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Found 150 results
  1. News Article
    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
  2. News Article
    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
  3. News Article
    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
  4. Content Article
    The Patient Safety Movement are looking for patients, family members, health workers and administrators to reach out if they have an experience related to harm or death due to a medication error in the operating room. While the specific numbers may be debated, that medication errors, while rare in the operating, could have catastrophic consequences. The Patient Safety Movement are interested in hearing your perspective concerning this issue. Please email events@patientsafetymovement.org if you have a story that you’d like to share. If you are worried about anonymity please submit your story at the link below.
  5. Content Article
    Effective communication is critical for patient safety. One potential threat to communication in the operating room is incivility. Although examined in other industries, little has been done to examine how incivility impacts the ability to deliver safe care in a crisis. Katz et al. sought to determine how incivility influenced anaesthesiology resident performance during a standardised simulation scenario of occult haemorrhage.
  6. Content Article
    This guideline from The Centre for Perioperative Care (CPOC) provides recommendations to support delivery of quality perioperative care for people with diabetes undergoing surgery, from time of contemplation of surgery to discharge back to the community. The recommendations are supported by a set of practical and visual resources collated from units across the NHS, who have developed perioperative services for people with diabetes undergoing surgery.
  7. Content Article
    We catch up with a regular contributor to the hub, theatre nurse Kathy Nabbie, to discuss how she is continuing to ensure patient's are kept safe in theatre, the challenges of COVID-19 and what else we can do to improve safety in the theatre. Kathy was a theatre sister for breast oncoplastic surgery and a practice development lead in a London private hospital group up until August 2017. She now works as a locum theatre bank scrub nurse practitioner and once a week as a non-medical surgical first assistant. She also works for an insourcing company on weekends around the country to help with the backlog of NHS patients who need surgery or treatment in clinics.
  8. Event
    This session will focus on blood and bodily fluids exposure, including sharps injuries as well as their risk factors and prevention strategies. This webinar will present the 2020 RCN study and the 2022 UK NHS Trust study of sharps injury (SI) among UK HCW and, by comparing these results with other countries, question whether UK 2013 Sharps Regulations went far enough, and whether increased emphasis may be required on reporting, recording and implementation of effective prevention strategies. Learning outcomes: Define sharps injuries (SI); the four steps in sharps usage that place staff at risk; and the top two staff groups at risk of SI. Discuss the incidence of SI in the UK and UK HCW staff groups compared with international incidences. Appraise whether facility’s reporting and recording of SI enables benchmarking of the efficacy of their preventive strategies. Define three prevention strategies proven to reduce SI. Register
  9. Event
    until
    The aim of this webinar is to share, engage and discuss with clinicians, patient safety managers, patients and leaders the latest standards. There will be 2 sessions: 17.30: Session 1 – NatSSIPs 2: what it is and why it matters Welcome and introduction The CPOC perspective The Patient Safety Learning perspective Photo review of why NatSIPPs matters The patient perspective What is new in NatSIPPs 2? Resources to support Implementation: Checklists, infographics Q&A 18.30: Session 2 – NatSSIPs 2: implementation, practical insights and tips Our NatSIPPs 2 Workshop and how to consider a NatSSIPs gap analysis Team training for NatSIPPs 2 Q&A Register
  10. Event
    until
    The provision of safe and quality care is the most fundamental principle to consider for patients in perioperative practice. Alongside this commitment, is the safety and welfare of all staff and visitors within the setting. Risk assessment, staffing ratios, competency and skill are crucial to ensuring that the intended outcome for patients is achieved as far as is reasonably practicable. The discussion will outline how this can be achieved utilising the recommendations by the Association for Perioperative Practice (AfPP). Learning outcomes: Understanding risk and the process of risk assessment in perioperative practice. The components of a safe perioperative environment. How to calculate a safe staffing model for your environment based on the AfPP standard. Register
  11. Event
    Understanding human factors will allow surgical teams to enhance performance, culture and organisation of operating theatres. This one day masterclass will concentrate on human factors within the operating room. This is aimed at all theatre staff. It will look at why things go wrong and how to implement change to prevent it from happening again or mitigate the risks. This Masterclass will focus on systems to improve patient safety as well as looking at never events and how to learn from them using a human factors approach. Key learning objectives: Safety culture Human factors Leadership Never events This masterclass is aimed at all theatre staff. Register hub members receive 20% discount using code hcuk20kh.
  12. Event
    Treating trauma can be traumatic. The UK now has over 30 major trauma centres which treat more than 40,000 patients with traumatic injuries each year. For people under the age of 40, trauma remains a leading cause of death, and trauma survivors often experience life-changing injury and long-term disability. This study day examines the impact of various traumatic injuries on patients and the teams who care for them. Exploring burns, orthopaedic and battlefield trauma, as well as how to manage mass casualty events, you’ll learn about a wide range of trauma care scenarios. The speakers will outline how battlefield experience can be adapted for frontline work in within the NHS, with a key focus on the mental, physical and practical skills required to manage trauma to achieve the best outcomes for both patient and practitioner. The goal is to provide you with theory and practical skills to help you manage the mental and physical aspects of trauma in different settings. The sessions will also support you with understanding how skills learnt in one area can be transferred to another. Topics include: Treatment of acute burn injuries. The role of the Orthopaedic Trauma Coordinator. Introduction to AO Trauma Principles. Mass Casualty Events and the Citizen Aid App – with practical demo. Trauma and resilience in the armed forces: A Captain’s perspective. Trauma management on the battlefield. Register
  13. Content Article
    Theatres are a high risk area. This poster from the Association for Perioperative Practice and BD illustrates how to plan and practise to manage a surgical fire. Download a pdf of the poster from the attachment below.
  14. Content Article
    Mölnlycke are keen to highlight the great work happening across the NHS, and share this best practice to benefit the wider healthcare system. They have developed this short survey as part of their ‘Spotlighting Surgical Excellence’ project, to collect positive case studies from across the patient pathway, and profile them in order to highlight ways of improving efficiency and patient outcomes in operating theatres across the system. Your answers will be collated and anonymously assessed by an independent expert advisory board of clinicians and healthcare experts. They will choose a selection of case studies to profile in-depth in a short Q&A podcast, which will be conducted virtually. This will provide the chosen entries with the opportunity to showcase the work happening in their trust, and share this with other healthcare professionals.
  15. Content Article
    On Monday 10 July 2023 the Centre for Perioperative Care (CPOC) and Patient Safety Learning jointly hosted a webinar on the new National Safety Standards for Invasive Procedures 2 (NatSSIPs 2). This article contains links to video recordings of this webinar.
  16. Content Article
    Dr Liz O’Riordan is a breast cancer surgeon who has battled against social, physical and mental challenges to practise at the top of her field. Under the Knife charts Liz’s incredible highs: performing like a couture dressmaker as she moulded and reshaped women’s breasts, while saving their lives; to the heart-breaking lows of telling ten women a day that they had cancer. But this memoir is more than just an eye-opening look at the realities of training to be a female surgeon in a man’s world. In addition to this high-powered, high-pressured role, Liz faced her own breast cancer diagnosis, severe depression and suicidal thoughts, in tandem with commonplace sexual harassment and bullying. And by revealing how she coped when her life crashed around her, she demonstrates there is always hope.
  17. Content Article
    Intrahospital transport is a common occurrence for many hospitalised patients. Critically ill children are an especially vulnerable population who experience preventable adverse events at least once a week, on average. Transporting these patients throughout the hospital introduces additional hazards and increases the risk of adverse events. The transport process can be decomposed into a series of steps, each incurring specific risk. These risks are numerous and few of these risks are specific to the transport process. There is a paucity of literature available on paediatric intrahospital transport and related adverse events. Elliot et al. recently reviewed the Wake Up Safe database, a paediatric anesthesia quality improvement initiative across member institutions to disseminate information on best practices, for paediatric perioperative adverse events associated with anaesthesia-directed transport. The authors present several examples of airway and respiratory events taken from the database and discuss the complexity of the transport process.
  18. Content Article
    The PIT stop (prosthesis/implant timeout) checklist is Birmingham Women's and Children's NHS Trust's visual and aid memoir. It was launched to limit 'human error' and thus preventing never events (wrong implant/prosthesis). The four steps cover the intra-operative stages when implants are required. It works by recording what is requested on a small, hand held white board, and works in harness with the NatSSIPs 8, specifically step 5 of the infographic that has been previously developed.
  19. Content Article
    Tony Clarke suffered from a chronic inflammatory skin disease, hidradenitis suppurativa. In September 2020, Tony underwent surgery to remove infected tissue on one side of his body. When he entered the operating theatre, Tony’s surgical team first covered part of his body with an alcohol-based solution, to keep the area clean. Then, when the operation began, the surgeons began cutting off the infected tissue using a diathermy pen, a device that targets electrically-induced heat to stop wounds from bleeding. However, shortly into the surgery, disaster struck: heat from the surgical pen had ignited the alcohol on Tony’s body. “But because alcohol burns so hot, no fire was seen,” says Tony, recalling an explanation he later received from the hospital.  “The surgeons were concentrating on the right side of my body. The left side was left burning for about 20 minutes.” For the next four months, Tony travelled back to the hospital every three days, to get his injuries checked and bandages changed. During that time, Tony describes himself as ‘totally disabled.’ In September this year, Tony, as a patient ambassador for prevention of surgical fires, spoke at a conference held in York by the Association for Perioperative Practice (AFPP). There, perioperative practitioners from across the country gathered to listen to Tony’s experience. “I was speaking to lots and lots of different professionals in the medical service and they'd never heard of it [being set on fire during surgery]. It was a rarity for them,” Tony says. Tony’s now working with different health agencies, with the aim of stopping preventable surgical burns entirely.
  20. Content Article
    This paper from Roberts et al. examines the application of the Surgical Safety Checklist (SSC) within NHS hospital operating theatres England. The aim of the study, through a combination of open-ended questions, was to solicit specific information including views and opinions from operating theatre experts to establish from how the World Health Organisations (WHO) SSC is being applied, and therefore and why intraoperative ‘Never Events’ continue to occur more than a decade after the SSC was introduced. Participants were from the seven regions identified by NHS England. The intention of this paper is not to establish definitively whether the quantitatively identified themes; including a lack of training and engagement with human factors explains the increased presence of intraoperative ‘Never Events’. However, these themes, when subjected to methodological triangulation with the current literature, do appear consistent, and therefore provide an exploratory approach to inform research intended to improve safety in the operating theatre by informing policy and its application to safe practice ultimately towards quality improvements.
  21. News Article
    London’s hospitals are less than two weeks from being overwhelmed by covid even under the ‘best’ case scenario, according to an official briefing given to the capital’s most senior doctors this afternoon. NHS England London medical director Vin Diwakar set out the stark analysis to the medical directors of London’s hospital trusts on a Zoom call. The NHS England presentation, seen by HSJ , showed that even if the number of covid patients grew at the lowest rate considered likely, and measures to manage demand and increase capacity, including open the capital’s Nightingale hospital, were successful, the NHS in London would be short of nearly 2,000 general and acute and intensive care beds by 19 January. The briefing forecasts demand for both G&A and intensive care beds, for both covid and non-covid patients, against capacity. It accounts for the impact of planned measures to mitigate demand and increase capacity. Read full story (paywalled) Source: HSJ, 6 January 2021
  22. News Article
    All non-urgent elective operations are being postponed for at least two weeks in a health system still seeing significant and growing pressure from coronavirus. The four acute trusts in Kent and Medway will still carry out cancer and urgent electives, but other work is being postponed. Relatively few elective operations are usually carried out around Christmas and New Year, meaning the county is likely to see little or no elective work for the next four weeks. In a covid update bulletin issued last night, the Kent and Medway Clinical Commissioning Group acknowledged the pressure hospitals across its area were under but stressed cancer and other urgent operations would go ahead. It added: “However, we are now pausing non-urgent elective services. This will allow staff to move to support the increased number of covid-19 patients. “Initially this will be for a two-week period. We will keep this under weekly review and will contact individual patients where appointments need to be rescheduled.” Read full story (paywalled) Source: HSJ, 8 December 2020
  23. News Article
    More than a million patient operations could be delayed because of widespread shortages of anaesthetists in the NHS – with 9 out of every 10 hospitals reporting at least one vacancy. As coronavirus paralysed the NHS earlier this year, more than 140,000 NHS patients have already waited over a year for treatment. The Health Foundation has warned that 4.7 million fewer patients have been referred for treatment because of the impact of coronavirus on NHS services. The Royal College of Anaesthetists (RCOA) told The Independent the scale of the vacancies was getting worse and labelled it a “workforce disaster” that could cost patients’ lives and have a widespread impact on hospital services. Read full story Source: The Independent, 22 November 2020
  24. News Article
    Death rates for a major emergency abdominal surgery are almost eight times higher at some outlier hospitals compared with top performers, a national report has found. A review of emergency laparotomies in England and Wales has identified six hospitals as having much higher-than-average 30-day mortality rates for the surgery between December 2018 and November 2019. Hospitals identified by the annual National Emergency Laparotomy Audit as having the best outcomes, such as Stepping Hill Hospital and Salford Royal Hospital, had mortality rates of around 2.5%. But the review, published this month, found some hospitals, such as George Eliot Hospital, had 30-day mortality rates for emergency laparotomies as high as 19.6% The national 30-day mortality rate for emergency laparotomies in England and Wales was 9.3% last year and has fallen consistently since the review started in 2013. Some trusts told HSJ that data collection issues were partly to blame for the high mortality rates recorded in the review. Read full story (paywalled) Source: HSJ, 20 November 2020 .
  25. News Article
    Labour is demanding new investment for the NHS as part of the government’s spending review next week, after analysis shows hundreds of thousands of patients are waiting for life-changing operations. The party’s shadow health secretary, Jonathan Ashworth, will challenge Matt Hancock in Parliament on today over the latest NHS data, which reveal almost 500,000 patients are waiting for surgery on their hips, knees and other bones. Last week, NHS England published new data showing more than 1.7 million people were waiting longer than the NHS target of 18-weeks for treatment. The target was last met in February 2016. An analysis of NHS England data reveal which specialities have been hardest hit by the growing backlog of operations, which has soared since the first wave of coronavirus caused widespread hospital cancellations earlier this year. There were 4.3 million patients on NHS waiting lists for hospital treatments in September. Labour said this included 477,250 waiting for trauma and orthopaedic surgery, with 252,247 patients waiting over 18 weeks. The next worst specialty was ophthalmology, which treats eye disorders, with 444,828 patients on waiting lists, 233,425 of whom have waited more than 18 weeks. There were six figure waiting lists over 18 weeks for other specialties including gynaecology, urology, general surgery, and ear, nose and throat patients. Read full story Source: 17 November 2020
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