

Which part of your role do you find the most fulfilling?

I find it very fulfilling being an advocate for each of my patients and playing a small role in their journey through a procedure. I can go home knowing I have kept my patients safe.

Part of this involves ensuring that the hospitals I work at adopt and apply safety warnings and practices. One example of this is in ensuring hydrogen peroxide is never used during surgery. In 2014, the Medicines and Healthcare products Regulatory Agency (MHRA) issued a yellow sticker warning banning the use of hydrogen peroxide to clean out wounds, as there were a number of case reports of it causing life-threatening or fatal gas embolism. 

In the years following, I was working as a bank nurse and found that some surgeons were still requesting hydrogen peroxide in theatre. On one bank shift, I witnessed hydrogen peroxide being used on a patient and it troubled me. So during the next shift I had, I made sure the hydrogen peroxide was locked away. Before the surgeon came into theatre, I spoke to the team about the MHRA ban and said that we shouldn’t be passing hydrogen peroxide to the surgeon to use. Sure enough, during surgery, the surgeon requested hydrogen peroxide solution, and it was the healthcare assistant who spoke up and told him that it had been banned so we wouldn’t be using it. Later, I also spoke to the pharmacy manager about the fact that hydrogen peroxide was still accessible during surgery. After showing her the MHRA warning, she sent out an email to the whole hospital staff explaining that all hydrogen peroxide had been removed from the cupboards and could not be ordered for use in theatre. 

By raising awareness, I was able to improve safety, even as ‘just’ a bank nurse. It’s so important to speak up when you see unsafe practices, and anyone in the theatre team can play an important role in keeping patients safe from potentially serious harm.

What challenges do you/does your organisation face at the moment?

One major challenge is that many organisations lack the ability and compassion to acknowledge and listen when staff speak up about patient safety. This also applies to patients; managers need to pay more attention to their suggestions and act on them, as patients and families often see issues that we don’t.

What do you think the next few years hold for patient safety?

To see real progress, we need to all get together and start implementing the ideas and principles we discuss about patient safety, rather than just paying it 'lip service'. I think that will help us move forward much faster. 

One change I specifically want to see is in our approach to preventing surgical fires. They urgently need to be classified as a ‘never event’. I have seen the dire effects of surgical fire injuries on patients, and I know that we have tools that can help prevent them occurring. At events and conferences I have been spreading the word about the Fire Risk Assessment Score (FRAS), an awareness tool used as part of the timeout before each procedure in theatre. The private sector hasn’t been good at sharing patient safety tools with the NHS, but that’s something I’m trying to help change; I am working with surgical colleagues in the NHS to make the FRAS tool available to NHS teams.

I also want to see diathermy tissue smoke evacuation made mandatory in all healthcare settings where tissue cauterisation takes place. This would help keep patients and perioperative staff safe by preventing the inhalation of harmful toxic fumes.

If you could change one thing in the healthcare system right now to improve patient safety, what would it be?

I think it starts with sharing tools and techniques with others, so I would make sure colleagues know about the changes I have implemented and encourage them to do the same.

Are there things that you do outside of work which have made you think differently about patient safety?

I will never stop doing two things: campaigning for patient safety and speaking up. We have to keep trying and pushing the boundaries to be successful. I love this quote by Wayne Dyer: “Change the way you look at things, and the things you look at change.”

Tell us one thing about yourself that might surprise us!

I waited for 12 hours in the queue to see Queen Elizabeth II lying in state on 17 September and was interviewed live on BBC news!