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April 2011

Issue No. 247

ISSN 1747-728X

The Leading Independent Journal For ALL Operating Theatre Staff

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NHS leading the world in the prevention of blood clots Health Minister praises transparent system pioneered by the NHS in England The NHS is leading the way with its system of monitoring patients risk of forming blood clots while in hospital and ensuring appropriate prevention measures, Health Minister Lord Howe said recently. Speaking at a meeting hosted by the All-Party Parliamentary Thrombosis Group, the Clinical Leadership Summit on blood clots (venous thromboembolism), the minister spokeout about the need to prevent needless death and disability for patients in the NHS. Every year, an estimated 25,000 people in England die from these clots in hospital. The blood clots form in the veins deep in the leg, usually in the calf and the majority of deaths in hospital are caused by part of the clot breaking off, travelling around the body and eventually lodging in the lungs, where it can cause a pulmonary embolism. The condition is largely preventable requiring a simple risk assessment to be carried out by NHS staff followed by appropriate prevention in line with NICE guidance. Speaking at the Summit, Lord Howe said: It is within our gift to do something about these clots, to reduce the suffering of thousands of people and to save a great many lives. The NHS has made a tremendous start in improving this, and those making the biggest difference are those on the front-line the junior doctors, nurses, pharmacists and GPs - who can work together to prevent needless suffering of patients. Their progress is a reÁection of what we want to achieve across the NHS clinical leadership and transparency. The need to do better was Àrst recognised by the previous Chief Medical OfÀcer, Sir Liam Donaldson, and NHS leaders some years ago, and since then we have pioneered a system where hospitals report how many patients have been risk assessed and locally decide whether the appropriate prevention measures are in place. The results are collated and published on a quarterly, soon to be monthly, basis this level of transparency on how a service deals with the risk of clots is unparalleled across the globe. The aim of the system is to see that every patient admitted to hospital has had a risk assessment and appropriate prevention. While the NHS still has some work to do to achieve this, the initial results are impressive the numbers of hospitals achieving the target of 90 per cent of patients assessed virtually trebled between July and December, from 18 to 53. The NHS in England is the only health system in the world to implement such a comprehensive system at a national level. Sir Bruce Keogh, NHS Medical Director, who has led the development of the new system, said: All of us working in the NHS have a moral, professional and social responsibility to address a longstanding issue of this magnitude which puts patients at unnecessary risk of avoidable death, long-term disability and chronic ill health. It is clearly the right thing to do. That is why all professions, clinical and managerial, agreed to make this the number one clinical priority for the NHS last year and why we have made such remarkable progress in such a short period of time. Chair of the All-Party Parliamentary Thrombosis Group, Andrew Gwynne MP said: The scale and cost of avoidable hospital acquired VTE Ànancially and in terms of long-term disability and lives lost is staggering. The APPTG is delighted to be hosting this summit. The APPTG will continue to work with NHS decision makers and clinicians to ensure effective use of the best practice and policy now available to the NHS. We hope that any opportunities presented by the new NHS structure will be used to deliver a reduction in the incidence of VTE, and a legacy of quality VTE prevention in patient care that we can be proud of.

National Charity BackCare Says Enough is Enough In Bid To Cut NHS Costs NHS staff who injure their backs in the course of their work cost taxpayers over £400 million a year according to a new publication by the national charity BackCare. In a bid to prevent such injuries BackCare, the charity for healthier backs, have published a new edition of its classic text book The Guide to The Handling of People.” The text book, often referred to as the Nurses Bible, has become an indispensable training and reference manual for those responsible at any level for the safety of patients and staff, from policy to practice. . Each new edition of the guide has set the standard of its time, presenting evidence, disseminating best practice, promoting discussion and informing decision making. This huge cost to the NHS is made up of staff sickness, absences, and wasted training of those forced to leave their jobs as a result. £400m is enough to employ 16,000 nurses for a year. Each year, over 80,000 nurses injure their backs at work and 3,600 health care workers are forced to retire early. Across the care sector handling injuries account for over a quarter of all reported injuries to employees. Dr Andrew Auty, BackCares Chairman of trustees, commented: We want to make sure that every single person working in the health and social care sectors has access to the very latest advice on how to work with patients and service users without injuring their own back. Back pain ruins lives and it is costing the NHS a fortune. BackCares Acting CEO, Sean McDougall, said: Cutbacks in NHS and local authority spending are apparently intended to reduce waste and increase efÀciency, yet the biggest single cause of work-related sickness absence in the health and social care sectors is largely preventable through better training and systems of management. Consultant physiotherapist Jacqui Smith, editor of the guide, says health and social care providers must adopt a more strategic approach. Although accidents have reduced signiÀcantly in the 30 years since this guide was Àrst introduced, the economic cost of musculoskeletal disorders such as back pain continues to rise; the human costs are often hidden and privately borne. Yet most of these conditions are preventable or manageable. There is good evidence that prevention-focused strategies including access to appropriate equipment, expert back care advice, and effective training are both effective and cost-effective in improving work attendance, enhancing performance and improving patient / service user care. This guide is therefore essential reading to all health and social care employers, budget holders and decision-makers. Welcoming the publication, Julian Topping, head of Workplace Health and Regulation at NHS Employers, warns that compensation claims for manual handling accidents to staff continue to rise. Every NHS employee who retires early because of a back injury costs the NHS at least an extra £60,000, money which could have been saved by effective training. Dr Peter Carter, Chief Executive and general secretary of the Royal College of Nursing, added: I commend this new edition to the nursing and caring professions at all levels, as well as to those who manage and fund healthcare provision, and am conÀdent that it will help to further advance standards of care, and of health and safety, for the beneÀt of all. RRP for the Guide to Handling of People is £50.00 however, we would like to offer a 10% discount (£45.00) to readers of The Operating Theatre Journal. Please quote ‘Operating Theatre Journal’ when ordering from info@backcare.org. uk or telephone 020 89775474 to take advantage of this unique offer.. Please note that this price does not include P&P. P&P is approximately £8.25.

The OTJ - Next issue copy deadline, Friday 22nd April 2011 All enquiries: Mr. L.A.Evans Editor/Advertising Manager, Mr. A. Fletcher Graphics Editor. The OTJ Lawrand Ltd, PO Box 51, Pontyclun, CF72 9YY Tel: 020 7100 2867 Email: admin@lawrand.com Website: www.lawrand.com The Operating Theatre Journal is published twelve times per year. Available in electronic format from the pages of www.otjonline.com and 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. © 2011 Journal Printers: The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD Ànd out more 020 7100 2867 • e-mail admin@lawrand.com

Issue 247

APRIL 2011

3


Bedford Hospital embraces innovation with mobile operating suite A mobile operating theatre has been deployed by Bedford Hospital NHS Trust in a groundbreaking bid to increase its surgical capacity and improve patient services across a range of procedures. Access to the state-of-the-art mobile services comes as the result of a new partnership with Vanguard Healthcare one of the worlds leading providers of mobile surgical units. Deployed in the hospital grounds, the sophisticated operating suite adds to Bedfords contingent of innovative temporary facilities, which includes a mobile MRI scanner currently operational on the site. The mobile operating theatre, which will be at Bedford for the next twelve months, allows hospital surgeons to perform additional procedures across a variety of surgical disciplines, without having to extend working hours or sacriÀce other services. Chris Wood, interim general manager of surgery and anaesthetics at Bedford Hospital said: The modular theatre has provided us with an efÀcient and cost effective solution to increasing our theatre capacity on a temporary basis. Patients and staff are really impressed with the modern facility and we look forward to continuing to work with Vanguard to explore new ways of delivering our services. Situated in close proximity to the main building, the mobile unit is a self-contained facility but allows the Trust to manage each stage of the operating process and retain control of the patient pathway, without sending patients to a different facility away from the main hospital. Patients are prepared in the anaesthetic unit, operated on and then moved into the recovery room, all within the mobile facility, before returning to the main hospital at all times being treated and supported by doctors and support staff from Bedford Hospital. Ian Gillespie, CEO of Vanguard Healthcare, said: We are very pleased to be working with Bedford, and hope that this can be the start of a partnership whereby the Trust can call upon us whenever they need a Áexible and cost-effective source of additional surgical capacity. The whole idea behind mobile solutions is to provide the high standards of service expected by patients, but through a more Áexible method of service provision. For the patient, the experience is no different to that of a permanent operating theatre or ward, he concluded. We have the same clinical staff on board the unit, the same equipment, even similar dimensions for each room the only difference is the Áexibility that our units provide for the hospitals managers. For more information, visit www. vanguardhealthcare.co.uk When responding please quote ‘OTJ’

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Orthos Limited announces CE approval to market its proprietary ȕGel synthetic bone graft substitute ȕ The UK orthobiologics company, Orthos Limited has announced CE approval to market its proprietary ȕGel synthetic bone graft substitute for use as a bone Àller in non-structural areas such as in spinal cages to assist fusion, inside acetabular defects caused by osteolysis and alongside pins and plates to assist bone fracture repair. The principal uses will be in the spine, pelvis and extremities. The new ȕGel product is available throughout Europe with immediate effect. ȕGel builds on the company’s proven ȕGran technology, offering an injectable and mouldable, reliable, synthetic putty with handling characteristics more commonly associated with allograft (from human donor bone) materials. Synthetic bone substitutes have become a valuable piece of the surgeon’s tool-kit in recent years. The worldwide market is already said to be greater than three billion pounds and is growing; the main use being in spinal procedures and the surgical revision of hip and knee joints.

This innovative injectable bone grout (ȕGel) marks a new generation of products which are easier to implant, completely Àll gaps and Àssures in bone effectively and then safely allows the body to repair the bone naturally.’ said Professor Christina Doyle, Non-Executive Director and Consultant. This new product (patents pending) complements the company’s other approved products, ȕGran synthetic bone substitute granules and OsteoBoost, a unique bone marrow aspiration kit. About the Company Orthos is an orthobiologics company focused on developing materials and devices that provide solutions for surgeons to use in the repair of skeletal defects and in the regeneration of bone. To achieve this the company works in partnership with clinicians and academia. The Company’s products are particularly targeted to newly emerging surgical techniques. The core technology of Orthos is based on the synthesis of orthobiologic materials which respond physiologically when implanted in the body. The Company has products approved for sale in both Europe and the USA.

Orthos, Technium Springboard, Llantarnam Park, Cwmbran, NP44 3AW Tel: 01275 376 377 Fax: 01275 376 378 When responding please quote ‘OTJ’

Verathon Medical launches GlideScope Direct intubation trainer Combines classic design of Macintosh blade with modern video technology to provide the best possible view to aid training Verathon Medical UK Ltd has added the GlideScope Direct intubation trainer to the GlideScope Range to enhance the teaching of basic direct laryngoscopy skills. This evolution has been based on feedback from clinical users wanting to use the superior views of video laryngoscopy to supervise and guide students in simulated and real time intubations. The reusable blade has the look and feel of a standard 3.5 size Macintosh blade. The GlideScope Direct provides clinicians with a DVD quality, recordable image on a large, shared monitor so they can guide and review procedures with their students. The GlideScope Direct may also be used in every day practice to perform video-guided direct laryngoscopy. Dr Peter Jaye, consultant in Emergency Medicine at Guys and St Thomas NHS trust said: This is an important new addition to the GlideScope range. It introduces the concepts of video-laryngoscopy to all those involved in advanced airway management. It markedly improves the acquisition of direct layngoscopic skills for the learner and, more importantly, signiÀcantly enhances patient safety. In my view, it is increasingly difÀcult to justify the teaching of this skill without the use of video-laryngoscopic support. Paul Knee, Managing Director at Verathon said: Airway management is moving towards the daily use of video laryngoscopes. However, clinicians have told us that they also want to use this technology to teach direct laryngoscopy skills. The GlideScope Direct is an important addition to our portfolio because it combines the classic design of the Macintosh blade with our respected technology to provide the best possible view for successful intubations.

THE OPERATING THEATRE JOURNAL

Verathon manufactures a complete range of GlideScope blades. This allows the device to be used for a full range of patients from premature babies to those who are morbidly obese. The adult blades have a 60º curve which is particularly useful to aid successful intubations for patients with difÀcult airways. In these situations, a Macintosh does not always provide the optimal view required for more difÀcult intubations. The GlideScope devices are used in a wide variety of clinical settings including emergency medicine, ITU, PICU, Theatres. Recently, the device has been successfully deployed to the UK Armed Forces in Bastion to be used for battleÀeld medicine. The GlideScope video laryngoscope was invented by Dr Jack Pacey who is President of Verathon Medical Canada. Verathons headquarters are based in Bothell, Washington in the US: the company also has ofÀces in the UK, Australia, Canada, Hong Kong, France, Germany, Italy, Japan, Spain and the Netherlands. The company employs around 425 people worldwide. Email: customerserviceuk@verathon.co.uk Web: http://www.verathon.co.uk

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Fukuda Denshi Breakthrough at Weymouth Street Clinic Fukuda Denshi is one of the world’s leaders in cardiology instrumentation patient monitoring and ultrasound technologies. The company is pleased to announce that it has won the contract to supply the Weymouth Street Clinic in London with 19 patient bedside monitors. Weymouth Street Clinic is a new build facility in the Harley Street area, which went ‘live’ in May 2010. In keeping with its state of the art technology, the clinic was keen to select the advanced Fukuda Denshi multi-parameter DS-7001 monitor, with wireless transmitter, for its critical care patients within the clinic. The clinic particularly liked the space-saving, slimline shape of the DS-7001 monitor, allowing them to be housed in cabinets to provide a modern, tidy, minimalistic look, which would be un-obtrusive to the patients. The DS-7001 monitor provides 96 hours of continuous patient monitoring and ensures digital transmission of ECG Ich, respiration and SpO2 parameters. They are linked to a Fukuda Denshi DS-7680 central station monitor, which displays waveforms and measurements for up to 16 patients. It also incorporates a built in 3-channel printer and alarm function. In summary, Fukuda Denshi Area Manager, Norman Turner, said “In choosing the company to fully equip this wonderful new facility with its choice of patient monitors, the Weymouth Street Clinic took into account their wireless system ability, their compactness and mobility, plus their good value.” For further information on the DS series of patient monitors, please contact Fukuda Denshi on 01483 728 065 or visit www. fukuda.co.uk. Fukuda Denshi: Healthcare bound by technology.

McIntyre, Bishop support hospital campaign Michael McIntyre and John Bishop paid tribute to Great Ormond Street Hospital recently. The comedians were visiting the London hospital in support of a campaign to raise £5m for a new operating theatre. They met children who are receiving treatment at the hospital and had their photographs taken with staff. McIntyre told The Mirror: “I’ve been lucky that my own children haven’t been in hospital, so I was worried I might Ànd it too much today. “But it was uplifting to go in there and see them so happy with the care they are getting. It’s clearly a very special place.” Bishop said that he had found the experience “quite humbling”. “We’re going to go in a room and make them laugh but when you see what a difference it will make, it’s great to think you are making a small contribution to that,” he added. Both men will join a host of fellow standups including Lee Evans, Jonathan Ross, Jack Whitehall and Jo Brand for a comedy gala on May 24 at the O2. Tickets are on sale and Channel 4 will broadcast the show later this year.

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Issue 247

Source: Digital Spy

APRIL 2011

5


FujiÀlm launch their Àrst portable diagnostic ultrasound system into the UK – the FAZONE CB FujiÀlm is a pioneer in diagnostic imaging and information systems for healthcare facilities. Their clinically proven products and technologies are constantly evolving to help medical professionals perform more effectively and efÀciently. The company has now expanded their range with the addition of their Àrst ultrasound system into the UK. FAZONE CB is a portable, lightweight ultrasound system offering high image quality on its large 12” screen, making it ideal for hospital wards and outpatient departments, as well as examination rooms or vehicles. It is ergonomically designed to provide userfriendly operation, with easy-to-use large buttons, which are cleverly grouped according to examination mode. FAZONE CB is equipped with a ‘sound speed correction’ function for faster, clearer examinations. This is based on ZONE Sonography™ technology, which transmits a broader ultrasound beam to collect extensive echo data immediately by using large zones. This makes a new, advanced image processing environment possible. In addition, it uses Channel Domain Processing software to provide enforced beam forming, and improved image resolution with Auto-Opt with ZST (Sound Speed Correction). Further image optimisation is available at the touch of a button, with GAIN and TGC being easily optimised by simply pushing the built-in ‘optimise’ button. FAZONE CB has USB, HDMI and network ports, so data can be exported easily in DICOM as well as the more common JPG format. In addition, workÁow can be further optimised with the use of FujiÀlm’s FCR View workstation. The FCR View enables transfer of ultrasound images, and their integration with patient information, to facilitate centralised management. The FAZONE CB also features a one-hour rechargeable battery pack for ultimate ultrasound on the go. A wide range of Convex, Sector, Linear and Transvaginal probes are available, and additional accessories include a CB Cart and monochrome or colour printer. For further information on the new FujiÀlm FAZONE CB, telephone the company on 01234 326 780 or visit www.fujimed.co.uk. FujiÀlm – pioneers in diagnostic imaging and information systems.

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Mölnlycke Launches New Accelerator Lack of intensive care Free Biogel® NeoDermTM Gloves equipment ‘causing deaths’ Mölnlycke Health Care has launched a new accelerator free, synthetic surgical glove, Biogel® NeoDermTM. The new glove is made from powder-free, synthetic polychloroprene with a Biogel coating. Being made from a synthetic elastomer, the gloves reduce the possibility of glove-related latex protein sensitisation. The new Biogel NeoDerm gloves are manufactured without using any of the following chemicals, commonly known as accelerators, which can cause skin reactions: Thiurams, Mercaptobenzothiazole, Diphenylthiourea, Diphenyl Guanidine and Dithiocarbamates. In a clinical study, Biogel NeoDerm demonstrated a reduced potential for causing reactions in healthcare professionals who have a known sensitivity to chemical additives used in rubber glove manufacture1. Biogel NeoDerm gloves are safe for healthcare professionals susceptible to Type I and Type IV allergic reactions to Natural Rubber Latex or chemical additives. The gloves are recommended for use in all surgical procedures or where latex allergies and/or chemical sensitivities are a concern for patients or clinicians. Graham Johnson, Registered Specialist Community Public Health Nurse in Occupational Health, says: “These new gloves will go some way towards helping individuals who suffer sensitivity from surgical gloves. They will enable them to continue their career rather than having to end it by not being able to wear appropriate gloves for the job. Torbjörn Turland, Gloves & Antiseptics Product Manager at Mölnlycke Health Care, says: “Biogel NeoDerm gloves may literally be career saving for healthcare professionals who are either chemical accelerator sensitive or suffer from a Type I latex allergy. We are pleased to have developed a solution to the problems faced by sufferers.” s The Th new Biogel NeoDerm gloves come co in range of sizes, from 5 ½ to 9. To Ànd out more about Biogel NeoDerm Ne gloves contact: Mölnlycke Mö Health Care Customer Services Se on Tel: 0800 917 4918 or visit www.molnlycke.com Ref References: 1. Source: Testing conducted at Bioscience Laboratories inc. 2009. Report 090250-304. Lab

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THE OPERATING OPERA THEATRE JOURNAL

The lack of a cheap and simple breathing monitor on NHS intensive care wards is causing unnecessary patient deaths, warn doctors. According to the Royal College of Anaesthetists, using a capnograph may avoid over 70% of breathing-related deaths on UK intensive care wards. A capnograph can detect problems as soon as they occur and immediately alert staff to intervene. It is already used almost universally in operating theatres. It works by detecting carbon dioxide in exhaled breath to conÀrm that the patient is breathing sufÀciently. But only a quarter of intensive care units in the UK use the device, according to this latest report. Report author Dr Tim Cook, who is a consultant anaesthetist at the Royal United Hospital in Bath, said: “The single most important change that would save lives is the use of a simple breathing monitor, which would have identiÀed or prevented most of the events that were reported. “We recommend that a capnograph is used for all patients receiving help with breathing on ICU. “Greater use of this device will save lives.” He said the introduction of capnography to more ICUs would require “modest cost” and some training of nurses and those doctors who are not familiar with its use. Patients at highest risk of breathing complications are those with other health problems, such as obesity. The report found obese patients had double the risk of airway problems when they needed a general anaesthetic compared with non-obese patients. It monitored all airway complications recorded between 2008 and 2009 in operating theatres, intensive care units and hospital emergency departments throughout the UK. Of 184 reports of complications, 38 resulted in a death. Sixteen of these deaths occurred while under general anaesthetic in the operating theatre, 18 occurred on intensive care units and four in emergency departments. A Department of Health spokesperson said: “We welcome this report and would encourage NHS trusts and staff to take note of the recommendations and take any necessary action to ensure high Source: BBC quality, safe patient care.” www.otjonline.com





KIMBERLY-CLARK LAUNCHES NEW KIMVENT* MULTI-ACCESS PORT CLOSED SUCTION SYSTEM Targeting the risk factors connected with Ventilator Associated Pneumonia (VAP) in mechanically ventilated patients, Kimberly-Clark Health Care has launched the new KimVent* Multi-Access Port Closed Suction System. The new system, which is based on the proven Trach Care* Technology, features a compact rotating manifold with multi-access ports, to allow clinicians to perform suctioning and other procedures, such as bronchoalveolar lavage, bronchoscopy or MDI drug delivery, whilst maintaining a closed ventilator circuit. Keeping the ventilator circuit closed helps to reduce the risk of crosscontamination and is recommended as part of a VAP prevention bundle strategy. A closed circuit maintains ventilation and oxygen therapy throughout suctioning and prevents approximately 50% of the lung volume fall observed when suctioning after disconnection from the ventilator (1). One of the procedures enabled by the multi-access ports is the sampling of lower lung respiratory tract secretions using the KimVent* Bal Cath* Bronchial Aspirate Sampling Catheter. Specially designed to be used with the KimVent* MultiAccess Port Closed Suction System, the Bal Cath* catheter can be inserted through the alternative therapy port to obtain a lower respiratory tract sample without opening the ventilator circuit. The Bal Cath* catheter’s soft, directional tip, allows safe and quick retrieval of samples, providing the right data for accurate lung infection diagnosis and for more effective targeted antibiotic treatment. The KimVent* Multi-Access Port Closed Suction System also contains a unique, isolated and vacuumsealed turbulent cleaning chamber.

The turbulent cleansing action results in an 89% cleaner catheter tip compared to a standard closed suction system(2). This reduced colonization may help reduce the risk of VAP in ventilated patients. In addition, the system features a single-use seal cassette to maintain PEEP during the insertion of a sampling catheter or other device and to clear excess secretions upon retraction. Whilst the port is in use, the catheter locks into a separate port to stay connected and clean. The catheter prevents over-retraction through its tether sleeve and is DEHP free. Additional replacement catheters can also be Àtted without opening the ventilator circuit. With VAP being the most common and fatal infection in the ICU, and approximately 86% of hospital associated pneumonia linked to mechanical ventilation (3), targeting and minimising the risk factors is our top priority, explains Alexia Pedrini, Kimberly-Clarks Marketing Manager for Medical Devices in EMEA. Manipulation of the ventilator circuit can increase cross-contamination, a potential source for VAP, so we believe closed suction is best practice because it protects patients by reducing the risk for contamination from outside pathogens, reducing colonization within the circuit and protecting caregivers from exposure to body Áuids. Keeping the ventilator circuit closed whilst being able to perform other vital procedures is a real breakthrough for patient safety. The addition of the Bal Cath* Bronchial Aspirate Sampling Catheter adds a further beneÀt in helping intensivists target the risk factors associated with VAP.

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The KimVent* solution bundle encompasses an extensive range of services such as education, in-service training, on-line VAP resources at www.VAP.kchealthcare.com and compliance programmes. This total solution of products and services provide a comprehensive and thorough approach to help protect patients from VAP. The KimVent* range of products include: KimVent* Oral Care Kits - a full portfolio of Áexible and easy-touse oral care solutions designed by nurses, for nurses helping to provide comprehensive oral care. KimVent* Closed Suction Systems featuring Trach Care* technology, the only catheter with a turbulent cleaning action reducing bacterial colonization by 89% compared to standard closed suction systems(2). Now available with integrated MultiAccess Port. KimVent* Bal Cath* Catheter- a bronchial aspirate sampling catheter that facilitates early and accurate diagnosis of VAP and enables more targeted antibiotic treatment.(4) KimVent* Microcuff* Endotracheal Tube for Adults - designed to reduce the micro-aspiration of secretions known to be a cause of VAP. KimVent* Microcuff* Pediatric Endotracheal Tube a cuffed ET tube speciÀcally designed for the pediatric anatomy offering the advantages of a cuffed tube with safe tracheal intubation and sealing in children.

References 1. Maggiore SM, Lellouche F, Pigeot J, Taille S, Deye N, Durmeyer X, Richard JC, Mancebo J, Lemaire F, Brochard L Prevention of endotracheal suctioninginduced alveolar derecruitment in actute lung injury. A J Repsir Crit Care Med. 2003 May 1;167(9):1215-24 2. Compared to Ballard* TrachCare* 24-hour closed suction systems. Ballard* Critical Care Products Trach Care* 72 Microbiology Report, Nelson laboratories Final Reports, Laboratory Numbers 18343, 163901.1 3. Richards MJ, Edwards JR, Culver DH, Gaynes RP (1999) Nosocomial infections on medical intensive care units in the United States. Nosocomial Infections Surveillance System. Crit Care Med. 1999 May 27 (5) 887-52 4. American Thoracic Society Guidelines for the Management of Adults with Hospital-acquired, Ventilatorassociated, and Healthcare-associated Pneumonia. American Journal of Respiratory and Critical Care Medicine, V. 171, 388-416 (2005). * Registered Trademark or Trademark of Kimberly-Clark Worldwide Inc.

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New surgical sterilisation unit at Yeovil hospital A Somerset hospital has unveiled a new “state-of-the-art” building which it hopes will improve cleanliness levels. Yeovil District Hospital’s £3.8m Sterile Services Decontamination Unit meets the most up-to-date national and international guidelines. Staff will be responsible for washing surgical instruments for theatre use, for both on and off-site services. “Keeping our patients safe is Yeovil District Hospital’s top priority,” said Yvonne Thorne, head of nursing. “This investment in the sterile services unit ensures that all our operating equipment is decontaminated to the highest of standards. “What the patients may notice is that we have a much more effective service, a much more responsive service to them.” A new specialist computer system will also allow staff to track all theatre instruments through the decontamination cycle. The new building is the Àrst sterile services unit in the country to receive an ‘excellent’ rating under the BREEAM environmental assessment scheme. It recognises a building’s sustainable design and environmental performance. Source: BBC

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Neurosign launches free easy reference poster for intraoperative nerve monitoring

Needless maternal deaths from pre-eclampsia due to inadequate care: time to act

Neurosign has developed a free, easy reference poster for users of intraoperative nerve monitoring (IONM), detailing basic set-up and procedures. Already laminated, the poster can be put up near an IONM device as a simple aide memoir.

The latest UK CMACE report into deaths in pregnancy (cmace.org.uk) reveals shock statistics showing that more than nine out of ten women who died from pre-eclampsia received sub-standard care. Almost half had seriously inadequate care where correct treatment could have prevented their deaths.

Proper and appropriate use of intraoperative nerve monitoring can be of great beneÀt to hospitals, surgeons and patients alike. In ENT, Neurosign is used to monitor the facial nerve during:

Profesor Christopher Redman, co-chair of PRECOG, co-founder of Action on Pre-eclampsia and professor of obstetric medicine at the University of Oxford said Of all the causes of maternal death, pre-eclampsia, by a long way, has the highest incidence of substandard care in this report. It is extraordinary that this is not highlighted in the CMACE report itself.

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Parotidectomy Mastoidectomy Cochlea implant Submandibular gland excision

It can also be used to monitor the accessory and hypoglossal nerves during neck dissections. With the aid of the laryngeal electrode, it can be used to monitor thyroid patients. This is a cost-effective electrode adhering to a standard endotracheal tube, so the anaesthetic department does not have to stock special tubes nor have to use non-standard tube sizes. Using the device, both the recurrent and superior laryngeal nerves can be monitored. The new reference poster can be requested for free from: http://is.gd/cLi1UV Neurosign is a division of Magstim, which provides clinicians and researchers with state-of-the-art stimulation and monitoring equipment to facilitate the assessment, protection and improvement in function of the human nervous system, with effort focused on applications related to magnetic neurological stimulation and intraoperative nerve monitoring. Magstim has gained an international reputation for the development, manufacture and distribution of electronic medical devices and has longstanding contacts with key opinion leaders within the clinical and academic sectors. When responding to articles please quote ‘OTJ’

These Àgures come six years after the national introduction of PRECOG guidelines (Milne et al, BMJ 2005;330:576-580) on identifying pre-eclampsia the most common medical complication of pregnancy - in pregnant women, and a year after the release of new recommendations on the management of hypertensive disorders including pre-eclampsia in pregnancy (www.nice. org.uk/CG107) by the National Institute of Health and Clinical Excellence (NICE). Despite the existence of clear guidance for health professionals in the community and hospitals on how to recognise and manage pre-eclampsia, basic failures in the management and organisation of care for pregnant women still cause unnecessary deaths, poorer health outcomes and suffering for mothers, babies and their families. The PRECOG Working Group believe that there is no excuse for such fundamental failures of care, and that all healthcare professionals who interact with pregnant women must be able to recognise clinical signs (hypertension, protein in the urine) and symptoms (upper abdominal pain, headache, visual disturbance in the mother or reduced fetal movements/ small baby) of preeclampsia and act accordingly. PRECOG member and obstetrician Professor Andrew Shennan of Kings College London commented: Pre-eclampsia need not be fatal if we follow basic clinical care.. This clearlyis not happening in some cases. The NHS must ensure that maternity care is delivered appropriately, not just provided. PRECOG is now beginning a new campaign to identify and address the issues that cause widespread substandard maternity care in the NHS, to ensure that women and babies receive the care they need to prevent further needless deaths.

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Issue 247

APRIL 2011

9


Manager numbers in the NHS decrease. The NHS has made good progress in reducing bureaucracy and management costs according to the latest workforce statistics out on the 22nd of March. The workforce census, published by the NHS Information Centre, shows that there was a reduction of 2,770 managers and senior managers in the NHS between September 2009 and September 2010 this equates to 2,416 full time equivalent (FTE) or a 5.7 per cent reduction. At the same time, the number of professionally qualiÀed clinical staff including consultants, GPs and nurses rose by 2,707 to 721,717 which equates to 617,232 FTE, an increase of 0.5 per cent. Commenting on the census data, Health Minister Simon Burns said: The latest census shows that the NHS has taken up the challenge to reduce management costs whilst the number of doctors and nurses has increased. Reducing bureaucracy is vital to modernising the NHS so that every penny saved can be reinvested into improving patient care and driving up quality. We have always been clear that efÀciency savings must not impact adversely on patient care. Instead the size and shape of the workforce needs to change so that we have less bureaucrats and the right levels of clinical staff so that care can be brought closer to home for patients. The census comes out on the same day as the latest monthly workforce data for December 2010 which also continues to show a decline in managers, senior managers and infrastructure support staff.

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S 10

NHS staff have their say as the results of national survey are published The results of the eighth annual survey to collect the views of NHS staff across England were pubished on16 March by the Care Quality Commission (CQC). Almost 165,000 employees at the country’s 388 trusts took part in the survey, which was carried out during the Ànal quarter of last year. This represented 54% of those who were asked to participate, compared with 55% in 2009. The survey covered all occupational groups, from doctors and nurses to clerical workers, and from radiographers to clinical psychologists. They were asked a broad range of questions seeking their experiences of, or opinions on, matters such as appraisals, training, job satisfaction, line management, work-related stress, experience of violence and abusive behaviour, and making a difference to patients. Cynthia Bower, CQC’s chief executive, said: “This is an important survey because it provides a snapshot of how those who work within the NHS feel about what they do and the experiences they have at work. “I know that the vast majority of NHS employees are personally committed and motivated to do the best work they possibly can. The survey results will help trusts to pinpoint what else they can do to support and develop staff to ensure they can provide the best care for patients. “The Department of Health will also make use of the Àndings, to inform its policy-making and its work on performance measurement and service improvement. “For our part, as the care services regulator, the survey Àndings will contribute to the information we gather on how well trusts are continuing to comply with some of the essential standards of quality and safety that underpin our work.” Some of the Àndings from the NHS staff survey Certain questions in the survey showed that ambulance personnel had poorer experiences compared with other groups of employees, for instance in the support they received from their manager and the extent to which they felt their work was valued by their trust. However, many ambulance staff work in a different environment to others in the NHS, making comparisons inappropriate. There were improvements for ambulance workers since the 2009 survey in some respects, notably the proportions that received appraisals and health and safety training. Appraisals, training and development Seventy-seven per cent of staff had received an appraisal or development review, up from 69% in 2009, but only 34% felt their appraisal or review was well structured, (31% in 2009). Despite high levels of training, only 35% of staff felt they had good opportunities to progress at work, against 40% in 2009. Of ambulance staff, 70% had an appraisal, up from 47% in 2009, but only 20% felt it

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was well structured (14% in 2009). While 78% of all staff received health and safety training (compared with 76% in 2009), the Àgures for ambulance staff rose considerably, to 55% compared with 45% in 2009. Staff as advocates Nearly two-thirds (64%) of respondents said they would be happy with the standard of care provided by their trust if a relative or friend needed treatment (compared with 62% in 2009), and over half (53%) said they would recommend their trust as a place to work (55% in 2009). Making a difference to patients Ninety per cent of staff felt that their role ultimately made a difference to patients, and 87% were satisÀed with the quality of care they personally gave. Both these Àgures were unchanged from 2009. Violence and abuse Eight per cent of staff overall reported experiencing physical violence from patients, relatives or other members of the public, while 15% said they had been subjected to bullying, harassment and abuse. The Àgures on violence were higher for front-line staff (12%), particularly workers in ambulance trusts (18%) and mental health trusts (15%). Bullying, harassment and abuse from patients and relatives were also more prevalent among front-line staff (18%) and much worse for ambulance workers (27%). Fifteen per cent of all staff had experienced bullying, harassment and abuse from their line manager or other colleagues. Hygiene There has been a slight reduction in the proportion of staff who said that hot water, soap and paper towels or alcohol rubs were always available when they needed them – down to 68% from 71% in 2009. Twenty Àve percent said that they were available most of the time, compared with 23% previously. Sixty per cent said that hand-washing materials were always available to patients (63% in 2009) and 22% that they were available most of the time (previously 21%). Errors, near misses and incidents Thirty-two per cent of staff said they had seen at least one error, “near miss” or incident that could have hurt staff or patients in the last month (compared with 33% in 2009). Of front-line staff, 42% said that they had witnessed at least one such adverse event in the last month (43% in 2009). The number of ambulance staff witnessing errors, near misses or incidents has decreased from 37% in 2009 to 34% in 2010. Staff turnover There has been a slight increase in the proportion of staff who said they intended to leave their employer. Twentynine per cent of all the respondents, compared with 28% in 2009, said they often felt like leaving their trust; 21% (20% in 2009) said they would probably look for another job in the next year; and 15% (14% in 2009) said they would leave as soon as they could Ànd another job.

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Fewer NHS managers, more Doctors and Nurses




Surgery Simulator Lives are in your hands as you take on the role of a top surgeon at a busy city hospital. With eight authentically recreated surgical procedures in your repertoire, your skills are much in demand. You will need to keep your brain as sharp as your scalpel as you operate on fractures, remove an inà amed appendix or tonsils, treat infected gall bladders, attend to varicose veins, repair hernias, restore vision in cataract procedures and deal with the injuries of a road trafÀc accident.

Blood Àow monitor could save NHS £400m per year – but only if implemented correctly... On 30th March 2011 NICE extended its recommendation on the CardioQ estimating that it could save the NHS in England more than £400m a year. The blood à ow monitor, which was originally developed in the UK, reduces the rates of post operative complications as well as reducing the length of critical care and overall hospital stay. However, in order for these patient and Ànancial beneÀts to be realised it is vital that this innovative technology is widely implemented throughout the NHS; not something the NHS is particularly good at or well known for.

Enjoy Complete Confidence Eschmann operating table

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Scrub up and enter The Operating Theatre re e Price: P i ÂŁ24 ÂŁ24.99 99 3Ă˜.!23$31("2Ă˜Ă˜&8$".+.&8

NICE is recognised as the organisation with the expertise to review the evidence linked to individual technologies but experience shows that NHS organisations also beneÀt from receiving practical support at the front line of care delivery to enable rapid uptake of this technology. The NHS Technology and Adoption Centre, or NTAC, which was developed to address the technology adoption issues which reside in the NHS has actively supported the uptake of CardioQ in a number of hospitals publishing a detailed How to Why to Guide™ about how to implement its use. NTAC was very pleased to collaborate with and share its work with NICE during their review.

Your patients are prepped for surgery ! Part of NTAC’s ongoing remit is to review 5(ZOBFDPMPHZBOE0CTUFUSJDT"DDFTTPSJFT ./$1 3(-&Ă˜3 !+$ healthcare technologies which have been

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Perform each  operation using state of the art medical equipment, assisted by $BSCPOĂ™ CSFBOBFTUIFUJDTDSFFO animated surgical staff. Make sure you monitor the vital signs of your patient and if blood pressure and heart rate falls be ready to intervene. You are the  /BSSPXBSNCPBSE lead surgeon and split second decisions that lead to triumph and tragedy are carried on your alone. shoulders 4UBOEBSEMFHLJU You are equipped the tools of the trade including scalpel, clamps,  with 'PPUSFTUFYUFOTJPO compresses, needles and sutures and a host of modern equipment, yet your greatest tools  are your steady hands and an incisive mind %JSFDUQMBDFNFOUMFHIPMEFST

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Featuring the following Operations...  "SUJDVMBUJOHMFHT p 4IPSUFSUBCMFUPQ NN SFEVDFTNBOVBMIBOEMJOH - Cataract p 1PXFSFECBDLSFTUBMMPXTGPSl"TTJTUFE%FMJWFSZm - Varicose veins (varicosis) -JHIUXFJHIUMFHLJU QPTJUJPOJOBTJOHMFNPWFNFOU - Gall bladder removal (laparoscopic cholecystectomy) - Hernia (herniotomy)  5VSOFS8BSXJDLLJEOFZTVQQPSUT p .BYJNVNQBUJFOUXFJHIUPGLHJOMJUIPUPNZQPTJUJPO - Treatment of a lower leg fracture p 8FJHIUBTTJTUFEBSUJDVMBUJOHMFHTFDUJPOT (tonsillectomy) *OTUSVNFOUUSBZ - Tonsil removal p 2VJDLBVUPMFWFMGVODUJPOGPSFNFSHFODZQSPDFEVSFT - Appendix removal (appendectomy)

 - TrafÀc accident

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Based in the  United5TJEFTVQQPSUT Kingdom, Excalibur is the mainstream PC publishing arm of Contact Sales. It’s headed up by Robert Stallibrass who brings *OĂ™MMTFDUJPO over 20 years’ experience in computer games sales and marketing to the “round tableâ€?. Until now Contact Sales has concerned itself exclusively with publishing Ă ight and train simulator add-ons. Its titles can be found in all of the major UK retail outlets including; PC World/Dixons, Game, Virgin, HMV, GameStation, Amazon and independent stores. 'PSGVSUIFSEFUBJMT WJTJU

under utilised within the NHS. For the technologies shown to offer signiÀcant patient beneÀt NTAC produces a How to Why to Guide™. These Guides provide comprehensive and  relevant information for clinicians, managers, key decision makers and other stakeholders on how to implement speciÀc technologies. Guides have been produced on a range of technologies including the Doppler Guided Intraoperative Fluid Management or the CardioQ.



Speaking about NICE’s recommendation Deltex Medical Group Chief Executive, Ewan Phillips said: “It takes a long time for ideas from the clinicians to feed through to the senior management – the sort of people who can make decisions to do things on a wide scale. That’s always been a problem in the NHS.  “NTAC is vital to widespread adoption of this, and many other, technologies with proven patient beneĂ€t and the opportunity to save the NHS millions. Essentially NTAC provides the roadmap which can help the NHS achieve better patient outcomes and also achieve the signiĂ€cant cost savings it is striving for,â€? As part of the development of the How to Why to Guide™ NTAC worked with three NHS hospitals across England implementing Doppler guided intraoperative Ă uid management into their routine clinical practice. Following a structured implementation programme, patient outcomes were measured ts and barriers and impact of implementation on in 1200 cases. The beneĂ€ the NHS resources assessed for each patient care episode by measuring and comparing hospital stay, the use of invasive central venous catheters, reoperation and readmission rates. The results of this implementation project demonstrated that encouraging research data can be reproduced in routine NHS clinical and operational practice with a three day reduction in hospital stay and fewer postoperative complications for patients • 3.5 day reduction in length of stay (LOS)*. • 4 day reduction in post-operative LOS • 23% decrease in CVC insertion rate. • 29% decrease in re-admission rate. • 30% decrease in re-operation rate. • A 5 day reduction in LOS within Critical Care (Level 3).

&TDINBOOÂ&#x;SBOHFPGBDDFTTPSJFTTQFDJĂ™DBMMZ  The product NTAC Chief Executive Sally Chisholm said: “Our work is focused on achieving EFWFMPQFEGPSPCTUFUSJDTBOEHZOBFDPMPHZ 03$"-Ă˜Ă˜Â&#x;Â&#x; Attention! This product is a computer game and not for training or tuition purposes!!! VVV DRBGL@MM BN TJSĂ˜

is NOT suitable for conveying specialist knowledge in medicine or surgery. All operations shown are simpliÀed considerably and only represented in excerpts. It is not possible to prepare yourself in any way for medical operations using this software or gain knowledge and skills that could be implemented in reality. We cannot accept ANY RESPONSIBILITY for the correctness of the operation procedures and information shown.

3%%Â&#x;).3)$%Â&#x;&/2Â&#x;$%4!),3 ( ) 20 (c) 2010 0 Visual Imagination SSoftware f (c) 2010 2010 rondomedia Marketing & Vertriebs GmbH Age Rating: 7, Fear Warning

Minimum System Requirements - Operating system: Windows XP, Windows Vista or Windows 7 - Processor 1.5 GHz, 1.5 GB RAM - At least 1.5 GB free hard disk space - 128 MB 3D graphic card - CD-ROM/DVD-ROM drive - DirectX 9.0 compatible hardware When responding to articles please quote ‘OTJ’

reproducible beneĂ€ts in the clinical setting, or more crudely, the real-world. By working with the NHS we can take under-utilised technologies which have shown that they can improve clinical outcomes whilst saving the NHS money and quite literally ‘show’ the NHS how to implement them effectively. Headlines such as ‘savings of ÂŁ400m per year’ are incredibly exciting, particularly in the current economic climate and with the Ă€nancial pressures being faced by the NHS. However, the stark reality is that if technologies such as the CardioQ are not implemented throughout the NHS these beneĂ€ts will never be anything but a headline.â€? For more information about the NHS Technology Adoption Centre visit http://www.technologyadoptionhub.nhs.uk/

Ànd out more 020 7100 2867 • e-mail admin@lawrand.com

When responding to articles please quote ‘OTJ’

Issue 247

APRIL 2011

11


Fewer NHS managers, more Doctors and Nurses Manager numbers in the NHS decrease. The NHS has made good progress in reducing bureaucracy and management costs according to the latest workforce statistics out on the 22nd of March.

NHS staff have their say as the results of national survey are published The results of the eighth annual survey to collect the views of NHS staff across England were pubished on16 March by the Care Quality Commission (CQC). Almost 165,000 employees at the country’s 388 trusts took part in the survey, which was carried out during the Ànal quarter of last year. This represented 54% of those who were asked to participate, compared with 55% in 2009.

was well structured (14% in 2009). While 78% of all staff received health and safety training (compared with 76% in 2009), the Àgures for ambulance staff rose considerably, to 55% compared with 45% in 2009. Staff as advocates Nearly two-thirds (64%) of respondents said they would be happy with the standard of care provided by their trust if a relative or friend needed treatment (compared with 62% in 2009), and over half (53%) said they would recommend their trust as a place to work (55% in 2009).

EschmannTheoperating table survey covered all occupational groups, from doctors and nurses to clerical workers, and from radiographers accessories ( to clinical psychologists. (&/&3"-"/%41&$*"-*45 &/&3"-"/%41&$*"-*45 OPERATING OPERATIN T G Making a difference to patients The workforce census, published They were asked a broad range of questions seeking 01&3"5*/(5"#-&4 Ninety per cent of staff felt that their4role ultimately TABLES

by the NHS Information Centre, their experiences of, or opinions on, matters such as shows that there was a reduction appraisals, training, job satisfaction, line management, of 2,770 managers and senior work-related stress, experience of violence and abusive managers in the NHS between behaviour, and making a difference to patients. September 2009 and September Cynthia Bower, CQC’s chief executive, said: “This is an 2010 this equates to 2,416 full 3Ă˜&$-$1 !+$ a snapshot of how important survey3(-&Ă˜3 because it provides time equivalent (FTE) or a +Ă˜241&$18Ă˜./$1 5.7 per those who work within the NHS feel about what they do cent reduction. 5IF5JTBIJHIMZBEBQUBCMFUBCMFDBQBCMF pp 5SBWFSTJOHUPQXJUIPGGTFUDPMVNOCSFBLJNQSPWFTUIFUBCMFTJNBHJOHĂš and the experiences they have at FYJCJMJUZ work. PGBWBSJFUZPGQSPDFEVSFT&TDINBOO -JHIUXFJHIU TFBNMFTTNBUUSFTTFTXJUITFDVSFn7FMDSPGSFFoĂ™ YJOHT At the pp same time, the number “I know that the vast majority of NHS employees are IBWFEFWFMPQFEBSBOHFPGBDDFTTPSJFT of professionally qualiĂ€ ed clinical p *OUFSDIBOHFBCMFIFBEBOEMFHTFDUJPOTPGGFSPQUJNVNQBUJFOUQPTJUJPOJOH p personally committed and motivated to do the best staff including consultants, GPs UIBUTJNQMJGZUIFVOEFSUBLJOHPGNPTU p p LHNBYJNVNQBUJFOUXFJHIUBOEFYUFOEBCMFNNXJEFUPQUP work they possibly can. The survey results will help and nurses rose by 2,707 to trusts to pinpoint what else they can do to support and QSPDFEVSFTJOUIFĂ™ FMETPGPCTUFUSJDTBOE TVJUBMMCPEZUZQFT 721,717 which equates to 617,232 develop staff to ensure they can provide the best care p increase VJEBOEEJSUJOHSFTT &BTJMZNBJOUBJOFE JNQBDUSFTJTUBOU"#4DPWFSTQSFWFOUĂš FTE, anp of 0.5 per cent. HZOBFDPMPHZ5IJTJTBDIJFWFECZFOTVSJOH for patients.

made a difference to patients, and 87% were satisÀed with the quality of care they personally gave. Both these Àgures were unchanged from 2009.

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groups of employees, for instance in the support they We have always been clear%JSFDUQMBDFNFOUMFHIPMEFST received from their manager and the extent to which that efĂ€ciency savings must not they felt their work was valued by their trust. However, impact adversely on  patient care. "SUJDVMBUJOHMFHT many ambulance staff work in a different environment to 3Ă˜.!23$31("2Ă˜Ă˜&8$".+.&8Ă˜3 !+$ Instead the size and shape of the others in the NHS, making comparisons inappropriate. workforce needs to  change so -JHIUXFJHIUMFHLJU p p 4IPSUFSUBCMFUPQ NN SFEVDFTNBOVBMIBOEMJOH There were improvements for ambulance workers that we have less bureaucrats and since the 2009 survey in some respects, notably the p p 1PXFSFECBDLSFTUBMMPXTGPSl"TTJTUFE%FMJWFSZm 1PXFSFECBDLSFTUBMMPXTGPSl"TTJTUFE%FMJWFSZm  staff 5VSOFS8BSXJDLLJEOFZTVQQPSUT the right levels of clinical so proportions that received appraisals and health and JOBTJOHMFNPWFNFOU that care can be brought closer to safety training.  *OTUSVNFOUUSBZ home for p p patients. .BYJNVNQBUJFOUXFJHIUPG,HJOMJUIPUPNZQPTJUJPO Appraisals, training and development p p 8FJHIUBTTJTUFEBSUJDVMBUJOHMFHTFDUJPOT  Seventy-seven per cent of staff had received an appraisal The census comes out on 4UFQTUBOET the p p "VUPMFWFMGVODUJPOXJUIJODSFBTFETQFFEGPSFNFSHFODZQSPDFEVSFT "VUPMFWFMGVODUJPOXJUIJODSFBTFETQFFEGPSFNFSHFODZQSPDFE or development review, upEVSFT from 69% in 2009, but only same day as the latest monthly  5TJEFTVQQPSUT 34% felt their appraisal or review was well structured, workforce data for December (31% in 2009). Despite high levels of training, only 35% 2010 which also continues to  *OĂ™MMTFDUJPO of staff felt they had good opportunities to progress at show a decline in managers, senior work, against 40% in 2009. Of ambulance staff, 70% had managers and infrastructure an appraisal, up from 47% in 2009, but only 20% felt it support staff. &TDINBOO)PMEJOHT-UE 1FUFS3PBE  5FM    'BY    -BODJOH 8FTU4VTTFY #/5+ 'PSGVSUIFSEFUBJMT WJTJU XXXFTDINBOODPVL

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Errors, near misses and incidents Thirty-two per cent of staff said they had seen at least one error, “near missâ€? or incident that could have hurt staff or patients in the last month (compared with 33% in 2009). Of front-line staff, 42% said that they had witnessed  at least one such adverse event in the last month (43% in 2009). The number of ambulance staff witnessing errors, near misses or incidents has decreased from 37% in 2009 to 34% in 2010. Staff turnover There has been a slight increase in the proportion of staff who said they intended to leave their employer. Twentynine per cent of all the respondents, compared with 28% in 2009, said they often felt like leaving their trust; 21% (20% in 2009) said they would probably look for another job in the next year; and 15% (14% in 2009) said they would leave as soon as they could Ă€nd another job.

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Hygiene There has been a slight reduction in the proportion of staff who said that hot water, soap and paper towels or alcohol rubs were always available when they needed them – down to 68% from 71% in 2009. Twenty Àve  percent said that they were available most of the time, compared with 23% previously. Sixty per cent said that hand-washing materials were always available to patients (63% in 2009) and 22% that they were available most of the time (previously 21%).

14 14 

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5IFEFUBJMTHJWFOJOUIJTMFBĂšFUBSFDPSSFDUBUUJNFPGHPJOHUPQSFTT4QFDJBMPGGFSTBSFWBMJEVOUJM UI"QSJM "QSJM BOEDBOOPUCFVTFEJODPOKVODUJPOXJUIBOZPUIFSPGGFS&RVJQNFOUNBZCFTVCKFDUUPBWBJMBCJMJUZ&TDINBOO BOEDBOOPUCFVTFEJODPOKVODUJPOXJUIBOZPUIFSPGGFS&RVJQNFOUNBZCFTVCKFDUUPBWBJMBCJMJUZ&TDINBOO It’s easy to subscribe, just visit our website at www.otjonline.com and pay via Card or Paypal. SFTFSWFTUIFSJHIUUPJNQSPWFUIFFRVJQNFOUTIPXOBUBOZUJNF5IFl&TDINBOOmOBNFBOEMPHP BSFUSBEFNBSLT SFTFSWFTUIFSJHIUUPJNQSPWFUIFFRVJQNFOUTIPXOBUBOZUJNF5IFl&TDINBOOmOBNFBOEMPHP BSFUSBEFNBSLT Subscribing to the OTJ costs ÂŁ14.00 per year for delivery in the UK or ÂŁ21.00 overseas. PG&TDINBOO)PMEJOHT-UEl&TDINBOO&RVJQNFOUmJTBUSBEJOHOBNFPG&TDINBOO)PMEJOHT-UE

10

Alternativelyy jjust Àll in your address details below and return with a cheque. y q

Name Address

___________________________________________ ___________________________________________ ___________________________________________ Town ___________________________________________ County ___________________________________________ Postcode ________________Tel_________________________ Please enclose cheque made payable to “Lawrand Ltd� and return to: Lawrand Ltd PO Box 51 Pontyclun CF72 9YY

THE OPERATING THEATRE JOURNAL



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p $PSEFEIBOETFUGPSTJNQMF JOUVJUJWFDPOUSPM p

Commenting on the census data, “The Department of Health will also make use of the SFEVDJOHUIFMFWFMPGNBOVBMIBOEMJOH Health Minister Simon Burns said: Ă€ndings, to inform its policy-making and its work on The latest censusSFRVJSFEUPQPTJUJPOUIFQBUJFOU shows that the performance measurement and service improvement. NHS has taken up the challenge 3Ă˜,.#4+ 1Ă˜&$-$1 !+$ the survey “For+Ă˜Ă˜.13'./ our part, as the care $#("Ă˜3 services 3 regulator, to reduce management costs Ă€ ndings will contribute to the information we gather whilst the number of doctors p 4JNQMFUPDPOĂ™ p HVSFGPSHFOFSBMPSPSUIPQBFEJDUSBVNBTVSHFSZ on how well trusts are continuing to comply with some  $BSCPOĂ™ CSFBOBFTUIFUJDTDSFFO and nurses has increased. p p 8JEFSBOHFPGPSUIPQBFEJDBUUBDINFOUTBWBJMBCMF of the essential standards of quality and safety that Reducing bureaucracy is vital p LHNBYJNVNQBUJFOUXFJHIUBOEFYUFOEBCMFNN p underpin our work.â€?  so/BSSPXBSNCPBSE to modernising the NHS

Eight per cent of staff overall reported experiencing physical violence from patients, relatives or other members of the public, while 15% said they had been subjected to bullying, harassment and abuse. The Àgures on violence were higher for front-line staff  (12%), particularly workers in ambulance trusts (18%) and mental health trusts (15%). Bullying, harassment and abuse from patients and relatives were also more prevalent among front-line staff (18%) and much worse for ambulance workers (27%). Fifteen per cent of all staff had experienced bullying, harassment and abuse from their line manager or other colleagues.




Surgery Simulator Lives are in your hands as you take on the role of a top surgeon at a busy city hospital. With eight authentically recreated surgical procedures in your repertoire, your skills are much in demand.

On 30th March 2011 NICE extended its recommendation on the CardioQ estimating that it could save the NHS in England more than £400m a year. The blood à ow monitor, which was originally developed in the UK, reduces the rates of post operative complications as well as reducing the length of critical care and overall hospital stay. However, in order for these patient and Ànancial beneÀts to be realised it is vital that this innovative technology is widely implemented throughout the NHS; not something the NHS is particularly good at or well known for.

You will need to keep your brain as sharp as your scalpel as you operate on fractures, remove an inà amed appendix or tonsils, treat infected gall bladders, attend to varicose veins, repair hernias, restore vision in cataract procedures and deal with the injuries of a road trafÀc accident.



Scrub up and enter The Operating Theatre re e

Your patients are  prepped for surgery !

Price: P i ÂŁ24 ÂŁ24.99 99

Perform each operation using state of the art medical equipment, assisted by animated surgical staff. Make sure you monitor the vital signs of your patient and if blood pressure and heart rate falls be ready to intervene. You are the lead surgeon and split second decisions that lead to triumph and tragedy are carried on your shoulders alone. You are equipped with the tools of the trade including scalpel, clamps, compresses, needles and sutures and a host of modern equipment, yet your greatest tools are your steady hands and an incisive mind Featuring the following Operations... - Cataract - Varicose veins (varicosis)  - Gall bladder removal (laparoscopic cholecystectomy) - Hernia (herniotomy) - Treatment of a lower leg fracture - Tonsil removal (tonsillectomy) - Appendix removal (appendectomy) - TrafĂ€c accident Based in the United Kingdom, Excalibur is the mainstream PC publishing arm of Contact Sales. It’s headed up by Robert Stallibrass who brings over 20 years’ experience in computer games sales and marketing to the “round tableâ€?. Until now Contact Sales has concerned itself exclusively with publishing Ă ight and train simulator add-ons. Its titles can be found in all of the major UK retail outlets including; PC World/Dixons, Game, Virgin, HMV, GameStation, Amazon and independent stores. 'PSGVSUIFSEFUBJMT WJTJU

Ă˜

NICE is recognised as the organisation with the expertise to review the evidence linked to individual technologies but experience shows that NHS organisations also beneÀt from receiving practical support at the front line of  rapid uptake of this technology. The NHS Technology care delivery to enable and Adoption Centre, or NTAC, which was developed to address the technology adoption issues which reside in the NHS has actively supported the uptake of CardioQ in a number of hospitals publishing a detailed How to Why to Guide™ about how to implement its use. NTAC was very pleased to collaborate with and share its work with NICE during their review. Part of NTAC’s ongoing remit is to review healthcare technologies which have been under utilised within the NHS. For the technologies shown to offer signiÀcant patient beneÀt NTAC produces a How to Why to Guide™. These Guides provide comprehensive and relevant information for clinicians, managers, key decision makers and other stakeholders on how to implement speciÀc technologies. Guides have been produced on a range of technologies including the Doppler Guided Intraoperative Fluid Management or the CardioQ.





Blood Àow monitor could save NHS £400m per year – but only if implemented correctly...

Speaking about NICE’s recommendation Deltex Medical Group Chief Executive, Ewan Phillips said: “It takes a long time for ideas from the clinicians to feed through to the senior management – the sort of people who can make decisions to do things on a wide scale. That’s always been a problem in the NHS. “NTAC is vital to widespread adoption of this, and many other, technologies with proven patient beneĂ€t and the opportunity to save the NHS millions. Essentially NTAC provides the roadmap which can help the NHS achieve better patient outcomes and also achieve the signiĂ€cant cost savings it is striving for,â€? As part of the development of the How to Why to Guide™ NTAC worked with three NHS hospitals across England implementing Doppler guided intraoperative Ă  uid management into their routine clinical practice. Following a structured implementation programme, patient outcomes were measured in 1200 cases. The beneĂ€ts and barriers and impact of implementation on the NHS resources assessed for each patient care episode by measuring and comparing hospital stay, the use of invasive central venous catheters, reoperation and readmission rates. The results of this implementation project demonstrated that encouraging research data can be reproduced in routine NHS clinical and operational practice with a three day reduction in hospital stay and fewer postoperative complications for patients • 3.5 day reduction in length of stay (LOS)*. • 4 day reduction in post-operative LOS • 23% decrease in CVC insertion rate. • 29% decrease in re-admission rate. • 30% decrease in re-operation rate. • A 5 day reduction in LOS within Critical Care (Level 3).

03$"--Ă˜Ă˜Â&#x;Â&#x; NTAC Chief Executive Sally Chisholm said: “Our work is focused on achieving

Attention! This product is a computer game and not for training or tuition purposes!!! The product VVV DRBGL@MM BN TJS is NOT suitable for conveying specialist knowledge in medicine or surgery. All operations shown are simpliĂ€ed considerably and only represented in excerpts. It is not possible to prepare yourself in any way for medical operations using this software or gain knowledge and skills that could be implemented in reality. We cannot accept ANY RESPONSIBILITY for the correctness of the operation procedures and information shown. (c) 2010 Visual Imagination Software (c) 2010 2010 rondomedia Marketing & Vertriebs GmbH Age Rating: 7, Fear Warning Minimum System Requirements - Operating system: Windows XP, Windows Vista or Windows 7 - Processor 1.5 GHz, 1.5 GB RAM - At least 1.5 GB free hard disk space - 128 MB 3D graphic card - CD-ROM/DVD-ROM drive - DirectX 9.0 compatible hardware When responding to articles please quote ‘OTJ’

reproducible beneĂ€ts in the clinical setting, or more crudely, the real-world. By working with the NHS we can take under-utilised technologies which have shown that they can improve clinical outcomes whilst saving the NHS money and quite literally ‘show’ the NHS how to implement them effectively. Headlines such as ‘savings of ÂŁ400m per year’ are incredibly exciting exciting, particularly in the current economic climate and with the Ă€nancial pressures being faced by the NHS. However, the stark reality is that if technologies such as the CardioQ are not implemented throughout the NHS these beneĂ€ts will never be anything but a headline.â€? For more information about the NHS Technology Adoption Centre visit http://www.technologyadoptionhub.nhs.uk/

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When responding to articles please quote ‘OTJ’

Issue 247

APRIL 2011

11


Manager g numbers in the NHS decrease. The NHS has made good progress in reducing bureaucracy and management costs according to the latest workforce statistics out on the 22nd of March.

NHS staff have their say as the results of national survey are published The results of the eighth annual survey to collect the views of NHS staff across England were pubished on16 March by the Care Quality Commission (CQC). Almost 165,000 employees at the country’s , p y y 388 trusts took part in the survey, which was carried out during the Ànal quarter of last year. This represented 54% of those who were asked to participate, compared with 55% in 2009. The survey covered all occupational groups, from doctors and nurses to clerical workers, and from radiographers to clinical psychologists.

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Commenting on the census data, “The Department of Health will also make use of the Health Minister Simon Burns said: Ă€ndings, to inform its policy-making and its work on The latest census shows that the performance measurement and service improvement. NHS has taken up the challenge 3Ă˜,.#4+ 1Ă˜&$-$1 !+$ the survey “For+Ă˜Ă˜.13'./ our part, as the care $#("Ă˜3 services regulator, to reduce management costs Ă€ ndings will contribute to the information we gather whilst the number of doctors p 4JNQMFUPDPOĂ™ HVSFGPSHFOFSBMPSPSUIPQBFEJDUSBVNBTVSHFSZ well trusts on how are continuing to comply with some and nurses has increased. p 8JEFSBOHFPGPSUIPQBFEJDBUUBDINFOUTBWBJMBCMF of the essential standards of quality and safety that Reducing bureaucracy is vital p LHNBYJNVNQBUJFOUXFJHIUBOEFYUFOEBCMFNN underpin our work.â€? to modernising the NHS so that everyXJEFUPQUPTVJUBMMCPEZUZQFT penny saved can be Some of the Ă€ndings from the NHS staff survey reinvested into improving patient p 4PGUTUBSUTUPQUFDIOPMPHZGPSQBUJFOUDPNGPSUBOETBGFUZ Certain questions in the survey showed that ambulance care and up quality. p driving 4IPVMEFSTVSHFSZNBEFFBTZXJUIUIFQPXFSBTTJTUFE5TIPVMEFSQPTJUJPOFS personnel had poorer experiences compared with other

ubscribe to the OTJ

made a difference to patients, and 87% were satisĂ€ed with the quality of care they personally gave. Both these Ă€gures were unchanged from 2009. Violence and abuse Eight per cent of staff overall reported experiencing physical violence from patients, relatives or other members of the public, while 15% said they had been subjected to bullying, harassment and abuse. The Ă€gures on violence were higher for front-line staff (12%), particularly workers in ambulance trusts (18%) and mental health trusts (15%). Bullying, harassment and abuse from patients and relatives were also more prevalent among front-line staff (18%) and much worse for ambulance workers (27%). Fifteen per cent of all staff had experienced bullying, harassment and abuse from their line manager or other colleagues. Hygiene There has been a slight reduction in the proportion of staff who said that hot water, soap and paper towels or alcohol rubs were always available when they needed them – down to 68% from 71% in 2009. Twenty Ă€ve percent said that they were available most of the time, compared with 23% previously. Sixty per cent said that hand-washing materials were always available to patients (63% in 2009) and 22% that they were available most of the time (previously 21%). Errors, near misses and incidents Thirty-two per cent of staff said they had seen at least one error, “near missâ€? or incident that could have hurt staff or patients in the last month (compared with 33% in 2009). Of front-line staff, 42% said that they had witnessed at least one such adverse event in the last month (43% in 2009). The number of ambulance staff witnessing errors, near misses or incidents has decreased from 37% in 2009 to 34% in 2010. Staff turnover There has been a slight increase in the proportion of staff who said they intended to leave their employer. Twentynine per cent of all the respondents, compared with 28% in 2009, said they often felt like leaving their trust; 21% (20% in 2009) said they would probably look for another job in the next year; and 15% (14% in 2009) said they would leave as soon as they could Ă€nd another job.

14

groups of employees, for instance in the support they We have always been clear received from their manager and the extent to which that efĂ€ciency savings must not they felt their work was valued by their trust. However, impact adversely on patient care. staff work in many ambulance a different environment to 3Ă˜.!23$31("2Ă˜Ă˜&8$".+.&8Ă˜3 !+$ Instead the size and shape of the others in the NHS, making comparisons inappropriate. workforce needs to change so p 4IPSUFSUBCMFUPQ NN SFEVDFTNBOVBMIBOEMJOH There were improvements for ambulance workers that we have less bureaucrats and since the 2009 survey in some respects, notably the p 1PXFSFECBDLSFTUBMMPXTGPSl"TTJTUFE%FMJWFSZm the right levels of clinical staff so proportions that received appraisals and health and JOBTJOHMFNPWFNFOU that care can be brought closer to safety training. home for p patients. .BYJNVNQBUJFOUXFJHIUPG,HJOMJUIPUPNZQPTJUJPO Appraisals, training and development p 8FJHIUBTTJTUFEBSUJDVMBUJOHMFHTFDUJPOT Seventy-seven per cent of staff had received an appraisal The census comes out on the p "VUPMFWFMGVODUJPOXJUIJODSFBTFETQFFEGPSFNFSHFODZQSPDFEVSFT or development review, up from 69% in 2009, but only same day as the latest monthly 34% felt their appraisal or review was well structured, workforce data for December (31% in 2009). Despite high levels of training, only 35% 2010 which also continues to of staff felt they had good opportunities to progress at show a decline in managers, senior work, against 40% in 2009. Of ambulance staff, 70% had managers and infrastructure an appraisal, up from 47% in 2009, but only 20% felt it support staff. &TDINBOO)PMEJOHT-UE 1FUFS3PBE  5FM    'BY    -BODJOH 8FTU4VTTFY #/5+ XXXFTDINBOODPVL

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Staff as advocates Nearly two-thirds (64%) of respondents said they would be happy with the standard of care provided by their trust if a relative or friend needed treatment (compared with 62% in 2009), and over half (53%) said they would recommend their trust as a place to work (55% in 2009).

(&/&3"-"/%41&$*"-*45 Making a difference to patients 01&3"5*/(5"#-&4 Ninety per cent of staff felt that their role ultimately

OPERATING TABLES

The workforce census, published They were asked a broad range of questions seeking by the NHS Information Centre, their experiences of, or opinions on, matters such as shows that there was a reduction appraisals, training, job satisfaction, line management, of 2,770 managers and senior work-related stress, experience of violence and abusive managers in the NHS between behaviour, and making a difference to patients. September 2009 and September Cynthia Bower, CQC’s chief executive, said: “This is an 2010 this equates to 2,416 full 3Ă˜&$-$1 !+$ a snapshot of how because it provides important survey3(-&Ă˜3 time equivalent (FTE) or a +Ă˜241&$18Ă˜./$1 5.7 per those who work within the NHS feel about what they do cent reduction. p 5SBWFSTJOHUPQXJUIPGGTFUDPMVNOCSFBLJNQSPWFTUIFUBCMFTJNBHJOHĂš work. and the experiences they have at FYJCJMJUZ -JHIUXFJHIU TFBNMFTTNBUUSFTTFTXJUITFDVSFn7FMDSPGSFFoĂ™ YJOHT At the p same time, the number “I know that the vast majority of NHS employees are of professionally qualiĂ€ed clinical p *OUFSDIBOHFBCMFIFBEBOEMFHTFDUJPOTPGGFSPQUJNVNQBUJFOUQPTJUJPOJOH personally committed and motivated to do the best staff including consultants, GPs p LHNBYJNVNQBUJFOUXFJHIUBOEFYUFOEBCMFNNXJEFUPQUP work they possibly can. The survey results will help and nurses rose by 2,707 to trusts to pinpoint what else they can do to support and TVJUBMMCPEZUZQFT 721,717 which equates to 617,232 develop staff to ensure they can provide the best care &BTJMZNBJOUBJOFE JNQBDUSFTJTUBOU"#4DPWFSTQSFWFOUĂš VJEBOEEJSUJOHSFTT FTE, anpincrease of 0.5 per cent. for patients.

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was well structured (14% in 2009). While 78% of all staff received health and safety training (compared with 76% in 2009), the Àgures for ambulance staff rose considerably, to 55% compared with 45% in 2009.

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Fewer NHS managers, more Doctors and Nurses

5




Surgery Simulator Lives are in your hands as you take on the role of a top surgeon at a busy city hospital. With eight authentically recreated surgical procedures in your repertoire, your skills are much in demand.

On 30th March 2011 NICE extended its recommendation on the CardioQ estimating that it could save the NHS in England more than £400m a year. The blood Áow monitor, which was originally developed in the UK, reduces the rates of post operative complications as well as reducing the length of critical care and overall hospital stay. However, in order for these patient and Ànancial beneÀts to be realised it is vital that this innovative technology is widely implemented throughout the NHS; not something the NHS is particularly good at or well known for.

You will need to keep your brain as sharp as your scalpel as you operate on fractures, remove an inÁ amed appendix or tonsils, treat infected gall bladders, attend to varicose veins, repair hernias, restore vision in cataract procedures and deal with the injuries of a road trafÀc accident.

Scrub up and enter The Operating Theatre re e

Blood Àow monitor could save NHS £400m per year – but only if implemented correctly...

Price: P i £24 £24.99 99

Your patients are prepped for surgery !

Perform each operation using state of the art medical equipment, assisted by animated surgical staff. Make sure you monitor the vital signs of your patient and if blood pressure and heart rate falls be ready to intervene. You are the lead surgeon and split second decisions that lead to triumph and tragedy are carried on your shoulders alone. You are equipped with the tools of the trade including scalpel, clamps, compresses, needles and sutures and a host of modern equipment, yet your greatest tools are your steady hands and an incisive mind Featuring the following Operations... - Cataract - Varicose veins (varicosis) - Gall bladder removal (laparoscopic cholecystectomy) - Hernia (herniotomy) - Treatment of a lower leg fracture - Tonsil removal (tonsillectomy) - Appendix removal (appendectomy) - TrafÀc accident Based in the United Kingdom, Excalibur is the mainstream PC publishing arm of Contact Sales. It’s headed up by Robert Stallibrass who brings over 20 years’ experience in computer games sales and marketing to the “round table”. Until now Contact Sales has concerned itself exclusively with publishing Áight and train simulator add-ons. Its titles can be found in all of the major UK retail outlets including; PC World/Dixons, Game, Virgin, HMV, GameStation, Amazon and independent stores. Attention! This product is a computer game and not for training or tuition purposes!!! The product is NOT suitable for conveying specialist knowledge in medicine or surgery. All operations shown are simpliÀed considerably and only represented in excerpts. It is not possible to prepare yourself in any way for medical operations using this software or gain knowledge and skills that could be implemented in reality. We cannot accept ANY RESPONSIBILITY for the correctness of the operation procedures and information shown. (c) 2010 Visual Imagination Software (c) 2010 2010 rondomedia Marketing & Vertriebs GmbH Age Rating: 7, Fear Warning Minimum System Requirements - Operating system: Windows XP, Windows Vista or Windows 7 - Processor 1.5 GHz, 1.5 GB RAM - At least 1.5 GB free hard disk space - 128 MB 3D graphic card - CD-ROM/DVD-ROM drive - DirectX 9.0 compatible hardware When responding to articles please quote ‘OTJ’

NICE is recognised as the organisation with the expertise to review the evidence linked to individual technologies but experience shows that NHS organisations also beneÀt from receiving practical support at the front line of care delivery to enable rapid uptake of this technology. The NHS Technology and Adoption Centre, or NTAC, which was developed to address the technology adoption issues which reside in the NHS has actively supported the uptake of CardioQ in a number of hospitals publishing a detailed How to Why to Guide™ about how to implement its use. NTAC was very pleased to collaborate with and share its work with NICE during their review. Part of NTAC’s ongoing remit is to review healthcare technologies which have been under utilised within the NHS. For the technologies shown to offer signiÀcant patient beneÀt NTAC produces a How to Why to Guide™. These Guides provide comprehensive and relevant information for clinicians, managers, key decision makers and other stakeholders on how to implement speciÀc technologies. Guides have been produced on a range of technologies including the Doppler Guided Intraoperative Fluid Management or the CardioQ. Speaking about NICE’s recommendation Deltex Medical Group Chief Executive, Ewan Phillips said: “It takes a long time for ideas from the clinicians to feed through to the senior management – the sort of people who can make decisions to do things on a wide scale. That’s always been a problem in the NHS. “NTAC is vital to widespread adoption of this, and many other, technologies with proven patient beneÀt and the opportunity to save the NHS millions. Essentially NTAC provides the roadmap which can help the NHS achieve better patient outcomes and also achieve the signiÀcant cost savings it is striving for,” As part of the development of the How to Why to Guide™ NTAC worked with three NHS hospitals across England implementing Doppler guided intraoperative Áuid management into their routine clinical practice. Following a structured implementation programme, patient outcomes were measured in 1200 cases. The beneÀts and barriers and impact of implementation on the NHS resources assessed for each patient care episode by measuring and comparing hospital stay, the use of invasive central venous catheters, reoperation and readmission rates. The results of this implementation project demonstrated that encouraging research data can be reproduced in routine NHS clinical and operational practice with a three day reduction in hospital stay and fewer postoperative complications for patients • 3.5 day reduction in length of stay (LOS)*. • 4 day reduction in post-operative LOS • 23% decrease in CVC insertion rate. • 29% decrease in re-admission rate. • 30% decrease in re-operation rate. • A 5 day reduction in LOS within Critical Care (Level 3). NTAC Chief Executive Sally Chisholm said: “Our work is focused on achieving reproducible beneÀts in the clinical setting, or more crudely, the real-world. By working with the NHS we can take under-utilised technologies which have shown that they can improve clinical outcomes whilst saving the NHS money and quite literally ‘show’ the NHS how to implement them effectively. Headlines such as ‘savings of £400m per year’ are incredibly exciting, particularly in the current economic climate and with the Ànancial pressures being faced by the NHS. However, the stark reality is that if technologies such as the CardioQ are not implemented throughout the NHS these beneÀts will never be anything but a headline.” For more information about the NHS Technology Adoption Centre visit http://www.technologyadoptionhub.nhs.uk/

Ànd out more 020 7100 2867 • e-mail admin@lawrand.com

When responding to articles please quote ‘OTJ’

Issue 247

APRIL 2011

11


BD launches new fast-clotting serum blood collection tube Delivers quality samples fast

Liberate Cosmetic Surgery: New Survey Reveals 30% Of Women NEVER Saw Their Cosmetic Surgeon During Treatment ‘BYPASS’ - Before You Pay, Ask to See Surgeon, says Liberate With the recent deaths following botched cosmetic surgery abroad of 21 year old Claudia Adeseye Aderotimi and former Miss Argentina Solange Magnano, mother of two in Buenos Aires, women still appear to put price above safety. A new survey conducted by Liberate, the UK’s largest network of BAAPS* and/or BAPRAS**-accredited cosmetic surgeons, clearly shows the need for women to be better informed about what can go wrong with cosmetic surgery and the importance of knowing the qualiÀcations and experience of their surgeon, to help them make an informed decision.

BD (Becton, Dickinson and Company) recently announced the launch of BD Vacutainer® Rapid Serum Tube, a blood collection device designed to help acute healthcare facilities rapidly analyse blood serum for patient diagnosis. The BD Vacutainer® Rapid Serum Tube features the BD Hemogard™ safety-engineered closure, which enhances healthcare worker safety as well as compatibility with clinical analysers utilising front-end automation. “Blood test results drive many important medical decisions, including how to treat or medicate patients,” said Ana Stankovic, MD, PhD, MSPH, Vice President, Medical and ScientiÀc Affairs and Clinical Operations for BD Diagnostics - Preanalytical Systems. “Technologies such as the BD Vacutainer® Rapid Serum Tube can help reduce the time it takes to get answers from blood tests and have a signiÀcant impact on patient care and hospital productivity.” With a Àve-minute clotting time and as little as three minutes of centrifugation (at 4000 g), the BD Vacutainer® Rapid Serum Tube can offer savings of up to 32 minutes of laboratory time . Standard serum separator tubes require a 30-minute clot time followed by 10 minutes of centrifugation before clinical laboratory professionals can begin analysing the sample and getting test results. “By taking essentially one sixth of the time of standard serum tubes to clot, the BD Vacutainer® Rapid Serum Tube is poised to help facilities signiÀcantly improve patient throughput, especially in places like emergency rooms where decisions to admit or treat patients are often based on blood test results,” said Stankovic. The 5 ml-draw, 13x100ml plastic sterile blood-collection tube combines a thrombin-based additive with gel technology, which creates a high quality serum sample by minimising Àbrin formation and haemolysis. Haemolysis and clotted specimens are two common examples of sub-optimal quality, both of which can lead to laboratory errors. Studies conducted by BD show a 59 percent reduction of haemolysis and Àbrin strand formation in the BD Vacutainer® Rapid Serum Tube versus the serum control tube. This observed sample quality improvement may help lower the number of repeat collections by phlebotomy, which in turn can increase the productivity of the laboratory. For more information, please visit www.bd.com. BD White Paper: VS5713: BD Vacutainer™ PLUS SST™ and Serum Tubes, Catalog #367969 and #367895: A Comparative Evaluation of the 16mm BD Hemogard™ Closures with Respect to User Exposure to Blood and Cap Removal and Reinsertion Forces. 2001. BD White Paper: VS8126 Evaluation of the Performance of the BD Vacutainer® Rapid Serum Tube with BD Hemogard™ Closure Over a Range of Centrifugation G-Force. 2010. Prusa R, Doupovcova J, Warunek D and Stankovic A.K. Improving Laboratory EfÀciencies Through SigniÀcant Time Reduction in the Preanalytical Phase. Clin Chem Lab Med 2010;48(2):293–296. Steindel S, Howanitz P. Physician satisfaction and emergency department laboratory test turnaround time. Arch Pathol Lab Med 2001;125:863–71 Bonini P, Plebani M, Ceriotti F, Rubboli F. Errors in Laboratory Medicine. Clinical Chemistry 2002:48(5):691–698. BD Data on Àle: Evaluation of Hemolysis and Fibrin in the BD Vacutainer® Rapid Serum Tube – 2010.

Liberate, which has over 60 locations across the UK, surveyed 3000 women between the ages of 18-34 and found that 30% of women had undergone cosmetic surgery with breast augmentation (“boob job”) being the most popular procedure (28%) followed by Nose (17%) eyes (11%) and Liposuction/tummy tuck (15%). However, the survey conÀrmed that many women do not receive the service they deserve from their cosmetic surgery provider. Even though 74% felt it was important to know and see their surgeon throughout the course of treatment, the reality was that 30% of women who had surgery NEVER saw their surgeon. The Liberate survey also highlights the need for women to be better informed of the dangers of cosmetic surgery abroad and in the UK. A staggering 40% admitted that they would consider having surgery abroad if it was cheaper and half the women surveyed would have cosmetic surgery if cost was no object with 17% prepared to take out a loan to cover this. Plastic and Cosmetic Surgeon James Murphy, a founder member of Liberate, said: “The new survey highlights the fact that although people claim safety is the most important decision when considering cosmetic surgery, many will still be inÁuenced by price regardless of the physical cost. Cosmetic surgery is a medical surgical procedure and it should be treated as such.” Without the tools needed to make responsible choices cosmetic surgery can end up costing people Ànancially, physically and psychologically, Liberate aims to give people the power to choose, providing them with a new and safer approach to cosmetic surgery. For more information, please visit www.liberatecosmeticsurgery.com

Medical device Àrm secures funding of €1.6 million An early-stage medical device company based in Galway has secured an investment of €1.6 million to develop its pain management technology. AeroSurgical uses aerosol technology to deliver medicine into the abdominal cavity of patients during surgery, to combat post-surgical complications such as pain and adhesions. Among the participants in this funding round were the Western Development Commission, Enterprise Ireland, existing shareholders and new private investors. The company was spun out of Aerogen Ltd in December 2009, to focus on the surgical drug delivery business. In 2008, Aerogen was the subject of a €20 million management buyout, led by chief executive John Power. He is a shareholder in AeroSurgical, as is pharmaceutical giant Novartis. AeroSurgical’s chief executive Nevan Elam said that the company’s technology was designed to deliver local anaesthetics into the abdomen during keyhole (or laparoscopic) surgery, so that the patient felt signiÀcantly less pain in recovery. The proceeds from the investment will allow the company to conduct clinical studies on its pain product, as well as to begin development on other products. AeroSurgical is one of a growing number of medical device and life science projects based in the west of Ireland. The region is being promoted as a centre of excellence for medical devices. To date, the Western Investment Fund has invested in 89 enterprises, 18 of which are in the medical device sector, making it one of the largest investors in this sector in Ireland. Source: The Post.IE

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Issue 247

APRIL 2011

13


BERCHTOLD’s new OPERON D 760 high-tech OR-Table An all-rounder with many applications Versatile, with premium construction and high capacity, the OPERON D 760 OR-Table guarantees ideal working conditions in the operating theatre with an extensive range of accessories and various mutually compatible leg plates. The surgeon can adjust the new OR-Table height by 440 mm for ergonomic working. Patients can be positioned Áexibly on a surface of four modules. The table can support extremely obese patients weighing up to 450 kg. The basic version of the table includes a head rest, and back and seat plates. The leg plate drive is available either in one piece as a standard or short version, or as split leg plates, ideal for laparoscopic abdominal surgery. The OPERON D 760 is suitable for all surgical aspects as well as for outpatient treatment. With a minimum height of 635 millimetres, a Trendelenburg position of 30 degrees and a tilt of up to 20 degrees, all major positions are easily achieved. Whether surgical procedures while standing or sitting are required, with its wide height adjustment range up to 1075 mm, the OPERON D 760 is ideal to meet the needs of surgeons at any time. An inÀnitely adjustable kidney elevator goes up to 75 millimetres in height. The robust construction of the table, along with four hydraulic cylinders ensures secure positioning and optimal patient safety. This is also due to the 534 mm wide bearing surface. Special padding protects the patient from pressure sores. BERCHTOLD achieves this pressure ulcer prophylaxis by a pad of high-quality viscoelastic and thermoactive foam that adjusts to the body. The table is equipped with an X-ray cassette tunnel along its entire length, even over the column. This is fully integrated under the tabletop, so that for conventional X-rays there is no need for additional X-ray attachments. The carbon Àber imaging extension plate permits 1117 mm metal-free imaging and unrestricted imaging above 1626 mm. The OPERON is adjusted by remote control. All functions are clearly laid out with keys on the user-friendly hand pendant. Comfort functions for all important patient positions are already programmed in. This makes the table intuitive and fast to use. Easy-moving rollers and the InstaDrive electro-hydraulic traction drive facilitate patient transport. This makes it easy to move and manoeuvre the table. Slow deceleration provides a high level of patient safety. The OR-Table has a serial interface that can be used for rapid and accurate status analysis, fault diagnosis or individual adaptation of parameters such as adjustment speeds. Operating staff can adjust the OPERON D 760 manually by foot pump and an additional hand pendant attached directly to the table column. Existing accessories from BERCHTOLD’s OPERON OR-Table range is compatible with the standard rails of the table and can be fully integrated. Further information email: Nicole.Schaumburg@BERCHTOLD.biz www.BERCHTOLD.biz When responding to articles please quote ‘OTJ’

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Figure 1: The split leg plates of the OPERON D 760 provide the surgeon with optimal access conditions during laparoscopic surgery.

Figure 2: The D 760 OR-Table height can be adjusted from 635 mm to 1075 mm.

Surgical instruments with electronic serial numbers Be it a heart transplant or a Cesarean section, every operation requires a wide variety of surgical instruments, from simple retractors, clamps, scalpels and scissors to more specialist devices such as cerclage wire passers, which surgeons employ to repair long, oblique fractures in bones. These are shaped in such a way as to half encircle the broken bone, and incorporate a hollow channel. In a process not unlike stringing a parcel for posting, thread or wire is fed through the channel around the damaged bone and then knotted in place, both to support the bone and to hold the broken parts together. “Until now, it has always been time-consuming and expensive to manufacture surgical instruments featuring this kind of channel,” says Claus Aumund-Kopp of the Fraunhofer Institute for Manufacturing Technology and Advanced Materials IFAM in Bremen. Because it is nigh-on impossible to machine curved channels, shaped tubes have traditionally had to be cast, or else welded or soldered retrospectively. At the MEDTEC Europe trade show in Stuttgart (from March 22 through 24), the Bremen-based scientists presented a technique that enables the manufacture of surgical instruments of any shape, even those with complex interiors like channels, or those with integrated RFID chips. The technique in question is laser melting. Originally developed for the production of industrial prototypes, this manufacturing method uses an extremely Àne laser beam to melt a powder material into almost any desired form, one layer at a time. “Nowadays, laser melting is a mature technology, which has already proved its worth in the manufacture of medical implants,” states Aumund-Kopp. Like all generative – i.e. bottom-up – manufacturing techniques, it has two major advantages: First, unlike in turning, drilling or milling, hardly any material is wasted; and second, there are no production-related restrictions on the shape or interior structure of the workpiece. “The designer can focus exclusively on the surgeon’s stated requirements,” says the engineer. For surgical instruments, either cobalt-chromium steel or titanium powders could be used – both are standard materials in generative manufacturing. Although no-one has yet begun using the laser melting technique to produce surgical instruments, Aumund-Kopp believes it would be an ideal manufacturing method: “Even small quantities of customized surgical instruments incorporating completely new functions could easily be produced in this way,” he reports. 3-dimensional model on a computer is the only template needed; intermediate stages, including the production of special tools or casting molds, are eliminated.

Figure 3: A tilt of 20° to the right or left is possible on the OPERON D 760.

Steel components that are produced using laser melting technology also demonstrate particular electrical properties. Normally, metals shield against electromagnetic radiation such as radio waves, so whenever an RFID chip is cast in metal, a small opening must be left above it, otherwise it will not be readable. But this is not necessary with laser-melted instruments; even though they are completely shrouded in metal, the integrated RFID chips are still able to transmit and receive over short distances. “We assume that the layered structure of the material shapes the Àeld in such a way that the chips remain readable despite their metal covering,” explains Aumund-Kopp. This could prove advantageous in the operating room: After every operation, all surgical instruments have to be cleaned, sterilized and counted; if they had integrated RFID chips, quantities and individual numerical codes could be checked quickly and easily and could be electronically linked to the operation report or to speciÀc instrument data such as date of manufacture, protocols for use or current state of cleanliness. Source: Eureka Alert

The UK ODP Message Group Figure 4: The D 760 OR-Table has a safety system with foot pump and a separate control unit integrated into the table column. All electro-hydraulic driven surfaces are also equipped with collision protection.

Joining is easy, just send an e-mail,stating your name, e-mail address,position and Hospital to: theatrepractitioners-subscribe@yahoogroups.com

Images: BERCHTOLD GmbH & Co. KG

THE OPERATING THEATRE JOURNAL

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MLE & Plasma Surgical’s surgical innovation partnership jets ahead Continuing clinical success with the PlasmaJet® system fuels rapid growth for both companies The PlasmaJet console developed in partnership by MLE Creative Electronics and Plasma Surgical One year on from the commercial launch of the ground-breaking PlasmaJet® surgical system for cutting and coagulating tissue in surgery, both Plasma Surgical and development partner MLE Creative Electronics have both achieved dramatic company growth. As the Àrst device to harness the power of a pure plasma for surgery, the PlasmaJet system has seen outstanding early clinical success in the hands of key opinion leader surgeons as a very safe alternative to electrosurgery. Following this growth, both MLE and Plasma Surgical now collectively employ 110 personnel, with both companies recently opening new facilities within the UK and US respectively. MLE’s technical expertise in medical Power Supply design, as well as extensive capabilities in embedded processors and control made this electronics design company the ideal partner to co-develop the PlasmaJet with the technology’s originator, Plasma Surgical. The capability of the PlasmaJet system today has moved beyond the original concept, having evolved greatly under MLE’s expert engineering development team who responded immediately and intelligently to meet and optimise Plasma Surgical’s Ànal product objectives cost effectively. The PlasmaJet system uses a pure plasma controlled by novel electronics to cut and simultaneously coagulate all tissues, including bone, with minimal damage to the surrounding structures. The electrically neutral nature of this plasma scalpel provides a very safe alternative to the use of electrosurgery, and eliminates the risks associated with exposure to high voltages and passing electrical current through the patient’s body. Used in both conventional open and laparoscopic or keyhole surgical procedures it can greatly reduce the risk and duration of complex surgical procedures, and in some cases reduce a patient’s hospital stay. “As the Àrst device to use a pure plasma for surgical purposes, the requirements for both the power supply and the control electronics of the PlasmaJet system are technically very complex,” explained Nigel Harley, Director of Strategic Development, MLE. “Understanding both the underlying scientiÀc principles behind this device as well as the medical needs, such as a low EMC emissions proÀle and a regulatory compliant universal power supply, was key

to our successful development of the console for this highly innovative surgical tool.” MLE’s use of specialised techniques to create an ingenious medical power supply means that the PlasmaJet system can be plugged in and ready to use anywhere in the world, since it is fully compliant with the latest regulations and international speciÀcations. The PlasmaJet console contains three embedded processors; the largest controlling the graphical user interface, controls, indicators, as well as plasma generation. The power supply requires two smaller processors to control mains side sequencing and temperature with plasma ignition. Following the initial experience with a device designed for coagulation, MLE has continued to work with Plasma Surgical in the development of the present system that combines both cutting and coagulation capability, and supports the company in the manufacture of the console. Due to the complexity of the design of the PlasmaJet system, MLE will continue to be responsible for nurturing future design upgrades and ensuring an uninterrupted global supply of this exciting product. “Within MLE we have found a true partner who has exceeded all of our expectations when it comes to developing an innovative medical device, both in terms of technical ability and understanding of our brief,” concludes Peter Gibson, CEO of Plasma Surgical. “We look forward to many more successful years of design and manufacturing partnership with MLE.” Further information available from: Nigel Harley, MLE Creative Electronics. Tel +44 (0)1794 885790 Email: nigel@ml-electronics.co.uk When responding to articles please quote ‘OTJ’

Ànd out more 020 7100 2867 • e-mail admin@lawrand.com

Issue 247

APRIL 2011

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St Anthony’s Hospital Receives Gold Standard For Keyhole Surgery Equipment St Anthony’s Hospital, (www. stanthonys.org.uk) an independent private hospital in Cheam, Surrey, has received the Gold Standard in the Àrst ever audit of laparoscopic (keyhole) surgery equipment.

It is part of our policy to make sure that our equipment is up-to-date and meets the highest standards.

It is one of only three independent hospitals that received the Gold Standard.

The Association of Laparoscopic Surgeons of Great Britain & Ireland (ALSGBI) found a wide variation in the availability and quality of equipment available in theatres across the country, including almost 28 per cent of hospitals operating with obsolete and, in some cases, potentially unsafe standard equipment (“Bronze” standard).

The audit revealed that only 11% of hospitals are operating with the highest standard of equipment and resource considered appropriate to carry out safe, advanced laparoscopic (keyhole) surgery.

Sister Sarah Feeley, Operating Theatres Manager, St Anthony’s Hospital, said “We are pleased to have received the Gold Standard in the Àrst ever audit of keyhole surgery equipment.

Laparoscopic surgery is used for almost all gastrointestinal and abdominal operations, bringing patients the beneÀts of smaller scars, less pain and rapid recovery.

Supplying the British Forces in Afghanistan Judd Medical are proud to announce that they have recently been awarded an order to supply the British Forces in Afghanistan with ten surgical headlights for use in Àeld based operative procedures.

It reÁects the importance that the sisters of the Congregation of the Daughters of the Cross, the charity which owns the hospital, attach to investing in the best equipment for patients.”

The National Audit of Theatre Equipment 2010, surveyed 474 hospitals across Great Britain and Northern Ireland and graded respondents either “Bronze”, “Silver” or “Gold”. The audit asked hospitals to outline the types of laparoscopic procedures regularly performed, the age, standard and type of equipment and how their equipment was powered and maintained. For further information about the audit, please visit: http://www.alsgbi.org/events/National_ Audit_of_Theatre_Equipment_2010.htm

West Yorkshire Hospitals £331m revamp PinderÀelds and Pontefract’s £331m rebuild consisted of complete reconÀguration of health services in the West Yorkshire community. The project has delivered a new acute inpatient centre for the whole of the WakeÀeld district at the PinderÀelds site. The Pontefract site provides all the facilities for outpatients clinics including day surgery, scanning and other diagnostic techniques.

The headlights are at the forefront of technology, being battery operated, LED headlights providing surgeons or clinical technicians with illumination without the need for a separate light source. The LED lights provide quality light, combined with robust construction and long lasting, rechargeable battery packs. Judd Medical are pleased to support the British Forces and also to represent the US manufacturer of these lights, Enova Illumination, exclusively in the United Kingdom. For more information on this, or any of other products please visit our website: www.judd-medical.co.uk When responding to articles please quote ‘OTJ’

Showing in your Theatre now! THE

OPERATING THEATRE JOURNAL 16

Brandon Medical, a Leeds based medical technology company, won a contract for the huge PFI and have recently completed the installation of their products throughout the hospitals, including Operating Theatres, Neo-Natal wards, A&E and Critical Care Areas. Brandon Medical have equipped the critical care and A&E areas with their Atlas™ Critical Care Pendants. A total of 47 pendants were installed at the head of each bed to maximize the number of patient services immediately accessible around the patient bed whilst minimizing the area occupied. This is done without compromising the pendants loading capacity, both in terms of weight and amount of services available (gas outlets, power sockets, data points etc).This can make working much easier for clinical teams in what is traditionally one of the most overcrowded and cramped areas of a hospital. 21 Operating Theatres in both PinderÀelds and Pontefract are equipped with Brandon Medical’s lighting and control and power systems. THE OPERATING THEATRE JOURNAL

Galaxy Ultra HD-LED was chosen for the project with 28 of them being installed in the theatres. Galaxy Ultra emits the perfect cold light which eradicates excess heat during surgical procedures. Galaxy also has a high intensity illumination of up to 160,000 and carries the advantages of HDLED technology, such as fat beam illumination, red balance control and full spectrum colour rendition. Brandon’s Operating Theatre control panels are also installed in the theatres. Every panel is designed to a bespoke speciÀcation and can include IPS controls, video camera controls and UCV controls. An impressive 120 Astralite HD-LED minor surgical lights and 70 Coolview Halogen Examination Lights are also in use throughout the hospital. Brandon Medical were thrilled to be involved in the new build beating off tough competition and successfully working with their clients to develop a design to match their exact requirements. Visit www.brandon-medical.com for more information or email enquries@brandon-medical.com. Please quote ‘OTJ’ www.otjonline.com


BARNA British Anaesthetic and Recovery Nurses Association

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Celebrating 25 Wonderful Years

THEATRE PRACTITIONERS You will currently be working in a UK Theatre department and ideally you will be competent in a mixture of specialities. Applications are particularly welcomed from RGN or ODP’s who are multi skilled. This Client can offer the opportunity to utilize all your existing skills, as well as the chance to develop new ones across a broad and interesting range of cases. Support, training and development within this forward thinking department will be available to the successful applicants. Good bene¿ts package on offer. Full time or part times hours are available.

Annual Conference, AGM and Exhibition

Tel: 01303 840 882 Fax: 01303 840 969 enquiries@sophiebellandassociates.co.uk www.sophiebellandassociates.co.uk

MSOFT ROLE VITAL IN HELPING TO PREVENT HOSPITAL BLUNDERS A leading healthcare technology Àrm is playing a key role in helping NHS hospitals avoid life-threatening blunders. The Government has unveiled its list of 25 preventable incidents that it believes should not be allowed to happen. Among those highlighted is transfusion of the wrong blood type, something that Ellesmere Port-headquartered MSoft is working successfully with hospitals across the UK to prevent. MSofts electronic blood tracking system BloodHound controls access to and from all blood fridges, while the bedside management system allows each bar-coded blood unit to be matched with the patients bar-coded wristband in a matter of seconds. The systems provide further enhanced security and safety by ensuring that only approved staff are allowed to access blood. The Àrms blood tracking solution provides positive identiÀcation of users and patients and in depth auditing of all bloods across each and every stage of the tranfusion process to help get the right blood into the right patient. Prime Minister David Cameron has previously hailed the MSoft blood tracking technology during a visit to Trafford Healthcare NHS Trust for its technological sophistication. Now Health Secretary Andrew Lansley has said that funding can be held back from hospitals if a so called never event, such as the wrong blood transfusion, is found to have occurred. Medical errors have been calculated to cost the NHS in excess of £2billion a year. Other serious blunders identiÀed in the list of 25 include operating on the wrong part of the body, inserting the wrong implant, leaving a surgical instrument inside a patient, severely scalding a patient and wrongly preparing a high-risk injectable drug. Matt McAlister, Managing Director of MSoft, said: We know from the vital work we have done with a number of NHS Trusts in the UK that many hospitals take the issue of blood transfusion extremely seriously. Our systems achieve a number of key objectives including reducing the number of staff needed to perform a transfusion and ultimately signiÀcant cost savings to the NHS. However, far and away the most important beneÀt, is the improvement our systems bring in terms of patient safety and security. Ultimately, this means helping to save lives. We are pleased that the Governments list of 25 blunders includes blood transfusion and we are happy to discuss how our systems can help either with individual Trusts or with the Government directly.

1st July 2011, Birmingham £100 for members £175 for Non-members

Supported by Supp y Dräger g

Natalie Quine BARNA Chair. ARNA - BARNA - Origins to the present Lesley Dowding, Keynote speaker, Inaugural member and past Chair ARNA Applied Anatomy and Physiology in Relation to Routine Airway Management Pat Smedley, President BARNA Pain Management in the PACU Denise O’Brien, Clinical Nurse Specialist University of Michigan Hospital Management of the Difficult Airway Dr. Anil Patel, Royal Ear Nose and Throat Hospital, Grays Inn Road Delayed Discharge Audit Lucie Lewellyn, Senior Lecturer Kingston University Jacqui Bishop, Team Leader, PACU, St. George’s Hospital, London UK National Competencies for PACU Practice Dr. David Whitaker AAGBI, (Association of Anaesthetists of Great Britain and Ireland) New Resuscitation Guidelines: Have These Made a Difference? Jon Sions, RGN, Dip A&E, Cert Ed. Director of Training, Resuscitation and Medi Consultancy Limited Running Enhanced Recovery Day by Day Marie Morris, Enhanced Recovery Nurse, Guy’s and St. Thomas’ NHS Foundation Trust PDNV (Post Discharge Nausea and Vomiting) Jan Odom-Forren, Faculty, University of Kentucky Anaesthesia Relating to the Bariatric Patient Simon Walton, Consultant Anaesthetist, Eastbourne Hospital Capnography Monitoring: Past Practice and New Advances Kim Kraft, Immediate Past President ASPAN The Impact of the HDU/ITU Patient in PACU Denise O’Brien, Clinical Nurse Specialist, University of Michigan Hospital Care of Critically Injured Soldiers Joanne Thompson, Senior Sister, Critical Care Debby Edwards, Consultant Nurse Acute Pain & Outreach Service Queen Elizabeth Hospital, Birmingham Final Close Life FinalinClose the Day Lifeof inathe Recovery Day of aNurse Recovery 1878Nurse 1878 Patricia Smedley Patricia BARNA Smedley President BARNA President

Join BARNA today... Online at: www.barna.co.uk

Established in 1987 for recovery and anaesthetic nurses who were not represented by any other association. BARNA became the UK representative for the International Federation of Nurse Anaethetists in 1993 and has long represented the view that non-physician provision of anaesthetics would be practical in UK. Membership includes Nurses, ODP’s and Doctors involved in the provision of care in the anaesthetic and recovery areas.

Among the NHS Trusts that MSoft is working with are Royal Liverpool and Broadgreen University Hospitals NHS Trust, Countess of Chester NHS Foundation Trust, United Lincolnshire Hospitals NHS Trust, Winchester and Eastleigh Healthcare NHS Trust, Royal Devon and Exeter NHS Foundation Trust and South Devon Healthcare NHS Foundation Trust. www.msoft.co.uk Ànd out more 020 7100 2867 • e-mail admin@lawrand.com

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Open to Anaesthetic and Recovery Nurses, ODPs and other professionals with an interest in this speciality.

Issue 247

APRIL 2011

The venue: Clarendon Suites, BIRMINGHAM, B16 9SB

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A one-stop resource for ALL your theatre related Career opportuniƟes

TEAMWORK TRAINING TO SAVE LIVES IN TOMORROWS HOSPITALS

Be sure to view the latest vacancies from the following organisations:

The University of Leicester, De Montfort University and University of Northampton are celebrating a major milestone in innovative interprofessional training for health and social care students, which will lead to improved healthcare for patients.

www.O OperaƟngT ngTheatre heatreJJobs.com

Cases of fatalities in our hospitals, fortunately extremely rare, receive major headlines in the national press. Some of these cases may be attributed to a breakdown in communication or lack of understanding between the different healthcare professionals involved. However, the incorporation of interprofessional education into the training of students in all areas of health and social care will mean a better understanding of the roles each of them play in caring for patients, better communications between them, greater awareness of patient needs and less room for error. Through the project more than 10,000 health and social care students have been brought together during their professional training over the past Àve years, to prepare to work in teams. The three universities have worked together to design joined up learning for trainee nurses, doctors, pharmacists, social workers, speech and language therapists, and other related professionals, ensuring that newly qualiÀed health and social care professionals understand how to work effectively together, sharing information and skills. Dr Elizabeth Anderson, Project Leader, who is Senior Lecturer in Shared Learning and a National Teaching Fellow in the University of Leicester, commented: The vast majority of the general public access health and social care services infrequently.

Theatre Practitioners Recovery Nurses Anaesthetic Nurses ODPs Scrub Practitioners Nurse Practitioners Medical Representatives and Clinical Advisers

Spanish surgeons perform gastric reduction through the mouth It’s the Àrst time the procedure has been performed in Spain Surgeons at the Teknon Medical Centre in Barcelona have successfully carried out their Àrst gastric reductions using a technique known as endoluminal surgery, surgery which is performed completely through the mouth, with no incisions being necessary. This minimally invasive technique reduces the risk of infection, leaves no scarring and allows a more rapid recovery. Europa Press reports that the Àrst four patients to undergo the procedure at the centre were discharged from hospital 12 hours after the surgery. The news agency indicates that 74 operations of this type have been performed in the U.S. and in Europe, with an average loss of 32% of excess body weight in the Àrst six months after the surgery. The Teknon is the Àrst medical centre to perform the procedure in Spain. Source: TypicallySpanish.com

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However, these encounters normally involve meeting more than one person. Medical teams can consist of receptionists, doctors, nurses, therapists and social workers, either in the community or in hospital. With the expansion of knowledge we have seen an expansion in new team members, often making effective team-working difÀcult. All too often vital information fails to be shared, possibly inÁuencing our care and causing, for example, delays in referrals. The Interprofessional Education programme developed by Leicester, De Montfort and Northampton Universities has helped to improve the knowledge and communication between health and social care professionals and emphasise the need for acquiring the right skills and attitude for care centred on clients and service-users. This is expected to improve, not just lack of understanding between health care workers, but also lack of collaboration and lack of recognition between the professions of what contribution each healthcare professional can make to patient care. Developing this new learning across ten programmes started in 2005, setting targets for 2010. It has been complex to organise and resource-intensive but today the three universities celebrate reaching their Àrst strategic milestone. This now means that in some local hospitals, as well as university classrooms, students learn together in preparation for future practice. In many hospital wards students are already working together in small teams and clients might be asked to support their learning. Many patients have come forward to help with the development of these programmes, accepting home visits by health and social care students. Others have shared their stories to help minimise poor practice. In some teaching units patients have run teaching sessions with academics. Now the universities plan to develop more interprofessional learning with health and social care organisations, and clients may just Ànd themselves surrounded by a trainee interprofessional student team next time they visit their local NHS. Any patient who would like to help should contact Dr Elizabeth Anderson, Senior Lecturer in Shared Learning and a National Teaching Fellow in the University of Leicester, direct tel: 0116 252 3767, Department tel: 0116 252 2946.

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