JPP PG January 2017 (Vol:05 Issue:06)

Journal of Perioperative Practice

PROCUREMENT GUIDE January 2017 Volume 05 Issue 06 01423 881300 www.afpp.org.uk

Adapt to meet the specific needs of surgical theatre teams Operating teams need technology and processes that provide accessible education and perioperative support* S2 Procedure Performance is an immediate and accessible solution that is designed to: • Provide accurate information on each surgeons procedural set up • Delivering customisable surgeon and hospital specific training • Creates a mental pathway of how each surgeon operates • Increase confidence in theatre teams and speed up learning by making procedures and surgeon instruments needs routine • Removes human error but not humans from the surgical process To learn more, read:

“Safety, service delivery and teamwork: A new solution with Syncera” in this issue of the Journal Perioperative Practice Procurement Guide View our video, download resources, read our blog:

www.syncera.co.uk

Get in touch:

*Guckian Fisher M. Safety, service delivery and teamwork: A new solution with Syncera. J Periop Pract Procurement Guide 2016;06(01).

01423 881300 www.afpp.org.uk

Bryn Davies

European General Manager bryn.davies@syncera.com

+44 7976 000323

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2017 Volume 05 Issue 06 www.afpp.org.uk

Contents

Welcome to your January 2017 Guide 04 Maintaining perioperative normothermia

10 Safety, service delivery and teamwork: A new solution with Syncera

16-19 Product News: 16 Nihon Kohden 16 Teleflex

16 Angloplas 17 QA3 Drive Patient Trolley

by Anetic Aid

18 Central Medical Supplies

is the exclusive UK distributor for The 37° Company’s patient warming products - The Mistral Air, Fluido® Air-Guard and the new Fluido® Compact

18 VIO3 from Erbe -

“plug and operate”

19 Wardray Premise

appointed as a distributor of the IV-eye® vein imager

Journal of Perioperative Practice Procurement Guide information In print within the AfPP Journal of Perioperative Practice covering national AfPP members, but also with a dedicated print and e-distribution to supplies and purchasing managers.

Key Sectors: NHS Supply Chain, Independent Hospitals, Higher Education.

Medical Device Companies.

Published 6 times a year we will focus on procurement issues in every edition as well as specialist subjects which for the following year include:

March 2017 Medical Instruments/Devices/ Equipment/Laparoscopic & Endoscopic Instruments May 2017 Infection Prevention/Infection Control/Decontamination/Clinical Waste/Wound Management July 2017 Consumables/Patient Trolleys

Contact Information: Advertising, Sponsorship & Partner Packages Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: frances.murphy@ob-mc.co.uk Editorial Chris Wiles Head of Publishing/Editorial AfPP T: 01423 882950 E: chris.wiles@afpp.org.uk

PR & press material.

All press releases welcome and we will feature as many as we can in each issue, all press releases need to be submitted to: Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: frances.murphy@ob-mc.co.uk

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2017 Volume 05 Issue 06 www.afpp.org.uk

Patient Warming

Maintaining perioperative normothermia Hypothermia is defined as a core body temperature of lower than 36°C. and is a common problem for patients undergoing surgery (NICE 2008).

Hypothermia is further defined as follows: • Mild hypothermia is a core body temperature between 32° and 35°C. • Moderate hypothermia is a core body temperature between 300 and 32°C. • Severe hypothermia is a core body temperature below 30°C (McArthur-Rouse & Prosser 2007).

Perioperative hypothermia can have a wide range of detrimental effects to the patient undergoing a surgical intervention. These include: • Increased risk of surgical wound infection • Delayed wound healing • Altered drug metabolism • Increased risk of venous thromboembolism for exam pie, stroke or myocardial infarction (Hooper et al 2009) • Increased perioperative blood loss and increased transfusion requirements • Postoperative shivering and oxygen consumption • Prolonged post-anaesthetic recovery and hospital stay • Morbidity • Increased risk of pressure ulcer formation.

Hypothermia can be deliberate or inadvertent. Deliberate hypothermia may be induced for medical or surgical reasons such as in cardiac or neurosurgery when reduced metabolic activity is required.

Hypothermia affects the circulatory, immune and coagulation systems of the body. This may contribute to increased blood loss by around 30%, as well as up to a 70% higher probability of need for transfusion during surgery or trauma (Winkler et al 2000).

Reduced metabolic rate prevents organ damage when perfusion decreases.

All patients are potentially at risk of inadvertent perioperative hypothermia, but it is acknowledged that the following factors can increase the risk: • Age, particularly the elderly over 70 years of age and neonates • Systemic disease such as diabetes or peripheral vascular disease • Nutritional status since a poor nutritional state can increase the risk of hypothermia • Prolonged preoperative fasting • Administering cold intravenous fluids • Type and duration of surgical intervention • Exposure of large areas of the body during the procedure • Loss of body heat through the evaporation of skin preparation solutions • Vasodilation and resultant heat loss from the use of volatile agents • Loss of shivering from the use of muscle relaxants • Patient gowns from material that have poor heat retention • Cool ambient temperatures, particularly during transfer from ward to theatre • Minimal covering during transfer • Exposure of a large area of skin at the surgical site • Exposure due to gown design

• The level of anaesthesia block in patients receiving spinal anaesthesia (AfPP2011, NICE 2008, Burger & Fitzpatrick 2009, Hooper et al 2009).

It is important that the risk of hypothermia is managed adequately within the perioperative environment.

Hypothermia may occur during any stage of the patient’s perioperative care pathway. NICE guidelines and other literature have identified measures to be taken in the preoperative, intraoperative and postoperative phases of interventions and procedures (NICE 2008, Hooper et al 2009, Paulikas 2008).

Maintaining the core temperature of the patient at or above 36°C is beneficial for the patient.

Hypothermia affects the circulatory, immune and coagulation systems of the body. This may contribute to increased blood loss by around 30%, as well as up to a 70% higher probability of need for transfusion during surgery or trauma (Winkler et al 2000).

The young and the elderly are at risk of hypothermia. In children the increased surface area to body weight ratio allows cooling to occur more efficiently. In the elderly the fixed or reduced cardiac output as a result of disease or drugs reduces the efficiency of vasodilatation, sweating and exercise (Wilkins & Wheeler 2004). >>

p=0.02

Incidence of SSIs (% of patients)

8

7.3 6

4

4.0

2% CHG / 70% IPA didn’t deliver a 45% reduction in SSIs: ChloraPrepTM did Preparing patients for caesarean delivery with ChloraPrep cut SSIs by almost half, compared with alcoholic povidone iodine1

2

0 Alcoholic povidone iodine (n=575) ChloraPrep (n=572)

Prescribing Information ChloraPrep® & ChloraPrep with Tint 2% chlorhexidine gluconate w/v / 70% isopropyl alcohol v/v cutaneous solution. Refer to the Summary of Product Characteristics before prescribing.

Presentation: ChloraPrep – each applicator contains 0.67ml, 1.5ml, 3ml, 10.5ml or 26ml of 20 mg/ ml chlorhexidine & 0.70 ml/ml isopropyl alcohol; ChloraPrep with Tint – each applicator contains 3ml, 10.5ml or 26ml of 20 mg/ml chlorhexidine & 0.70 ml/ml isopropyl alcohol. Indication: Disinfection of skin prior to invasive medical procedures. Dosage & administration: Applicator volume dependent on invasive procedure being undertaken. May be used for all age groups and patient populations. Use with care in newborn babies and those born prematurely. Applicator squeezed to break ampoule and release antiseptic solution onto sponge. Solution applied by gently pressing sponge against skin and moving back and forth for 30 seconds. The area covered should be allowed to air dry. Contra-indications: Patients with known hypersensitivity to ChloraPrep or ChloraPrep with Tint or any of its components, especially those with a history of possible Chlorhexidine-related allergic reactions. Warnings and precautions: Solution is flammable. Do not use with ignition sources until dry. Do not use in excessive quantities, allow to pool in patient skin folds or drip on materials in contact with patient skin. Remove any soaked materials before proceeding with the intervention. Ensure no excess product is present prior to application of occlusive dressing. For external use only on intact skin, do not use on open skin wounds or broken or damaged skin. Over-vigorous use on fragile or sensitive skin or repeated use may lead to local skin reactions. Avoid prolonged skin contact. Avoid contact with eyes, mucous membranes, middle ear and neural tissue. Chlorhexidine may induce hypersensitivity, including generalised allergic reactions and anaphylactic shock. May cause chemical burns in neonates, with a higher risk in preterm infants and within the first 2 weeks of life. Pregnancy & lactation: Although no studies have been conducted, no effects are anticipated as systemic exposure is negligible. Undesirable effects: Very rare; allergic or irritation skin reactions to chlorhexidine, isopropyl alcohol or sunset yellow (E110, present in ChloraPrep with Tint only), including erythema, rash, pruritus and blisters or application site vesicles, other local symptoms have included skin burning sensation, pain and inflammation.

Frequency not known; hypersensitivity including anaphylactic shock, dermatitis, eczema, urticaria, chemical burns in neonates. Discontinue use at the first sign of local skin reaction. Per applicator costs (ex VAT) ChloraPrep: 0.67ml (SEPP) – 30p; 1.5ml (FREPP) – 55p; 1.5ml – 78p; 3ml – 85p; 10.5ml – £2.92; 26ml – £6.50. ChloraPrep with Tint: 3ml – 89p; 10.5ml – £3.07; 26ml – £6.83. Legal category: GSL. Marketing Authorisation Numbers: ChloraPrep, PL31760/0004 & ChloraPrep with Tint, PL31760-0001. Marketing Authorisation Holder: CareFusion UK 244 Ltd, The Crescent, Jays Close, Basingstoke, Hampshire, RG22 4BS. Date of Preparation: February 2016.

Reporting suspected adverse reactions is important to monitor the benefit/risk balance of the medicinal product. Reporting forms and information can be found at www.mhra. gov.uk/yellowcard. Adverse events should also be reported to CareFusion Freephone number: 0800 0437 546 or email: CareFusionGB@professionalinformation.co.uk © 2016 BD. BD and BD Logo are property of Becton, Dickinson and Company. ChloraPrep logo is registered trademark of CareFusion Corporation.

Reference: 1. Tuuli MG et al. N Engl J Med 2016; 374(7): 647-55.

CHG: chlorhexidine gluconate IPA: isopropyl alcohol SSI: surgical site infection

0000CF02997 Issue 1 Date of preparation: November 2016

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2017 Volume 05 Issue 06 www.afpp.org.uk

>>

Recommendations for local policy Preoperative assessment The preoperative phase is defined by NICE as the hour before induction of anaesthesia and makes the following recommendations: • Body temperature should be monitored and maintained as close to normothermic as possible during the preoperative period (AORN 2014).

• All patients should have their temperature measured and documented on admission and in the preoperative period.

• The risks of inadvertent hypothermia should be assessed for every patient.

Higher risk patients can be determined if two or more of the following are identified: o ASA Grade of 11-V o A preoperative temperature of 36°C or lower which cannot be rectified by preoperative warming measures due to the urgency of the need for perioperative intervention o Where patients are to undergo general and regional anaesthesia o Patients who are to have major or intermediate perioperative procedures o Patients who are at risk of cardiovascular complications (NICE 2008).

• Determine thermal comfort level by asking the patient if he or she is cold (NICE 2008, Hooper et al 2009).

• Assess patient for signs of shivering which may indicate the patient is cold.

• Patients who have received or are to receive premedication such as nefopam, tramadol, midazolam or opiods require close monitoring to ensure that they do not become hypothermic (NICE 2008).

• Patient warming measures such as blankets, forced air warming or other suitable warming mattresses should

Patient Warming be used if core temperature is below 36°C. Hypothermia in the perioperative period is common and many associated complications can be avoided by using active warming methods (Hooper et al 2009, Leaper et al 2005, NICE 2008, Nice 2014).

• Special care should be taken when transferring patients from ward areas to the reception area of the operating theatre. This includes making sure that the patient is warm and well covered with blankets if being transferred by bed or trolley. It is recommended that at least one cotton sheet and two blankets or a duvet are used for this purpose (NICE 2008). If the patient is walking to theatre the patient should be suitably attired with a dressing gown and suitable footwear.

• On arrival at the theatre suite, measures should be taken to ensure that the patient is kept warm and comfortable (NICE 2008).

Anaesthetic care • The anaesthetic room should be kept warm during induction of anaesthesia and the patient should be kept free from draughts. Active warming measures such as warming mattresses or blankets, or increasing the room temperature to a minimum of 20 to 24°C should be considered (Hooper et al 2009).

• Patients should have their temperature measured and documented before the administration of anaesthesia.

• Induction of anaesthesia should not commence if the patient has a temperature of 36°C or below, unless the patient’s condition indicates immediate intervention is required for life or Iimb threatening injuries.

• The patient’s temperature

should be measured and documented every thirty minutes until the end of the perioperative intervention or procedure.

Intraoperative care • The operating theatre should be maintained at a minimum ambient temperature of 21°C when the patient is exposed.

Once forced air warming is established or in situations where the patient warming mattress is in use, the theatre temperature may be reduced to ensure the comfort of the perioperative team (NICE 2008).

• All patients undergoing perioperative procedures should be warmed intraoperatively by the use of a forced warm air device or the use of an appropriate patient warming mattress (NICE 2008, NICE 2014).

• All warming devices should be used in accordance with the manufacturer’s instructions.

Warmed air should never be blown directly onto the patient’s skin as burns may result (AfPP2011).

• During procedures involving extensive body cavity exposure, consideration should be given to a combination of under, upper and lower body forced air warming devices (AfPP2011).

• The patient should be adequately covered throughout the procedure and only the surgical site should be exposed.

• The time between preparation of the surgical site and draping the patient should be kept to a minimum.

• Surgical drapes should be prevented from getting wet.

• Core temperature monitoring is recommended. This may include nasopharyngeal, rectal, oesophageal or pulmonary artery monitoring.

Temperature regulating devices should be placed in an effective and safe manner according to the manufacturer’s

instructions and monitored during the surgical procedure.

Special care should be taken when using temperature regulating devices as thermal burns or necrosis may occur.

• Skin temperature monitoring is less satisfactory but may be considered in cases where the patient is awake (AfPP2011).

• It is acknowledged that there are perioperative interventions and procedures where core temperature monitoring is not feasible. In these situations alternative temperature measurements such as oral, rectal, temporal artery or tympanic membrane (using an infra-red sensor or axilla) can provide adequate near core temperature readings (Hooper et al 2009).

• Intravenous fluids that are not warmed and are administered at room temperature during surgery cause a decrease in mean body temperature of approximately 0.25o C (Kiekkas et al 2005, Bernard 2013). All intravenous fluids of 500ml or more and all blood products should be warmed using a dedicated fluid warming device that is specifically designed for this purpose (NICE 2008).

• The peritoneal cavity can be lavaged with warm fluids. All fluid for irrigation or lavage should be warmed to body temperature. Surgical irrigation fluids used for arthroscopy, cystoscopy and hysteroscopy should be warmed. Urology patients, especially those undergoing transurethral resection of the prostate, are at high risk of hypothermia (AfPP2011). All irrigation fluids that are used intraoperatively should be warmed in a designated warming cabinet which is designed for this purpose and thermostatically controlled to a temperature of 38 to 40°C (NICE2008).

• Humidified moisture exchangers should be used for the administration of all volatile gases (AfPP2011). >>

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>> Post-anaesthetic care The postoperative phase of recovery is the 24 hour period following the patient’s entry into a post anaesthetic care unit or recovery area (NICE 2008). Hypothermia can increase the length of stay in the post-anaesthetic care unit (PACU) and is identified as one of the most frequent adverse outcomes in the immediate postoperative period (Kiekkas et al 2005).

• The patient’s temperature should be measured and documented on admission to the recovery area and this should be repeated at 15 minute intervals (NICE 2008, Bernard 2013).

• Patients should be transferred

Patient Warming to pre-warmed beds where possible. Perioperative warming is cost effective and reduces patient discomfort by reducing the incidence of wound infections, length of stay in hospital and postoperative shivering (AfPP2011).

• If the patient’s temperature is below 36°C, then active warming with the use of a forced air warming system should be instigated until the patient is comfortably warm and reaches 36° C or above before discharge to the ward from the recovery oom (PACU) (NICE 2008).

• Hypothermia is the most common cause of postoperative shivering (Scott & Buckland 2006). Shivering can increase oxygen demands

and can also cause strain on the cardiovascular system.

Shivering can also cause distress to the patient. When this occurs the patient should be reassured with sensitive communication, explaining clearly the care to be administered to reduce and prevent the shivering (AfPP2011).

• The use of all warmed air devices should be documented on the local care plan or in the patient’s notes.

• The same method of temperature measurement should be used throughout each stage of the perioperative period to ensure accuracy and consistency in measurements (Hooper et al 2009).

References and further reading Association for Perioperative Practice 2014 Perioperative audit tool Harrogate, AfPP Association for Perioperative Practice 2011 Standards and recommendations for safe perioperative practice Harrogate, AfPP Association of perioperative Registered Nurses 2014 Recommended practices for safe care through Identification of potential hazards in the surgical environment In: Standards, recommended practices and guidelines Denver, AORN Inc Bernard H 2013 Patient warming in surgery and the enhanced

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2017 Volume 05 Issue 06 www.afpp.org.uk

recovery British Journal of Nursing 22 (6) 319-25 Burger L, Fitzpatrick J 2009 Prevention of Inadvertent hypothermia British Journal of Nursing 18 (18) 1114-19 Hooper VD, Chard R, Clifford T et al 2009 ASPAN’S evidence-based clinical practice guideline for the promotion of perioperative normothermia Journal of PeriAnesthesia Nursing 24 (5) 271-87 Kiekkas P, Poulopoulou M, Papahatzi A, Souleles P2005 Is post anaesthesia care unit length of stay increased in hypothermic patients?

AORN Journal 81 (2) 379-92

Patient Warming Leaper D, Kumar S, Bettles N 2005 Maintaining normothermia during surgery Clinical Services Journal 4 (8) 40-43

prevention of inadvertent hypothermia: Insights from the NHS NICE medical technology support [HTMTG7] London, NICE

McArthur-Rouse F, Prosser S 2007 Assessing and managing the acutely ill adult surgical patient Oxford, Blackwell Publishing Ltd

Paulikas CA2008 Prevention of unplanned hypothermia AORN Journal 88 (3) 358-68

National Institute for Health and Clinical Excellence 2008 Hypothermia: prevention and management in adults having surgery Available from: https:// www.nice.org.uk/guidance/cg65 [Accessed January 2016] National Institute for Health and Care Excellence 2014 NICE medical technology adoption support for lnditherm patient warming mattress for the

october/pub-003282.pdf [Accessed November 2016] Scott E, Buckland R 2006 A systematic review of Intraoperative warming to prevent postoperative complications AORN Journal 83 (5) 1090.111

Roberson M, Dieckmann L, Rodriguez R, Austin P 2013 A review of the evidence for active preoperative warming of adult patients undergoing general anesthesia American Association of Nurse Anesthetists 81 (5) 351-56

Wilkins IA, Wheeler DW 2004 Regulation of temperature Surgery 22 (7) 1 68a-e Winkler M, Akça 0, Birkenberg B et al 2000 Aggressive warming reduces blood loss during hip arthroplasty Anesthesia & Analgesia 91 (4) 978-84

Royal College of Nursing 2008 The management of inadvertent hypothermia in adults Available from: https://www.rcn.org.uk/-/ media/royal-college-of-nursing/ documents/publications/2008/

This is an extract from Standards and Recommendations for Safe Perioperative Practice 2016, published by the Association for Perioperative Practice.

NICE Guidance Supports the case to adopt Inditherm Alpha patient warming systems in the NHS

Every patient warmed with significant cost savings Unrivalled performance with unrestricted clinical access The new standard in patient warming

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2017 Volume 05 Issue 06 www.afpp.org.uk

Patient Monitoring

Safety, service delivery and teamwork: A new solution with Syncera The operating theatre is a hugely challenging environment fraught with risk that has to be managed on every level whilst not compromising the quality or delivery of care to the perioperative patient.

In many operating theatres, there exists a considerable disjointed approach, and unnecessary duplication around the procurement and availability of appropriate equipment and instrumentation for surgical procedures. This extends to the information that is available to the operating teams and the manner in which they have been educated or instructed and, in some cases, to having received no training whatsoever. It can never be overestimated that there is a need to pursue all necessary and available methods to join the processes together, in an effort to improve communication and enhance the patient and staff experience and outcome.

Imagine working in an operating theatre where individual surgical preference was available on every occasion, together with all the consumables required for the procedure, and regardless of whether the regular team was present or not. No more ‘tatty’ procedure cards with lots of illegible amendments, no more trying to figure out which sutures are needed or which approach is generally preferable for the operating surgeon. Imagine the calm and seamless process of teamwork that this picture creates.

Syncera’s S2 Procedure Performance learning platform is available 24/7 from any computer, so theatre staff can participate in learning when and where it best suits them.

Safety and value Patient safety is the numberone priority in our operating theatres. The NHS is a business that is struggling, and daily we hear of the enormous cash deficits that plague many organisations at this time. Any system that can enable safe and appropriate surgical care and reduce costs deserves our attention.

High-value patient care is multifactorial. The CEO of the US Seattle based Virgin Mason Medical Centre suggests that “the path to safer care is the same one as the path to lower cost”. This centre is recognised as one of the safest hospitals in the US (Virginia Mason Medical Center 2016).

I have had the privilege of seeing a product that has impressed me greatly and that I believe could be the answer to many of the challenges to safety and value that are presented for theatre staff on a daily basis. I admit to being totally skeptical when I was asked to review this system, and I think it’s the first time ever I have had to eat my own words in terms of my preconceived idea of what I would be exposed to.

‘An immediate and sustainable solution’ You may have heard of Syncera, a digital solution

by Smith & Nephew that offers an immediate and sustainable solution designed to help reduce unwarranted perioperative variation and optimise efficiency. I am no expert in digital technology, but what the Syncera S2 Procedure Performance demonstration provided to me was a clear and sustainable product that would benefit patients, surgeons, theatre practitioners, and supplies and procurement services.

S2 Procedure Performance could, in my view, contribute enormously to a proactive and potentially much better environment for patients and staff involved in delivering perioperative services.

Specific training needs of theatre teams S2 Procedure Performance is powerful in that it focuses on the specific training needs of theatre teams. Competency training is often disjointed or nonexistent, and surgical units are increasing productivity to meet the needs of a changing healthcare landscape.

Recommendations from the Francis Inquiry, Clinical Human Factors Group and the Royal College of Surgeons of England (RCSEng) have stressed that safer surgery and happier teams rest on whether hospitals can achieve a culture of effective teamworking (Giddings & Williamson 2007, CHFG 2013, The Health Foundation 2013).

Standardising systems in the operating theatre allows staff to focus on providing the appropriate care and quality service that is required for each individual patient. According to the RCSEng, ‘current accepted working practices, interdisciplinary relationships and training methods need to be improved using evidence from recent research, performance data and the experience of other high risk industries’ (Giddings & Williamson 2007).

The operating theatre needs the technology and the processes in place that can provide the

>>

Meeting Patient’s Temperature Needs Central Medical Supplies Ltd and The 37 Company have been experts in the field of temperature management for over 25 years. The Mistral-Air Forced Air Warming and Fluido Blood and Fluid Warming systems were designed together with users in the medical field, to fill existing needs for excellent clinical outcomes. The products along with the Virtual 37 Temperature Management Tool for education and support helps healthcare professionals maintain normothermia in the most efficient way.

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2017 Volume 05 Issue 06 www.afpp.org.uk

>> appropriate education and support for the entire team. It is well recognised that human error is an inevitable (Giddings & Williamson 2007) part of our existence, but one that we need make every effort to manage. Syncera provides the technology to help reduce human error by supporting the functions and responsibilities of staff involved in the surgical process.

S2 Procedure Performance customised surgeon-specific training helps theatre staff know what is required and when it is appropriate to provide it - through a system that gives scoring, instant feedback and rapid improvement suggestions with real-time metrics.

Lord Carter’s recent report highlights the importance of well-trained, engaged and empowered theatre staff in positive patient outcomes (Lord Carter of Coles 2016).

Practitioners undertaking advanced roles such as surgical first assistant (SFA) bring valuable skills to the surgical workforce, but more must be done to ensure they feel supported and that their roles are developed (Williams et al 2016). Training with S2 Procedure Performance helps staff feel fully supported in their everyday work activities, boosting their confidence in theatre which, in turn, has been shown to increase surgeon confidence in staff (Mathias 2014, Hensell & Pins 2015), and undoubtedly reduces the potential stress in this situation, making it a safe and overall better experience for patients and staff.

Syncera’s S2 Procedure Performance learning platform is available 24/7 from any computer, so theatre staff can participate in learning when and where it best suits them.

This approach can help reduce training time, increase learning opportunity, and promote self-belief and confidence in all who participate; in particular

Patient Monitoring where new procedures are commenced or there are changes in existing procedures.

S2 Procedure Performance can also be used just before a new or unfamiliar case to give that important boost in confidence when needed. Users are guided through the setup; they can order the instruments that will be required, and there is even a facility that allows staff to see what a specific surgeon calls each instrument. We all know what the variances can mean here, especially when it comes to ‘the one I always use’ or ‘my special’ or whatever variation on conversation that this involves at the operating table. It may sound funny, and often has been in my experience, but this too can be a stressful situation, and anything that can reduce stress at the many critical points during a surgical procedure reduces the potential risks on several levels. Knowing what that ‘special’ detail is in relation to a specific surgeon, task or procedure brings a whole extra level of competence to the nurse or operating department practitioner.

The goal is to eliminate unwarranted variation, which is well-recognised as key in minimising errors and improving outcomes (The Surgical Forum of Great Britain and Ireland 2011). Working to a set of specific, individualised protocols set by the surgeon in partnership with the theatre specialist means the first case of the day will largely be the same as the third, or as the fifth case the following week. In as far as anything can be predictable in this setting, Syncera comes close to providing a ‘personalised predictability’.

Potential to lower costs Surgery is expensive, and operating theatres utilise a major proportion of the hospital’s budget.

Instrumentation alone costs millions each year. >>

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Based on research carried out by other UK organisations and information taken from a Freedom of Information request, we have compiled the costings in Figure 1 as a guide to approximate costs for a 500-bed NHS hospital (Robinson 2009, DH 2011, Yoong 2014, Heart of England NHS Foundation Trust 2015, Health Services Journal 2016).

Actual amounts will depend on surgical volumes, average theatre delays in practice, the average sizes of your instrument trays for example, larger instrument trays will cost more to reprocess (but have a lower per-instrument cost) than smaller trays (which have a higher per-instrument cost).

In addition, these costings do not account for outliers such as large, multipiece equipment that is more expensive to reprocess on its own.

Patient Monitoring S2 Procedure Performance helps staff provide what’s required, as it is required, and cut down on the rest. The system’s ability to provide efficient tray inspection and tracking could result in up to 61% less instruments required and a 60% reduction in processing costs (Hensell & Pins 2015). Using the technology to streamline and save on even 10% of these example costs would represent a significant savings, and make the recovered resources available for other projects within the organisation.

Seamless integration to practice Syncera offers digital solutions (with a clinical transition specialist to support staff and surgeons along the way), with transparency on costs and

programmes, so that a clear and informed choice can be made.

These solutions blend and integrate with routine practices in theatre, becoming part of the workflow and enabling the team to be more efficient and effective.

In addition to enhancing the teamwork experience, so too is patient safety improved. Training that connects theatre staff and surgeons by using instructional methods aimed at improving team-based knowledge, skills, attitudes and problem-solving could help decrease error rates by up to 19% (McCraig 2016). A US-based study by orthopaedic surgeons using a cohort of 1,450 patients found implant-related errors occurred with implants 5% of the time (Ast et al 2014). For one in every 20 surgeries, things did not proceed as planned in theatre.

At the extreme end of this in the UK, we too frequently see ‘never events’. In the NHS, never events are defined as largely preventable patient safety incidents that should not occur if existing national guidance or safety recommendations have been implemented by healthcare providers (NHS Improvement 2016). The most recently published provisional statistics show that, in one month (August 2016), a total of nine wrong-site surgeries and seven retained foreign objects post-procedure were reported in England (NHS Improvement 2016).

Never events are different from other serious incidents, as the overriding principle of having the never events list is that even a single never event acts as a red flag that an organisation’s systems for implementing existing safety advice or alerts might not be robust. >>

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>> The authors in the US study implemented a computer-based e-tracking and compatibility system that standardised implant labeling, confirmed correct size and side (and patient), and ensured implant compatibility. The system saved valuable time and effort for surgical teams. Syncera’s automated point-of-care hip and knee replacement validation checker catches potential errors before the patient goes into theatre, improving quality and reducing waste by 85%. It also mitigates the risk of componentsize mismatches such as head and cup implantation which are ‘never events’ and ‘near miss’ incidents (Ast et al 2014).

As many operating theatres already have multiple systems in place for various functions, it is important to note that there are no barriers to using S2 Procedure Performance alongside other

Patient Monitoring systems already in existence.

Because it is an online resource, just one login per person, as with email or social media, it doesn’t need to be integrated with any NHS IT system. All that’s needed is the Internet and a web browser.

Exceptional potential Of course, nothing is ever foolproof, and all systems are only as functional as those who operate them. We must never lose sight in applying the basics of general enquiry and common sense. I can see, though, that Syncera’s S2 Procedure Performance does certainly have the potential to make theatres better organised and standardised, so that procedures can flow more smoothly and safely. This is the most exciting tool I have seen for some time, and I hope that before long I will have the opportunity to see it

working in practice. S2 Procedure Performance is a powerful and simple education tool and a great resource for standardisation and supporting staff in the perioperative environment.

Mona Guckian Fisher Independent Healthcare Consultant Immediate Past President AfPP

References and further reading Ast MP, Mayman DJ, Su EP, Gonzalez Della Valle AM, Parks ML, Haas SB 2014 The reduction of implant-related errors and waste in total knee arthroplasty using a novel, computer based, e.Label and compatibility system Journal of Arthroplasty 29 (1) 132–6 Clinical Human Factors Group (CHFG) 2013 Implementing human factors in healthcare:

Taking further steps Online: http://www.chfg.org/wpcontent/uploads/2013/05/ Implementing-human-factorsin-healthcare-How-to-guidevolume-2-FINAL-2013_05_16.pdf [Accessed November 2016] Department of Health 2011 GS1 UK. Application package: Surgical instrument traceability, version 6 Online: https://www. gs1uk.org/~/media/documents/ marketing-documents/surgical_ instrument_traceability_guidelines. pdf [Accessed November 2016] Giddings AEB, Williamson C 2007 The leadership and management of surgical teams London, The Royal College of Surgeons of England Online: https://www.rcseng.ac.uk/ library-and-publications/collegepublications/docs/leadershipand-management [Accessed November 2016]

Radiation & RF Shielding, MR & X-ray Imaging Accessories • MRI Products & solutions • X-ray Products & solutions • Servicing & support Installation & maintenance of hospital equipment • Bespoke engineering Monitor stands, Drug trolleys, Scoliosis chair, Step platforms • Export Agents in over 40 countries

T F E W

• +44(0) 20 8398 9911 • +44(0) 20 8398 8032 • sales@wardray-premise.com • www.wardray-premise.com

Quality without Compromise from the UK’s leading radiation shielding company

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2017 Volume 05 Issue 06 www.afpp.org.uk

Health Services Journal Guides 2016 How to tackle unwarranted variation Online: http://guides.hsj.co.uk/2230. guide [Accessed November 2016] Heart of England NHS Foundation Trust 2015 FOI 4172 Sterilisation of Surgical Instruments Online: http:// www.heartofengland.nhs.uk/foi-4172sterilisation-of-surgical-instruments [Accessed November 2016] Hensell MG, Pins J 2015 Virtual BackTable Reducing cost of onboarding Presented at the AORN Surgical Conference and Expo 2015, Denver, USA

Patient Monitoring Mathias JM 2014 Software orients staff, advances ‘rep-less’ model OR Manager 30 (12) 1, 6-9 Online: http://aimediaserver6. com/ORManager/digital/ ORM1214/#p=1 [Accessed December 2016] McCraig A 2016 Team training in health care can save lives Rice University News & Media Online: http://news.rice.edu/2016/07/14/ team-training-in-health-care-cansave-lives/#sthash.1fiNq1DQ. dpuf [Accessed November 2016] NHS Improvement 2016 Provisional summary of Never Events reported as occurring between 1 and 31 August 2016 Online: https://improvement.nhs. uk/uploads/documents/NE_data_ report_1-31_August_2016_FINAL. pdf [Accessed November 2016]

Lord Carter of Coles 2016 Operational productivity and performance in English NHS acute hospitals: Unwarranted variations Online: https://www. gov.uk/government/publications/ productivity-in-nhs-hospitals Robinson GB 2009 North JPP_138x188_sharps_BMS_JAN_FEB 04/10/2016 16:13Hospital Page 1 [Accessed November 2016] Tyneside General

Operating Department Online: https://www.northumbria.ac.uk/ static/5007/hces/ntgtheatre_polo. pdf [Accessed November 2016

mason-earns-a-for-patientsafety-in-national-hospitalsafety-score-program [Accessed November 2016]

The Health Foundation 2013 The Francis Inquiry report Online: http://www.health.org.uk/ about-francis-inquiry [Accessed November 2016]

Williams S, Buchanan A, Mathews J, Malais M, Eardley I 2016 A question of balance: The extended surgical team Online: https://www.rcseng.ac.uk/ library-and-publications/collegepublications/docs/question-ofbalance [Accessed November 2016]

The Surgical Forum of Great Britain and Ireland 2011 Training Surgeons for Service Requirements Glasgow, The Surgical Forum of Great Britain and Ireland Online: www.asgbi.org.uk/ download.cfm?docid=3A541052C425-427A-B42D95A7A410B4E3 [Accessed November 2016] Virginia Mason Medical Center 2016 Virginia Mason earns ‘A’ for patient safety in national Hospital Safety Score program 25 April 2016 Online: http://www. newswise.com/articles/virginia-

safety

Yoong WC 2014 Operating theatre time, where does it all go? A prospective observational study British Medical Journal 349 g7182 Disclosure: This is an independent report. Mona Guckian Fisher did not receive remuneration from Syncera or Smith & Nephew, and has no conflicts of interest in reviewing S2 Procedure Performance for the purposes of this article.

in mind first time, everytime In response to the EU Sharps Directive 2010/32/EU Swann-Morton have launched the KLEEN Blade Management system consisting of their standard blade enclosed within a protective cartridge thus supporting safe handling when fitting and removing the blade from your existing surgical handles. Complimented by Retractable Safety Scalpels, single use Blade Removers and “Cygnetic” they can now offer a complete range of compliant safety solutions.

Swann-Morton can offer in house sharps safety training in line with the new Directive so contact us on sharpssafety@ swann-morton.com for more information.

For more information on the complete range of surgical blades, handles, scalpels, disposable, fine and retractable scalpels please go to our website.

EMS 633531

All medical devices are CE marked in accordance with the Medical Device Directive (93/42/EEC)

FM 73368

Owlerton Green, Sheffield S6 2BJ Telephone: 0114 2344231, Sales: 0114 2344223, Fax: 0114 2314966 uksales@swann-morton.com, exportsales@swann-morton.com www.swann-morton.com ‘Swann-Morton’ and the ‘Ring Pattern Logo’ are the registered trade marks of Swann-Morton Limited and related companies.

www.swann-morton.com

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2017 Volume 05 Issue 06 www.afpp.org.uk

Product News

Nihon Kohden Nihon Kohden contributes to the field of medicine with unique and innovative technologies. Did you know Nihon Kohden engineer Dr Takuo Aoyagi first developed pulse oximetry to measure SpO2 in 1972.

Our patient monitors include; Cap-One - The only mainstream etCO2 sensor for intubated and non -intubated patients. Our sensors are robust, reliable and require no warm up time. iNIBP - For faster and gentler measurement our Linear Inflation technology measures blood pressure on cuff inflation to shorten the measurement to just 20 seconds

esCCO - to measure Continuous Cardiac Output using the vital signs ECG, SpO2 and NIBP without extra cost or specialised medical skills.

Nihon Kohden UK Ltd Tel: 0208 391 6800 Trident Court 118, 1 Oakcroft Road, Chessington Surrey, KT9 1BD Email: info@nihonkohden.co.uk Website: www.nihonkohden.net

Angloplas How can a 2.9mm device deliver 5mm performance?

By listening to and working with our many healthcare partners during 2016...

Percutaneous insertion!

With just a 2.9 mm shaft, Percuvance Percutaneous Surgical System from Teleflex has been engineered to reduce trauma for your patients, maintaining the performance of a 5 mm laparoscopic device.

Percuvance introduces a breakthrough form of minimally invasive surgery: percutaneous laparoscopy.

Using this approach, laparoscopic devices can enter through a small skin incision without trocars.

Your patients benefit from reduced trauma. You get the versatility and strength of a traditional laparoscopic device.

With the Percuvance System, minimally invasive surgery has now been reimagined– making it even less invasive.

Mob: +44 (0)7739 628969 Tel: +44 (0)1494 532761 Email: ian.mellors@teleflex.com Web: www.teleflex.com

Teleflex, Grosvenor House, Horseshoe Crescent, Old Town Beaconsfield, Buckinghamshire HP9 1LJ

...we have extended many of our product ranges and added completely new ones including; Clinical Waste Sack dispensers, Stryker® Hood Racks and Hood Dispensers, Surgical Count Boards, Suture Dispensers, Sign Holders, and since we’ve been producing signs for many years we’ve now added hospital signage to our list of services.

For more information please visit our website and/or download a catalogue using the QR code.

Please don’t forget that if you can’t find what you’re looking for, give us a call as we’re always happy to help. www.angloplas.co.uk

Journal of Perioperative Practice PROCUREMENT GUIDE January 2017 Volume 05 Issue 06 www.afpp.org.uk

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Product News

QA3 Drive Patient Trolley – more powerful, by design 2017 will see the launch of the new QA3 Drive from Anetic Aid – a suite of four new Patient and Emergency Trolleys with inbuilt motorised drive, offering controlled, effortless travel up to gradients of 10°.

Some models have electrically powered positioning too – raising and lowering the trolley itself, and the backrest. There is also a CPR button which when depressed will swiftly and automatically return the trolley to a horizontal, optimal height position for CPR treatment.

Another special model has an electrically powered ‘KneeFlex’ facility, providing additional comfort, particularly for patients undergoing abdominal procedures. The position also makes it very simple to elevate the legs for patients having leg and foot procedures.’

And of course these new QA3 models still have the features which have made it the trolley of choice for so many practitioners: • Side Rails fold away under the footprint of the mattress, leaving virtually zero transfer gap • Exceptionally low height range • K8 Pressure care mattress • Quick release fixed transfusion pole • Smooth moulded surfaces to aid infection control For further information or demonstration please contact sales@aneticaid.com

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2017 Volume 05 Issue 06 www.afpp.org.uk

Product News

Central Medical Supplies Central Medical Supplies Ltd (CMS) is the exclusive UK distributor for The 37° Company’s range of patient warming products, and CMS was recently given the prestigious “ 2016 Business Partner” award in appreciation of their excellent performance.

37° Company offer a range of warming systems designed to fill existing needs for excellent clinical outcome, which includes The Mistral Air, a ‘forced air warming’ system utilising a high volume low pressure system which does not interfere with laminar flow in the operating room, as well as the Fluido® Air-Guard and the new Fluido® Compact blood and fluid warmers, which are easy to use, accurate, safe and cost effective systems for daily blood and fluid warming. The unit rapidly warms fluids to the target temperature across all flow rates.

For more information log on to: www.centralmedical.co.uk

VIO3 from Erbe - “plug and operate” Erbe have shaped electrosurgery, developing it into today’s leading-edge operating theatre technology, making Erbe an essential and reliable partner for many users worldwide.

VIO3 is yet another of our milestones in electro-surgical technology, following the ICC series and alongside VIO200/300.

With its logical and intuitive interface the VIO3 is designed to ensure optimally userfriendly operation. The size of the touchscreen display alone speaks for itself; from the operating field the team always have a clear view of all control elements.

VIO3 provides via “stepGUIDE”, guidance by suggesting experienced starting settings used in various clinical applications.

This results in less setting adjustment or modification.

For further information please visit: vio.erbe-med.com

“Plug and Operate”. It couldn’t be easier.

Tel: 0113 253 0333 Email: sales@erbe-uk.com

VIO3 has the right mode for your surgical application, supporting monopolar and bipolar techniques and our proprietary hybrid technology.

Erbe Medical UK, The Antler Complex, 1A Bruntcliffe Way, Morley, Leeds LS27 0JG.

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Product News

Wardray Premise Wardray Premise Ltd are delighted to be appointed as a distributor of the new IV-eye® vein imager.

This innovative product helps healthcare professionals find a suitable vein for peripheral venepuncture or cannulation.

It provides a real-time clear image of a patient’s vascular structure, using near infrared light. It’s easy to operate,

requires no calibration and minimal training.

The IV-eye® vein imager helps reduce unsuccessful needle stick attempts, and assists in the best choice of vein, supporting better clinical outcomes and increased patient satisfaction. It’s a portable, lightweight, handheld device, similar in size to a smartphone.

evolution

This product’s appeal is not limited to one hospital department; it’s competitively priced; and represents an affordable piece of equipment.

Contact Wardray for more information.

Tel: 020 8398 9911 Email: sales@wardraypremise.com

Patient Trolley:

more powerful by design Anetic Aid has introduced a suite of four new QA3 Patient and Emergency Trolleys with inbuilt motorised drive, offering controlled, effortless travel up to gradients of 10°.

Some models have electrically powered positioning including a CPR button which, when depressed, will swiftly and automatically return the trolley to a horizontal, optimal height position for CPR treatment.

There is also a model with an electrically powered ‘KneeFlex’ facility.

Innovative technology – practically applied

• Inbuilt motorised drive • Powered functions • KneeFlex

Plus: all the features which have made the QA3 a trolley of choice for so many practitioners: Side Rails which fold away under the footprint of the mattress, leaving virtually no transfer gap, Exceptionally low height range, K8 Pressure Care Mattress, Quick-release Fixed Transfusion Pole, Smooth moulded surfaces to aid infection control and Lifetime Warranty – whole life cost transparency.

T +44 (0)1943 878647 sales@aneticaid.com Sapper Jordan Rossi Business Park, Otley Road, Baildon BD17 7AX, UK

aneticaid.com

The widest range of single use suctions.

t. 01226 732 333 e. info@susl.co.uk w. www.susl.co.uk