Journal of Perioperative Practice PROCUREMENT GUIDE January 2013 by Open Box Media & Communications

Journal of Perioperative Practice

PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk 01423 881300

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

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Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Contents

Welcome to your Jan/Feb 2013 Guide 05

Patient warming

Inadvertent hypothermia

Recovery

Recovery changes and improvements in day surgery since 1980: a personal perspective

Interview with Robert Sharpe, CEO of Purple Surgical

NICE publishes positive final guidance on device for use during electro surgery

Synoptics Health appoints Peskett Solutions as UK distributor for ProReveal as expert support of ultra-sensitive test for detecting protein on surgical instruments

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 2013 Medical devices May 2013 Laparoscopic surgery July/August 2013 Infection prevention September 2013 Airway management November 2013 Safety January 2013 Recovery

Contact Information: Advertising, Sponsorship & Partner Packages. Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: francesmurphy60@yahoo.com 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: francesmurphy60@yahoo.com

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

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Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Patient Warming

Patient warming Patient warming is recognised as an integral element of maintaining normothermia in perioperative patients and is undertaken in the pre, intra and post operative phases of patient care (AfPP 2011). Normothermia has been defined as “the presence of a normal body temperature” and “when the core body temperature is between 36.5oC and 37.2oC” (Smith & Williams 2004). Normothermia is maintained by a balancing of heat loss and heat production, and the hypothalamus is identified as the centre for thermoregulatory control in the conscious adult patient (Monahan et al 2007). It is acknowledged that the administration of anaesthesia can adversely affect these mechanisms (Kiekkas et al 2005, Good et al 2006).

postoperative recovery, increased blood loss and cardiovascular problems, increased risks of pressure ulcers and delayed wound healing and increased risk of infections (McNeil 1998, Scott & Buckland 2006, Paulikas 2008, Weirich 2008).

Some factors associated with heat loss have been identified in relation to the environment, the induction and maintenance of anaesthesia as well as in the surgical procedure (NICE 2008, Paulikas 2008, Burger & Fitzgerald 2009, AfPP 2011).

Prewarming is defined as the warming of the skin and peripheral tissues prior to the induction of anaesthesia (Hooper et al 2009) and the warming method of choice is that of forced air warming as this can be easily transferred for use in the intra and postoperative phases of the patient’s journey (Bellamy 2007, AORN 2008, NICE 2008).

It is imperative that the patient’s core body temperature is maintained at 36oC at all points in the perioperative journey and that action is taken immediately if the core body temperature falls in order to prevent hypothermia and associated complications from occurring (NICE 2008, AfPP 2011). The induction of anaesthesia should not occur if the patient’s temperature is below 36oC except in emergency situations when delay will potentially cause greater clinical complications. Some of the factors associated with hypothermia are prolonged

Patient warming measures Prewarming

Intravenous fluids

Any intravenous fluids or blood products with a volume in excess of 500mls should be warmed prior to infusion in order to assist in the maintenance of normothermia (AORN 2008, AFPP 2011).

Irrigation fluids

All irrigation fluids should be kept in a warming cabinet at a temperature of 38-40oC prior to administration (AORN 2008, Nice 2008, AFPP2011).

Skin preparation

The time between the removal of covering blankets, skin preparation and evaporation, and the placing of drapes should be undertaken in the minimum amount of time possible, in order to minimise heat loss. In addition, care should be taken to ensure that drapes remain as dry as possible during the procedure - wet drapes can lead to a decrease in skin temperature (Bellamy 2007, AORN 2008, AfPP 2011).

Removal of drapes

Care should be taken to ensure that the patient is suitably covered with blankets immediately after the removal of surgical drapes in order to minimise heat loss (NICE 2008, AfPP 2011).

Transfer to recovery

The patient should be transferred to a pre-warmed bed for transfer to recovery and covered with appropriate blankets. Forced air warming can be continued in the recovery area if identified as clinically necessary and/or should be recommenced if the core body temperature falls below 36oC (NICE 2008, AfPP 2011).

Warming devices

There are a number of warming devices available including warming mattresses and “space blankets”. However, it is acknowledged that forced air warming blankets and gowns are the most commonly used devices and are the recommended patient warming system advocated by NICE. In conclusion, it can be seen that patient warming is an essential facet of safe perioperative care and is a significant factor in reducing the risk of inadvertent perioperative hypothermia and associated complications. References: American periOperative Nurses Association 2008 Perioperative Standards and Recommended Practices Denver, AORN Association for Perioperative Practice 2011 Standards and Recommendations for Safe Perioperative Practice Harrogate, AfPP Bellamy C 2007 Inadvertent hypothermia in the operating theatre: an examination Journal of Perioperative Practice 17 (1) 18-25

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Burger L, Fitzpatrick J 2009 Inadvertent hypothermia prevention: the anaesthetic nurses’ role British Journal of Nursing 18 (18) 1114-1119 Good KK, Verble JA, Secrest J, Norwood BR 2006 A systematic review of the effectiveness of cutaneous warming systems to prevent hypothermia Journal of Clinical Nursing 83 (5) 1051-1066 Hooper VD, Chard R, Clifford T, Fetzer S, Fossum S, Godden B, Martinez EA, Noble KA, Obrien D, Odom-Forren J, Peterson C , Ross J 2009 ASPAN’s EvidenceBased Clinical Practice Guideline for the Promotion of Perioperative Normothermia Journal of PeriAnaesthesia Nursing 24 (5) 271-287

Patient Warming It is imperative that the patient’s core body temperature is maintained at 36oC at all points in the perioperative journey and that action is taken immediately if the core body temperature falls in order to prevent hypothermia and associated complications from occurring

Kiekkas P, Paulopoulou M, Paphatzel ANS, Aouleles P 2005 Effects of hypothermia and shivering on standards PACU monitoring of patients AANA Journal 73 (1) 47-53 McNeil B 1998 Addressing the problems of inadvertent hypothermia in surgical patients part 2: Self learning package British Journal of Theatre Nursing 8 (5) 25-33 Monahan FD, Sands JK, Neighbors M, Marek JF, Green CJ 2007 Phipps’ Medical-Surgical Nursing St Louis, Mosby Elsevier National Institute for Health and Clinical Excellence 2008 Inadvertent Perioeprative Hypothermia: The management of inadvertent hypothermia in adults London, Nice

Paulikas CA 2008 Prevention of unplanned perioperative hypothermia AORN Journal 88 (93) 379-392 Scott EM, Buckland R 2006 A systematic review of intraoperative warming to prevent postoperative complications AORN Journal 83 (5) 1090-1113 Smith B, Williams T 2004 Operating Department Practice A-Z London, Greenwich Medical Media Weirich TL 2008 Hypothermia/ Warming Protocols: Why are they not widely used in the OR? AORN Journal 87 (2) 333-334

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Patient Warming

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Patient Warming

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Patient Warming

Inadvertent hypothermia There are several published studies and commissioned guidance for the maintenance of perioperative normothermia in surgical patients (NICE 2008a, RCN 2008). Patient warming is considered important and significant; a cold patient does not recover well, and suffers increased postoperative discomfort and anxiety. Being cold is proven to be detrimental to wound healing as well as increasing the risk of surgical site infection (DH 2011, NICE 2008b). NICE (2008a) define inadvertent hypothermia as a core temperature below 36oC. All surgical patients are at risk of inadvertent hypothermia. NICE, (2008a) recommends that all patients are risk assessed prior to going to theatre for their individual risk of inadvertent hypothermia and the potential consequences of becoming too cold. The surgical patient is susceptible to hypothermia, even before they enter the operating theatre, as well as during surgery and the postoperative period. NICE (2008) provides guidance and recommendations for preventing inadvertent hypothermia during the well defined three phases of a surgical patient’s perioperative pathway: preoperative, intraoperative and postoperative. It is very important, that the patient receives education and information about why surgical patients should be kept warm, particularly while they are waiting for surgery. Patients who arrive in theatre ‘cold’ increase the risk of trying to play catch up in achieving and maintaining normothermia during surgery. If surgery is not urgent it may be

delayed if a patient is considered to be too cold (NICE, 2008). Patients have the right to refuse or accept treatment. Verbal and written information with explanation assists patients to make an informed decision. Equally, healthcare staff caring for the patient should be well informed as to the benefits of patient warming as well as the risks associated with inadvertent hypothermia. Healthcare staff should receive appropriate training in the medical devices used for patient warming. There are various methods of active and passive patient warming devices which assist in reducing inadvertent hypothermia in the surgical patient. Healthcare organisations need to refer to NICE medical technologies guidance when considering which will be the most effective system to implement into clinical practice. Ongoing support and training should also be considered as well as sustainability in line with ever reducing NHS budgets. When considering how effective patient warming is in your organisation, consider the following: Are the patients well informed of the benefits of patient warming? Has staff education and development taken to raise awareness of the risks and consequences of inadvertent hypothermia? Does warming begin well before the patient comes

to theatre for surgery and continues right into the postoperative phase? Has the most cost effective system been implemented into the organisation, taking into account NICE recommendations and guidance? Is practice being audited and reviewed against best practice benchmarks such as the ‘Saving Lives’ high impact interventions care bundles (DH 2010)?

Recommendations for Safe Perioperative Practice Harrogate, AfPP Department of Health 2010 Prevention of surgical site infection high impact intervention London, DH Available from: http:// webarchive.nationalarchives. gov.uk/20120118164404/hcai. dh.gov.uk/whatdoido/highimpact-interventions/

Maria Boutabba RODP, NEBSMCert, CertEd. Clinical Team Leader - Surgical Practice (Day Surgery) Surrey and Sussex NHS Trust

National Institute for Health and Clinical Excellence 2008a Perioperative hypothermia (inadvertent) (CG65) The management of inadvertent perioperative hypothermia in adults London, NICE

References: Association for Perioperative Practice 2011 Maintaining perioperative normothermia. In Standards and

National Institute for Health and Clinical Excellence 2008b Surgical site infection (CG74) Prevention and treatment of surgical site infection London, NICE

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Recovery

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Recovery

Recovery The recovery or post anaesthetic care unit (PACU) is an essential element of perioperative patient care and there are a number of issues to consider when developing and implementing plans for new departments or for refurbishing existing facilities. The purpose of a recovery area or PACU is to provide immediate and intermediate care of the postoperative patient (Parkinson 2012). The timescale for postoperative recovery has been defined as the 24 hour period which commences at the point of the patientâ&#x20AC;&#x2122;s admission to the recovery area or PACU (NICE 2008). As stated above there are a range of factors to consider to ensure an efficient and safe service to patients in the recovery or PACU, as well as the need to provide a safe working environment for staff. Some of the identified factors and issues are as follows:

Environment requirements

The recovery or PACU environment should be a patient centred environment with an ambience to aid recovery from anaesthesia (Yates 2005). The recovery area should ideally be situated in the centre of the department with easy access from all operating theatres as well as being situated near to the main entrance and/or reception to ensure that patients and staff have the minimum journey possible. A central staff station should be facilitated that will incorporate telephone and IT facilities as well as ensuring an adequate view of the entire recovery area or PACU (AfPP 2011, Parkinson 2012). In addition, all telephone systems should be capable of being muted in order to minimise disruption to staff and patients (Parkinson 2012).

The area should have maximum natural lighting to aid accurate assessments of a patientâ&#x20AC;&#x2122;s condition and artificial light should be dimmable in each space to suit the needs of the patient (AfPP 2011). Windows should be sealed double glazed units to reduce noise pollution and meet energy conservation needs (NHS Estates 2007). Adequate ventilation systems must be in situ and fully operational at all times. The systems must also include gas scavenging in order to facilitate the removal of waste anaesthetic gases and so reduce the risk of exposure to these products to patients, staff and visitors (AfPP 2011, Parkinson 2012).

The finish on walls should be robust in order to withstand knocks from trolleys and equipment such as X-ray machines, and reinforcement should be applied to areas of high risk such as doorways. The finish must also be hygienic and able to withstand regular cleaning as well as being a colour that is conducive to the lighting needs of the area and in addition, should be a colour that does not interfere with monitoring equipment (NHS Estates 2005). Flooring should be robust enough to withstand the frequent movement of trolleys and equipment and should have sealed or welded joints to prevent microbiological contamination. The floor surface must be capable of withstanding regular cleaning and be slip resistant to ensure staff safety (NHS Estates 2005). In new builds, and where possible during refurbishment, automatic closing doors should be installed and consideration should be given to lead lined doors to facilitate the use of X-ray. Glass panels can be fitted, but care should be taken to ensure the privacy of patients and this is often achieved with the use of an opaque covering or glass in the panel itself. Storage facilities should be designed to meet current needs and also to anticipate future

equipment needs. In addition, due to the desired central location in the perioperative environment, emergency equipment such as cardiac arrest trolleys are stored in recovery and these must be easily accessible at all times (NHS Estates 2007). Where possible in existing units, and an essential in new builds, is the designation of single sex accommodation or bays. In addition, a dedicated paediatric recovery area should also be available for any recovery area or PACU that has the potential to receive paediatric patients. Whilst it is unusual for a death to occur in the perioperative environment, it is often that the deceased patient will be taken to the recovery or PACU area. Consideration should be given to the provision of a private and peaceful area for relatives of the deceased (Parkinson 2012). Adequate waste disposal areas as well as utility and sluice areas are required (AfPP 2011).

Bed space requirements

A minimum bed space of 3.6 x 3.8 m is required for each bed space (NHS Estates 2004). Access to a hand wash basin, ideally at the end of each bed space is required for hygiene and infection prevention purposes and all hand wash facilities

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

should be operated with nontouch taps (AfPP 2011). Wall mounted 02 and air supply as well as suction points and monitoring equipment should be available in each bed space (Parkinson 2012). Sufficient electrical sockets should be available in each bed space and consideration should be given to the merits of an uninterrupted power supply (UPS) system to ensure continuity of care in the event of disruption to the power supply. Emergency call bells linked to a dedicated alert system should be available in all bed areas in order to summons prompt assistance in emergency situations. The potential for IT facilities at each bedside should be considered in order to facilitate prompt electronic recording of patient care.

Recovery In new builds, and where possible during refurbishment, automatic closing doors should be installed and consideration should be given to lead lined doors to facilitate the use of X-ray. Glass panels can be fitted, but care should be taken to ensure the privacy of patients, often achieved with the use of opaque glass itself.

References: Association for Perioperative Practice 2011 Standards and Recommendations for Safe Perioperative Practice Harrogate, AfPP

National Institute for Health and Clinical Excellence 2008 Inadvertent Perioperative Hypothermia: The management of inadvertent hypothermia in adults London, Nice

NHS Estates 1994 Health Technical Memorandum 2025: Ventilation in Healthcare Premises, Design Considerations London, The Stationery Office

Parkinson H 2012 The Perioperative Environment. In Woodhead K and Fudge L (Eds) 2012 Manual of Perioperative Care: An Essential Guide Chichester, Wiley-Blackwell

NHS Estates 2005 Health Building Note 26: Facilities for Surgical Procedures Vol 1 London, The stationery Office NHS Estates 2007 Health building Note 10-02 Surgery: Day Surgery Facilities London, The Stationery Office

Yates J 2005 Care of the Post Anaesthetic Patient. In Woodhead K and Wicker P (Eds) 2005 A Textbook of Perioperative Care Edinburgh, Elsevier Churchill Livingstone

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Recovery

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Recovery

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Recovery

Recovery changes and improvements in day surgery since 1980: a personal perspective When I started work in day surgery in 1980 in a district general hospital it was a new concept in hospital care, and the purpose built unit had only recently opened. There was no dedicated recovery area; we were expected to recover patients in the corridor directly outside the theatre doors! All we had was a portable suction unit, a free standing oxygen cylinder and no monitoring as we know it today. Fortunately, we only had to recover a few patients a week. As the theatre lists increased, we adapted an area for recovery, which although basic, was better than the corridor! Instead of the monitoring we are now all used to, and rely on, recovery was based on patient observation using our basic nursing skills and intuition, and of course, a sphygmomanometer. There was still only the portable suction unit and one oxygen cylinder - this increased to two as the unit grew! The ‘emergency’ call button was either a very loud shout or the telephone! This would be to summon someone from the ward area. I was originally employed as the sister for day surgery, which I believed was for the scrub side. There was no recovery nurse per se, and I found myself stepping into the role of a recovery nurse. The only ‘teaching’ and support I received was from a consultant anaesthetist, so learnt on the job. For a few years we didn’t have a dedicated recovery nurse, we were multi-skilled in recovery and scrub, which worked well. Obviously over the years as the unit has grown, the recovery area has improved to now encompass

full monitoring equipment, wall mounted suction, piped oxygen, drug cupboard and, most importantly, a resuscitation trolley and defibrillator - and of course, dedicated recovery staff.

Skills required

As a recovery nurse in a day unit we dealt with adults, children and special needs patients. Special needs and children’s lists were primarily dental lists - so not only having to deal with the more demanding needs of these patients, also ensuring that their airways were kept clear after surgery. These patients demanded a higher level of care and attention and were really the most challenging of all recovery. In an ideal world, we would always try to have two nurses to one child, but in reality this was seldom the case due to staffing issues. The second person was there for support and to help with restless patients. It is important that the child is kept safe, and trolley side bumpers are essential. More often or not with the special needs patients, we would recover that patient, with maximum staff, before sending for the next patient.

Over the years a Saturday Club for children was established, and this proved to be a great success with all concerned. This involved a recovery nurse, ward nurse and a play specialist. Unfortunately not all parents would bring their children to this club, which was apparent on the day of surgery. We would explain exactly what was going to happen and give them an opportunity to see theatre, ride on the trolley, and see and use the monitors. This alleviated many of their fears and made our job in recovery that much easier.

Advances and changes

In the 1980s the commonly used induction agent was Thiopentone. This was then gradually replaced by Propofol/ Diprivan, (cost at this time being a factor of when it was used) being the agent of choice due to shorter acting time. Diprivan is egg based, so it is important to note if the patient is allergic to eggs. This made life in recovery so much quicker, as instead of a first stage recovery taking at least 20 minutes, the patients were now waking up 5 minutes after leaving theatre. This was ideal for day surgery with the very quick turnover of patients, so potentially we could treat more patients. As the ward was adjacent to recovery, patients could be returned to the ward much sooner than if they were on a main ward. IV Paracetmol/Perfalgan was also a huge improvement in offering postoperative pain relief, as this is quick acting, and is given over 15 minutes. It is not recommended for children. It is important that day patients receive adequate pain relief as they will be discharged later that day, and to encourage both the anaesthetist and surgeon to give pain relief whilst the patient was in theatre, so that it would be acting once the patient was in recovery. This could be in the form of a block, suppositories, local infiltration or IV. In the first years of day surgery, it was not recommend that opiates, i.e. morphine be given

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Recovery

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Recovery for pain relief, as it was thought that the patient would be unable to go home the same day. Research has shown that morphine can be given and the patient can go home on the same day. Day surgery has changed dramatically over the years, and is now more based on a 24hr stay. As surgery has progressed, obviously skills in recovery have had to change, and all staff in recovery are now expected to be able to give IV or subcutaneous pain relief. Due to extended surgery, the time in recovery is also longer, which used to pose a problem if a ‘long’ case was followed by shorter cases, as one recovery nurse could be attending a patient for an hour, whilst maybe two or three other patients would pass through recovery – this could cause delays due to staffing issues.

Recovery is not only about general anaesthetics. There has been a shift over the years to using spinals and blocks. These have their own side effects which the recovery nurse must be aware of, as well as caudal epidurals. Local anaesthetics can carry their own risks, which again, staff must be aware of, and not be blasé about it ‘just being a local’. A thought to leave you with; no matter how good the monitoring, it is of no use if the patient is not breathing! Patient observation should be first and foremost in the recovery nurses mind, not actually worrying whether or not the patient is attached to the monitor in the first instance. Joanna Bowen RGN, MA Health Care Law & Ethics

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Product News

Interview with Robert Sharpe, CEO of Purple Surgical How long have you been with the company? Wow! I haven’t thought about that for a long time. I joined straight after finishing my Business degree in 1985, so it’s now 28 years. What made you choose a career in this industry? Since my mid-tens I always wanted to join the family business – that was after finding out I wasn’t going to make it as a professional footballer or F1 driver. What is your professional background? I have a BA Hons. in Business but I suppose after 28 years my greatest professional qualification is experience. How did the company begin and how long has it been running? Cory Bros started life as Cory Bros (Surgical Instrument Makers) Ltd in 1909, so we are technically 104 years old. Adverts for the Company appeared in the Red Cross publication as well as the Sunday Times and Suffragette newspapers around the time of the First World War. The company changed hands on a couple of occasions over the next 60 years until my father bought it in 1969. Soon after, we entered the Gynaecology market when we began distributing a range of Uterine Aspiration products which remains at the core of the business today. We introduced some of the first single-use electro surgery products at the end of the 1970s and were one of the first to enter the laparoscopy market in the mid-1980s. At the end of the 1990’s we were hit hard by the decisions of some large corporations in the U.S. to buy up a lot of small and medium sized manufacturers who we represented in the UK. So I made the decision to ensure the future

of the Company by switching our focus from UK distribution to manufacturing our own products for the global market. What is your biggest current news story? It has to be our Company name change. After 104 years trading as Cory Bros in the UK we have decided that going forward, our UK business is going to adopt the same name as our international one. From January 2013, Cory Bros has become Purple Surgical. This change is pretty similar to Norwich Union becoming known as Aviva. The people and the company have stayed the same, but utilising one brand will enable us to streamline all our activities. Why ‘Purple Surgical’? I’ve often been asked why we chose the name Purple Surgical and it’s really quite simple. We had a clean sheet of paper. We wanted to create a name that would translate internationally and that we could build a brand identity around. If it’s a purple

product and it’s in Theatres it’s likely to be ours. Lastly, purple is my favourite colour. If you visit our offices or production facility, that will be very evident. What was your job before this one? Whilst at school I worked most holidays either in the warehouse or office and when I was old enough I delivered orders to hospitals in and around London. When I joined the company full time I spent five years in sales before joining the management team. What are your plans for the future? We’ve got lots of exciting plans for the future. We’ve come a long long way since we started manufacturing our own products in 2002. At the time it was a massive decision to take but we’ve never looked back. Since 2000 we’ve expanded internationally and our products are now used in over 80 markets worldwide. Our manufacturing base has steadily grown and this year we’ll produce around 10 million products at our production facility in Somerset.

Over the last few years our primary focus has been in Uterine Aspiration, Laparoscopy, Safe Sharps Management in Theatres and Theatre consumables. Last summer, after a three year development program we entered the Surgical Stapling market and in Q1 2013 we’ll be introducing a new range of Gynaecological Essentials. Going forward, our three key strategic focusses will be: • Launching the Purple Surgical name in the UK and ensuring that all our past, present and future customers know that Cory Bros has now become Purple Surgical. • To continue to rapidly develop our business in the UK, especially with our new products. • To continue our international expansion by adding at least ten new markets in 2013. What do you think your experience can do to advance the interests of the company? Along with drive and enthusiasm, experience forms one of the three key support structures of every successful business. Looking back, I’ve been guilty of making some real clangers, but as I’ve gained more experience those mistakes are now thankfully few and far between. My experience has also helped me map out our overall strategic direction that will hopefully mean that we will more than double

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Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Product News

in size within the next 10 years. Probably, most importantly, experience has enabled me to make the right choices in building a team of great, likeminded colleagues.

are used every day in Theatres and our greatest focus is in General Surgery, Gynaecology and Laparoscopy. Our product portfolio is available on our website www.purplesurgical.com.

Do you find your job rewarding and if so how? Elements of my job are mundane. The devil is always in the detail.

What are your thoughts on customer service? We are technically a medium sized business which puts us in a perfect position to plan like a corporation and react like corner shop. It’s always been my philosophy that we should be grateful for every order a customer places with us and everyone in the company’s job is to ensure that the entire purchasing process, from raising the order to disposing of the product after surgery, is as smooth and cost effective as possible.

The biggest rewards I still get are when individuals or the team deliver on commitments they have made. My biggest buzzes come when we successfully launch a new product or we appoint a new distributor. The Medica exhibition in Dusseldorf each November is the highlight of the year for me because in just three days, I get to meet a host of our distribution partners from around the world, who are always very appreciative and positive about what we are doing. Does your job involve a lot of travelling? I don’t do as much travelling as I did but I’m probably away on business two months of the year, most often getting to know our new distribution partners. Where is the company based? Our head office is in Shenley, which is a North London suburb just inside the M25. Our production and distribution facility is hidden away in leafy Somerset, near Taunton. Does your company have branches abroad? No we don’t. Our international business is routed through local, exclusive distribution partners. They tend to know their markets and their customer’s needs the best. How many employees do you have? Right now we employ almost 120 people. Who are your customers and what products do you offer them? Our customers are clinicians and procurement teams in every NHS and Private Sector hospital and clinic in the country that undertakes surgery. Our products

How have changes in the economy affected your business? Generally speaking the healthcare market evolves rather than sprints. That said, although price has always been an important factor, in the last five years it has rapidly become the important factor when purchasing decisions are being made. Once again, being a medium sized business puts us in a great position. We don’t have to cover the huge overheads and shareholder demands of the corporations, so we are able to be far more competitive, whilst at the same time we operate with the highest possible standards of product quality and customer service. This has proven to be a very appealing combination to our customers. Do you foresee much expansion in the coming years? As I previously mentioned, one of our primary goals is to double the size of the business within the next ten years. The UK and world healthcare markets are absolutely huge – worth £billions. Our activities are only a drop in that ocean. So once you have got your product, service and price offering right, expansion will follow. How do you advertise your products? In the last few years we have bucked the trend of declining advertising because we’ve

wanted to convey some key messages to our customers. The most recent being the fact that we are one of the last genuine UK manufacturers left in our industry. Having conducted some extensive market research to see if that fact was important to our customers, we were delighted to be told that purchasing from a UK manufacturer held a strong preference with them. Our advertising over the last few months has been letting the UK market know. What makes you different from your competitors? We see ourselves as being very different to our competitors. Traditionally the market has been dominated by the high priced multi-nationals. As demands for cost savings have gained in importance, there has been an emergence of a handful of low cost distribution companies. But maintaining consistent high levels of product quality and customer service has not been their strength. We occupy the middle ground, combining highly competitive pricing with excellent customer service, high product quality, genuine UK production and 104 years of stability. How successful have you been to date? Having been severely challenged at the end of the 1990’s when several of the companies that we represented were acquired by multi-nationals with their own UK operations. We have developed from a UK distribution company

into a manufacturer, selling our products globally. Over the last 13 years we have averaged 20% annual growth and whilst we could have done better, I am happy with the progress we have made. How are you committed to quality? Quality is everything. Without it you have nothing. Every month the Directors of the Company have a Senior Management Meeting. The first item on the agenda is always a review of the reported quality issues we have had the previous month and the steps we are taking to resolve them. Whilst I’d like to say we don’t have any quality issues that wouldn’t be true. It’s a target we have to aim for but for the last twelve months we have averaged just over 20 issues per million products sold. Not perfect but I’m happy to stand by our record. How important are good customer relations? Happy, not just satisfied customers are as important to our business as consistent, high product quality. As with product quality, we don’t always deliver the perfect experience for our customers but we always strive to do our best and an on-going goal is to always attract those people to the Company who recognise the importance of extremely high customer satisfaction. If any of your readers have any issues with our products or service or they just want to tell me how happy they are with us, they are welcome to contact me directly at robert@purplesurgical.com

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Product News

Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Product News

NICE publishes positive final guidance on device for use during electro surgery The National Institute for Health and Clinical Excellence (NICE) has published final positive guidance on the use of the Mega Soft® Patient Return Electrode mats, supplied by Interglobal Surgical in the UK. NICE – the body that advises the UK National Health Service on the prevention and treatment of ill health including use of new medical devices – began evaluating this new technology in September 2011 and on 22 August introduced its guidance to the NHS in England recommending the mat for use by selected patient groups to help reduce the likelihood of burns on patient’s skin during surgery. The device, called Mega Soft® Patient Return Electrode, was developed by Megadyne Medical Products, Inc. in the US, whose sole distributor in the UK is Interglobal Surgical. The Mega Soft mat, which is placed on the operating theatre table and lies beneath the patient during surgery, was designed to eliminate the need for a disposable patient return electrode attached directly to the skin. The latter are currently used in the NHS and can cause skin burns. According to NICE the device can particularly benefit elderly people, patients with tender or already damaged skin and those whose skin would need shaving first. There are also possible benefits for theatre staff in terms of convenience and reduced setting-up time.

Paul Frandsen, Managing Director of Interglobal Surgical, said: “We are pleased to see NICE’s recommendation for the use of our mats by hospitals in England. In addition to the benefits identified by NICE, hospitals can also decrease waste and improve cost efficiency. One Mega Soft reusable return electrode can potentially eliminate 1,000 disposable pads per annum”. NICE medical technology guidance involves a new technology being evaluated in comparison to current practice or devices and reviewed against the evidence submitted and expert advice. Positive guidance is issued if the new technology or device offers benefits to the patient and NHS at a lower cost compared with similar products, or increased benefits for equal cost. The NICE guidance “Mega Soft Patient Return Electrode for use during monopolar electrosurgery” is available at www.nice.org.uk/MTG11 For more information about Interglobal Surgical and the Megadyne Mega Soft® Patient Return Electrode, please call 01242 262 680 or email enquiries@ igsurgical.co.uk

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Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

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Journal of Perioperative Practice PROCUREMENT GUIDE January/February 2013 Volume 01 Issue 06 www.afpp.org.uk

Product News

Synoptics Health appoints Peskett Solutions as UK distributor for ProReveal as expert support of ultrasensitive test for detecting protein on surgical instruments Synoptics Health, a new division of Synoptics, a world leader in the development and manufacture of innovative digital imaging systems for scientific applications, has announced the appointment of Peskett Solutions Ltd as its exclusive UK and Ireland distribution partner for ProReveal, an ultra sensitive fluorescent test for detecting protein contamination on surgical instruments. Under the terms of the agreements, Peskett Solutions will market and support Synoptics Health’s new ProReveal Test. The test consists of a ProReveal Protein Detection Test Kit, which conforms to BS EN ISO 15883-1 and a ProReveal Viewer, which when used in combination will detect nanogram amounts of fluorescent proteins on surgical instruments. This new ProReveal Test aligns with the recommendations of the new NHS CFPP-01-01 consultation document. In independent trials at sterile services departments (SSDs) in two major London hospitals the ProReveal Test achieved a 100-fold increase in sensitivity of protein detection, compared to current protein detection tests used in SSDs. Matthew Peskett, Managing Director of Peskett Solutions explained: “We saw the

ProReveal technology being developed by Synoptics Health in collaboration with Queen Mary University of London and were amazed by how easily it could detect where protein contamination is located on a surgical instrument. Current protein tests don’t really tell you where the protein is on an instrument and in an SSD, knowing where the protein is, can help you pin-point if and where, the issues lie with your decontamination process, and this is where ProReveal will provide a major benefit”. Paul Ellwood, CEO of Synoptics Health commented: “We are delighted to be partnering with such a well-respected decontamination company to help us support our ProReveal Test. Peskett Solutions has an extensive network of professionals with SSD expertise and this will make it quicker and easier for decontamination professionals to implement the

ProReveal technology into their facility, confident that they will have expert guidance in their transition to a more sensitive and cost-effective protein decontamination testing method”.

For further information: Jayne Arthur, Synoptics Health, Beacon House, Nuffield Road, Cambridge, CB4 1TF, UK. Tel: +44 (0) 1223-727114 Fax +44 (0) 1223-727101 Email: jayne.arthur@synopticshealth.com Web: www.synopticshealth.com Matthew Peskett, Peskett Solutions Ltd, Unit 4-5 Brampton Business Park, 55 Brampton Road, Eastbourne, East Sussex, BN22 9AF, UK. Tel: +44 (0) 01323 511038 Fax: +44 (0) 1323 503247 Email: matthew@peskettsolutions.com Web: www.peskettsolutions.com

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The Association for Perioperative Practice is a registered charity (number 1118444) and a company limited by guarantee, registered in England (number 6035633). AfPP Ltd is its wholly owned subsidiary company, registered in England (number 3102102). The registered office for both companies is Daisy Ayris House, 42 Freemans Way, Harrogate, HG3 1DH.