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Kathy Nabbie

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  1. Content Article Comment
    Awesome poster👌 Looking back to 2012 when there was a never event of a retained swab in a breast wound, I am now seeing this poster for the first time and realize that I dealt with it using some if not all of the framework as follows- - Decided on a different way of counting swabs - A new system to make the change - Researched my idea on Internet and AFPP journals - Made a plan and discussed it with my manager for approval - Brought in company reps to teach staff new system - Gained the support and cooperation of staff to use new system - Later, involved staff to do audits on new change - Change benefited both patients and staff safety. Swab safe management to prevent retained swabs - Improving systems of care - Patient Safety Learning - the hub.PDF
  2. Content Article
    Unfortunately surgical fires are still a patient safety issue. Each year patients needlessly suffer burns during surgical procedures which leave them with long-lasting, life-changing injuries and burdens the NHS with millions of pounds of avoidable costs and liabilities. Despite this, there is not a consistent, standardised approach across the NHS to prevent them. Kathy Nabbie, a theatre scrub nurse practitioner, shares how she implemented Fire Risk Assessment Score (FRAS) into her department. Developing the FRAS In January 2017, I read a tragic story in Outpatient Surgery involving an elderly patient in the US who suffered multiple burns following the use of chlorohexidine bottled alcoholic prep. I'd also read that in the US there are over 600 surgical fires every year. As the Practice Development Lead for my theatre department at the time, I decided to design a Fire Risk Assessment Score (FRAS). I discussed the FRAS with my manager and my suggestion to add the FRAS to the 'Time Out' of our WHO Surgical Safety Checklist. To further develop my ideas, I attended one of the Association for Perioperative Practice (AFPP) study days. All the delegates were asked to discuss and write a plan to make an immediate change in practice on return to their theatre department. I planned the FRAS. My manager who had originally agreed to my idea in January left in March, but I persevered with the idea and in July 2017 I made copies of the FRAS, discussed the score with senior staff, laminated the copies and placed one in each theatre. It was used as part of the WHO Surgical Safety Checklist Time Out. One month later I moved on and started bank shifts as a scrub practitioner in theatres. Fast forward 3 years Imagine my delight on a bank shift in August 2020 to see the FRAS as part of the patient profile on the hospital computer system – which meant it was in all six hospitals! So have fires decreased in theatres? Research shows that fires are still occurring in some UK theatres, and around the world, where a score is not part of the 'Time Out'; where bottled alcoholic prep is still used and not allowed to dry for 3 minutes before draping; and where lighted cables are sometimes allowed to rest on paper drapes. All perioperative staff need to have an awareness of surgical fires – where each flammable item used for the procedure is counted as 1 risk, and the score highlighted to the team and also documented before the start of the surgery. In doing this we can be reassured that we have taken all the necessary fire safety precautions for patients in our care, for the perioperative surgical team and also the preservation and the reputation of the hospital. Further reading The FRAS tool Kathy implemented Yardley IE, Donaldson LJ. Surgical fires, a clear and present danger. The Surgeon 2010; 8(2):87-92. Alani H et al. Prevention of surgical fires in facial plastic surgery. Australas J Plast Surg 2019; 28:40-9. Vogel L. Surgical fires: nightmarish “never events” persist. CMAJ 2018;190(4): E120. Cowles Jr CE, Culp Jr WC. Prevention of and response to surgical fires. BJA 2019; 8:261-266.
  3. Content Article Comment
    Congratulations to patient safety learning hub. 👏👏I joined the hub one year ago- With encouragement from Helen, Claire and the patient safety team, I started writing blogs on patient and staff safety issues. If like me, you have a passion for patient and staff safety, its a great idea to join the hub, as it helps you grow,develop and also gain confidence to write and share your knowledge to benefit your team.xx
  4. Content Article Comment
    I must admit it was truly heartbreaking to see carers donning a disposable mask, flimsy apron and disposable gloves before going into rooms in care homes with positive Covid 19 patients. I sincerely hope that they soon get tests,respirators and adequate PPE just like my NHS colleagues. Care homes and care staff have always been neglected in the past, and this pandemic is certainly opening our eyes to a lot of failings in this area. Let's hope when this is all over, we will see drastic changes and overall improvement in the care of patients and staff in care homes.
  5. Content Article Comment
    Another blog by Claire where she bares her deepest feelings about life at home and at the frontline of this pandemic.Truly heartbreaking! Compared to my last private hospital, where the scrubs were colour coded for intensive care,radiology, endoscopy and theatres- more than enough to go around and a further supply if necessary as well as availability of disposable scrubs if required for droplet infections. In some hospitals, we cannot wear a reusable cap, because we are not allowed to launder it at home! Why then, are NHS nurses allowed to risk their family safety and take their uniforms home to launder in a pandemic. Just like we have disposable PPE for a pandemic, we can ask the government to provide disposable scrub suits to the hospital staff and tonight I will do a petition to make this a reality. We are always fighting and speaking up for patient safety, so too we must fight and speak up for the health and safety of all healthcare staff in the NHS.
  6. Community Post
    I too am especially concerned about the lack of PPE for the healthcare staff. I am also heartbroken to learn that some staff never had Fit tests for FfP3 even though we had training for Ebola which was not airborne. The training should have continued yearly and on induction for new staff as we always have a new virus. Quite a number of staff still have no idea what a Fit test involves as some hospitals are either not doing them or doing a shortened version. I am really distressed thinking of healthcare staff who are looking after coronavirus positive patients with inadequate PPE! Many of the patients will die and many healthcare staff will never know if they have the virus unless they get tested. Hopefully when this is over, government and healthcare leaders will have learnt from errors made and in future start early to utilise and involve people who can help to expedite solutions. With every negative there are always positives. I believe this virus not only brought the world together, it taught the world to wash their hands, the meaning of PPE, fit tests, FFP3 and N95 respirator masks and the value of the roles of everyone in society.
  7. Content Article
    A tutor once told me that research means 'to search again'. I am always searching or, as someone told me recently, 'sleuthing' for knowledge to improve myself and then share with my colleagues. I would like to share with you my knowledge of hydrogen peroxide. During my many years of working in operating theatres, I observed that hydrogen peroxide was adopted by surgeons as a ritual for washing out wounds and deep cavities. An entire bottle of 200 ml hydrogen peroxide was mixed with 200 ml of normal saline. It seems this ritual was passed down from consultant to trainee and it then became a habit. In a recent post on the hub, I mentioned that women in 1920 were given Lysol as a disinfectant to preserve their feminity and maritial bliss! Lysol contains hydrogen peroxide, so women were daily irrigating their vaginas with a harmful solution of fizz, unaware of the hazards. I believe it is still being used to colour hair, remove blood stains, as a mouthwash gargle and also to whiten teeth. Then suddenly a breakthrough! In 2014, in my email inbox, a yellow sticker warning appeared from the Medicines and Healthcare products Regulatory Agency (MHRA) regarding the use of hydrogen peroxide in deep cavities. So why did the MHRA ban the use of hydrogen peroxide in deep cavities? Hydrogen peroxide is contraindicated for use in closed body cavities or on deep or large wounds due to the risk of gas embolism. Hydrogen peroxide breaks down rapidly to water and oxygen on contact with tissues. If this reaction occurs in an enclosed space, the large amount of oxygen produced can cause gas embolism.[1] There has been several case reports that have been published from around the world of life threatening or fatal gas embolism with use of hydrogen peroxide in surgery, of which five were from the UK. Most of the global reports describe cardiorespiratory collapse occurring within seconds to minutes of instillation of hydrogen peroxide as wound irrigation or when used to soak swabs for wound packing. This was sometimes accompanied by features associated with excess gas generation such as surgical emphysema, pneumocephalus, aspiration of gas from central venous lines, or the presence of gas bubbles on transoesophageal echocardiography. Non-fatal events were sometimes associated with permanent neurological damage such as neuro-vegetative state and hypoxic encephalopathy.[1] As the Practice Development Lead for the theatre department where I worked it was my role to pass on and act on the information received from the MHRA, so I discussed it with my very supportive theatre manager and then escalated to the theatre staff. But some consultants still ask for it today; it is always refused. So why do consultants request it when they are aware of the hazards? One theatre never event describes a syringe of hydrogen peroxide given to a consultant and injected into a joint instead of the required local anaesthetic![2] The patient survived but required care in the intensive care unit. As a scrub nurse practitioner this scares me. What about you? Would you now research this yellow sticker alert further, implement best practice and speak up, or would you just keep quiet and go "with the flow?" We all make mistakes, but learning from our errors will always be the ultimate key to improvement in healthcare and best practice and safety for our patients. References 1. Medicines and Healthcare products Regulatory Agency. Hydrogen peroxide: reminder of risk of gas embolism when used in surgery. 19 December 2014. 2. Chung J and Jeong M. Oxygen embolism caused by accidental subcutaneous injection of hydrogen peroxide during orthopedic surgery. A case report. Medicine (Baltimore) 2017; 96(43): e8342.
  8. Community Post
    Yes Claire- Lysol contains Hydrogen Peroxide. In my previous comments, you will note that it was used to flush the vagina of women before the gynaecologist delivered the baby. In 2014, the MHRA issued a safety warning about the usage of Hydrogen Peroxide. Since the hazards are many, and also another of my passions, I think it needs a blog which I will be writing soon.
  9. Community Post
    Still sold in the US, I understand Claire, and in UK as Chlorophenol. My concern here is, it was advertised and marketed with 'shocking and hilarious' ads, as being the gold star for feminine hygiene in 1920. However it was so potent, it was used to end an outbreak of cholera in Germany in 1889, the Spanish Flu in 1918 and also as an effective agent for the influenza virus. Also, it was used to wash the bedding and decontaminate the sick rooms and hospital walls! Marketing and advertising of products did not think of women then, and one hundred(100) years later, we are still being used as guinea pigs. With all the flashy medical devices aimed at saving time, sedation, space and money, our frail insides have been Meshed, Flushed and Morcellized to pieces. We need all the help and support from all available sources to fight this problem. -See attached screenshot image of how women were portrayed in 1920
  10. Community Post
    Thank you Claire. - Recently I have been researching this subject and some tales are gruesome. Over the years women have been prodded and poked. As far back as 1920,a product called Lysol- (a disinfectant) was marketed as a feminine hygienic product which preserved youth and marital bliss, used as a birth control agent via post coital douching and also used for abortions . Gynaecologists flushed the vagina with Lysol solution to prevent infections before delivering the baby . This practice was later abandoned, as it was thought its usage masked more serious problems- perhaps sepsis or even renal failure! One hundred years onwards, and women are still experiencing painful procedures and usage of harmful marketing products. When will it end? Why are we considered unequal and always used as trials? This is now 2020!-Is it not time to STOP?
  11. Content Article
    Kathy Nabbie reflects on the recent flights caught up in Storm Dennis and how 'routine' quickly became 'out of the ordinary'. As with aviation, in surgery we must always do the safety checks for each patient to ensure that every journey for the patient is a safe one. Recently Dr Peter Brennan tweeted a video of a plane landing at Heathrow airport during Storm Dennis. I looked at this with emotion, and with hundreds of in-flight safety information, human factors, communication and interpersonal skills running through my head. I thought of the pilot and his crew, the cabin crew attendants and the passengers, and how scared and worried they would have felt. On a flight, the attendants will take us through the safety procedures before take off. We are all guilty, I am sure, of partly listening because it is routine and we have heard it all before. Then suddenly we are in the midst of a violent storm and we need to utilise that information! We ardently listen to the attendants instructions and pray for the captain to land the plane safely, which he does with great skill! I now want to link this scenario to the care of our patients in the operating theatre. They are also on a journey to a destination of a safe recovery and they depend on the consultants and the team to get them there safely. Despite being routine, we need to do all the safety checks for each patient and follow the WHO Surgical Safety Checklist as it is written: ask all the questions, involve all members of the surgical team, even do the fire risk assessment score if it is implemented in your theatre. The pilot of that flight during Storm Dennis certainly did not think he was on a routine flight. He had a huge responsibility for the lives of his crew and many passengers! We can only operate on one patient at a time. Always remember, even though the operation may be routine for us, it may be the first time for the patient – so let's make it a safe journey for each patient. Do it right all the time!
  12. Community Post
    It's great the hospitals are highlighted in the link- In one story the patient did not know the people in the room- This is poor practice! Everyone in the room should be introduced to the patient- This is part of protocol and if not followed, is also disrespectful.
  13. Content Article Comment
    I agree with all the reporter said in this article. It took me a while to make a comment. Why? I was too busy crying, because it resonates with many other practitioners in so many hospital departments . This is exactly what happens- We are expected to work Harder, work Faster, work Longer and still do it Safely. Are we really "making a list and checking it not just twice but thrice?" We are supposed to in theatres- However there are times the patient is sent for too early- the surgeons are on a tight schedule, another surgeon may be following him- In most hospitals, sending early removes the anaesthetic practitioner from the theatre to the anaesthetic room- Who then assists the anaesthetist with the patient on the table?- Think about it! If the practitioner returns to help, who then stays with the patient in the anaesthetic room? Think about it! Please people- We can only do- ONE PATIENT AT A TIME! And to be extra safe, please can we avoid saying - "Send for the next patient"- The Patient has a Name- Use it! IT CAN AVOID ERRORS!
  14. Content Article Comment
    Hello Helen. Thank you. I sent you and Claire an email with links covering what I have done so far with the assistance of AFPP, and also what my plans are to increase more awareness of the hazards of diathermy tissue plume in ALL hospital theatres. I agree this project needs further help from social media to attract a wider audience . Kind regards Kathy
  15. Community Post
    Hello Helen, I encourage reporting all near misses.It immediately confirms no harm to the patient, no safeguarding issue, no duty of Candour- It is just a time of praise and congratulations and a celebration for the team who reported it! Theatre staff really need this incentive to move forward- Maybe by tapping near miss, the statistics can immediately enter into another system maybe a green light one to highlight and keep track of data and the number of near misses reported - I am sure there's smart IT technology that can do this-
  16. Content Article
    For over three decades, patients, consultants and perioperative staff have been exposed to diathermy tissue smoke in all operating hospital theatres. This smoke is called plaque and, when inhaled, is the same as smoking cigarettes. Research shows that inhalation of smoke from one gram of cauterised tissue is equal to smoking six cigarettes. This smoke is also cancerous and can mutate to other organs of the body just like cigarettes. Read my personal view of the harmful effects of diathermy smoke published in the Journal of Perioperative Practice, and also  watch the short video kindly made for me by Knowlex UK.
  17. Content Article
    In January 2017, I read an article in Outpatient Surgery involving an elderly patient in the US who suffered multiple burns following the use of chlorohexidine bottled alcoholic prep. The Oregon woman filed a million-dollar lawsuit against the Oregon Outpatient Surgery Center in Tigard, Ore., saying she suffered severe burns when her face caught on fire during an electrocautery procedure. Having read this tragic story and escalated it to my theatre manager and colleagues, I decided to design and evaluate a FRAS (Fire Risk Assessment Score) and use it as part of the WHO Surgical Checklist at "time out" to raise awareness of fires in operating theatres. Here is the FRAS tool I implemented: Fire risk assessment tool.pdf Other useful resources I found: Scoring_Fire_Risk-2.pdf Surgical Site Fire Triangle.pdf Surgical_Fire_Poster (1).pdf Video: Fire hazard demo by Zaamin Hussain and Mike Reed Demonstration: "Burning Bruce" drives home the reality of surgical fires - article in Outpatient Surgery
  18. Content Article
    Implementation of the Swabsafe™ management system at the The Princess Grace Hospital following a never event. It happened on a Saturday, 19.30pm, in April 2012. I was the theatre coordinator. We had a 'never event' of a retained swab in a breast wound. The following week, I changed practice following audits for four weeks in eight theatres. We never looked back. Attached is the poster presented in November 2016 at the Patient First Excel conference. Until recently no one ever asked me how I felt. I knew what to do. But I felt for the surgeon. As theatre scrub practitioners we complete counts and inform the surgeon. He acknowledges the count. If later on a swab is retained, it's the surgeon who has to inform the patient and remove it. By using a system especially designed for counting swabs (see video below), we can stop never events of retained swabs and maintain safety for the patient, the consultants, perioperative staff and also the hospital. We have the technology – let's use it! Kathy showcasing the Swabsafe Management poster at the Patient First Event, Excel London.

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