Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Operating Theatre Protocols
only a locum doctor for six months. He was an asset to Gisborne Hospital and
I am sorry that this was not always sufficiently appreciated.”
7.8 Straps were discussed at a theatre management committee meeting. Mr
Burton said he was happy to have the straps, as were the other surgeons,
especially for obese patients when tilting for certain surgery. The minutes
record:
“[The Theatre Manager] said the nursing staff were researching policies
on restraining patients. The straps are to go ahead at minimal cost made
by orthotics. [The Group Manager (Hospital)] is happy to write a patient
restraint policy for theatre.” (Minutes dated 22 March 2000. This policy
was not produced for the investigation team.)
Dr Lucas’ explanation
7.9 Dr Lucas responded as follows:
“It is common practice to use uterine displacement in a supine woman
being positioned for Caesarean section. This position minimises aortacaval
compression and consequent foetal compromise. The
displacement can be achieved by placing a pad under the hip to produce
the requisite 15 degrees of lateral pelvic tilt and a corresponding torsion
of the torso which, I believe, contributes to post operative backache. A
superior method in my opinion, is to tilt the whole table 15 degrees.
This causes the mother (both New Zealand and Canadian) to feel like
they are going to fall off the table but they are less frightened if they are
pre warned that the table is going to tilt. Feedback I received from Mr
Madden suggested that I was conspicuous compared to my colleagues,
in the length to which I explained things to my patients, obstetrical and
otherwise. I also tried, against nursing resistance, without much success,
to institute the routine of placing a pillow behind the knees of supine
parturients, also as a method of reducing post operative backache. A
second group of patients, who are tilted even more than in obstetrics, are
the people having laparoscopic cholecystectomies.
In both these groups of patients, or for that matter, in everyone who is
anaesthetised or has anaesthetised legs, it has been my observation that a
wide safety strap is placed across the legs at mid thigh level. This does
not happen at Gisborne.”
7.10 When Dr Lucas asked for the straps at Gisborne he was told by a nurse that
they were against the hospital policy regarding abusive and excessive patient
restraint. Dr Lucas took this issue to the Group Manager (Hospital) who
assured him it was not against policy.
Management response
7.11 In the opinion of the Group Manager (Hospital):
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