July 2012 Issue No 262 ISSN 1747-728XThe Leading Independent Journal For ALL Operating Theatre Staff

ALLENreg LIFT-ASSISTreg BEACH CHAIR Lightweight with Lift-Assisttrade Technology to Make Positioning Easy

Lightweight for

single person

set-up

1

For further information01244 660 954

wwwmelydmedicalcom

2 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

ScalpelScalpelA new lsquocutting edgersquo discussion forum for all

those involved with patient careand the operating theatre environment

Start a discussion Join a discussion Offer your opinion Have your say

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Assistant in the OR Draumlger Perseus A500New anesthesia workstation supports safe anesthetic administration Luumlbeck The new Perseus A500 anesthesia workstation can support the training of young anesthesiologists with its assistant function and thus makes a contribution to patient safety in the OR Draumlger celebrated the European premiere of the Perseus A500 at Euroanaesthesia the convention of the European Society of Anaesthesiology (EA) which took place in Paris France from June 9 -12 2012

ldquoWith the integration of the groundbreaking assistant system we are offering the next generation of anesthesiologists stronger technical supportrdquo said Dr Lars Friedrich chief physician of the clinic for anesthesiology and intensive medicine and lecturer at the Medical Academy of Hanover Germany ldquoThis helps them to be prepared for practical work in the OR and thus increases the patient safety in the sense of the Helsinki Declaration ldquo

VaporView new assistance system for gas dosage ldquoParticularly for young colleagues it is especially dif cult to precisely estimate the anesthetic gas concentration in the expiration gas through all anesthetic phases on the basis of the Vapor setting alone especially with low ow anestheticsrdquo said Dr Bert Mierke chief physician of the department for anesthesiology and intensive medicine at the St Elisabeth Hospital in Damme Germany

On the basis of pharmokinetic models the VaporView function on the Perseus A500 visualizes the calculated current and presumable concentration of the anesthetic gas in the expiration gas of an adult patient It displays the development of the anesthetic gas concentration in the inspiration gas (inspiration) and the expiration gas (expiration) of the last ten minutes and provides a preview of a period of 20 minutes in graphic form on the monitor

ldquoIf the fresh gas ow is reduced after the introduction phase and the rebreathing of the patient increases consecutively we use comparably less anesthetic gas and at the same time establish a better breathing gas acclimationrdquo explained Mierke VaporView supports the anesthetists in being able to better estimate the anesthetic gas concentration in the inspiration gas and expiration gas If the Vapor setting is changed VaporView displays the calculated anesthetic gas concentration in the preview mode before it is actually administered to the patient

The new Draumlger Perseus A500 anesthesia workstation (copy Draumlgerwerk AG amp Co KGaA)

This allows the setting of the vapor to be adjusted to the condition of an adult patient more easily ldquoThis helps us to provide a safe dosage and avoid underdoses

and overdosesrdquo said Mierke

Doubly safe anesthetic gas display on the monitor and vapor The communication between the Perseus A500 and the Vapor used

additionally ensures that the hand wheel position ll level as well as the anesthetic gas currently being dosed can be read and that the anesthetist can see these with a glance at the monitor

In addition the lights on the Vapor provide information as to how it is con gured At hand wheel position ldquo0rdquo the light is dimmed it lights up brightly at a hand wheel position greater than ldquo0rdquo A blinking light indicates that the OR team can

remedy the cause of an alarm simply by adjusting or re lling the Vapor For example this can be the case when the ll level of

the Vapor is low the Vapor is open or the anesthetic gas concentration in the inspiration gas is too high In addition to the blinking Vapor light the display eld on the monitor blinks until the cause of the alarm is remedied

Draumlger Medical GmbH is the manufacturer of the Perseus A500

You can nd more information at wwwdraegercomperseus

When responding to articles please quote lsquoOTJrsquo

nd out more 02921 680068 bull e-mail adminlawrandcom Issue 262 July 2012 3

The Next issue copy deadline Friday 27th July 2012All enquiries To the editorial team The OTJ Lawrand Ltd PO Box 51 Pontyclun CF72 9YY Tel 02921 680068 Email adminlawrandcom Website wwwlawrandcomThe Operating Theatre Journal is published twelve times per year Available in electronic format from the website wwwotjonlinecomand in hard copy to hospitals throughout the United Kingdom Personal copies are available by nominal subscription

Neither the Editor or Directors of Lawrand Ltd are in any way responsible for the statements made or views expressed by the contributors All communications in respect of advertising quotations obtaining a rate card and supplying all editorial communications and pictures to the Editor at the PO Box address No part of this journal may be reproduced without prior permission from Lawrand Ltd copy 2012The Operating Theatre Journal is printed on FSC approved papers using biodegradable ink Any waste from the production of the magazine is recycled

Journal Printers The Warwick Printing Co Ltd Caswell Road Leamington Spa Warwickshire CV31 1QD

Lives will be saved as junior doctors shadow new role

Junior doctors will spend a minimum of four working days shadowing the job that they will be taking up from this summer it was announced by NHS Medical Director Professor Sir Bruce Keogh recently

The rst few weeks of employment for medical graduates can not only be stressful but are also associated with increased risk for patients and NHS employers The Department of Health has asked Medical Education England for advice on enabling junior doctors to make the transition from student to doctor and employee in the safest way possible

According to research supported by Dr Foster Intelligence in 2009 people admitted to English hospitals in an emergency on the rst Wednesday in August have on average a six percent higher mortality rate than people admitted on the previous Wednesday

NHS Medical Director Professor Sir Bruce Keogh said

There is some evidence of increased risk to patients as new doctors take their rst steps So learning from pilots across the country we have agreed that all new rst year doctors should undertake a period of paid shadowing the doctor they will be replacing for a period of at least four days That scheme will start this year and will operate in late July every year

Patient safety and providing a high quality service is at the heart of a modern NHS This shadowing period could potentially save lives and will equip new junior doctors with the local knowledge and skills needed to provide safe high quality patient care from their rst day as a doctor

Three pilots have been carried out over the last three years at University Hospitals Bristol NHS Foundation Trust Cambridge University of East Anglia and Cardiff Medical School

From July 2010 junior doctors starting work at hospitals in Bristol undertook

- Ward-based shadowing or supervised work- Informal teaching sessions from current junior doctors- Formal teaching sessions on issues like patient safety and handovers- Social events in order to develop a peer network- Registration with the GMC one week early and are provided with a

free extra week of professional indemnity cover

Results from Bristol show that mistakes new doctors made in their rst four months were reduced by 52 after a week of shadowing and targeted teaching was made mandatory

Dr Rebecca Aspinall consultant anaesthetist and programme director for doctors training at UH Bristol said

Patient safety is at the heart of medical education We recognised that our outgoing rst year doctors could educate the new intake of junior doctors if their employment overlapped by a few days The outgoing doctorsrsquo collective memory and experience was used to design the teaching for incoming junior doctors

The resulting course is called From Scared to Prepared It contains aspects of patient care the doctors wished they had done better Attendance of this course has reduced our frequency of errors and made patients safer year on year I am delighted that the Department of Health has recommended this innovation across the UK

Prof Sir Bruce Keogh has written a series of letters to nal year medical students medical school deans postgraduate deans SHA Chief Executives and NHS Trust Chief Executives to explain that this period of mandatory paid shadowing will be introduced nationally and consistently for the rst time this year

Nursing and midwivesrsquo regulator lsquofailingrsquo patientsFailings ldquoat every levelrdquo of the Nursing and Midwifery Council (NMC) mean it is letting down patients in its prime duty to protect them says a report

The UKrsquos 670000 nurses and midwives have to register with the troubled regulator to enable them to work

The independent review gives details of the NMCrsquos backlog of complaints against nurses and midwives

The council apologised for what it admitted were ldquosubstantial failingsrdquo

The review by the Council for Healthcare Regulatory Excellence (CHRE) revealed the NMC had an annual staff turnover rate of 31

Almost 4500 cases are awaiting a decision by the regulator - and of those about 1000 have yet to be allocated a hearing date

ldquoStart QuoteSome cases that are still active and concern whether an individual nurse or midwife is t to practise contain allegations of the mistreatment of patients dating back as far as 2005

The NMC is currently holding 15 hearings a day and this will move to 18 from September in an effort to speed up the process

Troubled pastCHRE chief executive Harry Cayton said the council ldquohas been under-investing in tness-to-practise cases relative to the number it receives and their complexity

ldquoThe public have been let down It doesnrsquot mean nursing is unsafe - but the public nurses and midwives ought to feel con dent in the regulator They havenrsquot been able to

ldquoSigni cant delay in managing tness to practise cases in itself introduces risks

ldquoThe NMC is ful lling its functions but not to the standard or quality that the public have a right to expect

ldquoThe regulator must nally leave its troubled past behind New leaders must be appointed who are competent credible and capable of addressing its very serious organisational problemsrdquo

The report contains 14 recommendations Among them the NMC is told to improve its culture of ldquoresigned resiliencerdquo which has seen staff either leave rapidly or become resigned to accepting poor standards

A new NMC chairman and chief executive are currently being sought

The regulatorrsquos interim chief executive Jackie Smith said ldquoThe report highlights substantial failings We recognise these and we are sorry

ldquoIt is clear the NMC has not delivered effective and ef cient regulation We are committed to putting that rightrdquo

lsquoBailoutrsquoUnions representing nurses and midwives have also been critical - they are angry that annual registration fees are rising to pound120

Gail Adams Unison head of nursing said ldquoPublic protection is everyonersquos business ldquoWe fail to see why nurses and midwives should have to bail the NMC out of a nancial crisis of its own creationrdquo

The Royal College of Nursingrsquos chief executive and general secretary Dr Peter Carter said ldquoThe RCN welcomes this report which clearly goes to the heart of some fundamental weaknessesrdquo

Katherine Murphy of the Patients Association said

ldquoIt is clear that the NMC will not only have to develop more robust regulatory procedures but also work very hard to regain the trust placed in them by patients nurses and other healthcare professionals alikerdquo

Are you a nurse You can comment on the increase of fees on our discussion forum at httpotjonlinecomscalpel

Source By Jane Dreaper Health correspondent BBC News

4 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

Next Generation FDR AcSelerate from Fuji lm

Fuji lm is a pioneer in diagnostic imaging and information systems for healthcare with a range of constantly evolving clinically proven products and technologies designed to assist medical professionals perform ef ciently and effectively The company are pleased to announce the arrival of their next generation FDR AcSelerate the new pinnacle in diagnostic imaging

The new FDR AcSelerate is a streamlined solution that combines dynamic speed and sharp images for an X-ray room of the future with a new at panel detector with Csl scintillator and Fuji lmrsquos proprietary ldquoIrradiation Side Samplingrdquo (ISS) technology

The Csl scintillator capitalises on the high X-ray absorption characteristics of Csl and the ability of its needle crystals to deliver image sharpness The (ISS) technology enhances image quality by reading the data from the surface of the detector thus light is collected before the radiation can be attenuated and diffused within the detector ISS signi cantly improves MTF and DQE compared to conventional methods

AcSelerate has been ergonomically designed with both user and patient in mind It has a wide range of movement for various examinations and a weight capacity of up to 250Kg providing versatility and performance

Its lightweight ceiling suspension system and tube head provide smooth movement to any position any angle and any height within the examination room whilst its 2400mm x 850mm table with adjustable height of 550mm to 930mm from oor makes it extremely exible for easy positioning and accommodation of patients of all types and sizes

For more information on the X-ray Room of the Future FDR AcSelerate telephone Fuji lm on 01234 326780

Dr Sheraz Daya performs the UKs rst live VICTUS Femtosecond Laser cataract removal surgery

Eye healthcare company Bausch + Lomb and Technolas Perfect Vision have worked in partnership to bring the groundbreaking new VICTUS Femtosecond Laser to the UK market With the ability to perform cataract surgery in less than 20 seconds the VICTUS laser is believed to be the single most signi cant advancement in cataract surgery in the last 40 years

The surgery master class formed part of a conference at the Centre for Sight aimed at updating HCPs on new procedures and technology for eye health care Forty- ve optometrists viewed Dr Sheraz Daya performing surgery using the laser The VICTUS Femtosecond Laser will surgically replace the natural lens in the patientrsquos eye with an intraocular lens The introduction of the VICTUS Femtosecond Laser will improve accuracy during surgery reduce signi cant risk and increase patient safety

Dr Sheraz Daya comments With the introduction of the super-precise VICTUS laser and its real time microscopic imaging cataract surgery has truly entered the 21st century providing patients with a level of unprecedented accuracy and safety

VICTUS laser surgery provides patients with enhanced safety and accuracy taking cataract and refractive lens exchange into a whole new era The laser takes the place of the human hand and in less than 20 seconds makes a precise circular opening in the lens as well as effortlessly breaking up the lens or cataract This is truly Star Trek-like surgery

Andrew Webb European Vice President Bausch + Lomb added This is a signi cant milestone for Bausch + Lomb that will deliver breakthrough capabilities to our eye care professionals and the patients they serve

The VICTUS platform is uniquely designed to support cataract refractive and therapeutic procedures all on a single platform The femtosecond laser technology enables greater precision in both cataract and refractive procedures compared to manual techniques giving ophthalmologists more control and potentially enhancing the patient experience

About Femtosecond LasersFemtosecond lasers emit optical pulses of extremely short duration in the domain of femtoseconds as short as one-quadrillionth of a second These ultra-short pulses are too brief to transfer heat or shock to the material being cut and can make surgical incisions with extreme precision

bull The VICTUS is capable of supporting cataract refractive and therapeutic procedures in a single platform and is designed to enable greater precision compared to manual cataract surgical techniques potentially enhancing the patients experience

bull The interface is curved rather than at designed to reduce the amount of corneal applanation and distortion

bull The OCT [optical coherence tomography] is real time and dynamic rather than the static OCT systems in other lasers As a faster laser treatment times may be shorter which will also improve the patient experience

bull Bausch + Lomb and Technolas are currently working with regulatory authorities globally to secure marketing approvals for the VICTUS

An estimated 20 million aging baby boomers and seniors have cataracts A cataract is a clouding on the normally clear lens in the eye Cataract surgery is a procedure during which the natural lens in the patientrsquos eye is surgically replaced with an intraocular lens Over 15 million cataract surgeries are performed worldwide each year

Bausch + Lomb is one of the best-known and most respected healthcare companies in the world Its core businesses include contact lenses and lens care products ophthalmic surgical devices and instruments and ophthalmic pharmaceuticals Founded in 1853 the company is headquartered in Rochester NY and employs more than 10000 people worldwide Its products are available in more than 100 countries

More information is available at wwwbauschcom

Dr Sheraz Daya performs the UKs rst live VICTUS Femtosecond Laser cataract removal surgery in front of an audience of optometrists at the Centre for Sight in London on Wednesday 20 June 2012

Please quote lsquoOTJrsquo

When responding to articles please quote lsquoOTJrsquo

nd out more 02921 680068 bull e-mail adminlawrandcom Issue 262 July 2012 5

Our combination of high quality innovative products and

exceptional levels of service provide supreme clinical value

Your sterile single-use solution without compromise

Specialities served General and Vascular ENTMaxFax Gynaecological Neurosurgical Orthopaedic

T +44 (0)1792 797910F +44 (0)1792 797955 E infodtrmedicalcomwwwdtrmedicalcom

Orthopaed

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dic

Fukuda Denshi publish key CAVI Clinical Report on Anti-arteriosclerosis agents and CAVI

Fukuda Denshi is a leading supplier of advanced patient monitoring and user-con gurable clinical information management systems as well as cardiac monitoring and imaging technology The company has recently published a Clinical Report on Anti-arteriosclerosis agents and CAVI and is the second Clinical Report the company has published on the revolutionary Cardio Ankle Vascular Index measurement

The VaSera VS-1500N from Fukuda Denshi is a lightweight and compact vascular screening device with a wide range of features including CAVI and kCAVI providing a comprehensive report of key parameters in less than ten minutes

CAVI is the new arteriosclerosis index that measures the degree of artery stiffness between the heart and ankle and is independent from uctuations in blood pressure It has been derived by the constant parameter szlig providing a consistent result that can help to predict ischemic disease and future cardiovascular complications

Fukuda Denshi has published a paper exploring anti-arteriosclerosis agents and CAVI and describes the method for measuring CAVI along with the clinical implications of CAVI The Report also describes the in uence of hypoglycaemic agents on CAVI the in uence of antihyperlipidemic agents on CAVI and the in uence of antihypertensive agents on CAVI

Explanatory charts and diagrams enhance the six page full colour Clinical Paper which concisely details the key results found during the research

For a copy of the Clinical Paper contact Fukuda Denshi on 01483 728065

Fukuda Denshi Healthcare bound by technology When responding to articles please quote lsquoOTJrsquo

NEW WEST CUMBRIAN OPERATING THEATRE CUTS WAITING TIMES

Maryport hospitalrsquos upgraded operating theatre has been of cially opened

The Victoria Cottage Hospital refurbishment which cost pound177000 means that patients in West Cumbria can elect to have day surgical procedures including hernia operations at Maryport

It marks a major step forward for the cottage hospital which seven years ago was under threat of closure

Funding for the building refurbishment and new equipment has been provided by NHS Cumbria

Medical equipment including a theatre light and operating table which were previously funded by the hospitalrsquos League of Friends will also be used

Michelle Mulcahy Maryport Health Services business manager said surgery provision strengthened the importance of the local hospital

She said ldquoIt makes economic sense It costs about pound1000 less per patient having surgery performed here than it would in a general hospitalrdquo

Derek Thornthwaite 78 of James Street Maryport who had a hernia operation performed by Dr White said ldquoI got an appointment within days It was set for 10am and I was back home at 1130am I canrsquot fault the servicerdquo Source In-Cumbria

6 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

Brandon Medical Enhance Dedicated UK Service amp Support

Pompeyrsquos Queen Alexandra Hospital adds to its mobile X-ray eet

Reducing operating theatre downtime is becoming increasingly important as hospitals and clinics strive to reduce waiting times for their patients Leeds based Medical Technology Company Brandon Medical recognise this importance and have enhanced their post-sales service and support activities

The aim of the department is to correct any equipment malfunction from many different medical technology manufacturers in the shortest time possible This reduced downtime allows healthcare services to function uninterrupted and patient schedules to remain on time

The service and support department is headed by Installation and Service Manager Tony Booth Tony joined Brandon in 2010 bringing with him 20 years experience in the telecoms and IT sector

He is a member of IOSH and is a registered PRINCE2 practitioner Mandy Pearson who is of ce based can assist with any servicing day to day query and contractual agreements The department operates a team of full time service engineers All of the engineers have been trained on a full range of medical technology equipment including operating theatre lighting pendant systems surgeons control panels IPS UPS and battery back up systems

ldquoWe try to make the service as ef cient as possiblerdquo Tony Booth comments ldquoWe store most spare parts on site and wersquove also added a feature to our website to allow customers to request a service electronically This automatically enters their request into our system and Mandy will get back to them the same day to arrange a site visitrdquo

To ensure maximum exibility for their customers and the size of the healthcare institution Brandon have a choice of service contracts ranging from Planned Preventative Maintenance contracts yearly maintenance visits to break-down cover equipment loans and offer product training for all staff These service contracts are of long term value as they all provide discounted spare parts and call outs Brandon Medical adhere to providing solutions and giving the best customer service through exibility responsiveness and co-operation

For more information please contact our servicing department directly on Tel 0113 272 8535 email servicebrandon-medicalcom or visit wwwbrandon-medicalcom

When responding to articles please quote lsquoOTJrsquo

Since its opening in June 2009 the state-of-the-art Queen Alexandra Hospital has sat proudly on the high slopes of Portsdown Hill overlooking the historic Naval City of Portsmouth England The City along with it football team is nicknamed ldquoPompeyrdquo and is notable for its major Dockyard as a base for the Royal Navy and for being the United Kingdomrsquos only Island City

Whilst the Cityrsquos Island status may come as surprise to many outside the county of Hampshire it will not be a surprise that this prestigious hospital has Major Trauma Unit status and is part of the national project to improve major trauma care An important part of any emergency care department is the ability to provide high quality radiographic (X-ray) images to meet and to respond to the changing demands of the health professionals as they care for their patients

In March 2012 to aid rapid radiographic imaging in the Emergency Room at the bedside and in the Neonatal Care Unit Portsmouth Hospital NHS Trust appointed Gloucestershire-based Xograph Healthcare a leading independent UK medical equipment provider to supply a number of new mobile digital X-ray systems

The Hospital already owned an earlier generation Xograph digital mobile the MobileDaRt which was purchased when the hospital rst opened this unit is now complimented by ve younger siblings The MobileDaRt Evolution incorporates the latest Canon CXDI-70C Wireless digital imaging detector and the unique Canon CXDI-80C Wireless small format detector both offering exceptional direct digital images within 3 seconds at the point of care so ensuring enhanced work ow and maximum versatility

Nicola Sanchez Advanced Practitioner Radiographer at Pompeyrsquos Queen Alexandra Hospital said ldquoThe replacement of our mobile eet required equipment that could travel the large distances required of our hospital and provide almost instantaneous diagnostic images to our clinicians We also required versatility in imaging our wide range of patients including NICU The DaRt evolution was the only unit that ful lled all of these requirements I cannot fault the customer support provided by Xograph Healthcare both pre- and post-purchase of our new eet it has been outstanding and I would de nitely purchase from Xograph in the futurerdquo

Paul Andrews Commercial Manager for Xograph Healthcare said ldquoI am very pleased that the Trust have again chosen Xograph as their preferred supplier for these additional mobile X-ray systems It is also comforting to know that a dedicated MobileDaRt Evolution with an incubator-sized detector is now available for use within the Neonatal Unit allowing Radiographers to present instant digital X-ray images for diagnosis immediately in the department by the attending clinicians whilst also ensuring minimal disturbance to the newborn with less resultant distress for the parents at this dif cult time for their baby and familyrdquo

Nana Anane-Binfoh Radiographer Nicola Sanchez Advanced Practitioner Radiographer Lizzie Long Senior Radiographer and Sumitra Shrestha Radiographer at Queen Alexandra Hospital with Liam Neill Territory Manager for Xograph Healthcare Ltd holding the Canon CXDI-80C incubator-sized detector

wwwxographcom When responding to articles please quote lsquoOTJrsquo

nd out more 02921 680068 bull e-mail adminlawrandcom Issue 262 July 2012 7

wwwtimesco-anaesthesiacom

For more information samples and pricing call 01268 297 710 or

email salestimescocom

KEEPING THE NHS OPERATINGTM

A simple honest approach to customer service support amp competitive pricing

Features Low Profile Design

No-Touch Blade BlocksMacintosh and Miller Designs

SINGLE USE LARYNGOSCOPES

SYSTEMS

Peter Ellingworth highlights the importance of patient safety to Select Committee

ABHI Chief Executive Peter Ellingworth gave evidence to the UK Parliaments Science and Technology Select Committee on 13th June Mr Ellingworth addressed the Committee on the issue of the regulation of medical implants

Mr Ellingworth told the Committee that considering patient safety is of paramount importance when regulating medical devices He went on to add that in order to improve the system there needs to be increased transparency of information for patients and clinicians improved post market surveillance and better central coordination of the system ABHI Executive Director of Technical and Regulatory Mike Kreuzer appearing alongside Mr Ellingworth added that the system also needs better coordination between Competent Authorities on how they designate Noti ed Bodies He also indicated that Unique Device Identi cations could help with the setting up of registries

Mr Ellingworth stressed the importance that industry places upon regulatory compliance commenting- The companies we represent take patient safety incredibly seriously nding a quick or easier route is not in their long term interest

On the importance of the relationship between industry and the NHS Mr Ellingworth said ndash Therersquos a unique relationship here where the clinicians and the companies are focussed on the patient at the centre of this exercise and how they work together Nothing is developed purely on a bench

Speaking after the hearing Mr Ellingworth said I was delighted to be offered the opportunity to represent industry at this important Parliamentary Inquiry The issue of medical device regulation is fundamental to the future success of industry and the ability of patients to get access to safe innovative medical devices

Patient safety is a key objective in medical device regulation and has to be constantly borne in mind when evolving the system Industry has set out a number of changes which we believe will help improve the system and I was happy to discuss these with the committee The designation and control of Noti ed Bodies transparency of information central coordination and improvements to the post market surveillance system are all issues that industry wants to see addressed as soon as possible

Medical device manufacturers work closely with frontline clinicians to develop the technologies that patients need this relationship is crucial and must be supported by appropriate regulation which in turn will assure the availability of safe innovative products for patients

The medical technology industry is of signi cant scale in the UK- 3000 companies employing 64000 people the Government has picked out the med tech sector as being a cornerstone of life sciences it is crucial we maintain an appropriate regulatory regime in order to support industryrsquos continuous growth

Hypnosis can block surgery pain say specialists

HYPNOSIS can replace anaesthetics for some people during surgery allowing them to block their perception of pain doctors say

Psychiatrist and pain medicine specialist Bob Large yesterday told a meeting of anaesthetists in Perth that lsquorsquohypnotic analgesiarsquorsquo had been successfully used during a range of surgical procedures including gall bladder and thyroid removal and hysterectomies

While the practice was rare he said an Adelaide doctor who specialises in hypnosis Graham Wicks had used the technique on Australian patients for abdominal surgery One of these patients who had had a bad experience of surgery and wanted to try alternative pain relief has reported that she was relatively pain free during the procedure which would usually require a general anaesthetic

Dr Large from Auckland said people who had experienced hypnotic analgesia generally reported little pain but some sensations such as tugging in the part of the body being operated on

Dr Large said hypnotic analgesia could be very useful for women during childbirth people who had allergies to anaesthetic drugs and children undergoing some procedures

Australian and New Zealand College of Anaesthetists president Kate Leslie said that although some people were highly hypnotisable and could endure painful procedures without anaesthetics the majority of patients needed drugs to achieve suitable pain relief during surgery

Source theagecomau

8 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

The Coronerrsquos InquestAlthough the term lsquooperating theatre personnelrsquo can be applied to several distinct professions one thing all operating theatre personnel have in common is that they are likely to attend or provide evidence to a Coronerrsquos Inquest at some stage during their career The purpose of this rst of an occasional series of articles examining medico-legal issues is to help you to understand the Inquest process and prepare should you be required to attend an Inquest

Who is the Coroner and what is hisher function The Coroner is an independent judicial of cer and must be a quali ed doctor or lawyer of at least ve years standing Coroners operate on a local level and their duty is to investigate and adjudicate upon any death in their area which is sudden unexplained or cannot be registered by the Registrar of Births Deaths amp Marriages

When is an Inquest required In 2011 46 of all registered deaths in England amp Wales were reported to a Coroner Of these Inquests were opened in respect of 30981 deaths (about 14 of all deaths reported to the Coroner) The Coroner is required to hold an Inquest where

bull There is reason to suspect the deceased died a violent or unnatural deathbull The cause of death is unknownbull The deceased died in prison or otherwise in the custody of the State for example whilst detained under the Mental Health Act

What questions will the Inquest answer An Inquest is a public hearing directed solely at determining who the deceased person was and how when and where they died In certain circumstances for example where the deceased died in prison the scope of the Inquest can be widened to include a more detailed examination and commentary on the circumstances of the death Coronerrsquos verdicts are forbidden from including any opinion on criminal or civil liability for example allegations of clinical negligence This does not however prevent the Coroner from recording conclusions of unlawful killing or neglect when appropriate

As a healthcare professional it is important to remember that Inquests are inquisitorial meaning they are an exercise in fact- nding and not an exercise in apportioning guilt

Preparing for an Inquest Prior to the Inquest the Coroner will request statements from relevant witnesses and this will almost always include healthcare professionals If you are drafting a statement yourself without legal assistance make sure it is an honest chronological account of your involvement in events Include details of your background quali cations and experience and refer to key entries in the medical records Stick to the facts and avoid including your opinions or comments on the actions of others

Once the Coroner has received all the witness statements heshe will decide who is required to give oral evidence at the Inquest If your statement is thorough and covers all the issues or if your involvement was only peripheral the Coroner may conclude that your statement can simply be read at the Inquest and you do not need to attend in person

If the Coroner asks you to attend the Inquest it is advisable to do so Should the Coroner actually issue a Witness Summons then it is compulsory for you to attend the Inquest and not attending could result in proceedings for contempt of court

Prior to attending the Inquest you should read over the witness statement you provided to the Coroner review the deceasedrsquos medical records and request copies of key documents such as the post-mortem report and any SUI reports prepared following the death If recommendations were made in any SUI reports or if you have identi ed any learning points yourself it is important to try and implement these ndash Coroners wish to see evidence of lsquolearning from mistakesrsquo

Attending an Inquest At an Inquest you can expect to see the Coroner the Coronerrsquos Of cer interested persons (for example the relatives of the deceased) and legal representatives Inquests are public hearings and members of the public or press may also be in attendance

As a witness you will be escorted to the witness box by the Coronerrsquos Of cer and then invited to swear an oath or make a statutory af rmation to tell the truth You will usually read your witness statement aloud and then be given an opportunity to expand on or clarify any points The Coroner examines or questions each of the witnesses and conducts the inquiry Interested persons or their legal representatives also get an opportunity to question the witnesses You are not obliged to answer any questions tending to incriminate you and the Coroner will give you a warning if such questions are asked

It is helpful to bear in mind when giving evidence that you should direct your comments to the Coroner take your time (speaking slowly and clearly) and feel free to say so if you donrsquot understand a question or donrsquot know or remember the answer to a question Take time to consider your answers and try to be concise

After you have given evidence you will be released by the Coroner and are then either free to leave or stay and listen to the rest of the Inquest Once all the evidence has been heard and any legal submissions made the Coroner will deliver his ndings often called the verdict There are a number of short-form verdicts including lsquonatural causesrsquo lsquosuicidersquo and lsquoindustrial diseasersquo More and more often Coroners tend to record narrative verdicts where they summarise the evidence heard at the Inquest and explain their conclusions in some detail If the Coroner has identi ed a particular risk of other deaths or considers that particular action needs to be taken he can write to an appropriate body such as the General Medical Council or Health amp Safety Executive with recommendations This is known as a Rule 43 letter

Conclusion Most Inquests are routine and do not need to be feared The key to reducing any anxiety you might feel is (i) good preparation and (ii) seeking the right advice and assistance at an early stage when you do need professional help

Andrea James is Head of Healthcare Regulatory at George Davies Solicitors LLP former in-house Solicitor to the General Medical Council and specialises in advising healthcare professionals

For further information please visit httpwwwgeorgedaviescoukcontentOurServicesPublicSectorHealthcareRegulatoryaspx

Available in Print and Worldwide via the Internet

10 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

KIMBERLY-CLARK ANNOUNCES WINNERS OF INAUGURAL HAI WATCHDOG AWARDS

Kimberly-Clark Health Care has announced the rst winners of a new scheme to reward individuals and teams who are championing infection prevention in UK hospitals

The category winners are Northumbria Healthcare NHS Foundation Trust Doncaster amp Bassetlaw Hospitals NHS Foundation Trust and Hull and East Yorkshire Hospitals NHS Trust

The HAI WATCHDOG Awards recognise the work and dedication of doctors and nurses who are making a difference in reducing and preventing healthcare associated infections (HAIs) in wards and departments throughout the country The winning hospitals each received a pound1000 educational grant and a commemorative plaque

The entries were scrutinized by an expert panel of judges comprising Andrea Berry Lead Nurse Greater Manchester Critical Care Network and Chair of Critical Care National Network Nurse Lead Forum Andrea Denton a member of the Infection Prevention Society (IPS) Education and Professional Development Committee Derek Butler Chairman and co-founder of MRSA Action UK and Louise Frampton Editor of Clinical Services Journal

Highly impressed with the standards of the entries and the commitment of individuals and teams to deliver excellent standards of care the judges said that the winners should be extremely proud of their achievements and many more hospitals would bene t when the experiences of the winners are shared

The winner of the category for Operating Theatre Infection Prevention Initiative was Northumbria Healthcare NHS Foundation Trust which made a pledge to drive down surgical site infections (SSI) in orthopaedic surgery

The changes included employing two dedicated SSI surveillance nurses and a range of initiatives in theatres including restricting access to the department screening patients for potential infections before they come into hospital and improving skin preparation across the Trust

In the ICU Infection Prevention Initiative category the winner was Doncaster amp Bassetlaw Hospitals NHS Foundation Trust The programme to reduce ventilator associated pneumonia (VAP) through high standards of oral care focused initially on getting the basics right and creating stability which involved deciding on a practical de nition of VAP and recording infection rates The second phase was to re-design the hospitalrsquos care bundle which included enhancing the oral care element

Highly commended in the ICU category was The Royal Wolverhampton NHS Trust for its campaign lsquoBeyond Bacteraemias ndash Introducing the Device Related Hospital Acquired Bacteraemias (DRHAB)

The range of initiatives included a VAPteraemia court to tackle the dif cult issue of determining the source of bacteraemias

In the Clinicianrsquos Choice category the winner was decided through online voting via the website wwwhaiwatchdogcom First prize went to Hull and East Yorkshire NHS Hospitals Trust for their lsquoGive Soap a Chancersquo campaign The programme focused upon taking the lessons learned about hand hygiene in hospital out to the community and to teach the art of proper hand washing In partnership with the Business School at Hull University the Trust worked with businesses schools and the general public to get its message across In schools children were inspired by Sammy Soap and the Clean Team to learn effective hand hygiene

Phil Crook Country Manager for Kimberly-Clark Health Care in the UK and Ireland said ldquoThe winning Trusts have set inspiring examples of what can be accomplished in the ght to reduce healthcare infections and we hope that their achievements in these awards will help the successful teams receive the recognition they deserve

ldquoKimberly-Clark is committed to working in partnership with hospitals to deliver the best possible patient care and we feel that the HAI WATCHDOG Awards have an important role to play in highlighting pioneering work from across the UKrdquo

Central to the HAI WATCHDOG Awards is a dedicated website ndash wwwhaiwatchdogcom ndash to help facilitate the sharing of best practice and host discussions about all kinds of infection prevention issues Summaries of the winning entries are posted there

The awards also ran simultaneously in the United States and Canada as well as Australia and New Zealand with the aim that the HAI WATCHDOG website can become a central point for the sharing of international HAI prevention best practice

Northumbria Healthcare NHS Foundation Trust1 Mike Reed Consultant in Trauma and Orthopaedics and SSI lead at Northumbria Healthcare NHS Foundation Trust Phil Crook Country Manager Kimberly-Clark Health Care in the UK and Ireland Gill Davis SSI Audit Administrator and Helen Geraghty SSI Coordinator at North Tyneside Hospital

Northumbria Healthcare NHS Foundation Trust2 Darren Robinson Account Manager for Kimberly-Clark Health Care Gail Lowdon SSI coordinator at Wansbeck General Hospital Dorothy Dickinson Theatre Manager at Hexham Hospital Phil Crook Country Manager Kimberly-Clark Health in the UK and Ireland Care Wendy McDonaugh Theatre Manager at North Tyneside Hospital Jackie Hall Theatre Manager at Wansbeck General Hospital

MediBox provides cool storage solution for sensitive medical substancesMediBox was just one of the eleven innovative design projects on display at the Institute for Manufacturing on June 6th to mark the end of a year-long project

The Manufacturing Engineering Tripos (MET) course is a programme for 3rd and 4th-year engineering students who have successfully completed the rst two years of an engineering degree at the Institute of Manufacturing part of the University of Cambridge MET takes the best engineers and provides them with the management competence business acumen and interpersonal and organisational skills they need to become world-class leaders

Medibox has been designed and produced by Ed West Simon Holroyd Sidharth Khandelwal and Elliott Dobson and offers the unique solution for the transportation and monitoring of temperature sensitive medical substances

MediBox allows the safe reliable and ef cient transportation of temperature sensitive medical substances designed to solve real problems experienced in the eld A wide range of medical substances most notably vaccines and blood samples require careful temperature control during transportation and storage

In the case of vaccines regulations state that they must be discarded if they fall outside a 2 to 8degC temperature window Current systems provide inaccurate methods of validating the temperature history of samples which can lead to unnecessary wastage or false positives

With features such as Peltier elements and an in-situ thermometer the temperature of the contents is precisely maintained and recorded while warning systems alert the user to potential deviations Convenience is ensured through an intuitive and user-friendly interface allowing instant veri cation of temperature history MediBox eliminates the need for using heavy and awkward ice-packs while drastically reducing potential wastage due to insuf cient temperature control

The key purpose of the design project is to develop a new product with real business potential Each of the teams consist of just three or four MET students Working together they must rstly identify a customer need research the market develop an original design concept and create a full business plan The projects have once again generated some exciting new ideas and innovative technology

wwwifmengcamacukWhen responding to articles please quote lsquoOTJrsquo

nd out more 02921 680068 bull e-mail adminlawrandcom Issue 262 July 2012 11

NICE Guidance supports the caseto adopt Indithermpatient warmingsystems in the NHSbull Clinical evidence supports Indithermrsquos

effectiveness at preventing hypothermia bull Annual cost savings of pound9800 per

Operating Theatrebull Additional savings from reductions in

post-operative infections energy usageand clinical waste

Contact any of our Medical team today for furtherinformation or a free trial on +44 (0) 1709 761000 oremail medicalindithermplccom and quote Ref MTG0811

wwwindithermcommedical

The new standard in patient warming

Full guidance can be found at wwwniceorgukguidanceMTG7

Northumbria Healthcare NHS Foundation Trust1 LtoR Mike Reed Phil Crook Gill Davis Helen Geraghty

HAI WATCHDOG Awards 2011Category Operating Theatre Infection Prevention InitiativeZero Tolerance on Surgical Site InfectionNorthumbria Healthcare NHS Foundation Trust

Programme OverviewTransforming the culture and behaviour of a 200-strong multindashdisciplinary team is at the heart of Northumbriarsquos successful campaign to reduce infection rates in orthopaedic surgery

ObjectivesThe Zero Tolerance on Surgical Site Infection campaign was launched to reduce surgical site infection rates to below the national average of 1 or lower

The SolutionsTo achieve the objectives orthopaedic surgeon Mike Reed who has a particular interest in patient safety took on the role of lsquochampionrsquo He established a team of key opinion leaders across all disciplines to look at the information available and to being to review current practices that may be affecting infection rates within the Trust

For the programme to work everyone needed to understand why they were being asked to change long-held practices and what was required of them

To underline the Trustrsquos commitment to reduce Surgical Site Infections (SSI) in its operating theatres across the Trustrsquos three main sites two designated SSI surveillance nurses were appointed to follow patients through the care pathway from surgery to recovery at home

The improvements in theatres included pre-operative skin assessment and preparation including MSSA screening restricting access to the theatres suite including introducing a colour-coded uniform policy introducing an initiative to maintain patientsrsquo temperatures committing to the Patient Safety WHO Checklist and further raising awareness among staff of the importance of infection control

Communicating the policy objectives and the progress of the improvements were key to the programmersquos success As well as the Trust Chief Executive and the Trust Board updates were given regularly to a number of different groups and committees including the trauma and orthopaedic board clinical policy group and infection control committee as well as presentations to community nurse forums There were also updates to the wider orthopaedic community via publications in four articles on separate aspects of the programme in peer reviewed journals

OutcomesAll the changes were monitored and assessed and results fed back to the Trust Board The team succeeded in reducing their rates to less than 1 and the lessons that have been learned are taking the SSI programme forward to other surgical categories including breast surgery obstetrics and gynaecology and the colorectal unit

Judgesrsquo CommentsAndrea Berry Lead Nurse Greater Manchester Critical Care Network and Chair of Critical Care National Network Nurse Lead Forum said ldquoThe entry was very detailed and clearly presented It showed a full system project with executive backing which is vital in making changes of this scalerdquo

Derek Butler Chairman of MRSA Action UK said ldquoTaking on these ambitious objectives is all about spending to save Once resources have been made available you can inspire people to take ownership of change to see it throughrdquo

Andrea Denton member of the Infection Prevention Societyrsquos (IPS) Education and Continuing Professional Development Committee said ldquoThe campaign clearly showed some innovative thinking and the potential impact of this kind of campaign throughout the hospital could be signi cantrdquo

12 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

KIMBERLY-CLARK LAUNCHES NEW STERILISATION WRAP THAT REINFORCES

CONFIDENCE IN STERILITY OF INSTRUMENTS

An innovative sterilisation wrap has been launched by Kimberly-Clark Health Care to provide immediate con dence that the integrity of sterile surgical instruments has not been compromised

Kimguard One-Step Quick Check offers visual reassurance that the wrap is free from tears cuts and holes It works by combining two sheets of thermally bonded wrap ndash a blue layer and a white layer ndash so that any breaches in the fabric are easily identi able

As problems occurring on single colour wrap might be hard to spot this new feature saves valuable time in the operating room as it avoids the need to add additional steps into the inspection process

This time saving enhances the existing advantages of the Kimguard One Step range which delivers the protection of double wrapping in a single step so that users can save up to 49 of time wrapping and opening packages compared to a more conventional sequential wrapping process(1)

In addition the new wrap also features Kimberly-Clarkrsquos patented PowerGuard Technology to provide a robust microbial barrier that gives excellent protection against contamination By incorporating a stabilised charge in the bres of Kimguard the treated fabric captures the bacteria and helps to prevent it from passing through the fabric on to the sterilised devices and instruments even when challenged with steam

ldquoQuick Check is a great addition to the One Step range as it adds yet further bene ts to this highly effective and easy to use sterilisation wraprdquo explained Karina Engels Sterilisation Product Manager for Kimberly-Clark ldquoThe new product provides bene ts both to the CSSD and the OR it provides additional peace of mind to the surgical team that devices and instruments are sterile and that they can focus on their own roles and their patients in the OR For the CSSD it allows staff to colour code trays and make them stand out from the restrdquo

References(1) This study was undertaken by Kurt Salmon Associates inc to quantify the time required to wrap and open packages using Kimguard One-Step compared to conventional sequential wrap

Registered Trademark or Trademark of Kimberly-Clark Worldwide Inc copy KCWW All rights reserved

Xograph BuckyStar Intuition DR system takes part in 2012 Olympics

When responding to articles please quote lsquoOTJrsquo

The southern coastal town of Weymouth UK is geared up for the 2012 Olympics by building a giant sandcastle measuring 4m x 2m on Weymouth beach to mark 100 days to the start of the London Olympic Games on 27 July At the same time a more permanent construction of a longer lasting legacy is taking place at Weymouth Community Hospital

Weymouth and Portland is the only venue outside London hosting the Olympic and Paralympics Games for the full duration of the 2012 Games it is therefore essential that the local Hospital is also ready for whatever challenges may come its way In preparation for the 10 sailing events which will be contested 380 athletes from 61 nations and a further 80 Paralympic sailors taking part in three subsequent events Weymouth Community Hospital is now installing a brand new direct digital X-ray system supplied by leading independent diagnostic imaging supplier Xograph Healthcare

The Xograph system known as the lsquoBuckyStar Intuitionrsquo is a complete general purpose radiography room system combining the latest Canon direct digital imaging technology with a new lightweight ceiling suspended X-ray tube support a motorised patient table a patient wall stand and a high frequency X-ray generator Images are displayed almost instantly to the radiographer directly in the X-ray room

greatly decreasing examination times and increasing patient work ow The Intuition also includes an image stitching function allowing multiple spine and full length leg images to be digitally stitched together to aid diagnosis and treatment planning

Linda Chappell Lead Superintendent Radiographer at Weymouth Community Hospital said ldquoThis new X-ray system will greatly bene t us in preparation for the Olympic sailing events We have worked with Xograph Healthcare before at Dorset County Hospital and have been very pleased with the after sales service they provide and the reliability of their equipment This is extremely important to us as a small community hospital preparing to provide a service for the Olympic athletes and the many thousands of spectatorsrdquo

wwwxographcom When responding please quote lsquoOTJrsquo

Common medicines dictionary approved

for NHSA common medicines dictionary approved today will reduce the chance of medical errors by ensuring all staff who work in the NHS and healthcare use the same common language when referring to medicines

The Information Standards Board for Health and Social Care has approved the NHS dictionary of medicines and devices (dm+d) as a fundamental standard which must be used by all staff

All doctors nurses and pharmacists should move towards using the common medicines dictionary so that information exchanged electronically is accurate and safe Using a single drug terminology will enable information about patients medicines to transfer more effectively between different healthcare settings reducing the risk of medication mistakes caused by human error

The NHS dictionary of medicines and devices is already widely used in the UK for the exchange of clinical information including the Electronic Prescription Service and for patients Summary Care Records

Dr Charles Gutteridge National Clinical Director for Informatics at the Department of Health and Medical Director Barts and the London NHS Trust said The adoption of dm+d is an important milestone It will mean clearer and consistent communication throughout the NHS ensuring health professionals in all care settings can deliver a more integrated and safer healthcare system

ldquoI encourage all clinicians to accelerate their use of this common medical dictionary for the bene t of the patients we care for

Heidi Wright from the Royal Pharmaceutical Society (RPS) said The Royal Pharmaceutical Society supports the need for a single terminology to facilitate interoperability and to enable such initiatives as the Electronic prescription Service (EPS) We believe that the opportunities created for using dm+d are substantial in terms of interoperability opportunities for comparison and reducing variation enhancing patient safety ie reducing risks associated with system interfaces and providing links to clinical systems such as the British National Formulary (BNF)

The dm+d is a dictionary containing unique identi ers and associated textual descriptions for medicines and medical devices dm+d has been developed and delivered through a partnership between the Department of Health Informatics Directorate and the NHS Business Services Authority httpwwwdmdnhsuk

The Information Strategy (The Power of Information) states 358 ldquoReducing the number of inconsistent or incompatible terminologies from 2015 (via the lsquoroute-maprsquo) will allow better integration between systems and across health and social care and better information to support care and improvement of care In due course for patient care purposes all relevant systems should use the same terminology to exchange coded information SNOMED CT adapted to t all necessary uses is the appropriate terminology to base this on Similarly to allow drugs to be consistently referenced systems will consistently use the electronic drugs dictionary (dm+d)rdquo

httpwwwdhgovukhealth201205information-strategy

nd out more 02921 680068 bull e-mail adminlawrandcom Issue 262 July 2012 13

Medical Seating

Unit B bull Charlton Mill Way bull CharltonNr Chichester bull West Sussex bull PO18 0HZTelephone +44 (0)1243 811881

Fax +44 (0)1243 811855E-mail Willmurrayequipmentcoukwwwmurrayequipmentcouk IAB 00441ISO 9001

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Operating Theatres bull Anaesthetics bull Eye Clinics bull Recovery bull ICU - HDUPain Management bull Ultrasound bull Maternity Units bull Delivery Suites bull Clinical Areas

A leading UK supplier of operating stools for NHS clinicians

Winners of Clinical Seating OJEU contract for Barts

amp The London NHS

Criteria Ergonomics Infection Control and Build Quality

ALDER HEY IMPROVING EFFICIENCIES WITH DIGITAL DICTATION

New Good Practice Guide

Will Help Tackle Concerns About

Practitioner Behaviour

The National Clinical Assessment Service (NCAS) has published a new good practice guide aimed at helping NHS organisations deal with concerns about a practitionerrsquos behaviour

Handling Concerns about a Practitionerrsquos Behaviour and Conduct builds on NCASrsquo eleven years of experience in advising referring organisations on the most effective ways of handling concerns about practitioner performance It is a ldquolessons learnedrdquo document drawing on NCAS experiences from referrals about behavioural concerns

NCAS Lead Adviser Karen Wadman explained ldquoBehaviour relates to how someone interacts with other people - how they communicate how they might relate to communications dif culties how individuals work in teams and how they react when under stress

ldquoHowever such concerns can also relate to an organisation and how the workplace is organised and the way resources and teams are structured This guide can be used wherever practitioners work - general practice community and hospital sectors and whatever their speciality grade or employment statusrdquo

NCAS found that between December 2007 and October 2010 when it handled 3000 cases of practitioner performance concern 57 per cent were recorded as having some type of behavioural component

Interim Medical Director at NCAS Professor Pauline McAvoy said ldquoThose responsible for managing health professionals and in particular those charged with monitoring performance are in a good position to identify potential problems

ldquoIt is vital that concerns about behaviour or indeed changes in behaviour are addressed at an early stage to minimise impact on patient care But it is also important to ensure that factors which may be contributing to the behaviour such as ill health or work context are consideredrdquo

To download a copy of Handling Concerns about a Practitionerrsquos Behaviour please visit httpwwwncasnhsukpublications

Alder Hey Childrenrsquos NHS Foundation Trust is introducing a new integrated digital dictation platform to improve work ow patient care and deliver time and ef ciency savings for clinicians and secretaries

Olympus hardware has been utilised to promote ef ciency and cost bene ts via the DR xed microphone range MedisecTRUST Digital Dictation tags dictated voice les from Alder Hey clinicians with central Patient Administration System (PAS) data to automatically generate clinical correspondence

ldquoThis is a key move in our drive to improve administrative ef cienciesrdquo said Alder Heyrsquos EPS Project Manager Heather Swanston

ldquoWe had already streamlined the transfer of patient information using the MedisecTRUST solution but transcription times will now be much faster with the integration of Medisecrsquos digital dictation platformrdquo

Digital dictation eliminates the time-consuming process of physically moving le notes and audio cassettes between hospital departments while the tagged les allow dictations to be quickly identi ed and transcribed

When a patient is selected the system opens the integrated dictation software The resulting voice le is tagged to the patient and automatically appears in the relevant medical secretaryrsquos work ow

When the secretary opens the voice le the system automatically inserts patient information from the hospital PAS into a letter template Consultants are able to edit and authorise all clinical correspondence online

ldquoI previously used to write my letters out longhand and pass them to my secretary for typing which was a time-consuming processrdquo

said Consultant Paediatric Dentist Rod Llewellyn ldquoThis system is quicker and more ef cientrdquo

Tom Rothwell Medisec Softwarersquos Managing Director added ldquoDigital dictation combined with an advanced work ow solution can realise signi cant ef ciency gains and in collaboration with Olympus we are delighted to announce this roll-out of at Alder Heyrdquo

For further information please visit wwwmedisecsoftwarecoukwwwolympuscouk

wwwfacebookcomTheOTJ

When responding to articles please quote lsquoOTJrsquo

14 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

Tel 01303 840 882 Fax 01303 840 969 enquiriessophiebellandassociatescouk

wwwsophiebellandassociatescouk

WEST MIDLANDSTHEATRE PRACTITIONERS

You will be an experienced RGN or ODP with Scrub andor AnaestheticRecovery skills to join this busy department You will be a good team player and will be expected to provide and maintain a high quality service Support from a strong management team will be provided as well as the opportunity

to work alongside expert clinicians Ideally you will have comprehensive orthopaedic and general scrub skills and you will be required to provide

exible skills in Anaesthetics Recovery or HDU

Tel 01303 840 882 Fax 01303 840 969 enquiriessophiebellandassociatescouk

wwwsophiebellandassociatescouk

LONDONDAY SURGERY UNIT MANAGER

An energetic amp innovative Manager is required for this unit which consists of 4 theatres 12 patient bays amp 8 Chairs The role includes managing the operational nancial HR amp governance perspectives A talented individual is required to maximize the use of

resources and dynamically develop amp expand the services provided You will have the ability to execute projects to a high standard meeting deadlines amp within budget You will

also provide positive team leadership amp a professional service promoting amp safeguarding the well being and interests of all patients amp customers of the unit Further quali cations which support your clinical amp managerial development will be expected

----

Itrsquos easy to subscribe just visit our website at wwwotjonlinecom and pay via Card or Paypal

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Itrsquos easy to subscribe just visit our website at wwwotjonlinecom and pay via Card or Paypal Subscribeto the OTJ

Delivered to your door every month

Name ___________________________________________Address ___________________________________________ ___________________________________________Town ___________________________________________County ___________________________________________Postcode ________________Tel_________________________ Please enclose cheque made payable to ldquoLawrand Ltdrdquo and return to Lawrand Ltd PO Box 51 Pontyclun CF72 9YY

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Subscribing to the OTJ costs pound1400 per year for delivery in the UK or pound2100 overseas Alternatively just ll in your address details below and return with a cheque

GIBRALTAR HEALTH AUTHORITY

OPERATING DEPARTMENT PRACTITIONER

pound23251 to pound31044 pa plus allowances (depending on experience) Relocation Assistance Provided (Passages payable in full amp Subsidised Accommodation)

OVERDUE A SABBATICAL ARE YOU ON A CAREER BREAK

WANT TO WORK SOMEWHERE UNIQUE The Gibraltar Health Authority is looking for an enthusiastic and highly motivated Operating Department Practitioner Candidates must feel comfortable working in a busy Operating Department that provides a comprehensive range of surgical services such as General Urology Obs amp Gynae Ophthalmic ENT Dentals Maxillo-Facial Plastic Orthopaedics and Trauma Surgery The above appointment will be on contract terms for a period of 10 months If you would like to discuss any aspects of the post please contact Ms Sandie Gracia Clinical Nurse Manager - Allocations on Tel 00-350-200-72266 ext 2314 or email sandiegraciaghagi Application Packs are obtainable from the Recruitment Section on Tel 00-350-200-72266 ext 2081 or Fax 00-350-200-43864 or email philipdavittghagi

Closing Date 5th August 2012

MHRA tells surgeons to stop using R3 metal cup liner and extends

patient monitoring advice

The Medicines amp Healthcare products Regulatory Agency (MHRA) has recently issued new advice to surgeons that they should not use a particular type of metal cup liner that is used in some metal-on-metal hip replacement operations

A Medical Device Alert was issued today by the MHRA following a product recall by manufacturer Smith amp Nephew of the R3 metal cup liner component of the R3 Acetabular System The R3 metal cup liner is used with appropriate Smith amp Nephew hip replacement femoral components

Post-market surveillance data has shown a high revision rate of 63 at 4 years for patients implanted with the R3 metal liner This high revision rate is not in line with the 4 guidance gure at 4 years from the National Institute of Health and Clinical Excellence (NICE) and therefore the MHRA has told surgeons to stop using the metal cup liner and to annually monitor the 281 patients who have been tted with these cup liners so that any complications such as pain or swelling are picked up and treated early

The MHRA also issued updated advice today to surgeons about extending the period of follow-up to annual monitoring of their patients if they are experiencing complications such as pain or swelling from their metal-on-metal hip resurfacing implants or metal-on-metal hip replacements that have a head diameter below 36 millimetres The new advice of annual monitoring replaces previous patient monitoring advice for these size of implants that patients should be followed up for a minimum of ve years

Todays new information is viewed as a routine patient monitoring advice update by the independent expert advisory group that was set up by the MHRA to look at the management of patients with metal-on-metal hip implants There is no new evidence of an increased safety risk associated with metal-on-metal hip implants and people with these implants who are not experiencing any problems do not need annual monitoring

Dr Susanne Ludgate the MHRAs Clinical Director of Medical Devices said In the UK 281 patients have been tted with this speci c R3 metal cup liner Evidence from post market surveillance data has shown that the revision rate for this implant is high and that is why we have taken action to advise surgeons to stop using this device and to monitor the patients implanted with this cup liner on an annual basis

Clinical evidence shows that patients have a small risk of suffering complications from having metal-on-metal hip implants but we believe after advice from our expert advisory group that it makes sense for surgeons to annually monitor any patients who are showing any symptoms such as pain or swelling if they have metal-on-metal hip implants By monitoring patients with symptoms every year any complications will get picked up and they can be treated earlier

The Medical Device Alert on the R3 metal cup liner can be viewed here

httpwwwmhragovukPublicationsSafetywarningsMedicalDeviceAlertsCON155761

The Medical Device Alert on the updated patient monitoring advice can be viewed here

httpwwwmhragovukPublicationsSafetywarningsMedicalDeviceAlertsCON155761

nd out more 02921 680068 bull e-mail adminlawrandcom Issue 262 July 2012 15

wwwOpera ngpera ngTheatreheatreJobscomobscomA one-stop resource for ALL your theatre related Career opportuni es

View the latest vacancies online

HCA

Theatre Practitioners Recovery Nurses Anaesthetic Nurses ODPs Scrub Practitioners Nurse Practitioners Medical Representatives

and Clinical Advisers

ldquoit is recommended that all hospitals have second generation SADs available for both routine use and rescue airway managementrdquo 1

Reference (1) 4th National Audit Project of The Royal College of Anaesthetists and the Difficult Airway Society Major complications of airway management in the UK Report and findings March 2011 Section 3 Appendix page 210

Quality innovation and choicewwwi-gelcom