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Showing results for tags 'Operating theatre / recovery'.
Found 150 results
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Content Article
A day in the life of an Operating Department Practitioner
Patient Safety Learning posted an article in Surgery
There are three main aspects of the Operating Department Practitioner (ODP) role; namely, anaesthetics, surgery and post-anaesthetic care. There are some overarching qualities that are necessary for any ODP. These include excellent communication skills including verbal, non-verbal and written. Treating patients with dignity and respect, maintaining confidentiality throughout. -
Content Article
The role of the operating department practitioner
Patient Safety Learning posted an article in Surgery
The operating department practitioner (ODP) participates in the assessment of the patient prior to surgery and provides individualised care. The College of Operating Department Practitioners provides an overview of what an ODP does. -
News ArticleA baby with a serious heart condition has died after she received an infection from mould in a Seattle hospital's operating room, her mother says. Elizabeth Hutt was born with a heart condition that she battled for the entirety of her six-month-long life. The young child underwent three open heart surgeries, and after the third one is when it's believed she contracted an Aspergillus mould infection in the hospital's operating room. The mould in the hospital's operating rooms was first detected in November, around the same time as the child's third surgery. It was later determined the infection was contracted from the mould discovered in three of the 14 operating rooms at the hospital in November. The mould came from the hospital's air-handling units in the operating rooms, and 14 patients have developed infections from the mould since 2001, the hospital revealed. Seven of those 14 children have since died from their infections. Elizabeth's parents have joined a class action suit against Seattle Children's Hospital in January, which alleges facility managers knew about the mould since 2005 and failed to fix the problem. Read full story Source: The Independent, 14 February 2020
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Content Article
Ten Thousand Feet: workshops and consultancy
Claire Cox posted an article in Suggest a useful website
Ten Thousand Feet UK is a Consultancy led by Rob Tomlinson in collaboration with the Association for Perioperative Practice. Rob is a clinical nurse in the NHS and is leading the way to improving patient safety through clinician-led culture change in the UK. Rob has already delivered workshops on a national scale with success for teams who have embraced the new procedure. 'Never Events' within the NHS are still on the rise with distraction and a loss of situational awareness still being cited as one of the main causes. Ten Thousand Feet aim to embed new patient safety culture into operating theatre teams nationwide, so at any time, anyone working in the theatre who needs to focus their attention at the task in hand can can use the language tool “Ten Thousand Feet” to improve team efficiency and most importantly patient safety. At the end of the workshop theatre staff will be educated and empowered to use this concept in a safe and effective manner. -
News Article
India: When a ‘never event’ hits a patient
Patient Safety Learning posted a news article in News
A young woman was left with a retained foreign object, after surgery in an India hospital. A checklist could have avoided her death. The response from the health officials was: “We have issued a show-cause notice to the staff seeking an explanation. We will initiate departmental action based on their replies and finding of our inquiry.” In the fields of healthcare quality and patient safety, such punitive measures of “naming and shaming” have not worked. T.S. Ravikumar, President, AIIMS Mangalagiri, Andhra Pradesh, moved back to India eight years ago with the key motive to improve accountability and safety in healthcare delivery. He believes that we have a long way to go in reducing “preventable harm” in hospitals and the health system in general. "We need to move away from fixing blame, to creating a 'blame-free culture' in healthcare, yet, with accountability. This requires both systems design for safe care and human factors engineering for slips and violations". "Providing safe care without harm is a 'team sport', and we need to work as teams and not in silos, with mutual respect and ability to speak up where we observe any deviation or non-compliance with rules, says Ravikumar. Basic quality tools and root-cause analysis for adverse events must become routine. Weekly mortality/morbidity conferences are routine in many countries, but not a routine learning tool in India. He proposes acceleration of the recent initiative of the DGHS of the Government of India to implement a National Patient Safety Framework, and set up an analytical “never events” or sentinel events reporting structure. Read full story Source: The Hindu, 12 January 2020 -
Content ArticleA candid account from a healthcare professional on how it feels to have to tell a patient in intensive care that their treatment is to be delayed. Part of the Guardian newspaper's Blood, sweat and tears series.
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News Article
Hywel Dda cancels operations after 'critical pressures'
Patient Safety Learning posted a news article in News
A health board has cancelled planned operations at four of its hospitals "in the interest of patient safety". Hywel Dda University Health Board made the decision after "an extraordinary weekend" of "critical pressures". On Monday, inpatient operations were cancelled at Bronglais, Glangwili, Prince Philip and Withybush hospitals in mid and west Wales. The health board said it had contacted the patients affected and outpatient appointments continued as normal. No decisions have been taken yet to cancel more non-emergency operations on Tuesday, it added. Dr Philip Kloer, the health board's medical director, said the weekend saw hospitals "at a level of escalation not seen before". "It is in the interest of patient safety that we have postponed planned operations today," he added. Plaid Cymru's shadow minister for health, Helen Mary Jones, said the decision to cancel operations was "deeply concerning". She said that patients in Wales "deserve so much better". Read full story Source: BBC News, 6 January 2020 -
News ArticleMore than 80% of patients who have signs of a deadly sepsis infection before high-risk surgery are not getting antibiotics fast enough, a major NHS report has warned. Sepsis kills an estimated 44,000 people in England every year and rapid access to antibiotics within the first hour after diagnosis is vital to halt the infection. However, a review of performance across 179 NHS hospitals has found a majority of patients undergoing emergency bowel surgery are not getting medication early enough. A leak of the bowel can cause sepsis and while antibiotics will help treat the infection, surgery is essential to repair any sepsis-causing leak. The Royal College of Anaesthetists, which carried out the study for the NHS, said although the number of patients getting surgery in time had improved over the last five years, the numbers receiving antibiotics within an hour had not. Read full story Source: The Independent, 4 January 2020
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Content ArticleSurgical fires are fires that occur in, on or around a patient undergoing a medical or surgical procedure. Surgical fires are rare but serious events. The ECRI Institute estimates that approximately 550 to 600 surgical fires occur each year in the USA. The American Association of Nurse Anesthetists (AANA) is a collaborating partner of the FDA Preventing Surgical Fires Initiative. This initiative was launched to increase awareness of factors that contribute to surgical fires, disseminate surgical fire prevention tools, and promote the adoption of risk reduction practices throughout the healthcare community.
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Content ArticleThe hospital environment is both unique and unusual in that electrical equipment is directly applied to the human body. From this contact either capacitive or resistive coupling may lead to current flow and harm. Surgical diathermy, patient monitoring and imaging, although universal, are often misunderstood, and many clinicians are ignorant of their principles and hazards. Electrical equipment in hospital therefore has the potential to lead to serious injury or death. This article published in Anaesthesia and Intensive Care Medicine outlines the basic physics of electricity, in particular the principles behind diathermy, the hazards posed by it and by other devices and the various measures available to reduce the risk of these.
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News Article
Woman awarded £8m after doctors left sponge inside her during surgery
Patient Safety Learning posted a news article in News
A woman has been awarded $10.5 million (£8m) in damages after medical staff left a sponge inside her body. The sponge – which measured 18-by-18 inches and was left behind during surgery – was inside the woman's body for years before she realised. It had been left in her body after she underwent heart surgery at a Kentucky hospital in 2011. The bypass surgery is said to have gone wrong, leaving a mess – and as nurses rushed to deal with the problems, the sponge was left inside her body. It was not discovered for four years, until she had a CT scan in 2015. In the meantime, the sponge had moved around the woman's body, shifting around her intestines and causing pain as it did so. She had her leg amputated and was left with gastrointestinal issues after the sponge eroded into her intestine. The patient's lawyers said the case should be a reminder to hospitals to ensure that objects such as needles and other sharp objects, as well as sponges, are removed from patients after surgery. Read full story Source: The Independent, 1 January 2020 -
Content ArticleAccording to the National Institutes of Health (January 2019), more than 130 people in the United States die after overdosing on opioids every day. Among these deaths are patients in the hospital setting, recovering from surgical procedures or undergoing sedation, who are often prescribed opioids such as morphine and oxycodone to manage pain – a necessity for healthy and comfortable recovery. But at certain doses, these drugs can also cause respiratory failure, and, because each patient is different, there is no one dose that is 'right' or 'wrong'. Hospitals must take action to ensure their staff are aware of these risks, and put protocols in place to prevent patient deaths. The authors of this US article, published by Medium, offer recommendations for improving patient safety in this area.
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Content ArticlePatient safety groups consider surgical fires “never events,” incidents that can be avoided entirely with organisational checks and balances. Yet, the Canadian Medical Protective Association (CMPA) has handled dozens of lawsuits and regulatory complaints involving surgical burns in recent years. According to a review of 54 cases of perioperative burns between 2012 and 2016, almost a third involved surgical fires, while the rest involved burns from surgical equipment and chemicals used in surgery. Many patients were left scarred, disfigured and psychologically traumatised. Fifteen percent were severely harmed, with airway damage or full-thickness burns destroying the sensory nerves and all layers of the skin.
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News Article
Woman dies after being set on fire during surgery in Romania
Patient Safety Learning posted a news article in News
A woman has died after being set on fire during surgery in Romania, the country’s health ministry has said, in a case that has cast a spotlight on the ailing Romanian health system. The patient, who had pancreatic cancer, died on Sunday after suffering burns to 40% of her body when surgeons used an electric scalpel despite her being treated with an alcohol-based disinfectant. Contact with the flammable disinfectant caused combustion and the patient “ignited like a torch”, Emanuel Ungureanu, a Romanian politician, said. A nurse threw a bucket of water on the 66-year-old woman to prevent the fire from spreading. The health ministry said it would investigate the “unfortunate incident”, which took place on 22 December. “The surgeons should have been aware that it is prohibited to use an alcohol-based disinfectant during surgical procedures performed with an electric scalpel,” the Deputy Minister, Horatiu Moldovan, said. Read full story Source: The Guardian, 30 December 2019 the hub has a number of posts on preventing surgical fires: Surgical fires: nightmarish “never events” persist MHRA. Paraffin-based skin emollients on dressings or clothing: fire risk (18 April 2016) National Patient Safety Agency: Fire hazard with paraffin-based skin products (Nov 2007) How I raised awareness of fires in the operating theatre -
News Article
Royal Derby Hospital: Disposable sterile hijabs introduced
Patient Safety Learning posted a news article in News
A hospital trust believes it is the first in the UK to introduce disposable sterile headscarves for staff to use in operating theatres. Junior doctor Farah Roslan, who is Muslim, had the idea during her training at the Royal Derby Hospital. She said it came following infection concerns related to her hijab that she had been wearing throughout the day. It is hoped the items can be introduced nationally but NHS England said it would be up to individual trusts. Ms Roslan looked to Malaysia, the country of her birth, for ideas before creating a design and testing fabrics. "I'm really happy and looking forward to seeing if we can endorse this nationally," she said. Consultant surgeon Gill Tierney, who mentored Ms Roslan, said the trust was the first to introduce the headscarves in the UK. "We know it's a quiet, silent, issue around theatres around the country and I don't think it has been formally addressed," she said. Read full story Source: BBC News, 19 December 2019 -
Content ArticleThis document sets out Barts Health Local Safety Standards for Invasive Procedures (LocSSIPs) based on the National National Safety Standards for Invasive Procedures (NatSSIPs). It includes eight sequential steps that are reinforced with clear organisational standards. These standards are a minimum, based on national best practice, to improve safety. They apply to all staff and all services that perform invasive procedures at Barts Health NHS Trust.
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Content Article
Medical negligence: Diathermy burns
Patient Safety Learning posted an article in Legal matters
If you have suffered a diathermy burn during surgery, you will probably have a number of questions that need to be answered. For example, why did you wake up from surgery with a burn on your skin? Is this the fault of your surgeon? And is there any action you can take? -
News Article
Health strike: Action could delay cancer diagnoses
Patient Safety Learning posted a news article in News
Patients are facing a week of disruption, with more than 10,000 outpatient appointments and surgeries cancelled in Belfast. Some people referred by their GPs on suspicion of cancer could have their diagnosis delayed, the head of the Belfast Trust has said. The trust apologised, blaming industrial action on pay and staffing. Martin Dillon said outpatient cancellations "could potentially lead to a delay in treatment" for cancer. The Department of Health said the serious disruption to services was "extremely distressing". Read full story Source: BBC News, 2 Decmeber 2019 -
Content Article
HSJ. Roundtable: Infection prevention and control
Patient Safety Learning posted an article in Surgery
A Health Service Journal (HSJ) and Mölnlycke roundtable discusses how the NHS can improve infection control and prevention in the operating theatre – and the benefits of greater focus on this area -
Content ArticleWaste in the operating theatre costs money and is harmful to the environment. Reducing waste in the NHS is paramount if we want to reduce costs and help save the planet!
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News Article
Patient died after 'transplant surgeon error'
Patient Safety Learning posted a news article in News
A transplant patient died after a surgeon failed to disclose he had spilt stomach contents on organs which went on to be used in NHS operations. The 36-year-old died of an aneurysm caused directly by infection from a donated liver, while two other patients became ill from transplants. The incident took place in 2015 but only came to light when one of the sick patients attended a hospital in Wales. It had involved a surgeon from Oxford University NHS Foundation Trust. Several organs became infected with Candida albicans, a fungal infection, after the surgeon cut the stomach in a donor while retrieving organs, spilling the contents over other organs. The surgeon did not tell anyone as he should have done and the organs were transplanted into three patients. The patient, who did not want to be named, said: "What angers me to this day is that fact that the surgeon who removed the organs from the donor wasn't honest. It was only when people who received the organs became unwell that the truth was told." Read full story Source: BBC News, 21 November 2019 -
Content ArticleFor 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.
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Content ArticleFrom pre-operative care, through the anaesthetic and surgical phases to post-operation and recovery, this easy-to-read, quick-reference resource uses the unique at a Glance format to quickly convey need-to-know information in both images and text, allowing vital knowledge to be revised promptly and efficiently.
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Content Article
Electrosurgery. Managing the risk (September 2004)
Patient Safety Learning posted an article in Surgery
This poster from the National Association of Theatre Nurses (ATN) aims to give an overview of electrosurgery in the perioperative setting. It identifies and defines some of the common forms of electrosurgery used in perioperative practice and identifies some of the hazards that can be associated with these products. -
Content ArticleReacting to a never event is difficult and often embarrassing for staff involved. East Lancashire Hospitals NHS Trust has demonstrated that treating staff with respect after a never event, creates an open culture that encourages problem solving and service improvement. The approach has allowed learning to be shared and paved the way for the trust to be the first in the UK to launch the patient centric behavioural noise reduction strategy ‘Below ten thousand’. Published in the Journal of Perioperative Practice.
