The Operating Theatre Journal theatre journal... · 2015-10-04 · ‘perfect storm’ of demographic and wider economic and social trends are converging to push up the cost of healthcare

October 2015 Issue No 301 ISSN 1747-728XThe Leading Independent Journal For ALL Operating Theatre Staff

3rd National Conference

Now in its 3rd year the conference has developed to include an interesting programme of issues exploring safety and effectiveness in the modern operating theatre Local initiatives combined with a national policy agenda delivered by theatre professionals from all over the UK make this event a must for theatre managers and senior perioperative professionals The day also provides an excellent opportunity for face to face networking and exchanging experiences and ideas

The venue is Park Inn by Radisson Manchester which is located in the city centre and close to main line train stations and city centre car parking There are a selection of hotels within close distance and a listing can be found on the MampK website wwwmkupdatecouk

bull The use of AfPP and Governmental targets to influence training and development of theatre staff

bull Delivering an efficient operating theatre pathway from pre-assessment through theatre to discharge using electronic theatre management and lean principles

bull Staffing for safe and effective Operating Theatres

bull Angels or Demons Exploring the role of a Practice Development Team (PDT) in delivering safe and effective care in theatres

bull Cell salvage in the DGH environment The practicalities of establishing and running a service

bull Operating Department Fire Evacuation ndash Testing fire plans using simulation

bull Improving performance through Simulated Practice and Assessment

bull Diathermy smoke - Is it hazardous to health

bull The Assistant Theatre Practitioner (ATP) Scope of Practice - is there really any consensus

Key conference benefits include

Networking | Interaction | Building relationships | Exchanging ideas Face to face contact

Also from MampK

Developing the role of Healthcare Support Workers 22 October 2015 - London

How to book

Online wwwmkupdatecouk Email bookingsmkupdatecouk Tel 01768 773030

Programme includes

11th November 2015 | Park Inn by Radisson Manchester pound259 pp

Delivering safe and effective Operating Theatres

UPDATE

MampK Update Ltd Keswick Cumbria CA12 5AS Tel 01768 773030 wwwmkupdatecouk

professionals training professionals since 1992

Find out more 02921 680068 bull e-mail adminlawrandcom Issue 301 October 2015 3

The next issue copy deadline Friday 23rd October 2015All 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 subscriptionNeither 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 above No part of this journal may be reproduced without prior permission from Lawrand Ltd copy 2015

Operating Theatre Journal is printed on paper sourced from Forest Stewardship Council (FSC) approved paper mills and is printed with vegetable based inks All paper and ink waste is recycled

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

NHS-approved apps found lsquoleakingrsquo ID data

Many NHS-accredited smartphone health apps leak data that could be used for ID theft and fraud a study has foundTh e apps are included in NHS Englandrsquos Health Apps Library which tests programs to ensure they meet standards of clinical and data safetyBut the study by researchers in London discovered that despite the vetting some apps fl outed privacy standards and sent data without encrypting itTh e apps that leaked the most data have now been removed from the libraryldquoIf we were talking about health apps generally in the wider world then what we found would not be surprisingrdquo said Kit Huckvale a PhD student at Imperial College London who co-wrote the studyBut given that the apps the study looked at were supposed to have been vetted and approved fi nding that most of them did a poor job of protecting data was a surprise he addedFake dataMr Huckvale and colleagues looked at 79 separate apps listed in the NHS library Over six months they periodically supplied the apps with fake data to assess how they handled itTh e apps in the library are aimed at helping people lose weight stop smoking be more active and cut back on drinkingOf the total 70 sent personal data to associated online services and 23 did so without encrypting itTh e study found that four apps sent both personal and health data without protecting it from potential eavesdroppingimed at helping people be more active manage their drinking and stop smokingIf intercepted the data could be used for ID theft or fraud said Mr HuckvaleMore than half of the apps had a privacy policy but many of these were vaguely worded and did not let people know what types of data were being sharedMr Huckvale said the most of the data the apps gathered and shared was about a personrsquos phone or their identity with only a handful collecting information about the health of usersTh e results of the study are published in the open access journal BMC MedicineMr Huckvale added that the NHS needed to work harder on testing because of how apps were likely to be used in the futurelsquoWorrying informationrsquoldquoTh e study is a signal and an opportunity to address this because the NHS would like to see strategic investment in apps to support people in the futurerdquo he told the BBCldquoWe will see them used more often and become much more complex over timerdquoNHS England said ldquoWe were made aware of some issues with some of the featured apps and took action to either remove them or contact the developers to insist they were updatedldquoA new more thorough NHS endorsement model for apps has begun piloting this monthrdquoSecurity expert Ken Munro of Pen Test Partners said the study revealed the shortcomings of many developers who were not following well-established ways of handling personal dataldquoItrsquos worrying informationrdquo he said of the study ldquoWhere insecure storage of personal data often fails is with developers not understanding the consequence of poor security practicerdquo Source BBC News

Think tank urges health leaders to ensure NHS ef ciency savings donrsquot limit investment in innovation and prevention

bull Th e UK is home to some of the worldrsquos leading innovation in healthcare but we can learn from successes in USA India Australia Africa and Europe

bull ILC-UK urge health leaders to work to ensure that the pound22bn savings being asked of the NHS act to stimulate not prevent innovation

Th e NHS should be supported to continue to invest in innovation in order to save more money in the long-term argues a major new report lsquoCreating a sustainable 21st century healthcare systemrsquo by the International Longevity Centre ndash UK (ILC-UK)lsquoCreating a sustainable 21st century healthcare systemrsquo sponsored by EY is the fi rst report in ILC-UKrsquos SOS 2020 Health series It highlights how a lsquoperfect stormrsquo of demographic and wider economic and social trends are converging to push up the cost of healthcare across the globe Th e report showcases examples of innovation from across the world which could save lives and money if introduced more widely Th e UKrsquos healthcare system provides a third of the exemplary case studies showcased in the report but the report suggests that more work needs to be done to share and spread innovation in the UK and that therersquos much to learn from other leading markets such as India Australia Europe and the US Th e report points out that the 15 million people who have a long term health condition account for 70 of the total health and care spend in England Yet across Europe on average only 3 of healthcare expenditure is allocated to prevention and public health programmesTh e NHS is committed to achieving pound22bn effi ciency savings through productivity gains of 2 or 3 a year between now and 2020 Th e ILC-UK research has shown this target will be very challenging without real innovation Th e OBR highlight productivity in the health sector only rose by around 1 per annum on average between 1979 and 2010Th e report suggests that a concerted focus on innovation and prevention - developing more empowered health consumers whilst also maximising the potential of big data - would help to deliver signifi cant savings in the long-termPhase two of the report due out in 2016 will model the impact of applying the leading global innovations showcased in the fi rst report to new markets to highlight the potential global savings of sharing innovationBaroness Sally Greengross ILC-UK Chief Executive said ldquoWhilst innovation can save money in the long term it requires up-front investment And the nature of introducing new or dual systems can mean that for the fi rst few years costs go up and services donrsquot improve Th e picture is not as bleak as it may sound however Advances in health technology have the potential to signifi cantly infl uence patientrsquos access to health care and the way that health care is delivered Big data can revolutionise the way services are focussed on the individual But for us to maximise the potential we have to create a climate for innovation in the health service We might also accept that if we are to innovate to reduce costs and improve services over the long term public and private investment is vital Government must ensure that the pound22bn savings being asked of the NHS act to stimulate not prevent innovationrdquoShaun Crawford EY Global Insurance Sector Leader said ldquoTh is report has sourced a bank of robust innovative global case studies and innovations as a fi rst step in developing verifi able models to deliver better health outcomes and reduced costs across the world at a time of growing pressure on our health care systemsrdquo Gary Howe partner and UK health lead at EY adds ldquoEmpowering consumers and harnessing big data will be crucial to delivering long-term savings for the sectorrdquo wwwilcukorguk

4 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

wwwfacebookcomTheOTJ

Are You Linkedin Join our Group

The Operating Theatre Journal in TM

Anetic Aid your total Tourniquet partner NEW Single-use Sterile Tourniquet Cuff s

Anetic Aidrsquos British-designed and manufactured AT4 Tourniquet system is easy to use and ideal for single or bi-lateral orthopaedic surgery and pain management

Th e electronic version operates from its own integral air supply removing the need for an external pressure source and both this and the pneumatic version have in-built leak compensation facilities as well as automatic self diagnostic checks on start up which mean they are calibrated every time they are switched on

In a recent innovation the fascia panels now feature OLED (Organic Light Emitting Diode) technology to give a brighter display ndash and enlarged fi gures on the face to make it even clearer and easier to read

A special safety feature has also been incorporated for Bierrsquos block regional anaesthetic procedures (IVRA) it is not be possible to defl ate cuff s in the wrong order risking the dangerous release of anaesthetic into the rest of the patientrsquos body

But all this is only part of the off er as well as providing commissioning and staff training for our tourniquet systems Anetic Aid also off ers a comprehensive servicing and support package through its team of fi eld engineers based around the UK

And of course the tourniquet machine is not a stand-alone item Anetic Aid also off ers a complete range of tourniquet cuff s and other accessories

We have recently launched a Single-use Sterile Cuff ndash an ideal solution when sterility is key Th is perfectly complements the Six-use Day Cuff s which are both easy to clean and cost eff ective and the robust Premier Re-usable Cuff s for long term use

Other accessories include another new item a disposable Padded Cuff Cover which is made from a hypoallergenic waterproof material Encasing the tourniquet cuff the special foldback design provides an eff ective barrier to prevent fl uids such as prep or blood from seeping under the cuff and aff ecting the patientrsquos skin ndash or contaminating the cuff

Th e range also includes the Rhys Davies Exsanguinator and our specialist highly visible Toe-niquetsTM

bull COST SAVINGS call now to ask about our special deals which include free tourniquet machines as part of regular orders for Six-use or Single-use Cuff s 01943 878647 When responding to articles please quote lsquoOTJrsquo

Researchers identify new molecular marker for killer cells

Cell marker enables prognosis about the course of infections

When a pathogen invades the body specifi c cells in the human immune system are ready to take immediate action in order to destroy it Th e molecular characteristics of these killer cells were unknown until recently Now for the fi rst time a team from the Technical University of Munich (TUM) has managed to create a molecular profi le of the protective cells By studying these immune cells from patientsrsquo blood the researchers were able to predict the course of infections

Th e immune system defends us against pathogens and cancer cells As it does so it forms immune cells that attack and kill infected cells or cancer cells in a very targeted way typical of the action of pathogens Th is is why they are also known as killer cells Until now in the event of infection it was diffi cult to predict how many of these killer cells would be active and therefore how eff ectively the body could fi ght the disease

Characteristic markers for killer cells

ldquoAssessing a patientrsquos ability to control an infection has always been a protracted process because there were no markers to reliably label killer cells ndash the real lsquotask forcersquo of the immune systemrdquo explains Prof Percy Knolle head of the Institute for Molecular Immunology amp Experimental Oncology at TUM University Hospital Klinikum rechts der Isar ldquoYet this type of prediction is extremely important for selecting a suitable course of treatmentrdquo

Percy Knolle and his team have now managed to identify a marker for killer cells for the fi rst time Th eir fi ndings have been published in the journal Nature Communications Th e scientists found a molecule ndash the CX3CR1 receptor ndash occurring only on the surface of these killer cells Th ey fi rst demonstrated this in infection models with mice and then verifi ed their fi ndings in a human patient study

Fewer killer cells in chronic infections

In some patients viral infections such as Hepatitis B can become chronic ie a certain amount of the virus remains permanently in the body Th e immune system cannot control the infection and the disease is not completely cured Th e scientists asked themselves whether the reason for this could lie with the killer cells To fi nd out they used their newly discovered marker

Th ey launched a patient study with participants who had chronic hepatitis infections and discovered that these patients had only a very small number of killer cells targeting the hepatitis viruses By contrast the patients had developed many killer cells against other viral infections that they had overcome during the course of their lives ldquoIt appears that the lack of specifi c killer cells is the reason why some infections become chronic and the patients are unable to eff ectively kill off the virusesrdquo explains the scientist

Percy Knolle sees great potential in the results ldquoTh e new marker will make predictions about the course of infections much faster and more precise All we need to do is take blood from the patient and identify the number of killer cells using the new markerrdquo Th is would allow suitable treatment to be initiated at an early stage he explains

Publication

Jan P Boumlttcher Marc Beyer Felix Meissner Zeinab Abdullah Jil Sander Bastian Houmlchst Sarah Eickhoff Jan C Rieckmann Caroline Russo Tanja Bauer Tobias Flecken Dominik Giesen Daniel Engel Steff en Jung Dirk H Busch Ulrike Protzer Robert Th imme Matthias Mann Christian Kurts Joachim L Schultze Wolfgang Kastenmuumlller and Percy A Knolle Functional classifi cation of memory CD8+T cells by CX3CR1 expression Nature Communications September 2015

DOI 101038ncomms9306httpw w wnaturecomncomms2015150925ncomms9306absncomms9306html


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bullbull SSSuuuuprreemmmelyyy mannoeuvvraablebullbull EExxccxxx eeppttiioonnaall llooww hheeiigghhttbullbull VViirrttuuaallllyy zzeerroo ttraannssffeerr ggaapbull Eassillyy gguuiiddeedd bbyy oonnee ppeerrssoonnbullbull DDeessiiggnneedd ffoorr ppaattiieenntt ccoommffoorrttbull GGas aassssiistteed bbaaccklifttbull KK88 PPrreessssurree ccaaree mmaattttrreessssbull FFiixxeexxx dd ttrraannssffuussiioonn ppoollee ndash qquuiicckk rreelleeaasseebull Infection control ndashndash ssmooothh mouldedd ssuurrffaacceessbull Lifetime waww rrantytt ndash whhole life cost traansppaarreennccyy

Innovative TeTT chnology ndash Practically Applied

LIFETIME WARRANTY

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SUBJECT TO ANNUAL SERVICING

HCPC launches revised lsquoHealth Disability and Becoming a Health and

Care Professionalrsquo Guide Th e Health and Care Professions Council (HCPC) has launched revised guidance for disabled people who are considering or training to become a professional regulated by the HCPCare considering or training to

Th e guide will also be useful for individuals working in education and training careers advisors those teaching supervising or supporting disabled students and occupational health professionals

Th ere are four parts which encompass information about HCPC and our standards useful information for disabled people a section for education providers and also where to fi nd more dedicated website pages on health and disability

Following a three month consultation with stakeholders including course leaders professional bodies students and employers it also now includes new guidance on disclosing disabilities information about education providersrsquo responsibilities and detailed examples of reasonable adjustments to refl ect complex cases

Nicole Casey HCPC Acting Director of Policy and Standards commentedldquoDisabled people have an important contribution to make to the health and care professions we regulate Having a health condition or disability should not be seen as a barrier to becoming a registered health and care professional Many people who have disabilities successfully complete our approved training programmes go on to register with us and practise as health and care professionals

ldquoWe hope that this revised guidance will encourage enable and support disabled people who are considering or training to become HCPC-registered professionalsrdquo

Th e Guide is available in a range of diff erent formats available on request by emailing publicationshcpc-ukorg or you can download a copy by visiting our dedicated webpage httpwwwhcpc-ukorgaboutregistrationhealthanddisability

Papworth Hospital surgeons ranked among best in the UK for heart surgery

Surgeons at Papworth Hospital have been ranked among the best in the UK at lifesaving heart surgery according to the latest fi gures from the Society for Cardiothoracic Surgery (SCTS)

Th e latest audit published last week on the SCTS website and NHS Choices has revealed that over the last three years the hospital has carried out the largest number of major heart operations in the country whilst achieving survival rates that are signifi cantly higher than expected

Th e new fi gures show Papworth has some of the best cardiac surgery outcomes in the country while treating some of the highest risk cardiac surgery patients

With a 985 per cent risk adjusted survival rate Papworth achieved the best survival rate (above that expected) compared with all other UK hospitals

More than 5400 heart operations have taken place at Papworth Hospital between April 2011 and March 2014

John Dunning consultant surgeon and the Director of Surgery at Papworth Hospital said

Th ese are excellent fi gures Heart surgery at Papworth Hospital is a world-leading service and our results refl ect the very high standards not only of our surgeons and anaesthetists but also the nurses and other staff groups involved in delivering care to our patients

Dr Roger Hall Medical Director at Papworth Hospital added I am incredibly proud of the entire Papworth team who dedicate their time and energy each and every day to improving patient outcomes A lot of hard work has led to these excellent results of which I know our patients are very grateful

While there is no room for complacency the survival rate at Papworth fi rmly places Papworth as a world leading hospital Our focus now is to further improve upon these excellent results Source Cambridge News


wwwOOpera ngpera ngTTheatreheatreJJobscomobscomA one-stop resource for ALL your theatre related Career opportuni es

MEDICAL AIR TECHNOLOGYrsquoS LAY-UP CABINET ndash A COMPLETELY SELF-CONTAINED SOLUTION

FOR ANY OPERATING THEATREMedical Air Technology (MAT) recently launched the latest version of its unique self-contained lay-up cabinet an innovative solution to a diffi cult challenge HTM 03-01 states that ldquolaying-up in the clean zone is preferable for infection control reasonsrdquo but this is not always possible due to limited space Where this is the case the MAT lay-up cabinet provides the ideal solution creating a mini-clean zone and facilitating good infection control practice maintaining the safety of both patient and healthcare professional

Th e cabinet is fully self-contained and requires only a 13 amp power supply making it ideal for installation within existing conventional theatres or prep rooms that may require extra protection from airborne bacteria Medical equipment placed under the cabinetrsquos diff user is bathed in uni-directional HEPA-fi ltered air which passes directly over the sterile instrument tray It provides in excess of 1000 air changes per hour over the instruments many times more even than under a UCV canopy creating a safe sterile lay-up area Th e instrument tray can then be covered with a sterile cloth and taken into the operating theatre clean zone

Requiring only 14m of free wall space and minimum installation time MATrsquos lay-up cabinet is the perfect solution when space is limited but infection control essential It also helps operating theatres to run more effi ciently by reducing downtime due to contamination issues supporting the hospitalrsquos infection control regimen Th is newest and most advanced version of the cabinet is available in three sizes and features an electronic control panel adjustable fan speed integral LED lighting and a high quality powder-coated fi nish MATrsquos range of ultraclean ventilation canopies ECO-fl owtrade meant the company had the experience and engineering expertise to produce a piece of equipment that is practical easy to install and highly eff ective

Th e MAT lay-up cabinet is currently being off ered at a reduced price as part of MATrsquos commitment to supporting hospitalsrsquo infection control strategiesFor more information contact Ric Taylor on 0844 871200 or email salesmedicalairtechnologycom When responding to articles please quote lsquoOTJrsquo

View the journal online wwwissuucomlawrandOTJ Back issues are also available to view

Registration is Free wwwotjonlinecom

ODPs Theatre Anaesthetic amp Recovery NursesYour Favourite Journal is available ONLINE

(Simple Free Registration)

Jobs News Study Days Books Clinical Articles

Register Today at wwwotjonlinecom

Jobsitewwwoperatingtheatrejobscom

Get Your Personal Copy


Inspiration Healthcare in Reverse-Acquisition of Inditherm now re-named Inspiration Healthcare Group plc

Inspiration Healthcare Ltd a leading supplier of medical equipment is pleased to announce the acquisition of Inditherm plc a provider of innovative specialised heating solutions listed on the Alternative Investment Market (AIM) Th e transaction was subject to the approval of Inditherm Shareholders which was received at an ExtraordinaryGeneral Meeting held on 23 June 2015

Following the acquisition the enlarged company has been named Inspiration Healthcare Group plc and its shares are traded on the AIM under the symbol IHC

Th e enlarged company moves closer to becoming a major supplier of neonatal critical care

equipment on a global scale as well as consolidating its position as a supplier of operating theatre and parenteral feeding equipment in the UK and Ireland

Commenting on the acquisition Neil Campbell Managing Director of Inspiration Healthcare Ltd said ldquoTh e acquisition creates a company with a diverse product portfolio that will allow us to compete more eff ectively in a global market We will continue to invest in developing innovative products and look forward to utilizing the resources of an enlarged company to continue our growthrdquo

Inditherm plc has an exciting range of medical products that complement the growing portfolio from Inspiration Healthcare Ltd As part of a larger organisation the true potential of these products will be unlocked and a synergistic approach to the market will benefi t customers and patients around the world

Th is is a very exciting development for Inspiration Healthcare and Inditherm Summarising the future Neil Campbell concluded lsquoTh is really allows the larger group to drive forward adding products expertise and critical mass will allow the company to develop technologies that will help change outcomes and off er cost eff ective solutions for healthcare providers We look forward to getting to know all of Indithermrsquos partners and customers as we build a truly global brand supplying high quality medical device technologyrsquo

About Inspiration Healthcare

Inspiration Healthcare is a global supplier of medical technology for critical care operating theatre and other medical applications Our mission is to provide high quality innovative products to patients and caregivers around the world that help to improve patient outcomes and effi ciencies of healthcare organisations with patient focused customer service and technical support

Our own brand of critical care solutions span non-invasive respiratory management thermoregulation and diagnostics and patient warming for newborns through to adults in intensive care and the operating theatre whilst our distribution business supplies solutions to support specialised surgical procedures and infusion therapies

Present in over 50 countries worldwide our success has been built on continuous innovation excellent customer service and an inherent commitment to improving the quality of life of patients working in close collaboration with key opinion leaders and stakeholders in the clinical and medical community across the globewwwinspiration-healthcarecom

When responding to articles please quote lsquoOTJrsquo

wwwindithermcom

NICE Guidance supports thecase to adopt Inditherm patientwarming systems 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 usage and clinical wasteFull guidance can be found at wwwniceorgukguidanceMTG7Contact any of our Medical team today for further information or a free trial on +44 (0) 1709 761000 or emailmedicalindithermplccom and quote Ref OTJ15

Fukuda Denshirsquos state-of-the-art systems on

display at the European Society of Intensive

Care MedicineFukuda Denshi is a leading supplier of advanced patient monitoring and user-confi gurable clinical information management systems as well as cardiology and imaging technology Th e company attended the 28th annual congress of the European Society of Intensive Care Medicine (ESICM) held from 3rd to 7th October in Berlin

Taking place at Citycube in Berlin the congress and exhibition aimed to update clinicians nursing staff and allied professionals on the latest and most relevant advances in critical care and emergency medicine and Fukuda Denshi attended with their range of Dynascope monitors including their latest addition to the range the DS-8900

Th e DS-8900 provides instant clarity of information in an eff ortlessly powerful monitor that can display up to 32 beds on its multi-confi guration 26in full colour HD monitor It provides up to 120 hours (5 days) of continuous waveforms and parameter recording and uses the latest high-speed storage device to enable users to review waveforms and parameters stored when necessary

Also on display was Fukuda Denshirsquos DS-8500 high end anaesthesiacritical care monitor as well as their transportable and powerful DS-8200 modular monitor that uses the same GUI as Fukuda Denshirsquos high-end DS-8500

Fukuda Denshirsquos DS-8100 compact lightweight integrated monitor was also on display along with their MetaVision Clinical Information System the MVICU which is specifi cally designed for critical care use

Visitors received a warm welcome from the Fukuda Denshi team who were on hand to demonstrate their state-of-the-art products as well as provide full product information and answer any questions

Fukuda Denshi Healthcare bound by technologyFor more information visit wwwfukudacouk Quote lsquoOTJrsquo


Smiths Medical Helping Hospitals Prepare For New ISO Safety StandardSmiths Medical a leading global medical device manufacturer has launched a training programme to help ensure healthcare providers are up to speed and prepared for the forthcoming International Standard Organisation (ISO) new neuraxial small-bore connector safety standard ndash ISO Standard 80369-6

As part of its commitment to helping healthcare professionals get ready for the new ISO safety standard Smiths Medical is carrying out awareness sessions and presentations Firstly the company conducted a survey among a cross section of its customers to gauge the level of awareness of the new ISO standard and from this developed a tool kit to help increase knowledge Smiths Medical surveyed over eighty of its customers face to face and found

bull 64 percent had low or no awareness of the ISO standard

bull 73 percent agreed the adoption of the ISO standard 80369-6 is important for their hospital

bull 59 percent ranked their hospital as having little or no preparation for the standard today

bull 98 percent felt the Smiths Medical presentation was somewhat or very helpful in providing information on how to prepare for the ISO standard design change

Smiths Medical is committed to supporting healthcare professionals who have a responsibility for administering and supervising the use of the new design small-bore connectors Th e company is helping hospital trusts get staff up to speed with the requirements of the new international standard and be prepared for the new neuraxial-specifi c connectors through its awareness programme

Th e new ISO safety standard is being introduced as the widely used small-bore connectors commonly referred to as Luer connectors allow for misconnections and misinjections between unrelated delivery systems with vastly diff erent uses For example a neuraxial misconnection would be when drugs intended for the intravenous route are administered via the spinal or epidural route or where local anaesthetic intended for the epidural or regional block is administered intravenously When patients receive the wrong drug the results can be catastrophic causing them injury or in some cases death

In advance of the new ISO standard Smiths Medical is continuing to provide hospital trusts with its CorrectInjecttrade Spinal Safety System which has been used in the NHS since its launch in 2011 Th e CorrectInjecttrade Spinal Safety Systemrsquos unique interlocking connectors allow only medication delivered with a CorrectInjecttrade syringe to reach the patient through the spinal needle Connections of the CorrectInjecttrade Spinal Safety System are distinctly diff erent from standard Luer connections commonly used on medical products and help prevent misconnections

Th e CorrectInjecttrade Spinal Safety System is a dedicated neuraxial connector system Th e system consists of components that have a unique non-Luer taper that allows connection of compatible CorrectInjecttrade components that when used together as a system help reduce the risk of misconnection and the chance of injecting medication not intended for the spinal space

For more information on the Smiths Medical training and support for the forthcoming changes or to arrange a presentation on the new ISO safety standard please contact Glen Johnson UK Marketing Manager at Smiths Medical on 01233 722 100 or email glenjohnsonsmiths-medicalcom

Further details of the CorrectInjecttrade Spinal Safety System are available by contacting Glen Johnson at Smiths Medical on 01233 722 100 or by logging on to wwwsmiths-medicalcom

Further information relating to the new ISO safety standard can be found by visiting the website of the Association for the Advancement of Medical Instrumentation (AAMI) which is leading the small-bore connectors initiative ndash wwwaamiorghottopicsconnectors


Register now for ASPiHrsquos 6th Annual Conference

More than 500 delegates expected in Brighton for a stimulating programme of lectures workshops posters and networking events from 3-5 November 2015

Brighton will play host to the 6th ASPiH (Association for Simulated Practice in Healthcare) Annual Conference later this year as key note speakers round table debates and more than 20 interactive workshops headline the only UK national multi-disciplinary conference dedicated to the role of simulation in healthcare education training and error modelling Building on the foundations from last yearrsquos conference the 2015 event will focus on how simulated practice and technology-enhanced learning can improve patient care and professional performance

Th e conference will take place at Th e Brighton Conference Centre from 3rd to 5th November 2015 to register please go to httpbitlyASPPRE

Invited experts will refl ect the latest developments and hot topics in the sector ndash Professor John Schaefer will look at generating value for simulated practice Professor Sir Muir Gray asks if we are the end of the quality era and Dr Stephen Shorrock from European Air Traffi c Control will discuss how to develop a high-reliability organisation Th ere will also be a special session on Th ursday 5 November focusing on performance improvement across the NHS delivered by Professor Ian Curran and Professor Derek Galen Th e expanding role of simulated patients and their integration with technology to create realistic patient-orientated training events will be another major topic this year

Andy Anderson Chief Executive of ASPiH said ldquoI am very excited about this yearrsquos conference Not only are we set to welcome the largest number of delegates ever the programme is also the biggest and most ambitious we have ever staged Th ree particular highlights for me will be the world premier of the new fi lm from Martin Bromiley that looks at what has changed in the 10 years since Emily Bomileyrsquos tragic death following a routine operation the launch of the latest developments from the Health Education England Technology Enhanced Learning HUB and the presentation of ASPiH Standards for Simulated Practice ndash a fi rst step to establishing a quality platform for simulation based education I look forward to welcoming everyone to Brighton for what Irsquom sure will be an inspirational three daysrdquo

After the success of the previous SIM Heroes competition delegates are invited to form a team and join in with this yearrsquos competition Th e focus is to stimulate discussion amongst participants on how to develop a scenario that demonstrates a learning outcome For full details of how to enter a team visit httpbitlyASPSIM

Now established as the major UK simulation based education event this conference is supported by major manufacturers of simulation and training products who will exhibit their latest developments Last but not least the organisers have planned a fun and engaging networking and social programme To keep up to date with developments ahead of the event follow aspihUK or visit httpbitlyASPCON wwwaspihorguk

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

View the latest vacancies online

or Scan QR Code

DOWNLOADGet our App

for Android

wwwOpera ngpera ngTheatreheatreJobscomobscom

More than 500 delegates are expected to attend the 6th ASPiH Annual Conference in Brighton


ISO 9001 ACCREDITED

TELEPHONE 01652 657200 FAX 01652 657009 WEB wwwoakmedicalservicescouk EMAIL infooakmedicalservicescouk

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OAK MEDICALSERVICES LTD

All new TQ electronic tourniquetfrom Oak Medical Services Ltd

A gimmick free electronic tourniquet - Quick Quiet amp Easy to use

The TQ is manufactured by Oak Medical Services Ltd in the UK

Dual channel supply for bilateral procedures

Back up battery power supply

Height Adjustable utility cart with Utility baskets

Antistatic castors

We pride ourselves on qualityOur commitment to quality is an ongoing process con rmed by our ISO134852003 status Even after the product is delivered our aftercare service ensures the machine is kept in good condition

Prevee-Prep

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All our products are manufactured in England

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Display rotary tilt function

Push click cuff pressure Rotary knobs for easy preset pressure selection adjustment and de ation

Digital display Pre-set pressure cuff pressure in ation time

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List-Cuff

10 uses per cuff

100 uses per pack

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Management of Complex Clinical Issues within the Perioperative EnvironmentNatalie Lockhart ndash Student Operating Department Practitioner ndash Edge Hill University - FACULTY OF HEALTH amp SOCIAL CARE

Th is refl ection is going to explore an aspect of an emergency situation I participated in examine the role I played in that situation and how the experience has aff ected my training towards becoming a good practitioner

I was on my last night shift on an anaesthetics placement and when I arrived on shift my Operating Department Practitioner (ODP) mentor was already in Accident and Emergency He was helping to treat a male patient in his 60s with a gastrointestinal haemorrhage (see Appendix 1)

Th e model of refl ection I will be using will be the Rolfe et al (2001) framework for refl ective practice because I feel that this model of refl ection is simple yet informative It will help me describe the situation in a systematic way whilst also allowing me to describe my feelings and input improvements that can be made According to Fook and Gardner (2013) refl ection is vital for the understanding of what went right or wrong in a scenario and also to look back at the feelings that were encountered helping to understand why I felt that way in particular It is a contributing factor to the path of professional maturity because if we did not refl ect on our experiences we would not be able to progress and perhaps improve on the experience when it next comes around (Gray 2009)

As the situation was my fi rst emergency case I took a lot of lessons and feelings away from this experience However when refl ecting on the scenario after it had happened there were certain aspects of it that I kept thinking about and I am going to explore why I thought about them so much Also after refl ecting and researching around the subject of oesophageal varices not only did it enhance my knowledge but it also heightened my understanding of emergency situations and the impact that they can have

Brooks et al (2010) explains that oesophageal varices occurs when there is a backup of blood in the portal vein because cirrhosis of the liver causes scarring and it is harder for blood to fl ow through the liver Th is is called portal hypertension as the pressure is increased in the vein Th is backup of blood causes veins in the stomach and oesophagus to enlarge and this is the formation of oesophageal varices (Rothrock 2011)

According to Mayo Clinic (2014) the main origins of oesophageal varices are conditions such as chronic liver disease which causes the cirrhosis Th is can be due to alcohol or chronic hepatitis it can also be caused by an obstruction in the portal vein or a thrombosis (Mayo Clinic 2014) Th e patient in this situation had liver disease because it was the scarring on his liver that caused the portal hypertension which in turn caused the varices I am now going to explore parts of the scenario that I refl ected on the most discover why that was and the eff ect it had on me as a student

A potential problem occurred when the time came to insert the Sengstaken-Blakemore tube during the Oesophago-Gastro Duodenoscopy (OGD) to diagnose the bleed Th e tube requires traction so that the balloon infl ated in the stomach compresses on the gastro-oesophageal junction and reduces blood fl ow to the oesophageal varices (Bonner et al 2007) In my trust the traction is maintained by putting the tube through a spliced tennis ball and taping the ball to the patientsrsquo mouth

When my mentor explained this to me I was surprised that a piece of sports equipment was the implement of choice to sustain this traction No complicated medical equipment just a tennis ball After researching into the Sengstaken-Blakemore tube however I have discovered that the use of a spliced tennis ball is a legitimate way of maintaining traction (Gastro Training 2011)

Th e problem was on that night the spliced tennis ball that normally lies with the Sengstaken-Blakemore tube was nowhere to be found As it is a vital piece of equipment to the procedure a replacement traction device had to be used otherwise the operation would not have been eff ective My mentor improvised and attached a bag of saline to a tie which was then tied to the end of the tube to act as a weight which would maintain traction I recall thinking it was a good solution to the problem and how the ODPsrsquo quick thinking had solved the issue According to Gastro Training (2011) I discovered that the preferred method of using traction on the tube is indeed to use a bag of saline showing that the alternative method used was correct Th is was a major refl ection for me as I began to question whether I would be as quick thinking and resourceful when put in that situation I concluded to myself that the scenario I had witnessed has taught me to be more resourceful to think logically and to problem-solve

It was my fi rst experience with a lot of situations in this scenario such as blood loss as even in the emergency operations I have previously witnessed the blood loss is still quite controlled My mentor informed me when I fi rst entered AampE that an upper gastrointestinal bleed can often mean signifi cant blood loss but I did not fully grasp this until I saw the blood coming from his mouth and nose during the operation and it was my fi rst experience with melena as well I was assigned to suction the blood so I put on the Personal Protective Equipment available which were a mask with a visor an apron and gloves (Health and Safety Executive 2014) I found that I could not suction fast enough for the amount of blood being expelled Th at was the point where I realised this was a life threatening situation for this man to be in but I also recognised the fact that everything possible was being done to save him According to Avery and Avery (2010) bloods were being administered in the correct way giving red blood cells and fresh frozen plasma through a rapid infuser Also a procedure was taking place to stop the bleeding and the Anaesthetists were doing everything to induce haemostasis restore the equilibrium in the body that the bleeding had altered and ensure he was being oxygenated to avoid organ failure or brain damage should the bleeding be stabilized (Tait et al 2012)

After we had left the scenario behind my mentor explained to me that a massive haemorrhage had taken place Th e main reason we could not do any further procedures is because the origin of the bleed could not be found plus the patient was still bleeding so there would be no more surgical interventions until the bleeding stops and the clotting is in order (Malone et al 2006) Th is lesson that was learnt from dealing with this blood loss is that blood is vital for survival and transfusions can be ineff ective if the initial bleed cannot be stopped

Th e main issue that I refl ected on regarding this scenario was dealing with the fact that there was nothing more to be done for this man who was gravely ill I recall asking my mentor after every step lsquoso what happens nextrsquo and lsquowhat is the next course of action we will be takingrsquo As the initial OGD and placing of the Sengstaken-Blakemore tube did not work and the CT scan was inconclusive there came a point when my mentor replied that there was nothing more to be done for the patient we had done everything possible at that point in time Th is was my fi rst experience of coming across a patient that an operation did not lsquofi xrsquo him and because of that he was most certainly going to die I remember feeling incredulous that there was nothing else to be done to the point where I was making ridiculous suggestions such as an oesophageal transection to fi nd the bleeding varices as if no one else would think to do that or that it was in any way a possibilityTh e British Society of Gastroenterology (2008) have guidelines on dealing with oesophageal varices and have produced an algorithm on how to deal with it Th is showed me as I followed the algorithm with the patientsrsquo scenario in my mind that we did everything correctly and as the guidelines stated Th is reassured me further that even though the patient did die we did everything right in terms of treatmentAs part of the Multi-Disciplinary Team I am accountable for my actions and the impact they can have on the patient According to the Health and Care Professions Council (2014) Standards of Profi ciency I have to act in the best interests of the patient and be their advocate and I always have this in mind when participating in looking after any patientWhen my mentor explained that this patient was going to die I was thinking that surely there must be more that can be done to save him such as the Transjugular Intrahepatic PortoSystemic Shunt (TIPSS) procedure (Medline Plus 2013) I could argue that I was not being the patients advocate there I was acting illogicallyTh e reason for this is that the TIPSS procedure was not attempted as the patient had lost too much blood the bleed could not be found and he would surely die on the operating table My thought on that was if he is going to die anyway then why not try the procedure If I was thinking rationally and on behalf of the patient I should have thought to myself is it not right to put the patient through an operation that he probably will not survive However I am glad I did question why the procedure was not being done so I could rationalise it to myself laterAs this was an emergency there were many more members of staff in the operating theatre helping to deal with this emergency as fast as possible With more bodies in the room than usual I was expecting chaos as there is limited space and that fact that everyone was going about their tasks with a hurried urgency (Undre et al 2006) However it was not chaos it was a very effi cient process Everyone knew their roles and the tasks were spread amongst the team instead of an individual trying to do all the jobs Th e point where I noticed a shift in the team dynamics was when we were transferring the portable monitoring and ventilation onto the anaesthetic machine and the patient started bleeding


Th e speed at which tasks were being completed even though fast to begin with sped up even though no one verbally said we have to act faster the team just knew that which impressed me According to Jelphs and Dickinson (2008) this effi cient team working means that care can be delivered to the patient quicker but whilst still following correct procedures and policiesIn conclusion this scenario I witnessed aff ected me more than anything else I have seen in my training so far Th e reason for that is fi rstly the patient died which I did not expect when I fi rst saw the patient in A and E Apart from looking pale and clammy on the outside he looked normal there was no physical signs of trauma because it was an internal bleedI take away many lessons from this scenario for example I learnt the need to be effi cient in an emergency I also learnt that sometimes you have to problem solve under pressure for example if there is equipment missing which means you cannot panic you have to keep calm I think this scenario will have an impact on me in my future training and writing this refl ection has helped me Researching about the anatomy and physiology and the causes of oesophageal varies has prepared me for if I was ever to encounter it again Also this refl ection has helped me explore my feelings at the time and helped me recognise why I was feeling that way and I think this has helped me the most in terms of becoming a better practitioner in the future

Appendix

Appendix 1 Lockhart N (2014) lsquoOesophageal Varicesrsquo PowerPoint Presentation

References

Avery D amp Avery K (2010) lsquoBlood component therapyrsquo American Journal of clinical medicine 7 (2) pp 57-59British Society of Gastroenterology (2008) UK guidelines on the Management of Variceal Haemorrhage in Cirrhotic Patients Edinburgh BSGBonner S Carpenter M amp Garcia E (2007) Care of the Critically Ill Medical Patient Philadelphia ElsevierBrooks A Cotton B Tai N amp Mahoney P (2010) Emergency Surgery Oxford Blackwell PublishingFook J amp Gardner F (2013) Critical Refl ection in context Applications in Health and Social Care New York RoutledgeGastro Training (2011) lsquoSengstaken-Blakemore tube insertionrsquo Endoscopy httpwwwgastrotrainingcom [Accessed 11 November 2014] Gray M (2009) Evidence-Based Healthcare and Public Health How to make decisions about health services and public health London ElsevierHealth and Care Professions Council (2014) Standards of Profi ciency Operating Department Practitioners London HCPC httpwwwhcpc-ukorguk [Accessed 11 November 2014]Health and Safety Executive (2014) lsquoPersonal Protective Equipment (PPE)rsquo How to control risks at work httpwwwhsegovuktoolboxppe [Accessed 15 December 2014]Jelphs K amp Dickinson H (2008) Working in Teams Bristol Th e Policy PressMalone D Hess J amp Fingerhut A (2006) lsquoMassive transfusion practices around the globe and a suggestion for a common massive transfusion protocolrsquo Th e Journal of Trauma and Acute Care Surgery 60 (6) pp91-96 httpjournalslwwcom [Accessed 12 December 2014]Mayo Clinic (2014) lsquoEsophageal Varicesrsquo Diseases and Conditions httpwwwmayoclinicorg [Accessed 6 December 2014]Medline Plus (2013) lsquoTransjugular Intrahepatic Portosystemic Shunt (TIPS) Health Topics httpwwwnlmnihgovmedlineplus [Accessed 13 December 2014]Rolfe G Freshwater D amp Jasper M (2001) Critical Refl ection for Nursing and the Helping Professions A Userrsquos Guide Basingstoke Palgrave MacmillanRothrock J (2011) Care of the patient in surgery Missouri ElsevierTait D James J Williams C amp Barton D (2012) Acute and critical care in adult nursing London Sage PublicationsUndre S Sevdalis N amp Healey A (2006) lsquoTeamwork in the operating theatre Cohesion or Confusionrsquo Journal of Evaluation in Clinical Practice 12 (2) pp 182-189 httponlinelibrarywileycom [Accessed 20 October 2014]


Blood conservation in critical care white paper published by Sphere Medical

90 chance of anaemia in ICU patients after 3 days - diagnostic blood sampling a key factor

IntroductionAnaemia is a frequent complication of critical care with up to 90 of ICU (Intensive Care Unit) patients being anaemic by their third day in the ICU1 Anaemia is associated with poor patient outcomes especially amongst those patients with cardiovascular disease2 3 4 5 The treatments of choice for anaemia are the minimisation of blood loss and the transfusion of red blood cells when necessary This paper explores the issues in critical care around anaemia transfusions and blood conservation With diagnostic testing being a significant factor in cumulative blood loss and the risk of anaemia the use of a patient dedicated arterial blood gas analyser to minimise blood loss is described

Anaemia in the intensive care unitCauses The reasons for anaemia in critically ill patients are multifactorial and include acute blood loss (eg from trauma surgery or internal bleeding) iatrogenic blood loss associated with diagnostic sampling and blunted red blood cell production6 Of these the blood loss associated with diagnostic testing is the factor that is most easily in the control of the intensivistLaboratory results are an important tool to achieve diagnosis and guide medical care and a certain amount of blood is required to obtain this information The gold standard for monitoring oxygenation acid-base status and ventilation is an arterial blood gas measurement ndash and consequently is one of the most frequently ordered tests in the ICU7 Patients with indwelling central venous or arterial catheters have more frequent blood draws as blood sampling is easier7 and relatively large volumes are drawn in comparison to that needed for the measurement itself When sampling from an arterial line it is important to remove an adequate discard volume to ensure that a representative blood sample is obtained If an insufficient discard volume is removed the sample will be contaminated with saline flush solution resulting in an increased cNa+ and cCl- and decreased cK+8 Consequently removal of at least three times the dead space volume is recommended9 and the average discard volume drawn is 32ml10 Iatrogenic anaemia (also known as hospital-acquired anaemia) results from blood loss that occurs from collecting samples for laboratory testing Blood samples may be drawn up to 24 times in a day within the ICU 6 11 12 Therefore a series of small iatrogenic blood losses can add up resulting in patients becoming anaemic13

Blood conservation with a patient dedicated arterial blood gas analyser

Dr Jess Fox amp Dr Gavin Troughton Sphere Medical Limited

Table 1 shows reported average phlebotomy-induced blood loss (mlday) for various ICUs

Reporting country Setting

Average phlebotomy-

induced blood loss (mlday)

USA Cardiothoracic ICU 377

USA General surgical ICU

240

USA Medical surgical ICU

415

UK First day in ICU 853

UK Following days 661

Europe Medical ICUs 411

Table 1 Average phlebotomy-induced blood lost in critically ill patients11

Effects of anaemiaOxygen delivery is determined by arterial blood oxygen content and cardiac output Healthy individuals increase cardiac output in response to anaemia but many critically ill patients have limited capacity to generate the cardiac output required for adequate tissue oxygenation14 Due to the loss in oxygen carrying capacity the consequences of anaemia in critically ill patients include reduced tissue oxygenation and eventually ischaemia of end organs Correlating anaemia to outcome can be complex as the anaemia itself can be caused by underlying co-morbidities Studies on postoperative outcomes for anaemic patients who refused transfusion on religious grounds suggested that mortality was inversely related to postoperative haemoglobin level in comparison to a control group15 Other data have linked the increased risk of mortality with patients with cardiovascular disease15

Blood transfusions within the ICU Frequency of transfusions Due to the prevalence of anaemia in intensive care a large number of patients receive blood transfusions17 in the form of packed red blood cell (PRBC) transfusions1 In two large multicentre cohort studies in the United States and Western Europe 37 and 45 of intensive care patients received PRBC transfusions respectively1 18 Longer stays result in a higher rate of transfusion with a reported 85 of patients residing in the ICU for one week or more requiring blood transfusions10

Sphere Medical innovator in critical care monitoring and diagnostics equipment has published a white paper exploring the issues in critical care around anaemia transfusions and blood conservation Entitled lsquoBlood conservation with a patient dedicated arterial blood gas analyserrsquo the new white paper is available for download from Spherersquos online clinical resource centre

Anaemia is a frequent complication in critical care and is associated with poor patient outcomes It results from many factors including acute blood loss iatrogenic blood loss from diagnostic blood sampling and blunted red blood cell production Since up to 90 of patients develop hospital-acquired anaemia by their third day in the ICU (Intensive Care Unit) with many requiring subsequent transfusions blood conservation strategies can be of signi cant bene t to patients and will help reduce costs of care Transfusion costs alone can be pound763 for two units of blood [1]

The new paper observes that within the ICU setting the total amount of diagnostic (iatrogenic) blood loss is a signi cant predicator of anaemia and subsequent allogeneic transfusion Notably iatrogenic blood loss is the factor most easily controlled by the intensivist However laboratory results are crucial for diagnosis and guiding medical care and taking a certain amount of blood is essential to obtain this information Discussing in depth the main methods of reducing the contribution of blood tests to the incidence of iatrogenic anaemia the paper notes three key blood conservation strategies - appropriate sampling drawing smaller samples and re-infusion of discard volume

One of the most frequently ordered tests in the ICU is an arterial blood gas measurement as it is the gold standard for monitoring oxygenation acid-base status and ventilation [2] Consequently the paper moves on to discuss how the new Proxima patient dedicated blood gas analyser supports all blood conservation strategies whilst also enabling more frequent measurements if appropriate

Operating as a closed system integrated into the patientrsquos arterial line the Proxima blood gas analyser minimises blood handling and infection risk as a blood sample is drawn directly from the patient and over the Proxima sensor for analysis Crucially the device also results in zero net loss of blood as all sample is returned to the patient following its analysis Results are displayed immediately on the patientrsquos bedside monitor

ldquoAs highlighted in our newly published white paper transfusions are associated with poorer patient outcomes and longer stays with subsequent cost implications Therefore blood conservation strategies have the potential to not only bene t patients but also help reduce costs of carerdquo said Dr Gavin Troughton Sphere Medical ldquoProxima has been speci cally designed to address blood conservation strategies whilst also allowing more frequent measurement if required therefore enabling closer monitoring of ICU patients at critical timesrdquo

For more information on Sphere Medical and the Proxima in-line blood gas analyser please view wwwspheremedicalcom

References 1 Abraham I Sun D Th e cost of blood transfusion

in Western Europe as estimated from six studies Transfusion 2012 52 1983-1988

2 Woodhouse S Complications of critical Care Lab testing and iatrogenic anemia Med Lab Obs 2001 33(10)28-31When responding please quote lsquoOTJrsquo


BIARGS 6th Annual Meeting Wirral University Teaching Hospital

5th and 6th November 2015 On behalf of the gynaecology robotic nursing team at Wirral University Teaching Hospital we would like inform of the 6th British and Irish Association of Robotic Gynaecological Surgeons (BIARGS) annual conference Th e conference will be held on Th ursday 5th November and Friday 6th November it is a great programme that will be held at the Wirral University Teaching Hospital with two full days of education on robotic surgery nursersquos sessions on both days and a gala dinner on the fi rst night which will be held at the beautiful Th ornton Hall Hotel As well as a comprehensive surgical programme we also have two nursersquos session on which will cover topics such asbull Developing robotic surgery at WUTHbull Patient safety and human factors within robotic surgery bull Managing costs in robotic surgery bull Th e impact on perioperative nursing in robotic surgery bull Care of the anaesthetised patient in robotic surgery bull Th e role of the fi rst assistant in robotic surgerybull Th e need for standards and guidelines in robotic surgery bull Maximising effi ciency in robotic surgery bull Team leading in robotic surgery bull Managing clinical emergencies in robotic surgery bull Th e future of robotic surgery We are inviting all robotic surgery theatre staff whether you are part of a robotic surgery team or if you are interested in this fi eld of surgery to come and join us We have been mindful to include topics which are specifi c to robotic practice as we want theatre practitioners to get the most from this conference Th ey are also relevant to robotic teamsteam members at every level whether you are new to robotic surgery have a new interest in robotic surgery or if you are part of an established robotic team Th e links below will forward you to the conference website where there is access to the full conference programme registration details details on nearby hotels and a list of the speakers If you know of anyone that would be interested in attending the conference could you forward the information so that they can gain access to the websiteswwwwirralbiargscouk wwwbiargsorguk Sharing knowledge at events such as this enables us to create a robotic network of knowledge this will ensure that new robotic teams can start off on the right path that established robotic teams can review their practices whilst also keeping up to date with developments to promote awareness of robotic surgery and the great things our teams are doing on a daily basis and fi nally to promote an open safety culture amongst robotic surgery teamsFor further information please contactBIARGS Organising CommitteeTerri New Tracey KearnsWomen amp Childrenrsquos Divisionwih-trbiargsnhsnet

Dezita TaylorLead for nursing sessions Wirral BIARGS 2015Senior ODPTeam leaderTh e Royal Wolverhampton Trustdezitataylornhsnet01902 307999 EXT 5192When responding to articles please quote lsquoOTJrsquo

----

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 PaypalSubscribeto the OTJ

Delivered to your door every month

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Have your own personal copy of the Operating Theatre Journal

Subscribing to the OTJ costs just pound1400 per year to cover delivery in the UK For corporate and overseas customers just pound2400

Visit wwwotjonlinecomsubscriptionphp or Email adminlawrandcom

Home care of children crucial after oral sedation (USA)

Anesthesia Progress ndash Sedation often helps children who need dental treatment by keeping them safe and calm during the procedure Oral sedatives are commonly used but their eff ects can be unpredictable Th e level of consciousness while the patient is sedated can vary depending on the drug and the patient so the dental practitioner must be aware of each patientrsquos sedation level at all times Th e eff ects can also vary once the patient is discharged so the caregiver must watch the child closely

A study reported in the current issue of the journal Anesthesia Progress investigated the adverse eff ects of oral sedation that occurred once young patients left the dental offi ce Th e authors used the observations of dental practitioners and the childrenrsquos caregivers to fi nd the most common lingering eff ects of oral sedatives and the best ways to care for patients who had been sedated

For this study 51 children who needed dental treatment were given some form of oral sedation More than 75 of the studyrsquos subjects were given a drug combination that included morphine Th e dentist completing the treatment then rated the visit Finally caregivers reported how the children felt and acted once they were home

Th e authors analyze the experiences of 46 patients 23 girls and 23 boys Most of the children were Hispanic or Latino and all were older than 2 years but no more than 10 years of age No serious medical problems occurred Th e caregivers reported that most of the patients slept in the car after the treatment and at home where most napped longer than usual It was hard to wake up some of the children and some were nauseated A few vomited or ran a fever Although some of the children returned to normal behavior within 2 hours the largest group took between 2 and 6 hours to recover Some caregivers reported signifi cant recovery time a small percentage of patients didnrsquot feel normal until the morning after the dental visit A few children reportedly experienced dizziness mood changes or hallucinations

In most cases the dentist rated the visits as fair to excellent indicating that morphine one of the primary drugs used in the study with other sedatives may be a promising medication for pediatric dental sedation But given the frequent complications reported and the amount of time it took some children to recover dentists should emphasize the need to properly care for and monitor young patients at home after dental surgery

Th e authors believe that their fi ndings will allow dental practitioners to give caregivers a better idea about what to expect at home thus improving patient safety ldquoTh e fi ndings of this study strongly support the importance of proper post-operative instructions to the patientrsquos caregiver including possible complications and the necessity of careful vigilance of the child until recovery is completerdquo said fi rst author Annie Huang DDS

Full text of the article ldquoOral Sedation Post discharge Adverse Events in Pediatric Dental Patientsrdquo Anesthesia Progress Vol 62 No 3 2015 is now available at httpwwwanesthesiaprogressorgdoifull1023440003-3006-62391

About Anesthesia ProgressAnesthesia Progress is the of cial publication of the American Dental Society of Anesthesiology (ADSA) The quarterly journal is dedicated to providing a better understanding of the advances being made in the science of pain and anxiety control in dentistry The journal invites submissions of review articles reports on clinical techniques case reports and conference summaries To learn more about the ADSA visit httpwwwadsahomeorg


ldquoI know that the needs of every Trust and service are diff erent and my initial job is to listen I still approach any situation from a clinical perspective

Working for Vygon means I now have the fl exibility to off er customers bespoke products and services which can enhance their overall effi ciency improve patient safety prevent errors and support the staff

ldquoLaunching this new infusion technology is a very exciting and rewarding role and is one that really can make a diff erence to those using it and those benefi tting from itrdquo

John who is married with two children from Gloucestershire is

wwwwagocouk

Looking for a new challenge in Western Australia

WA Health is seeking registered nurses and midwives with at least two years recent experience in the UK or Ireland Competitive salary packages and sponsored work visas are available to suitably qualified nurses in the following areas

Midwifery Theatre Rural and Remote

Neonates Child Health Community

We want to hear from you if you have

1 comparable UKIrish nursingmidwifery qualifications or current Australian nursing registration

2 a high level of verbal and written communication skills and 3 a well written detailed CV (a CV template can be downloaded

at wwwwagocouk follow the lsquoMigration gtOpportunities for Health Professionalsrsquo links)

To check your eligibility or to apply for Australian nursing registrations go to wwwnursingmidwiferyboardgovau

If you meet these requirements please forward your CV to nurseswagocouk

DO

H-0

1296

6 M

AY

rsquo15

Broome

Karratha

Albany

Esperance

PerthBunbury

Kalgoorlie

Geraldton

Kununurra

VYGONrsquoS NEW BUSINESS MANAGERS PROUD TO OFFER A BESPOKE SERVICE WITH QUALITY PRODUCTS

Two new Business Managers have joined Vygon (UK) Ltd this summer covering four specialist areas ndash PICCs Midlines and Regional Anaesthesia and Infusion Technology

Helen Stephens is Vygonrsquos new UK Pump Business Manager and is working with hospitals around the country to introduce a new aitecs Infusion platform which includes syringe and large volumetric pumps

John Th omson is the companyrsquos new Business Development Manager with responsibility for PICCs Midlines and Regional Anaesthesia across the UK

Both Helen and John come with a wealth of experience in their specialist fi elds Helen was a Matron for the Critical Care Directorate at the Royal London Hospital Whitechapel before specialising in IV therapy and medication training She then moved into business management in the commercial sector working with healthcare providers to fi nd bespoke cost effi cient solutions

John qualifi ed as a nurse in 1997 and worked at a Bristol hospital but has spent the last 14 years in various commercial roles liaising and consulting with health practitioners medical staff clinicians hospitals and patients themselves

Helen a mother of two from Hampshire is already working closely with medical staff at the West Middlesex Hospital that is the fi rst to evaluate and utilise the aitecs infusion platform

Helen said ldquoI have worked in critical care and specialised in IV therapy for many years now so this was a perfect opportunity to work with and support hospitals who need a bespoke IV service that is right for the needs of their staff and patients

also working with hospitals up and down the country in his fi eld of expertise ndash PICCs Midlines and Regional Anaesthesia

He said ldquoVygon has a very strong reputation for its clinical focus and quality of product and Irsquom delighted to be part of a company with those principles Providing innovative technology or products that really make a diff erence to clinicians and improve patient care for the long-term is for me what itrsquos all about

In his BDM role John is co-ordinating the development sales and marketing of PICCs Midlines and Regional Anaesthesia to customers across the UK He is ensuring his portfolio of Vygon products is tailored to the needs of the end-user while enhancing patient care and safety

John added ldquoIrsquom looking forward to meeting Vygon customers existing and new I want to ensure that hospitals and their medical staff receive the most appropriate products and service from us while developing new ideas and technology for the futurerdquo Vygon (UK) Ltd Tel 01793 748830 wwwvygoncouk

Helen Stephens

John Th omson



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------

475 Llangyfelach RoadBrynhyfredSwanseaSA5 9LR

01792 464958Infotruehaircoukwwwtruehaircouk

OFFER for NHS staff and their families 20 off salon services on the presentation of this voucher OFFER for NHS staff and their families 20 off salon services on the presentation of this voucherOTJ Offer - October 2015

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We are please to announce the dates for the 2015 conference Following the huge success of last yearrsquos conference the established format is set to continue - with two full days of trauma and two days of cardiac arrest topics

In line with hugely positive delegate feedback the popular format of short talks with key questions presented by high quality experts along with longer keynote lectures will return as will the lsquoquick-fi rersquo sessions where key messages to controversial points are presented in 10 minutes

Look out for updates on the fantastic speaker line up for 2015 as well as information on the host of Breakaway Session topics that will be addressed at this years London Trauma Conference

Research Submissions

Research submissions will be invited for several research related events at this years conference Accepted submissions will be displayed at the conference and presenters will be asked to make a fi ve minute oral presentation to a selected group of researchers at a specifi ed time during the conference Submission dates and criteria will be announced in the coming weeks

Th e London Trauma Conference Abstracts selected for 2013rsquos conference are available to view online through the Scandinavian Journal of trauma resuscitation and emergency medicineTh e 2014 Abstracts will be made available shortly

Breakaway Sessions 2015

Th is years breakaway sessions (which can be mixed with attendance at the main conference) will include

Save the Date 8thndash11th

December 2015

Thursday 10th - Friday 11th December

The London Cardiac Arrest Symposium

Returning for 2015

Set to return for 2015 Th e London Cardiac Arrest Symposium brings together an internationally renowned faculty of experts in the fi eld of cardiac arrest management and addresses key questions concerning this most critical of medical emergencies

Th e symposium will examine the latest developments and will share information from the front line whilst providing a novel insight for even the most experienced of delegatesFor more information or to register your interst please email enquirieslondontraumaconferencecom

2015 Breakaway Sessions Included

Trauma Surgery Symposium - Trauma Research - Trauma Surgery Trauma NursingPaediatric TraumaCore Topics in TraumaCardiac MasterclassTh oracotomyREBOA MasterclassParamedic Critical Care

Th ese sessions are tailor made in-line with delegate feedback and form a vital part of the Trauma Conference

When responding please quote lsquoOTJrsquo

-------------------------------------------------------

New Zealand are looking for theatre staff (ODPs and Nurses) who want to work in the private or public sector Interviews in the UK in October 2015 in person (or by Skype Phone by arrangement)Accent Health Recruitment can off er assistance with

Short or long term job placements Relocation ndash To New Zealand from the UK Registration with the NZ registration board

Any questions email or call Prudence on prueaccentnetnz or call the UK to NZ free phone 0808 23 444 68 or skype accentprudence




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

and Clinical Advisers

The respiratory care specialists

Intersurgical provide flexible patient solutions for use within the hospital environment

bull Airway Management

bull Anaesthesia

bull Critical Care

bull Oxygen amp Aerosol Therapy

The Complete Solutionfrom Patient to Equipment

lnteract with us

wwwintersurgicalcoukQuality innovation and choice

3rd National Conference

Now in its 3rd year the conference has developed to include an interesting programme of issues exploring safety and effectiveness in the modern operating theatre Local initiatives combined with a national policy agenda delivered by theatre professionals from all over the UK make this event a must for theatre managers and senior perioperative professionals The day also provides an excellent opportunity for face to face networking and exchanging experiences and ideas

The venue is Park Inn by Radisson Manchester which is located in the city centre and close to main line train stations and city centre car parking There are a selection of hotels within close distance and a listing can be found on the MampK website wwwmkupdatecouk

bull The use of AfPP and Governmental targets to influence training and development of theatre staff

bull Delivering an efficient operating theatre pathway from pre-assessment through theatre to discharge using electronic theatre management and lean principles

bull Staffing for safe and effective Operating Theatres

bull Angels or Demons Exploring the role of a Practice Development Team (PDT) in delivering safe and effective care in theatres

bull Cell salvage in the DGH environment The practicalities of establishing and running a service

bull Operating Department Fire Evacuation ndash Testing fire plans using simulation

bull Improving performance through Simulated Practice and Assessment

bull Diathermy smoke - Is it hazardous to health

bull The Assistant Theatre Practitioner (ATP) Scope of Practice - is there really any consensus

Key conference benefits include

Networking | Interaction | Building relationships | Exchanging ideas Face to face contact

Also from MampK

Developing the role of Healthcare Support Workers 22 October 2015 - London

How to book

Online wwwmkupdatecouk Email bookingsmkupdatecouk Tel 01768 773030

Programme includes

11th November 2015 | Park Inn by Radisson Manchester pound259 pp

Delivering safe and effective Operating Theatres

UPDATE

MampK Update Ltd Keswick Cumbria CA12 5AS Tel 01768 773030 wwwmkupdatecouk

professionals training professionals since 1992





































Publication








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or Scan QR Code

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ISO 9001 ACCREDITED










Antistatic castors


Prevee-Prep

Dispozee-Cuff


TM







List-Cuff

10 uses per cuff

100 uses per pack

Strike through tags


Extended size range


















Appendix


References











Average phlebotomy-




240


415





















----


--- -- ---



---

----

----

----

----

----

----

----

-


















wwwwagocouk











DO

H-0

1296

6 M

AY

rsquo15

Broome

Karratha

Albany

Esperance

PerthBunbury

Kalgoorlie

Geraldton

Kununurra













Helen Stephens

John Th omson



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------




---

----

----

----

----

----

----

----

----

----

----

-










December 2015



Returning for 2015







-------------------------------------------------------












bull Anaesthesia

bull Critical Care



lnteract with us






































Publication








LIFETIME WARRANTY


















































wwwindithermcom






































or Scan QR Code

DOWNLOADGet our App

for Android




ISO 9001 ACCREDITED










Antistatic castors


Prevee-Prep

Dispozee-Cuff


TM







List-Cuff

10 uses per cuff

100 uses per pack

Strike through tags


Extended size range


















Appendix


References











Average phlebotomy-




240


415





















----


--- -- ---



---

----

----

----

----

----

----

----

-


















wwwwagocouk











DO

H-0

1296

6 M

AY

rsquo15

Broome

Karratha

Albany

Esperance

PerthBunbury

Kalgoorlie

Geraldton

Kununurra













Helen Stephens

John Th omson



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------




---

----

----

----

----

----

----

----

----

----

----

-










December 2015



Returning for 2015







-------------------------------------------------------












bull Anaesthesia

bull Critical Care



lnteract with us




























Publication








LIFETIME WARRANTY


















































wwwindithermcom






































or Scan QR Code

DOWNLOADGet our App

for Android




ISO 9001 ACCREDITED










Antistatic castors


Prevee-Prep

Dispozee-Cuff


TM







List-Cuff

10 uses per cuff

100 uses per pack

Strike through tags


Extended size range


















Appendix


References











Average phlebotomy-




240


415





















----


--- -- ---



---

----

----

----

----

----

----

----

-


















wwwwagocouk











DO

H-0

1296

6 M

AY

rsquo15

Broome

Karratha

Albany

Esperance

PerthBunbury

Kalgoorlie

Geraldton

Kununurra













Helen Stephens

John Th omson



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------




---

----

----

----

----

----

----

----

----

----

----

-










December 2015



Returning for 2015







-------------------------------------------------------












bull Anaesthesia

bull Critical Care



lnteract with us







LIFETIME WARRANTY


















































wwwindithermcom






































or Scan QR Code

DOWNLOADGet our App

for Android




ISO 9001 ACCREDITED










Antistatic castors


Prevee-Prep

Dispozee-Cuff


TM







List-Cuff

10 uses per cuff

100 uses per pack

Strike through tags


Extended size range


















Appendix


References











Average phlebotomy-




240


415





















----


--- -- ---



---

----

----

----

----

----

----

----

-


















wwwwagocouk











DO

H-0

1296

6 M

AY

rsquo15

Broome

Karratha

Albany

Esperance

PerthBunbury

Kalgoorlie

Geraldton

Kununurra













Helen Stephens

John Th omson



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------




---

----

----

----

----

----

----

----

----

----

----

-










December 2015



Returning for 2015







-------------------------------------------------------












bull Anaesthesia

bull Critical Care



lnteract with us































wwwindithermcom






































or Scan QR Code

DOWNLOADGet our App

for Android




ISO 9001 ACCREDITED










Antistatic castors


Prevee-Prep

Dispozee-Cuff


TM







List-Cuff

10 uses per cuff

100 uses per pack

Strike through tags


Extended size range


















Appendix


References











Average phlebotomy-




240


415





















----


--- -- ---



---

----

----

----

----

----

----

----

-


















wwwwagocouk











DO

H-0

1296

6 M

AY

rsquo15

Broome

Karratha

Albany

Esperance

PerthBunbury

Kalgoorlie

Geraldton

Kununurra













Helen Stephens

John Th omson



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------




---

----

----

----

----

----

----

----

----

----

----

-










December 2015



Returning for 2015







-------------------------------------------------------












bull Anaesthesia

bull Critical Care



lnteract with us
















wwwindithermcom






































or Scan QR Code

DOWNLOADGet our App

for Android




ISO 9001 ACCREDITED










Antistatic castors


Prevee-Prep

Dispozee-Cuff


TM







List-Cuff

10 uses per cuff

100 uses per pack

Strike through tags


Extended size range


















Appendix


References











Average phlebotomy-




240


415





















----


--- -- ---



---

----

----

----

----

----

----

----

-


















wwwwagocouk











DO

H-0

1296

6 M

AY

rsquo15

Broome

Karratha

Albany

Esperance

PerthBunbury

Kalgoorlie

Geraldton

Kununurra













Helen Stephens

John Th omson



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------




---

----

----

----

----

----

----

----

----

----

----

-










December 2015



Returning for 2015







-------------------------------------------------------












bull Anaesthesia

bull Critical Care



lnteract with us



























or Scan QR Code

DOWNLOADGet our App

for Android




ISO 9001 ACCREDITED










Antistatic castors


Prevee-Prep

Dispozee-Cuff


TM







List-Cuff

10 uses per cuff

100 uses per pack

Strike through tags


Extended size range


















Appendix


References











Average phlebotomy-




240


415





















----


--- -- ---



---

----

----

----

----

----

----

----

-


















wwwwagocouk











DO

H-0

1296

6 M

AY

rsquo15

Broome

Karratha

Albany

Esperance

PerthBunbury

Kalgoorlie

Geraldton

Kununurra













Helen Stephens

John Th omson



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------




---

----

----

----

----

----

----

----

----

----

----

-










December 2015



Returning for 2015







-------------------------------------------------------












bull Anaesthesia

bull Critical Care



lnteract with us


ISO 9001 ACCREDITED










Antistatic castors


Prevee-Prep

Dispozee-Cuff


TM







List-Cuff

10 uses per cuff

100 uses per pack

Strike through tags


Extended size range


















Appendix


References











Average phlebotomy-




240


415





















----


--- -- ---



---

----

----

----

----

----

----

----

-


















wwwwagocouk











DO

H-0

1296

6 M

AY

rsquo15

Broome

Karratha

Albany

Esperance

PerthBunbury

Kalgoorlie

Geraldton

Kununurra













Helen Stephens

John Th omson



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------




---

----

----

----

----

----

----

----

----

----

----

-










December 2015



Returning for 2015







-------------------------------------------------------












bull Anaesthesia

bull Critical Care



lnteract with us


















Appendix


References











Average phlebotomy-




240


415





















----


--- -- ---



---

----

----

----

----

----

----

----

-


















wwwwagocouk











DO

H-0

1296

6 M

AY

rsquo15

Broome

Karratha

Albany

Esperance

PerthBunbury

Kalgoorlie

Geraldton

Kununurra













Helen Stephens

John Th omson



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------




---

----

----

----

----

----

----

----

----

----

----

-










December 2015



Returning for 2015







-------------------------------------------------------












bull Anaesthesia

bull Critical Care



lnteract with us



Appendix


References











Average phlebotomy-




240


415





















----


--- -- ---



---

----

----

----

----

----

----

----

-


















wwwwagocouk











DO

H-0

1296

6 M

AY

rsquo15

Broome

Karratha

Albany

Esperance

PerthBunbury

Kalgoorlie

Geraldton

Kununurra













Helen Stephens

John Th omson



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------




---

----

----

----

----

----

----

----

----

----

----

-










December 2015



Returning for 2015







-------------------------------------------------------












bull Anaesthesia

bull Critical Care



lnteract with us






----


--- -- ---



---

----

----

----

----

----

----

----

-


















wwwwagocouk











DO

H-0

1296

6 M

AY

rsquo15

Broome

Karratha

Albany

Esperance

PerthBunbury

Kalgoorlie

Geraldton

Kununurra













Helen Stephens

John Th omson



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------




---

----

----

----

----

----

----

----

----

----

----

-










December 2015



Returning for 2015







-------------------------------------------------------












bull Anaesthesia

bull Critical Care



lnteract with us







wwwwagocouk











DO

H-0

1296

6 M

AY

rsquo15

Broome

Karratha

Albany

Esperance

PerthBunbury

Kalgoorlie

Geraldton

Kununurra













Helen Stephens

John Th omson



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------




---

----

----

----

----

----

----

----

----

----

----

-










December 2015



Returning for 2015







-------------------------------------------------------












bull Anaesthesia

bull Critical Care



lnteract with us



twittercomOTJOnline

----------------------------------------------------------------------------------------------------------------------




---

----

----

----

----

----

----

----

----

----

----

-










December 2015



Returning for 2015







-------------------------------------------------------












bull Anaesthesia

bull Critical Care



lnteract with us










bull Anaesthesia

bull Critical Care



lnteract with us





bull Anaesthesia

bull Critical Care



lnteract with us


Documents

The Operating Theatre Journal theatre journal... · 2015-10-04 · ‘perfect storm’ of demographic and wider economic and social trends are converging to push up the cost of healthcare