Surgery
are delayed due to safety concerns. Most areas would have a process for this action, whether or not it is formally accepted as a policy, although it is not always escalated out of theatres. NatSSIPs say that it is beyond the scope of the document to directly quantify these needs and they are intimately related with the processes, resources and culture of the rest of the organisation and the wider healthcare system.
Implementation oversight Within each hospital/Trust/Health Board NatSSIPs, there should be a senior practising clinician within the invasive procedures domain, who (at Board-level) has NatSSIPs within their portfolio. They are responsible for strategic direction
and oversight of implementation, developments and improvements related to NatSSIPs. They should, of course, have protected time to undertake this role. The individual should chair an formally constituted multidisciplinary steering group with a range of responsibilities, such as: l Strategic oversight l Review of relevant data / intelligence/ insight l Provision of assurance to the Board l Providing updates as a standing agenda item to Governance and Quality Boards
l Organisational sign-off of NatSSIPs-related policies and procedures
l Reinforcing that NatSSIPs are more than ‘checklists’ and that they require a strategy for organisational as well as Sequential Standards improvement
l Embedding systems and human factors knowledge and understanding
l Ensuring alignment of NatSSIPs with Trust Safety Strategy and Quality Objectives
The NatSSIPs Steering group should look on a regular basis at data on agency staffing rates, staff leaving rates, as well as retention and turnover values. There should be cultural surveys on the ability/opportunities for staff to speak up and be listened to. This new group has the potential to be at odds with the current Theatre Management Group, which works very well in many hospitals and reviews many of the same data.
Sequential standards The sequential standards are performed for every patient, whatever their invasive procedure and comprise: l Consent, procedural verification and site marking
l Team brief l Sign In l Time Out l Safe and efficient use of implants (where relevant)
l Reconciliation of items in the prevention of retained foreign objects
l Sign out l Handover/ Debrief
The sequential standards cover all invasive procedures and all settings, including hospital based theatres, clinics, treatment centres and primary care, as well as invasive investigations in outpatient departments. These standards
have made a differentiation between major and minor procedures throughout the document. Readers who are very assured in their
knowledge and practice of patient safety in surgery will recognise that the above steps relate to ‘Five Steps to Safer Surgery’ but have been added to, and now become the NatSSiPs Eight! These are not new processes, rather a clarification of expectation (many hospitals practise them without fail for every procedure, already) but they are now all in one place as stated standards. This could be designated ‘harmonisation’.
Conclusion The standards, both organisational and sequential, are warmly welcomed and it is hoped that theatre teams and others involved in invasive procedures will fully engage with them. They make sense, are well written and use team concepts and human factors to ensure that everyone on the team is equally responsible. Patients should be involved in checks being made, prior to surgery, without fail. There is much to admire in the work, and it is to be hoped that there is capacity among the theatre teams to implement them in full.
References 1 National Safety Standards for Invasive Procedures. 2023 The National Safety Standards for Invasive Procedures (NatSSIPs) | Centre for Perioperative Care (
cpoc.org.uk)
2 Executive summary of NHS England Surgical Never Events Taskforce report. 2014. Accessed at sur-nev-ev-tf-sum-rep2.pdf (
england.nhs.uk).
CSJ
March 2023 I
www.clinicalservicesjournal.com 17
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64
