Perioperative practice
which aim to improve safety and reduce the risk of complications.2
The guidelines include the
need to “standardise, harmonise and educate”, and also incorporate the WHO checklist. NatSSIPs2 consists of two inter-related sets
of standards: l The organisational standards are clear expectations of what Trusts and external bodies should do to support teams to deliver safe invasive care.
l The sequential standards are the procedural steps that should be taken where appropriate by individuals and teams, for every patient undergoing an invasive procedure.
The sequential standards cover eight things that should happen for every relevant patient: 1. Consent and procedural verification. 2. Team brief. 3. Sign in. 4. Time out. 5. Implant use. 6. Reconciliation of items. 7. Sign out. 8. Debrief/handover.
“Basically, we want to standardise, harmonise and to educate – so that if someone is covering in a different theatre that they don’t know, they can feel safe and comfortable,” she commented. There is a need to reduce variation, commit to safety education, human factors and systems thinking; as well as creating a safety infrastructure, and promoting understanding and training in cultural change. Engagement with the team brief is a required
behaviour in the delivery of safe care and is a demonstration of mutual respect to the multidisciplinary team and professionalism. It shows a commitment to the importance of
Investing in excellence: Organisation Paid Member Scheme
AfPP has just launched the Organisation Paid Member Scheme which allows organisations to cover the cost of individual AfPP memberships for their employees, helping to unlock their potential, and enhance the quality of care and patient safety. It is beneficial to individual practitioners and
organisations. Individuals get all the benefits of AfPP membership paid for by their organisation,
communication for patients, staff and patient safety. The brief should also “assume nothing” and ensure staff familiarity with equipment, the kit requirements, expected behaviours, as well as checking “is your bucket full?”, for example. Good leadership will ensure that all members of the team feel comfortable, valued and empowered, so that any issues of safety can be volunteered. This will encourage an environment of openness and flattened hierarchies. “The team brief is the most important bit. You
can really set up the team for that day or that session,” she commented. Prof. McNally highlighted the importance of discussing what the list is going to look like, the patients for that day, when breaks are planned, and checking whether the implant is compatible, etc. There are some key aspects of the team brief that can be evaluated – it should start on time, senior clinicians and all team members should be present, all team members should be “engaged” (silent focus), and a team brief record should be kept. Members of the surgical team should also be educated on the need to ensure they are not chatting during the reconciliation of objects, such as swabs used in surgery or guidewires used in interventional radiology. The first count should be before closure of a cavity or major organs; before closure of the first layer of muscle and before wound closure begins. The final count should be at the beginning of closure of the skin or before the end of the procedure. This point should be identified to the team (pause for gauze). The end is when the “final count complete” is announced.
Prof. Scarlett McNally discussed ‘how to get awesome perioperative care’.
The need for prevention and preparation Prof. McNally highlighted the importance of prevention to avoid the need for surgery in the first place, as well as the importance of preparation to optimise patients’ health to ensure better surgical outcomes. During her presentation,
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www.clinicalservicesjournal.com I December 2024
and organisations enjoy improved patient safety, higher staff retention rates, and gaining a reputation for excellence in surgical care. Investing in organisation paid membership can lead to cost savings in the long-run by reducing turnover and boosting surgical efficiency. For more details go to
https://www.afpp.org. uk/membership/organisation-paid-member- scheme
she highlighted seven things that are proven to reduce complications – some by 50%: 1. Stopping Smoking 2. Exercise 3. Good Nutrition 4. Medication review 5. Avoidance of alcohol/drugs 6. Mental health and psychological preparedness 7. Practical preparedness.
Prof. McNally pointed out that genetics only causes 20% of ill health and most ill health is caused by smoking, nutrition, physical inactivity, pollution and excessive alcohol consumption. It is also socially determined, and health inequalities are an important issue. “If you exercise for 150 minutes a week, you
reduce your risk of dementia by 30%. If people thought about that, they’d do it…In healthcare, we are getting it wrong by focusing on ‘fixing stuff’. If you consider falls, about half the hip fractures that we see and operate on are preventable with some exercise, getting out in the sunshine, and better nutrition,” she explained. Prof. McNally pointed out that 10%-15% of
operations have a complication, but this is increased x4 if the patient is physically inactive. There is a 30%-80% decrease in complications with daily exercise, yet 27% of UK adults do no exercise at all. She pointed out that around 10% of adults in the UK are on a waiting list and they should be doing 20 minutes a day or more of exercise to build up their muscles. Other keynote speakers at this year’s
conference, included: Dr. David Hamilton, who originally worked in R&D in the pharmaceutical industry developing drugs for cardiovascular disease and cancer. He went on to leave the industry to author books and educate people in how they can harness their mind and emotions to improve their mental and physical health. Dr. Hamilton points out that kindness doesn’t cost anything and that a seemingly small act or a few simple
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