Operating theatres
the Delphi study is detailed in figure ten and is not conclusive. As discussed previously, LocSSIPs were launched on 7 September 2015 across the NHS. An audit was undertaken by the author in November 2021, as part of the literature review, and a response rate of 58% was achieved. However, six Trusts had yet to implement
LocSSIPs. In 2018, a survey conducted by NHS Improvement found that the existence and implementation of LocSSIPs was inconsistent and challenging, with the main barriers being a lack of time; staff not having protected time to do the work; a lack of multidisciplinary training; not seen as a priority; and lack of internal expertise, as well as an understanding of which areas qualify at a Trust level (NHS England, 2018).42
Should the Care Quality
Commission (CQC) issue improvement notices? Interestingly, five out of the original six Trusts that responded in November 2021, that have yet still to implement LocSSIPs, are participants in the Delphi study and still have not implemented LocSSIPs (end of November 2022). The purpose of the question shown in figure
11 was to gather the opinion of theatre safety experts as to whether Trusts should be held accountable. Over 77% of respondents felt that NHS Trusts should be held accountable for not having LocSSIPs. The Delphi study results highlight that much education is needed following the launch of NatSSIPs 2, in 2023.
Surgical fires There is no national guidance or safety recommendations to prevent fires in the operating theatres. These types of incidents, therefore, cannot be defined as a never event. Does this make it right? Stormont, Anand and Deibert (2022)43
stated that “very few fires are
unpreventable, and all surgical fires should be considered a never event”. Fisher’s American study (2015, cited in Stormont, Anand and Deibert, 2022)43
stated
that the number of surgical fires ranges from 550-600 annually, which is about as common as incorrect surgical site procedures. Choudhry et al ’s American study (2017), cited in Stormont, Anand and Deibert (2022),43
claimed that, of 114
cases identified involving surgical fires, 60% resulted in a median award of $215,000, or £188,969 (based on 6 November 2022 exchange rates). At a time of austerity and the current living
crisis, this is monies that global health providers can ill afford to pay out. In contrast, the National Reporting and Learning System (NRLS) database in England and Wales identified thirty-seven reported surgical fires between January 2012 and December 2018 (Keeley, 2020).17
Strongly agree 13.64% Agree 13.64% Somewhat agree 18.18% Neither agree nor disagree 13.64% Somewhat disagree 22.73% Disagree 13.64% Strongly disagree 4.55%
Figure 10 – Are staff shortages in the operating theatres hampering patient safety
Strongly agree 22.73% Agree 54.55% Somewhat agree 4.55% Neither agree nor disagree 18.18% Somewhat disagree Disagree Strongly disagree
Figure 11 – Should NHS Trusts be held accountable for not implementing LocSSIPs
March 2023 I
www.clinicalservicesjournal.com 23
London
East of England Midlands
South East North East South West
North East and Yorkshire 0% 2% 4% 6% 8% FTE vacancy rate, January - March 2022
Figure 9 – NHS vacancies by region (Nuffield Trust, 2022) NHS Revolution (2019), cited in Keeley (2020),17
reported that £13.9 million has been paid out in damages and legal costs for 459 cases relating to clinical negligence caused by surgical burn. Therefore, the study sought to solicit from the theatre safety experts, across NHS England, whether surgical fires should be classed as a never event. Over 80% of respondents felt that non-airway surgical fires should be classed as a never event. Finally, to ensure cyclical learning and continuous improvement for effective learning, NHS England (2022)23
state that a new national
NHS learn from patient safety events (LFPSE) is in the final stages of development. The thought is that, at a national level, it will
allow for new safety issues to be identified and acted upon on an NHS wide scale, ensuring providers across the country take action to reduce the risk. It is planned to launch phase one from mid 2023.
10% 12%
Discussion The literature to support a greater understanding of the impact on the implementation of checklist is still emerging. The review, to date, is not intended to be exhaustive, but allows the framing of further questions, to identify some of the contextual issues, and to plan for the third and final Delphi round. The use of a Delphi study was born out of curiosity to see what the theatre safety experts (matrons, managers and clinical educators) thought of the current checklist across England since its introduction thirteen years ago. Contextually, it can be anticipated that invasive
procedures in the NHS and, indeed, in healthcare globally, will continue to rise, in part as a result of the advancement of new supportive technologies, such as robotics and enhanced minimally invasive approaches. Furthermore, access to such treatments is being made more readily available to different patient groups whose needs and longer-term rehabilitation may be more
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