Issue No. 262
The Leading Independent Journal For ALL Operating Theatre Staff
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Scalpel A new ‘cutting edge’ discussion forum for all those involved with patient care and the operating theatre environment. Start a discussion, Join a discussion, Offer your opinion, Have your say. http://otjonline.com/scalpel/ Assistant in the OR: Dräger Perseus A500 New anesthesia workstation supports safe anesthetic administration
This allows the setting of the vapor to be adjusted to the condition of an adult patient more easily. “This helps us to provide a safe dosage and avoid underdoses and overdoses”, said Mierke.
Lübeck The new Perseus A500 anesthesia workstation can support the training of young anesthesiologists with its assistant function and thus makes a contribution to patient safety in the OR. Dräger celebrated the European premiere of the Perseus A500 at Euroanaesthesia, the convention of the European Society of Anaesthesiology (EA), which took place in Paris, France, from June 9 -12, 2012. “With the integration of the groundbreaking assistant system, we are offering the next generation of anesthesiologists stronger technical support”, said Dr. Lars Friedrich, chief physician of the clinic for anesthesiology and intensive medicine and lecturer at the Medical Academy of Hanover, Germany. “This helps them to be prepared for practical work in the OR and thus increases the patient safety in the sense of the Helsinki Declaration. “ VaporView: new assistance system for gas dosage “Particularly for young colleagues, it is especially difÀcult to precisely estimate the anesthetic gas concentration in the expiration gas through all anesthetic phases on the basis of the Vapor setting alone, especially with low Áow anesthetics”, said Dr. Bert Mierke, chief physician of the department for anesthesiology and intensive medicine at the St. Elisabeth Hospital in Damme, Germany. On the basis of pharmokinetic models, the VaporView function on the Perseus A500 visualizes the calculated current and presumable concentration of the anesthetic gas in the expiration gas of an adult patient. It displays the development of the anesthetic gas concentration in the inspiration gas (inspiration) and the expiration gas (expiration) of the last ten minutes and provides a preview of a period of 20 minutes in graphic form on the monitor.
The new Dräger Perseus A500 anesthesia workstation (© Drägerwerk AG & Co. KGaA)
Doubly safe: anesthetic gas display on the monitor and vapor The communication between the Perseus A500 and the Vapor used additionally ensures that the hand wheel position, Àll level, as well as the anesthetic gas currently being dosed can be read and that the anesthetist can see these with a glance at the monitor.
“If the fresh gas Áow is reduced after the introduction phase and the rebreathing of the patient increases consecutively, we use comparably less anesthetic gas, and at the same time, establish a better breathing gas acclimation”, explained Mierke. VaporView supports the anesthetists in being able to better estimate the anesthetic gas concentration in the inspiration gas and expiration gas. If the Vapor setting is changed, VaporView displays the calculated anesthetic gas concentration in the preview mode, before it is actually administered to the patient.
THE OPERATING THEATRE JOURNAL
In addition, the lights on the Vapor provide information as to how it is conÀgured: At hand wheel position “0”, the light is dimmed; it lights up brightly at a hand wheel position greater than “0”. A blinking light indicates that the OR team can remedy the cause of an alarm simply by adjusting or reÀlling the Vapor. For example, this can be the case when the Àll level of the Vapor is low, the Vapor is open, or the anesthetic gas concentration in the inspiration gas is too high. In addition to the blinking Vapor light, the display Àeld on the monitor blinks until the cause of the alarm is remedied. Dräger Medical GmbH is the manufacturer of the Perseus A500. You can Ànd more information at: www.draeger.com/perseus
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Lives will be saved as junior Nursing and midwives’ doctors shadow new role regulator ‘failing’ patients Junior doctors will spend a minimum of four working days shadowing the job that they will be taking up from this summer, it was announced by NHS Medical Director Professor Sir Bruce Keogh recently.
Failings “at every level” of the Nursing and Midwifery Council (NMC) mean it is letting down patients in its prime duty to protect them, says a report.
The Àrst few weeks of employment for medical graduates can not only be stressful but are also associated with increased risk for patients and NHS employers. The Department of Health has asked Medical Education England for advice on enabling junior doctors to make the transition from student to doctor and employee in the safest way possible.
The independent review gives details of the NMC’s backlog of complaints against nurses and midwives.
According to research supported by Dr Foster Intelligence in 2009, people admitted to English hospitals in an emergency on the Àrst Wednesday in August have, on average, a six percent higher mortality rate than people admitted on the previous Wednesday. NHS Medical Director, Professor Sir Bruce Keogh, said: There is some evidence of increased risk to patients as new doctors take their Àrst steps. So, learning from pilots across the country, we have agreed that all new Àrst year doctors should undertake a period of paid shadowing the doctor they will be replacing, for a period of at least four days. That scheme will start this year, and will operate in late July every year. Patient safety and providing a high quality service is at the heart of a modern NHS. This shadowing period could potentially save lives, and will equip new junior doctors with the local knowledge and skills needed to provide safe, high quality patient care, from their Àrst day as a doctor. Three pilots have been carried out over the last three years, at University Hospitals Bristol NHS Foundation Trust, Cambridge / University of East Anglia, and Cardiff Medical School. From July 2010, junior doctors starting work at hospitals in Bristol undertook: -
Ward-based shadowing or supervised work Informal teaching sessions from current junior doctors Formal teaching sessions on issues like patient safety and handovers Social events in order to develop a peer network Registration with the GMC one week early and are provided with a free extra week of professional indemnity cover.
Results from Bristol show that mistakes new doctors made in their Àrst four months were reduced by 52% after a week of shadowing and targeted teaching was made mandatory. Dr Rebecca Aspinall, consultant anaesthetist and programme director for doctors training at UH Bristol, said: Patient safety is at the heart of medical education. We recognised that our outgoing Àrst year doctors could educate the new intake of junior doctors if their employment overlapped by a few days. The outgoing doctors’ collective memory and experience was used to design the teaching for incoming junior doctors. The resulting course is called From Scared to Prepared. It contains aspects of patient care the doctors wished they had done better. Attendance of this course has reduced our frequency of errors and made patients safer year on year. I am delighted that the Department of Health has recommended this innovation across the UK. Prof Sir Bruce Keogh has written a series of letters to Ànal year medical students, medical school deans, postgraduate deans, SHA Chief Executives and NHS Trust Chief Executives to explain that this period of mandatory paid shadowing will be introduced nationally and consistently for the Àrst time this year.
The UK’s 670,000 nurses and midwives have to register with the troubled regulator to enable them to work.
The council apologised for what it admitted were “substantial failings”. The review by the Council for Healthcare Regulatory Excellence (CHRE) revealed the NMC had an annual staff turnover rate of 31%. Almost 4,500 cases are awaiting a decision by the regulator - and of those, about 1,000 have yet to be allocated a hearing date. “Start Quote Some cases that are still active and concern whether an individual nurse or midwife is Àt to practise contain allegations of the mistreatment of patients dating back as far as 2005. The NMC is currently holding 15 hearings a day and this will move to 18 from September in an effort to speed up the process. Troubled past CHRE chief executive Harry Cayton said the council “has been underinvesting in Àtness-to-practise cases, relative to the number it receives and their complexity. “The public have been let down. It doesn’t mean nursing is unsafe - but the public, nurses and midwives ought to feel conÀdent in the regulator. They haven’t been able to. “SigniÀcant delay in managing Àtness to practise cases in itself introduces risks. “The NMC is fulÀlling its functions, but not to the standard or quality that the public have a right to expect. “The regulator must Ànally leave its troubled past behind. New leaders must be appointed who are competent, credible and capable of addressing its very serious organisational problems.” The report contains 14 recommendations. Among them, the NMC is told to improve its culture of “resigned resilience”, which has seen staff either leave rapidly or become resigned to accepting poor standards. A new NMC chairman and chief executive are currently being sought. The regulator’s interim chief executive, Jackie Smith, said: “The report highlights substantial failings. We recognise these and we are sorry. “It is clear the NMC has not delivered effective and efÀcient regulation. We are committed to putting that right.” ‘Bailout’ Unions representing nurses and midwives have also been critical - they are angry that annual registration fees are rising to £120. Gail Adams, Unison head of nursing, said: “Public protection is everyone’s business. “We fail to see why nurses and midwives should have to bail the NMC out of a Ànancial crisis of its own creation.” The Royal College of Nursing’s chief executive and general secretary, Dr Peter Carter, said: “The RCN welcomes this report, which clearly goes to the heart of some fundamental weaknesses”. Katherine Murphy, of the Patients Association, said: “It is clear that the NMC will not only have to develop more robust regulatory procedures, but also work very hard to regain the trust placed in them by patients, nurses and other healthcare professionals alike.” Are you a nurse? You can comment on the increase of fees on our discussion forum at http://otjonline.com/scalpel/ Source: By Jane Dreaper Health correspondent, BBC News
The Next issue copy deadline, Friday 27th July 2012 All enquiries: To the editorial team, The OTJ Lawrand Ltd, PO Box 51, Pontyclun, CF72 9YY Tel: 02921 680068 Email: email@example.com Website: www.lawrand.com The Operating Theatre Journal is published twelve times per year. Available in electronic format from the website, 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. © 2012 The Operating Theatre Journal is printed on FSC approved papers using biodegradable ink. Any waste from the production of the magazine is recycled.
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Next Generation FDR AcSelerate from FujiÀlm FujiÀlm is a pioneer in diagnostic imaging and information systems for healthcare, with a range of constantly evolving, clinically proven, products and technologies designed to assist medical professionals perform efÀciently and effectively. The company are pleased to announce the arrival of their next generation FDR AcSelerate, the new pinnacle in diagnostic imaging. The new FDR AcSelerate is a streamlined solution that combines dynamic speed and sharp images for an X-ray room of the future, with a new Á at panel detector, with Csl scintillator, and FujiÀlm’s proprietary “Irradiation Side Sampling” (ISS) technology. The Csl scintillator capitalises on the high X-ray absorption characteristics of Csl and the ability of its needle crystals to deliver image sharpness. The (ISS) technology enhances image quality by reading the data from the surface of the detector, thus light is collected before the radiation can be attenuated and diffused within the detector. ISS signiÀcantly improves MTF and DQE compared to conventional methods. AcSelerate has been ergonomically designed with both user and patient in mind. It has a wide range of movement for various examinations, and a weight capacity of up to 250Kg, providing versatility and performance. Its lightweight ceiling suspension system and tube head provide smooth movement to any position, any angle and any height within the examination room, whilst its 2400mm x 850mm table with adjustable height of 550mm to 930mm from Áoor makes it extremely Áexible for easy positioning and accommodation of patients of all types and sizes. For more information on the X-ray Room of the Future, FDR AcSelerate, telephone FujiÀlm on 01234 326780.
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Dr Sheraz Daya performs the UKs Àrst live VICTUS Femtosecond Laser cataract removal surgery Eye healthcare company, Bausch + Lomb and Technolas Perfect Vision have worked in partnership to bring the groundbreaking new VICTUS Femtosecond Laser to the UK market. With the ability to perform cataract surgery in less than 20 seconds, the VICTUS laser is believed to be the single most signiÀcant advancement in cataract surgery in the last 40 years.
The VICTUS platform is uniquely designed to support cataract, refractive and therapeutic procedures all on a single platform. The femtosecond laser technology enables greater precision in both cataract and refractive procedures compared to manual techniques, giving ophthalmologists more control and potentially enhancing the patient experience.
The surgery master class formed part of a conference at the Centre for Sight aimed at updating HCPs on new procedures and technology for eye health care. Forty-Àve optometrists viewed Dr Sheraz Daya performing surgery using the laser, The VICTUS Femtosecond Laser will surgically replace the natural lens in the patient’s eye with an intraocular lens. The introduction of the VICTUS Femtosecond Laser will improve accuracy during surgery, reduce signiÀcant risk and increase patient safety.
About Femtosecond Lasers Femtosecond lasers emit optical pulses of extremely short duration in the domain of femtoseconds, as short as one-quadrillionth of a second. These ultra-short pulses are too brief to transfer heat or shock to the material being cut and can make surgical incisions with extreme precision.
Dr Sheraz Daya comments: With the introduction of the super-precise VICTUS laser and its real time microscopic imaging, cataract surgery has truly entered the 21st century, providing patients with a level of unprecedented accuracy and safety. VICTUS laser surgery provides patients with enhanced safety and accuracy, taking cataract and refractive lens exchange into a whole new era. The laser takes the place of the human hand and, in less than 20 seconds, makes a precise circular opening in the lens as well as effortlessly breaking up the lens or cataract. This is truly Star Trek-like surgery. Andrew Webb, European Vice President, Bausch + Lomb added: This is a signiÀcant milestone for Bausch + Lomb that will deliver breakthrough capabilities to our eye care professionals and the patients they serve,
• The VICTUS is capable of supporting cataract, refractive and therapeutic procedures in a single platform and is designed to enable greater precision compared to manual cataract surgical techniques, potentially enhancing the patients experience • The interface is curved rather than Á at, designed to reduce the amount of corneal applanation and distortion • The OCT [optical coherence tomography] is real time and dynamic rather than the static OCT systems in other lasers. As a faster laser, treatment times may be shorter, which will also improve the patient experience • Bausch + Lomb and Technolas are currently working with regulatory authorities globally to secure marketing approvals for the VICTUS. An estimated 20 million aging baby boomers and seniors have cataracts. A cataract is a clouding on the normally clear lens in the eye. Cataract surgery is a procedure during which the natural lens in the patient’s eye is surgically replaced with an intraocular lens. Over 15 million cataract surgeries are performed worldwide each year.
THE OPERATING THEATRE JOURNAL
Dr Sheraz Daya performs the UKs À rst live VICTUS Femtosecond Laser cataract removal surgery in front of an audience of optometrists at the Centre for Sight in London on Wednesday, 20 June 2012.
Bausch + Lomb is one of the best-known and most respected healthcare companies in the world. Its core businesses include contact lenses and lens care products, ophthalmic surgical devices and instruments, and ophthalmic pharmaceuticals. Founded in 1853, the company is headquartered in Rochester, N.Y., and employs more than 10,000 people worldwide. Its products are available in more than 100 countries. More information is available at www.bausch.com.
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Fukuda Denshi publish key CAVI Clinical Report on Anti-arteriosclerosis agents and CAVI Fukuda Denshi is a leading supplier of advanced patient monitoring and user-conÀgurable clinical information management systems, as well as cardiac monitoring and imaging technology. The company has recently published a Clinical Report on Anti-arteriosclerosis agents and CAVI, and is the second Clinical Report the company has published on the revolutionary Cardio Ankle Vascular Index measurement.
Maryport hospital’s upgraded operating theatre has been ofÀcially opened. The Victoria Cottage Hospital refurbishment, which cost £177,000, means that patients in West Cumbria can elect to have day surgical procedures, including hernia operations, at Maryport.
The VaSera VS-1500N from Fukuda Denshi is a lightweight and compact vascular screening device with a wide range of features including CAVI and kCAVI, providing a comprehensive report of key parameters in less than ten minutes.
It marks a major step forward for the cottage hospital, which seven years ago was under threat of closure. Funding for the building refurbishment and new equipment has been provided by NHS Cumbria.
CAVI is the new arteriosclerosis index that measures the degree of artery stiffness between the heart and ankle, and is independent from Áuctuations in blood pressure. It has been derived by the constant parameter ß, providing a consistent result that can help to predict ischemic disease and future cardiovascular complications. Fukuda Denshi has published a paper exploring anti-arteriosclerosis agents and CAVI, and describes the method for measuring CAVI, along with the clinical implications of CAVI. The Report also describes the inÁuence of hypoglycaemic agents on CAVI, the inÁuence of antihyperlipidemic agents on CAVI and the inÁuence of antihypertensive agents on CAVI. Explanatory charts and diagrams enhance the six page, full colour Clinical Paper, which concisely details the key results found during the research. For a copy of the Clinical Paper, contact Fukuda Denshi on 01483 728065. Fukuda Denshi: Healthcare bound by technology.
NEW WEST CUMBRIAN OPERATING THEATRE CUTS WAITING TIMES
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Medical equipment including a theatre light and operating table, which were previously funded by the hospital’s League of Friends, will also be used. Michelle Mulcahy, Maryport Health Services business manager, said surgery provision strengthened the importance of the local hospital. She said: “It makes economic sense. It costs about £1,000 less per patient having surgery performed here than it would in a general hospital.” Derek Thornthwaite, 78, of James Street, Maryport, who had a hernia operation performed by Dr White, said: “I got an appointment within days. It was set for 10am and I was back home at 11.30am. I can’t fault the service.” Source: In-Cumbria July 2012
Brandon Medical Enhance Dedicated UK Service & Support Reducing operating theatre downtime is becoming increasingly important as hospitals and clinics strive to reduce waiting times for their patients. Leeds based Medical Technology Company Brandon Medical, recognise this importance and have enhanced their post-sales service and support activities. The aim of the department is to correct any equipment malfunction, from many different medical technology manufacturers, in the shortest time possible. This reduced downtime allows healthcare services to function uninterrupted and patient schedules to remain on time. The service and support department is headed by Installation and Service Manager, Tony Booth. Tony joined Brandon in 2010 bringing with him 20 years experience in the telecoms and IT sector.
He is a member of IOSH and is a registered PRINCE2 practitioner. Mandy Pearson who is ofÀce based, can assist with any servicing day to day query and contractual agreements. The department operates a team of full time service engineers. All of the engineers have been trained on a full range of medical technology equipment including operating theatre lighting, pendant systems, surgeons control panels, IPS, UPS and battery back up systems. “We try to make the service as efÀcient as possible”, Tony Booth comments. “We store most spare parts on site and we’ve also added a feature to our website to allow customers to request a service electronically. This automatically enters their request into our system and Mandy will get back to them the same day to arrange a site visit”.
To ensure maximum Áexibility for their customers and the size of the healthcare institution, Brandon have a choice of service contracts ranging from Planned Preventative Maintenance contracts, yearly maintenance visits to break-down cover, equipment loans and offer product training for all staff. These service contracts are of long term value as they all provide discounted spare parts and call outs. Brandon Medical adhere to providing solutions and giving the best customer service through Áexibility, responsiveness and cooperation. For more information, please contact our servicing department directly on Tel: 0113 272 8535 email: email@example.com or visit: www.brandon-medical.com When responding to articles please quote ‘OTJ’
Pompey’s Queen Alexandra Hospital adds to its mobile X-ray Áeet Since its opening in June 2009 the state-of-theart Queen Alexandra Hospital has sat proudly on the high slopes of Portsdown Hill overlooking the historic Naval City of Portsmouth, England. The City along with it football team is nicknamed “Pompey” and is notable for its major Dockyard, as a base for the Royal Navy and for being the United Kingdom’s only Island City. Whilst the City’s Island status may come as surprise to many outside the county of Hampshire it will not be a surprise that this prestigious hospital has Major Trauma Unit status and is part of the national project to improve major trauma care. An important part of any emergency care department is the ability to provide high quality radiographic (X-ray) images to meet and to respond to the changing demands of the health professionals as they care for their patients.
Nicola Sanchez, Advanced Practitioner Radiographer at Pompey’s Queen Alexandra Hospital, said: “The replacement of our mobile Áeet required equipment that could travel the large distances required of our hospital, and provide almost instantaneous diagnostic images to our clinicians. We also required versatility in imaging our wide range of patients including NICU. The DaRt evolution was the only unit that fulÀlled all of these requirements. I cannot fault the customer support provided by Xograph Healthcare both pre- and post-purchase of our new Áeet; it has been outstanding and I would deÀnitely purchase from Xograph in the future.”
Paul Andrews, Commercial Manager for Xograph Healthcare said “I am very pleased that the Trust have again chosen Xograph as their preferred supplier for these additional mobile X-ray systems. It is also comforting to know that a dedicated MobileDaRt Evolution with an incubatorsized detector is now available for use within the Neonatal Unit allowing Radiographers to present instant digital X-ray images for diagnosis immediately in the department by the attending clinicians whilst also ensuring minimal disturbance to the newborn with less resultant distress for the parents at this difÀcult time for their baby and family.”
In March 2012, to aid rapid radiographic imaging in the Emergency Room, at the bedside and in the Neonatal Care Unit, Portsmouth Hospital NHS Trust appointed Gloucestershire-based Xograph Healthcare, a leading independent UK medical equipment provider, to supply a number of new mobile digital X-ray systems. The Hospital already owned an earlier generation Xograph digital mobile, the MobileDaRt, which was purchased when the hospital Àrst opened; this unit is now complimented by Àve younger siblings. The MobileDaRt Evolution incorporates the latest Canon CXDI-70C Wireless digital imaging detector and the unique Canon CXDI80C Wireless small format detector both offering exceptional direct digital images within 3 seconds, at the point of care, so ensuring enhanced workÁow and maximum versatility.
Nana Anane-Binfoh, Radiographer, Nicola Sanchez, Advanced Practitioner Radiographer, Lizzie Long, Senior Radiographer and Sumitra Shrestha, Radiographer, at Queen Alexandra Hospital with Liam Neill, Territory Manager for Xograph Healthcare Ltd holding the Canon CXDI-80C incubator-sized detector.
THE OPERATING THEATRE JOURNAL
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Peter Ellingworth highlights the importance of patient safety to Select Committee ABHI Chief Executive, Peter Ellingworth, gave evidence to the UK Parliaments Science and Technology Select Committee on 13th June. Mr. Ellingworth addressed the Committee on the issue of the regulation of medical implants.
SINGLE USE LARYNGOSCOPES SYSTEMS
Mr. Ellingworth told the Committee that considering patient safety is of paramount importance when regulating medical devices. He went on to add that in order to improve the system there needs to be increased transparency of information for patients and clinicians, improved post market surveillance and better central coordination of the system ABHI Executive Director of Technical and Regulatory, Mike Kreuzer, appearing alongside Mr. Ellingworth, added that the system also needs better coordination between Competent Authorities on how they designate NotiÀed Bodies. He also indicated that Unique Device IdentiÀcations could help with the setting up of registries. Mr. Ellingworth stressed the importance that industry places upon regulatory compliance, commenting- The companies we represent take patient safety incredibly seriously, Ànding a quick or easier route is not in their long term interest. On the importance of the relationship between industry and the NHS, Mr. Ellingworth said – There’s a unique relationship here where the clinicians and the companies are focussed on the patient at the centre of this exercise and how they work together. Nothing is developed purely on a bench. Speaking after the hearing Mr. Ellingworth said: I was delighted to be offered the opportunity to represent industry at this important Parliamentary Inquiry. The issue of medical device regulation is fundamental to the future success of industry and the ability of patients to get access to safe innovative medical devices. Patient safety is a key objective in medical device regulation and has to be constantly borne in mind when evolving the system. Industry has set out a number of changes which we believe will help improve the system and I was happy to discuss these with the committee. The designation and control of NotiÀed Bodies, transparency of information, central coordination and improvements to the post market surveillance system are all issues that industry wants to see addressed as soon as possible. Medical device manufacturers work closely with frontline clinicians to develop the technologies that patients need; this relationship is crucial and must be supported by appropriate regulation which in turn will assure the availability of safe, innovative products for patients. The medical technology industry is of signiÀcant scale in the UK- 3000 companies employing 64,000 people, the Government has picked out the med tech sector as being a cornerstone of life sciences, it is crucial we maintain an appropriate regulatory regime in order to support industry’s continuous growth.
Hypnosis can block surgery pain, say specialists
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HYPNOSIS can replace anaesthetics for some people during surgery, allowing them to block their perception of pain, doctors say. Psychiatrist and pain medicine specialist Bob Large yesterday told a meeting of anaesthetists in Perth that ‘’hypnotic analgesia’’ had been successfully used during a range of surgical procedures including gall bladder and thyroid removal and hysterectomies.
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While the practice was rare, he said an Adelaide doctor who specialises in hypnosis, Graham Wicks, had used the technique on Australian patients for abdominal surgery. One of these patients, who had had a bad experience of surgery and wanted to try alternative pain relief, has reported that she was relatively pain free during the procedure, which would usually require a general anaesthetic.
Dr Large, from Auckland, said people who had experienced hypnotic analgesia generally reported little pain but some sensations, such as tugging, in the part of the body being operated on. Dr Large said hypnotic analgesia could be very useful for women during childbirth, people who had allergies to anaesthetic drugs and children undergoing some procedures. Australian and New Zealand College of Anaesthetists president Kate Leslie said that although some people were highly hypnotisable and could endure painful procedures without anaesthetics, the majority of patients needed drugs to achieve suitable pain relief during surgery. Source: theage.com.au
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The Coroner’s Inquest Although the term ‘operating theatre personnel’ can be applied to several distinct professions, one thing all operating theatre personnel have in common is that they are likely to attend or provide evidence to a Coroner’s Inquest at some stage during their career. The purpose of this Àrst of an occasional series of articles examining medico-legal issues is to help you to understand the Inquest process and prepare should you be required to attend an Inquest. Who is the Coroner and what is his/her function? The Coroner is an independent judicial ofÀcer and must be a qualiÀed doctor or lawyer of at least Àve years standing. Coroners operate on a local level and their duty is to investigate and adjudicate upon any death in their area which is sudden, unexplained or cannot be registered by the Registrar of Births, Deaths & Marriages. When is an Inquest required? In 2011, 46% of all registered deaths in England & Wales were reported to a Coroner. Of these, Inquests were opened in respect of 30,981 deaths (about 14% of all deaths reported to the Coroner). The Coroner is required to hold an Inquest where: • There is reason to suspect the deceased died a violent or unnatural death; • The cause of death is unknown; • The deceased died in prison or otherwise in the custody of the State, for example whilst detained under the Mental Health Act. What questions will the Inquest answer? An Inquest is a public hearing directed solely at determining who the deceased person was and how, when and where they died. In certain circumstances, for example where the deceased died in prison, the scope of the Inquest can be widened to include a more detailed examination and commentary on the circumstances of the death. Coroner’s verdicts are forbidden from including any opinion on criminal or civil liability, for example allegations of clinical negligence. This does not, however, prevent the Coroner from recording conclusions of unlawful killing or neglect when appropriate. As a healthcare professional, it is important to remember that Inquests are inquisitorial, meaning they are an exercise in fact-Ànding and not an exercise in apportioning guilt. Preparing for an Inquest Prior to the Inquest, the Coroner will request statements from relevant witnesses and this will almost always include healthcare professionals. If you are drafting a statement yourself without legal assistance, make sure it is an honest, chronological account of your involvement in events. Include details of your background, qualiÀcations and experience and refer to key entries in the medical records. Stick to the facts and avoid including your opinions, or comments on the actions of others. Once the Coroner has received all the witness statements, he/she will decide who is required to give oral evidence at the Inquest. If your statement is thorough and covers all the issues, or if your involvement was only peripheral, the Coroner may conclude that your statement can simply be read at the Inquest and you do not need to attend in person. If the Coroner asks you to attend the Inquest it is advisable to do so. Should the Coroner actually issue a Witness Summons, then it is compulsory for you to attend the Inquest and not attending could result in proceedings for contempt of court. Prior to attending the Inquest you should read over the witness statement you provided to the Coroner, review the deceased’s medical records and request copies of key documents such as the post-mortem report and any SUI reports prepared following the death. If recommendations were made in any SUI reports, or if you have identiÀed any learning points yourself, it is important to try and implement these – Coroners wish to see evidence of ‘learning from mistakes’. Attending an Inquest At an Inquest, you can expect to see the Coroner, the Coroner’s OfÀcer, interested persons (for example, the relatives of the deceased) and legal representatives. Inquests are public hearings and members of the public or press may also be in attendance. As a witness, you will be escorted to the witness box by the Coroner’s OfÀcer and then invited to swear an oath or make a statutory afÀrmation to tell the truth. You will usually read your witness statement aloud and then be given an opportunity to expand on or clarify any points. The Coroner examines, or questions, each of the witnesses and conducts the inquiry. Interested persons or their legal representatives also get an opportunity to question the witnesses. You are not obliged to answer any questions tending to incriminate you and the Coroner will give you a warning if such questions are asked. It is helpful to bear in mind when giving evidence that you should direct your comments to the Coroner, take your time (speaking slowly and clearly) and feel free to say so if you don’t understand a question or don’t know or remember the answer to a question. Take time to consider your answers and try to be concise. After you have given evidence you will be released by the Coroner and are then either free to leave, or stay and listen to the rest of the Inquest. Once all the evidence has been heard and any legal submissions made, the Coroner will deliver his Àndings, often called the verdict. There are a number of short-form verdicts, including ‘natural causes’, ‘suicide’, and ‘industrial disease’. More and more often Coroners tend to record narrative verdicts, where they summarise the evidence heard at the Inquest and explain their conclusions in some detail. If the Coroner has identiÀed a particular risk of other deaths or considers that particular action needs to be taken he can write to an appropriate body, such as the General Medical Council or Health & Safety Executive with recommendations. This is known as a Rule 43 letter. Conclusion Most Inquests are routine and do not need to be feared. The key to reducing any anxiety you might feel is (i) good preparation and (ii) seeking the right advice and assistance at an early stage when you do need professional help. Andrea James is Head of Healthcare Regulatory at George Davies Solicitors LLP, former in-house Solicitor to the General Medical Council and specialises in advising healthcare professionals. For further information please visit: http://www.georgedavies.co.uk/content/OurServices/PublicSector/HealthcareRegulatory.aspx
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MediBox provides cool storage solution for sensitive medical substances MediBox was just one of the eleven innovative design projects on display at the Institute for Manufacturing on June 6th, to mark the end of a year-long project. The Manufacturing Engineering Tripos (MET) course is a programme for 3rd and 4th-year engineering students who have successfully completed the Àrst two years of an engineering degree, at the Institute of Manufacturing, part of the University of Cambridge. MET takes the best engineers and provides them with the management competence, business acumen and interpersonal and organisational skills they need to become world-class leaders. Medibox, has been designed and produced by Ed West, Simon Holroyd, Sidharth Khandelwal and Elliott Dobson and offers the unique solution for the transportation and monitoring of temperature sensitive medical substances. MediBox allows the safe, reliable and efÀcient transportation of temperature sensitive medical substances designed to solve real problems experienced in the Àeld. A wide range of medical substances, most notably vaccines and blood samples, require careful temperature control during transportation and storage.
In the case of vaccines, regulations state that they must be discarded if they fall outside a 2 to 8°C temperature window. Current systems provide inaccurate methods of validating the temperature history of samples which can lead to unnecessary wastage or false positives. With features such as Peltier elements and an in-situ thermometer the temperature of the contents is precisely maintained and recorded, while warning systems alert the user to potential deviations. Convenience is ensured through an intuitive and user-friendly interface allowing instant veriÀcation of temperature history. MediBox eliminates the need for using heavy and awkward ice-packs while drastically reducing potential wastage due to insufÀcient temperature control. The key purpose of the design project is to develop a new product with real business potential. Each of the teams consist of just three or four MET students. Working together they must Àrstly identify a customer need, research the market, develop an original design concept and create a full business plan. The projects have once again generated some exciting new ideas and innovative technology.
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KIMBERLY-CLARK ANNOUNCES WINNERS OF INAUGURAL HAI WATCHDOG* AWARDS Kimberly-Clark Health Care has announced the Àrst winners of a new scheme to reward individuals and teams who are championing infection prevention in UK hospitals. The category winners are Northumbria Healthcare NHS Foundation Trust, Doncaster & Bassetlaw Hospitals NHS Foundation Trust and Hull and East Yorkshire Hospitals NHS Trust. The HAI WATCHDOG* Awards recognise the work and dedication of doctors and nurses who are making a difference in reducing and preventing healthcare associated infections (HAIs) in wards and departments throughout the country. The winning hospitals each received a £1000 educational grant and a commemorative plaque. The entries were scrutinized by an expert panel of judges comprising Andrea Berry, Lead Nurse Greater Manchester Critical Care Network and Chair of Critical Care National Network Nurse Lead Forum, Andrea Denton, a member of the Infection Prevention Society (IPS) Education and Professional Development Committee, Derek Butler, Chairman and co-founder of MRSA Action UK, and Louise Frampton, Editor of Clinical Services Journal. Highly impressed with the standards of the entries and the commitment of individuals and teams to deliver excellent standards of care, the judges said that the winners should be extremely proud of their achievements and many more hospitals would beneÀt when the experiences of the winners are shared. The winner of the category for Operating Theatre Infection Prevention Initiative was Northumbria Healthcare NHS Foundation Trust which made a pledge to drive down surgical site infections (SSI) in orthopaedic surgery. The changes included employing two dedicated SSI surveillance nurses and a range of initiatives in theatres including restricting access to the department, screening patients for potential infections before they come into hospital and improving skin preparation across the Trust. In the ICU Infection Prevention Initiative category the winner was Doncaster & Bassetlaw Hospitals NHS Foundation Trust. The programme to reduce ventilator associated pneumonia (VAP) through high standards of oral care focused initially on getting the basics right and creating stability which involved deciding on a practical deÀnition of VAP and recording infection rates. The second phase was to re-design the hospital’s care bundle which included enhancing the oral care element. Highly commended in the ICU category was The Royal Wolverhampton NHS Trust for its campaign ‘Beyond Bacteraemias – Introducing the Device Related Hospital Acquired Bacteraemias (DRHAB).
The range of initiatives included a VAPteraemia court to tackle the difÀcult issue of determining the source of bacteraemias. In the Clinician’s Choice category, the winner was decided through online voting via the website www.haiwatchdog.com . First prize went to Hull and East Yorkshire NHS Hospitals Trust for their ‘Give Soap a Chance’ campaign. The programme focused upon taking the lessons learned about hand hygiene in hospital out to the community and to teach the art of proper hand washing. In partnership with the Business School at Hull University, the Trust worked with businesses, schools and the general public to get its message across. In schools children were inspired by Sammy Soap and the Clean Team to learn effective hand hygiene. Phil Crook, Country Manager for Kimberly-Clark Health Care in the UK and Ireland said: “The winning Trusts have set inspiring examples of what can be accomplished in the Àght to reduce healthcare infections and we hope that their achievements in these awards will help the successful teams receive the recognition they deserve. “Kimberly-Clark is committed to working in partnership with hospitals to deliver the best possible patient care and we feel that the HAI WATCHDOG* Awards have an important role to play in highlighting pioneering work from across the UK.” Central to the HAI WATCHDOG* Awards is a dedicated website – www. haiwatchdog.com – to help facilitate the sharing of best practice and host discussions about all kinds of infection prevention issues. Summaries of the winning entries are posted there. The awards also ran simultaneously in the United States and Canada as well as Australia and New Zealand with the aim that the HAI WATCHDOG* website can become a central point for the sharing of international HAI prevention best practice. Northumbria Healthcare NHS Foundation Trust1: Mike Reed Consultant in Trauma and Orthopaedics and SSI lead at Northumbria Healthcare NHS Foundation Trust, Phil Crook Country Manager Kimberly-Clark Health Care in the UK and Ireland, Gill Davis SSI Audit Administrator and Helen Geraghty SSI Coordinator at North Tyneside Hospital. Northumbria Healthcare NHS Foundation Trust2: Darren Robinson Account Manager for Kimberly-Clark Health Care, Gail Lowdon SSI coordinator at Wansbeck General Hospital, Dorothy Dickinson Theatre Manager at Hexham Hospital, Phil Crook Country Manager Kimberly-Clark Health in the UK and Ireland Care, Wendy McDonaugh Theatre Manager at North Tyneside Hospital, Jackie Hall Theatre Manager at Wansbeck General Hospital.
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NICE Guidance supports the case to adopt Inditherm patient warming systems in the NHS • Clinical evidence supports Inditherm’s effectiveness at preventing hypothermia • Annual cost savings of £9800 per Operating Theatre • Additional savings from reductions in post-operative infections, energy usage and clinical waste
Contact any of our Medical team today for further information or a free trial, on +44 (0) 1709 761000 or email: firstname.lastname@example.org, and quote Ref: MTG0811
The new standard in patient warming Full guidance can be found at www.nice.org.uk/guidance/MTG7
HAI WATCHDOG* Awards 2011 Category: Operating Theatre Infection Prevention Initiative Zero Tolerance on Surgical Site Infection Northumbria Healthcare NHS Foundation Trust Programme Overview Transforming the culture and behaviour of a 200-strong, multi–disciplinary team is at the heart of Northumbria’s successful campaign to reduce infection rates in orthopaedic surgery. Objectives The Zero Tolerance on Surgical Site Infection campaign was launched to reduce surgical site infection rates to below the national average of 1% or lower. The Solutions To achieve the objectives, orthopaedic surgeon Mike Reed, who has a particular interest in patient safety, took on the role of ‘champion’. He established a team of key opinion leaders across all disciplines to look at the information available and to being to review current practices that may be affecting infection rates within the Trust. For the programme to work everyone needed to understand why they were being asked to change long-held practices and what was required of them.
To underline the Trust’s commitment to reduce Surgical Site Infections (SSI) in its operating theatres across the Trust’s three main sites, two designated SSI surveillance nurses were appointed to follow patients through the care pathway from surgery to recovery at home. The improvements in theatres included pre-operative skin assessment and preparation including MSSA screening, restricting access to the theatres suite including introducing a colour-coded uniform policy, introducing an initiative to maintain patients’ temperatures, committing to the Patient Safety WHO Checklist and further raising awareness among staff of the importance of infection control. Communicating the policy objectives and the progress of the improvements were key to the programme’s success. As well as the Trust Chief Executive and the Trust Board, updates were given regularly to a number of different groups and committees including the trauma and orthopaedic board, clinical policy group and infection control committee as well as presentations to community nurse forums. There were also updates to the wider orthopaedic community via publications in four articles on separate aspects of the programme in peer reviewed journals. Outcomes All the changes were monitored and assessed and results fed back to the Trust Board. The team succeeded in reducing their rates to less than 1% and the lessons that have been learned are taking the SSI programme forward to other surgical categories including breast surgery, obstetrics and gynaecology and the colorectal unit. Judges’ Comments Andrea Berry, Lead Nurse Greater Manchester Critical Care Network and Chair of Critical Care National Network Nurse Lead Forum, said : “The entry was very detailed and clearly presented. It showed a full system project with executive backing which is vital in making changes of this scale.” Derek Butler, Chairman of MRSA Action UK, said: “Taking on these ambitious objectives is all about spending to save. Once resources have been made available you can inspire people to take ownership of change to see it through.”
Northumbria Healthcare NHS Foundation Trust1 LtoR Mike Reed, Phil Crook, Gill Davis, Helen Geraghty
Andrea Denton, member of the Infection Prevention Society’s (IPS) Education and Continuing Professional Development Committee, said: “The campaign clearly showed some innovative thinking and the potential impact of this kind of campaign throughout the hospital could be signiÀcant.”
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Common medicines dictionary approved for NHS A common medicines dictionary, approved today, will reduce the chance of medical errors by ensuring all staff who work in the NHS and healthcare use the same common language when referring to medicines. The Information Standards Board for Health and Social Care has approved the NHS dictionary of medicines and devices (dm+d) as a fundamental standard which must be used by all staff. All doctors, nurses and pharmacists should move towards using the common medicines dictionary so that information exchanged electronically is accurate and safe. Using a single drug terminology will enable information about patients medicines to transfer more effectively between different healthcare settings, reducing the risk of medication mistakes caused by human error. The NHS dictionary of medicines and devices is already widely used in the UK for the exchange of clinical information, including the Electronic Prescription Service and for patients Summary Care Records. Dr Charles Gutteridge, National Clinical Director for Informatics at the Department of Health and Medical Director, Barts and the London NHS Trust said: The adoption of dm+d is an important milestone. It will mean clearer and consistent communication throughout the NHS ensuring health professionals in all care settings can deliver a more integrated and safer healthcare system. “I encourage all clinicians to accelerate their use of this common medical dictionary for the beneÀt of the patients we care for. Heidi Wright, from the Royal Pharmaceutical Society (RPS) said: The Royal Pharmaceutical Society supports the need for a single terminology to facilitate interoperability and to enable such initiatives as the Electronic prescription Service (EPS). We believe that the opportunities created for using dm+d are substantial in terms of interoperability, opportunities for comparison and reducing variation, enhancing patient safety i.e. reducing risks associated with system interfaces and providing links to clinical systems such as the British National Formulary (BNF). The dm+d is a dictionary containing unique identiÀers and associated textual descriptions for medicines and medical devices. dm+d has been developed and delivered through a partnership between the Department of Health Informatics Directorate and the NHS Business Services Authority. http://www.dmd.nhs.uk/ The Information Strategy (The Power of Information) states 3.58 “Reducing the number of inconsistent or incompatible terminologies from 2015 (via the ‘route-map’) will allow better integration between systems and across health and social care, and better information to support care and improvement of care. In due course, for patient care purposes, all relevant systems should use the same terminology to exchange coded information; SNOMED CT, adapted to Àt all necessary uses, is the appropriate terminology to base this on. Similarly, to allow drugs to be consistently referenced, systems will consistently use the electronic drugs dictionary (dm+d)”. http://www.dh.gov.uk/health/2012/05/ information-strategy/
KIMBERLY-CLARK LAUNCHES NEW STERILISATION WRAP THAT REINFORCES CONFIDENCE IN STERILITY OF INSTRUMENTS An innovative sterilisation wrap has been launched by Kimberly-Clark Health Care to provide immediate conÀdence that the integrity of sterile surgical instruments has not been compromised. Kimguard One-Step* Quick Check* offers visual reassurance that the wrap is free from tears, cuts and holes. It works by combining two sheets of thermally bonded wrap – a blue layer and a white layer – so that any breaches in the fabric are easily identiÀable. As problems occurring on single colour wrap might be hard to spot, this new feature saves valuable time in the operating room as it avoids the need to add additional steps into the inspection process. This time saving enhances the existing advantages of the Kimguard One Step* range which delivers the protection of double wrapping in a single step so that users can save up to 49% of time wrapping and opening packages compared to a more conventional sequential wrapping process.(1) In addition, the new wrap also features Kimberly-Clark’s patented PowerGuard* Technology to provide a robust microbial barrier that gives excellent protection against contamination. By incorporating a stabilised charge in the Àbres of Kimguard*, the treated fabric captures the bacteria and helps to prevent it from passing through the fabric on to the sterilised devices and instruments even when challenged with steam. “Quick Check* is a great addition to the One Step* range as it adds yet further beneÀts to this highly effective and easy to use sterilisation wrap,” explained Karina Engels, Sterilisation Product Manager for Kimberly-Clark. “The new product provides beneÀts both to the CSSD and the OR: it provides additional peace of mind to the surgical team that devices and instruments are sterile and that they can focus on their own roles and their patients in the OR. For the CSSD it allows staff to colour code trays and make them stand out from the rest.” When responding to articles please quote ‘OTJ’
References (1) This study was undertaken by Kurt Salmon Associates, inc, to quantify the time required to wrap and open packages using Kimguard One-Step* compared to conventional sequential wrap * Registered Trademark or Trademark of Kimberly-Clark Worldwide, Inc. © KCWW. All rights reserved.
Xograph BuckyStar Intuition DR system takes part in 2012 Olympics The southern coastal town of Weymouth, UK is geared up for the 2012 Olympics by building a giant sandcastle measuring 4m x 2m on Weymouth beach to mark 100 days to the start of the London Olympic Games on 27 July. At the same time a more permanent construction of a longer lasting legacy is taking place at Weymouth Community Hospital. Weymouth and Portland is the only venue outside London hosting the Olympic and Paralympics Games for the full duration of the 2012 Games; it is therefore essential that the local Hospital is also ready for whatever challenges may come its way. In preparation for the 10 sailing events, which will be contested 380 athletes from 61 nations and a further 80 Paralympic sailors taking part in three subsequent events, Weymouth Community Hospital is now installing a brand new direct digital X-ray system supplied by leading independent diagnostic imaging supplier Xograph Healthcare. The Xograph system known as the ‘BuckyStar Intuition’ is a complete general purpose radiography room system combining the latest Canon direct digital imaging technology with a new lightweight ceiling suspended X-ray tube support, a motorised patient table, a patient wall stand and a high frequency X-ray generator. Images are displayed almost instantly to the radiographer directly in the X-ray room, THE OPERATING THEATRE JOURNAL
greatly decreasing examination times and increasing patient workÁow. The Intuition also includes an image stitching function allowing multiple spine and full length leg images to be digitally stitched together to aid diagnosis and treatment planning. Linda Chappell, Lead Superintendent Radiographer at Weymouth Community Hospital said: “This new X-ray system will greatly beneÀt us in preparation for the Olympic sailing events. We have worked with Xograph Healthcare before at Dorset County Hospital and have been very pleased with the after sales service they provide and the reliability of their equipment. This is extremely important to us as a small community hospital preparing to provide a service for the Olympic athletes and the many thousands of spectators.” www.xograph.com www.otjonline.com
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New Good Practice Guide Will Help Tackle Concerns About Practitioner Behaviour
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The National Clinical Assessment Service (NCAS) has published a new good practice guide aimed at helping NHS organisations deal with concerns about a practitioner’s behaviour.
A leading UK supplier of operating stools for NHS clinicians Winners of Clinical Seating OJEU contract for Barts & The London NHS Criteria: Ergonomics, Infection Control and Build Quality
Handling Concerns about a Practitioner’s Behaviour and Conduct builds on NCAS’ eleven years of experience in advising referring organisations on the most effective ways of handling concerns about practitioner performance. It is a “lessons learned” document drawing on NCAS experiences from referrals about behavioural concerns.
Operating Theatres • Anaesthetics • Eye Clinics • Recovery • ICU - HDU Pain Management • Ultrasound • Maternity Units • Delivery Suites • Clinical Areas
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Medical Device Directive Approved ISO 9001
ALDER HEY IMPROVING EFFICIENCIES WITH DIGITAL DICTATION Alder Hey Children’s NHS Foundation Trust is introducing a new integrated digital dictation platform to improve workÁow, patient care and deliver time and efÀciency savings for clinicians and secretaries.
Digital dictation eliminates the timeconsuming process of physically moving Àle notes and audio cassettes between hospital departments while the tagged Àles allow dictations to be quickly identiÀed and transcribed.
Olympus hardware has been utilised to promote efÀciency and cost beneÀts via the DR Àxed microphone range. MedisecTRUST Digital Dictation tags dictated voice Àles from Alder Hey clinicians with central Patient Administration System (PAS) data to automatically generate clinical correspondence.
When a patient is selected, the system opens the integrated dictation software. The resulting voice Àle is tagged to the patient and automatically appears in the relevant medical secretary’s workÁow.
“This is a key move in our drive to improve administrative efÀciencies,” said Alder Hey’s EPS Project Manager Heather Swanston. “We had already streamlined the transfer of patient information using the MedisecTRUST solution, but transcription times will now be much faster with the integration of Medisec’s digital dictation platform.”
When the secretary opens the voice Àle, the system automatically inserts patient information from the hospital PAS into a letter template. Consultants are able to edit and authorise all clinical correspondence online. “I previously used to write my letters out longhand and pass them to my secretary for typing which was a time-consuming process,”
NCAS Lead Adviser Karen Wadman, explained: “Behaviour relates to how someone interacts with other people - how they communicate, how they might relate to communications difÀculties, how individuals work in teams and how they react when under stress. “However, such concerns can also relate to an organisation and how the workplace is organised and the way resources and teams are structured. This guide can be used wherever practitioners work - general practice, community and hospital sectors and whatever their speciality, grade or employment status.”
said Consultant Paediatric Dentist Rod Llewellyn. “This system is quicker and more efÀcient.” Tom Rothwell, Medisec Software’s Managing Director, added: “Digital dictation combined with an advanced workÁow solution can realise signiÀcant efÀciency gains and, in collaboration with Olympus, we are delighted to announce this roll-out of at Alder Hey.” For further information, please visit: www.medisecsoftware.co.uk www.olympus.co.uk When responding to articles please quote ‘OTJ’
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NCAS found that between December 2007 and October 2010, when it handled 3,000 cases of practitioner performance concern, 57 per cent were recorded as having some type of behavioural component. Interim Medical Director at NCAS, Professor Pauline McAvoy, said: “Those responsible for managing health professionals, and in particular those charged with monitoring performance, are in a good position to identify potential problems. “It is vital that concerns about behaviour, or indeed changes in behaviour, are addressed at an early stage to minimise impact on patient care. But it is also important to ensure that factors which may be contributing to the behaviour such as ill health or work context are considered”. To download a copy of Handling Concerns about a Practitioner’s Behaviour, please visit http://www. ncas.nhs.uk/publications/. July 2012
MHRA tells surgeons to stop using R3 metal cup liner and extends patient monitoring advice
A Medical Device Alert was issued today by the MHRA following a product recall by manufacturer Smith & Nephew of the R3 metal cup liner component of the R3 Acetabular System. The R3 metal cup liner is used with appropriate Smith & Nephew hip replacement femoral components.
WEST MIDLANDS THEATRE PRACTITIONERS You will be an experienced RGN or ODP with Scrub and/or Anaesthetic/ Recovery skills to join this busy department. You will be a good team player and will be expected to provide and maintain a high quality service. Support from a strong management team will be provided as well as the opportunity to work alongside expert clinicians. Ideally you will have comprehensive orthopaedic and general scrub skills and you will be required to provide Àexible skills in Anaesthetics, Recovery or HDU.
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Post-market surveillance data has shown a high revision rate of 6.3% at 4 years for patients implanted with the R3 metal liner. This high revision rate is not in line with the 4% guidance Àgure at 4 years from the National Institute of Health and Clinical Excellence (NICE) and therefore the MHRA has told surgeons to stop using the metal cup liner and to annually monitor the 281 patients who have been Àtted with these cup liners so that any complications such as pain or swelling are picked up and treated early. The MHRA also issued updated advice today to surgeons about extending the period of follow-up to annual monitoring of their patients if they are experiencing complications such as pain or swelling from their metal-onmetal hip resurfacing implants or metal-on-metal hip replacements that have a head diameter below 36 millimetres. The new advice of annual monitoring replaces previous patient monitoring advice for these size of implants that patients should be followed up for a minimum of Àve years.
LONDON DAY SURGERY UNIT MANAGER An energetic & innovative Manager is required for this unit which consists of 4 theatres, 12 patient bays & 8 Chairs. The role includes managing the operational, ¿nancial, HR & governance perspectives. A talented individual is required to maximize the use of resources and dynamically develop & expand the services provided. You will have the ability to execute projects to a high standard, meeting deadlines & within budget. You will also provide positive team leadership & a professional service, promoting & safeguarding the well being and interests of all patients & customers of the unit. Further quali¿cations which support your clinical & managerial development will be expected.
Todays new information is viewed as a routine patient monitoring advice update by the independent expert advisory group that was set up by the MHRA to look at the management of patients with metal-on-metal hip implants. There is no new evidence of an increased safety risk associated with metal-on-metal hip implants and people with these implants who are not experiencing any problems do not need annual monitoring Dr Susanne Ludgate, the MHRAs Clinical Director of Medical Devices, said: In the UK, 281 patients have been Àtted with this speciÀc R3 metal cup liner. Evidence from post market surveillance data has shown that the revision rate for this implant is high and that is why we have taken action to advise surgeons to stop using this device and to monitor the patients implanted with this cup liner on an annual basis. Clinical evidence shows that patients have a small risk of suffering complications from having metal-on-metal hip implants but we believe, after advice from our expert advisory group, that it makes sense for surgeons to annually monitor any patients who are showing any symptoms such as pain or swelling if they have metal-on-metal hip implants. By monitoring patients with symptoms every year, any complications will get picked up and they can be treated earlier. The Medical Device Alert on the R3 metal cup liner can be viewed here: http://www.mhra.gov.uk/Publications/Safetywarnings/MedicalDeviceAlerts/ CON155761 The Medical Device Alert on the updated patient monitoring advice can be viewed here: http://www.mhra.gov.uk/Publications/Safetywarnings/MedicalDeviceAlerts/ CON155761
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GIBRALTAR HEALTH AUTHORITY OPERATING DEPARTMENT PRACTITIONER £23,251 to £31,044 p.a. plus allowances (depending on experience) Relocation Assistance Provided (Passages payable in full & Subsidised Accommodation) OVERDUE A SABBATICAL? ARE YOU ON A CAREER BREAK? WANT TO WORK SOMEWHERE UNIQUE? The Gibraltar Health Authority is looking for an enthusiastic and highly motivated Operating Department Practitioner. Candidates must feel comfortable working in a busy Operating Department that provides a comprehensive range of surgical services such as General, Urology, Obs & Gynae, Ophthalmic, ENT, Dentals, Maxillo-Facial, Plastic, Orthopaedics and Trauma Surgery. The above appointment will be on contract terms for a period of 10 months. If you would like to discuss any aspects of the post, please contact Ms Sandie Gracia, Clinical Nurse Manager - Allocations on Tel: 00-350-200-72266 ext 2314 or email email@example.com Application Packs are obtainable from the Recruitment Section on Tel: 00-350200-72266 ext 2081 or Fax: 00-350-200-43864 or e.mail: firstname.lastname@example.org th
Closing Date: 5 August 2012
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The Medicines & Healthcare products Regulatory Agency (MHRA) has recently issued new advice to surgeons that they should not use a particular type of metal cup liner that is used in some metal-on-metal hip replacement operations.
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“.....it is recommended that all hospitals have second generation SADs available for both routine use and rescue airway management” 1
Reference (1): 4th National Audit Project of The Royal College of Anaesthetists and the Difﬁcult Airway Society. Major complications of airway management in the UK. Report and ﬁndings. March 2011. Section 3, Appendix, page 210.
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