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News and updates from today's Operating Theatres Summit

Following the chairs introductions, Mark Rigby Chair NPAG Operating Theatres Benchmarking Group Head of Theatre Services Warrington and Halton Foundation Trust, opens the conference with a session on 'Effective Operating Theatres' discussing:

• advancing standards and reducing the variability of patient outcomes
• improving efficiency and productivity in operating theatres
• looking ahead to the operating theatre of the future 

Conference chair Mr Hugh Rogers, continues the morning sessions with a presentation on 'What have we learned from the Productive Operating Theatre Programme?' covering:

• have we achieved a step change in operating theatre performance?
• improving efficiency and productivity in operating theatres
• improving reliability and outcomes
• system issues and enablers for change
• moving forward: critical success factors

Mr Hugh Rogers biography:

I am a consultant urologist, and for most of my career I have been involved in quality improvement at local and national level in the NHS. I worked on lean implementation programs - notably the Productive Series - for the NHS Institute for Innovation & Improvement until it was consumed by the ‘bonfire of the Quangos’ in 2011. I had a leading role in The Productive Operating Theatre program (‘TPOT’) and rolled out a nationwide series of training workshops in human factors applied to the operating theatre.

My current work as Associate Medical Director is to help steer innovation and transformation within a newly integrated organization.  We are now working on a substantial IT implementation which will utterly change the way clinicians work.  In addition my time as CQC special advisor has given me privileged insight into the way different trusts are improving their operating theatre performance.

Opening the afternoon sessions is Dr Suzanne Shale Chair Surgical Never Events Taskforce NHS England, who discusses 'Improving safety in the operating theatre' and talks about:

• patient safety in theatres: where are we now?
• human factors: changing the way we work
• case studies and improvement tips 

Dr Shale comments: "Humans are immensely capable risk takers

How does safety (not happen)? Resilience v Risk
-    A lot of variation
-    Historically inadequate safety barriers; we haven’t included much safety specific education for professionals
-    We are fallible risk-takers
-    Production pressure is a constant risk
-    Very reliant on individual vigilance

How might a patient end up getting the wrong procedure?
-    Poor documentation/communication
-    Changes to list
Increase safety by increasing efficiency

Standardise processes
Entire workforce is well educated

Organisational & Sequential
-    Most organisations are reporting back that sequential side has been easier to complete
-    Background has been more difficult
Problem with memory
-    In a hurry/distracted/tired
-    Humans are not robots
-    Hungry/stressed/late/tired? – not functioning at our best
-    If any of these, you should stop as not in a safe place
-    This is where errors creep in

The problem with vigilance:
-    How observant are you?
-    Not nearly as good at spotting changes as we think we are"

Dr Shale's biography:

Suzanne Shale is an independent consultant in patient safety (including clinical human factors) and healthcare ethics. She supplies guidance, research, training and one-to-one support. Her current portfolio of work includes surgical safety reviews, projects to improve investigations into healthcare harm, and developing the support available to patients and professionals following adverse events.

Suzanne’s book Moral Leadership in Medicine: Building Ethical Healthcare Organizations was published by Cambridge University Press in 2012.

Continuing is Bill Kilvington President The College of Operating Department Practitioners and Associate Director Women and Child Health Surrey Sussex Healthcare NHS Trust who delivers a session on 'Theatre Staffing and developing the role of the Operating Department Practitioner' covering:

• addressing the challenge of safe staffing in theatres
• developing the role and competence of the operating department practitioner
• moving forward

Bill comments "Human story behind reports/wrong-site surgery
-    Very traumatic experience, but could’ve been worse!?
-    Could happen to you

A lot of focus on sequential but not so much organisational:
-    Safe staffing/workforce
-    Number and skillmix of staff
-    Job plans to take into account time needed for safety checks etc

Teamwork is essential
-    Support needs to be observing all areas as surgeon/anaesthetist will be focused on particular sites"


Bill's presentaion abstract:
We take a brief look at some of the key milestones in the development of the ODP as a profession, from the founding of the College in 1945; registration with the HCPC in 2004 to acceptance into the Allied Health Professions family earlier this year. The demographics of the profession have also changed and 60% of registered ODPs are women, with just over 13,000 of us.
It is now almost 2 years since the National Safety Standards for Invasive Procedures (NatSSIPs)    were published as a Level 2 Patient Safety Alert, yet Never Events seem to be as prevalent as ever. In the last financial year 178 wrong site procedures were carried out; 149 were given an incorrect implant and; 109 had a retained foreign object.  
I believe that the provision of a well-trained perioperative workforce is crucial to improving safety and the Workforce Standard in the NatSSIPs provides some direction. With the exception of the anaesthetic assistant role, the importance of staff being qualified in specialty for perioperative care is received insufficient attention, certainly in comparison with other critical care areas such and ITU and Neonatal Units. This has to change.
During the presentation we’re going to conduct a small experiment in selective attention which I hope will demonstrate why teamwork in the operating theatre is so important and why competent staff are so important.
Operating Department Practitioners should play a key role in providing solutions problems and our recent inclusion in the family of Allied Health Professions provides a new framework within which ODPs can make that contribution. AHPs into Action  looks at the Impact made by AHPs, our Commitment to way services are delivered and; the Priorities to meet the challenges of changing care needs.
ODPs have also been given the opportunity to make our case for inclusion in the list of professions able to administer medicines under patient group directions (PGDs).  The College frequently hears from ODPs who are hampered in their practice because they are unable to take on team roles where PGDs are an important element of the care pathway. The College will be working with NHS England to make the clinical case for the necessary regulatory changes, including a public consultation. We anticipate this to take about two-years.
In conclusion, the College of Operating Department Practitioners continues to develop the role of the ODP so that the profession is flexible across the perioperative care roles and adaptable to new challenges and changing roles. This ensures that ODPs will continue to meet the needs of patients in an ever changing service environment.

Bill's biography:

Immediate past President and the Patient Safety Lead of the College of Operating Department Practitioners, qualified at St. Thomas’s Hospital London 1980 and has been a member of the Professional Council since 1983. 
Bill played has played a key role in the development of the ODP as a profession, including Registration with the HCPC in 2004 and the introduction of the BSc in Operating Department Practice as the primary qualification for ODPs. In April of this year ODPs came under the remit of the Chief Allied Health Professions Officer, formally joining the wider family of AHPs.
He is passionate advocate of patient safety and was a member of the Surgical Never Events Taskforce and chaired one of the writing groups that produced the National Safety Standards for Invasive Procedures (NatSSIPs)
Bill is the Associate Director for Women and Child Health Services at Surrey and Sussex Healthcare NHS Trust in Surrey

Also of interest:

Emergency Day Surgery Summit
Thursday 23 November 2017 
De Vere West One Conference Centre, London

Improving Outpatient Services: National Summit
Friday 15 September 2017 
De Vere West One Conference Centre, London

In-depth legal masterclass: Informed Consent After Lanarkshire
Wednesday 13 December 2017 
De Vere West One Conference Centre, London

7 July 2017


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