The Operating Theatre Journal March 2022

THE THE

THE

SEPTEMBER MARCH 2020 2020 2022 ISSUE ISSUE NO. NO. 360 360 378 ISSN ISSN 0000-000X

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Cardiff and Vale University Health Board introduces ophthalmic hub to help combat elective care backlog

Leading medical infrastructure provider Vanguard Healthcare Solutions

has created and installed a new ophthalmic hub at the University

Hospital of Wales in Cardiff to help tackle the region’s acute care

backlog.

The bespoke mixed-modality facility includes two mobile laminar flow

theatres and a modular ward and staff welfare facility and it has been

installed by Vanguard to help the Health Board meet increasing demand

for essential procedures.

As a result of the damaging impact of the Covid-19 pandemic and the

numerous lockdowns that followed, the UK faces its biggest backlog

in elective care since the NHS was first introduced, with 5.8 million

waiting for routine surgery.

The Cardiff and Vale University Health Board is committed to addressing

this backlog through the opening of its new ophthalmic hub which

should efficiently provide life-changing cataract surgery for patients.

Working alongside the Health Board’s team, Vanguard designed a

bespoke solution to meet the hospital’s and wider area’s needs. The

hub is made up of two Vanguard mobile laminar flow operating theatres.

A modular unit, designed, built and installed by Vanguard, houses a

reception, consultation room, staff facilities and short-stay ward. This

allows the entire patient journey to take place within the hub, with no

need for patients to visit the main hospital building.

Surgery will take place in one of the two theatres which each include

an anaesthetic room, operating theatre and a recovery room.

The facility will be on site until January 2023 and will support the

Health Board through efficiently carrying out ophthalmic procedures

and will be operating 5 days a week.

Maxine Lawson. Account Manager for the South at Vanguard Healthcare

Solutions said: “The use of this mixed-modality solution in Cardiff is an

example of how mobile and modular solutions are an excellent way to

help healthcare providers meeting demands as the need for additional

capacity continues to rise. The modular section of the facility provides

additional space for staff welfare areas, an area that we were keen to

include in this contract.

“We are delighted to have worked with Cardiff and Vale University

Health Board on this project, assisting in reducing the elective care

backlog in Cardiff and the Vale of Glamorgan”.

When responding to articles please quote ‘OTJ’

Handheld breathing device could reduce breathlessness

and improve physical fitness in long COVID patients

New research presented at The Physiological Society’s Long COVID: Mechanisms, Risk Factors, and Recovery during February shows that a small

handheld breathing device helped reduced breathlessness and improved physical fitness of people with long COVID. The low cost, home-based

rehabilitation programme increased the strength of respiratory muscles speeding up the rate of recovery from COVID-19.

Approximately, one in ten people recovering from COVID-19 experience long COVID (reports on this figure still vary), which negatively impacts

quality of life. Many people with long COVID feel breathless, tired and can have difficulties performing basic tasks of daily living.

The new intervention improved respiratory health and fitness levels of people with long COVID by training the muscles that you use to breath.

Training the breathing muscles strengthens them just like other muscles in the body. Participants felt less breathless, stronger, fitter, and could

move around more easily, similar to pre-COVID levels.

148 participants took part in the study. They were recruited through social media and included a few discharged hospital patients. They were

randomised into intervention and control groups.

Participants were provided with their own small handheld device to do breathing exercises three times a week for about 20 minutes over eight

weeks. They would breathe into the device as deeply as they could for as long as they could. The device would then feedback to the user. The

results were compared with participants in a control group who had no intervention.

Breathlessness was reduced by 33%, twice the level considered clinically meaningful, in the intervention group compared with the control group.

Estimated fitness increased by approximately 10% and respiratory strength increased by approximately 36% in the intervention group compared to

control group. The health improvements were 2-14 times greater for the intervention group compared to the control group.

The intervention was developed by a UK-wide team of breathing experts, who have worked with people with many types of respiratory conditions

such as chronic obstructive pulmonary disease, asthma and cystic fibrosis. The clinical benefits suggest the programme should be considered for

wider implementation as part of COVID-19 recovery strategies.

One-to-one interviews were carried out to evaluate participants’ experiences of COVID, recovery from it and the impact of the inspiratory muscle

training. Researchers assessed breathlessness, quality of life, the strength of the respiratory muscles and estimated aerobic fitness.

The study was conducted during various phases of UK-wide COVID-19 restrictions and lockdowns. Conducting it entirely remotely via online video

conferencing limited the robustness of the measures the research team could use.

Professor Melitta McNarry, University of Swansea, UK, the presenter and lead author of this research said: “It’s vital we develop safe and effective

home-based rehabilitation methods to help people recover quickly and fully from COVID-19. Breathing muscle training enabled people to return to

activities they had been unable to do for weeks or months, providing physical and mental health benefits. The unsupervised nature of this method

and the relatively low cost of the devices could be used to ease the strain on the NHS.”

Further funding is needed to implement this rehabilitation programme in collaboration with healthcare providers to assess its feasibility in a realworld

setting.

Further reading: https://bit.ly/OTJPTS322

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RCEM welcomes NHS commitment to measure

12-hour waits from time of arrival in A&E

Commenting on changes made to the NHS Standard Contract 2022/23 in response to consultation feedback,

President of the Royal college of Emergency Medicine, Dr Katherine Henderson said:

“We welcome the amendment to the NHS Standard Contract 2022/23 which changes the way 12-hour waits

in Emergency Departments (EDs) are calculated, with data to now be measured from point of arrival in A&E

to discharge, admission or transfer, rather than from the decision to admit to admission. We expect NHS

England to publish this data in full on a monthly basis; we see no reason why this should not be feasible from

the start of the new financial year.

“We have long been calling for this change, and we are delighted to see this significant step towards greater

transparency. The full publication of this data will be an immensely positive step that could be the catalyst

for transformation of the Urgent and Emergency Care pathway that should help to improve the quality of

care for patients.

“We know that long stays in Emergency Departments harm patients and long stays (usually due to lack

of an available bed) have consequences for other patients; ambulances cannot transfer patients into the

department, and then cannot back into the community, thereby putting further lives at risk.

“When published, together with NHS England and the Department of Health and Social Care, we will be able

to assess in full the state of Urgent and Emergency Care and both bring about and implement the changes

that staff and patients urgently need.”

Further reading: https://bit.ly/OTJRCEM322

New study explores potential of bariatric surgery in

preventing COVID-19 deaths for people with severe obesity

New clinical evidence has revealed that bariatric surgery could prevent COVID-19 deaths in people living with

obesity, a group that has been disproportionately affected during the pandemic.

The study comes at a time when the NHS continues to be under pressure from COVID-19. The findings are

part of a study, ‘Cost-effectiveness of bariatric and metabolic surgery, and implications of COVID-19 in the

United Kingdom2’, co-authored by Dimitri Pournaras, a specialist in Upper Gastrointestinal, Bariatric, and

Metabolic Surgery and funded by Johnson & Johnson Medical Devices Companies. It explored the possible

clinical and economic benefits of bariatric surgery compared with nonsurgical treatment options, considering

the broader impact of COVID-19 on people living with obesity. The research team concluded that increased

provision of bariatric surgery could reduce COVID-19-related morbidity and mortality, along with obesityrelated

co-morbidities, ultimately reducing the clinical and economic burden of obesity.

Among 1,000 individuals with body mass index (BMI) ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 with obesity-related comorbidities,

bariatric surgery would prevent 117 deaths due to COVID-19 alone. Looking at the impact on

hospital usage in the same group and assuming that they would all get COVID-19, 124 people would not be

admitted to the hospital and 161 would not be admitted to the intensive care unit. Delaying bariatric surgery

by five years further increased costs and had a negative impact on quality of life, compared with not delaying

treatment.

Mr. Pournaras stated:

“These striking figures are only focusing on outcomes associated with the pandemic. The benefits of bariatric

surgery with sustained weight loss maintenance will have a persistent effect on improving survival, reducing

the burden of obesity-associated disease and improving functional outcomes for the individuals who have

received this type of treatment.

With the pandemic set to continue for the foreseeable future, the effective treatment of obesity should be

a societal responsibility that we tackle together. Not just to ease the burden on the NHS, but to optimise

outcomes for people living with obesity.”

Sarah Le Brocq, obesity advocate and key stakeholder across several obesity groups - including sitting on the

strategic council for the All-Party Parliamentary Group on Obesity - said:

“People living with obesity are genuinely fearful of contracting COVID-19, amid a growing number of reports

that they are at greater risk of dying. We clearly need to introduce measures that tackle this, both in terms

of reducing the risk to patients and the probable impact of them in the long-term.”

References

1. https://www.thelancet.com. 2020. Obesity and COVID-19: a call for action from people living with obesity. [online] Available at: <https://

www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30236-9/fulltext> [Accessed 24 January 2022].

2. Thibaut Galvain et al. / Surgery for Obesity and Related Diseases - (2021) 1–8 Cost-effectiveness of bariatric and metabolic surgery, and

implications of COVID-19 in the United Kingdom

Inside this issue

‘Laryngeal biopsies in the

Outpatient setting in people

with suspected head and

neck dysplasia/cancer’

P4

LocSSIPs – An Audit of NHS

England Hospital Trust

Operating Theatres

P6-9

Integrated Operating

Theatre delivered at

Epsom Hospital

P12

Leading heart failure

society launches

animated video – in six

different languages

P16

Operating Theatres

finally reopen after

Covid closures

P18

New MRI method will

better inform surgical

decisions for babies born

with a heart defect

P18

Nothing routine about

routine operations

P20

Video killed the

medico-legal war

P22

Warrington Hospital

practitioners in UK-first

graduation honour

P26

Delivering just what

the doctor ordered

with ERP/MRP

P28

Portsmouth wins

£300K to supercharge

post-Covid Nursing

Training

P29

Endoscopic surgery

of herniated discs

demonstrates statistically

significant pain relief

P29

Council and Hospital

honour nurses involved

in historic birth of world’s

first IVF baby

P31

Students become

‘Surgeons for the Day’

at Operating Theatre Live

P32

Find out more 02921 680068 • e-mail admin@lawrand.com Issue 378 March 2022 3

‘Laryngeal biopsies in the Outpatient setting in people with suspected head and neck

dysplasia/cancer’, a topic proposed by Olympus, has been progressed to full appraisal

by Health Technology Wales following the publication of a Topic Exploration Report.

Health Technology Wales (HTW) research

and evaluate the best available clinical

and cost-effectiveness evidence about a

health technology. Based on this evidence,

HTW’s Appraisal Panel produces guidance

on whether the health technology should be

adopted for use in Wales. Whilst progression

to full appraisal means a further, more critical

review of the evidence will take place, it does

not guarantee that guidance will be issued

recommending adoption of a technology in

Wales. More information about their Health

Technology Appraisal (HTA) process can be

found at: www.healthtechnology.wales/

about/our-appraisal-process/

Summary of the Available Evidence

The Topic Exploration Report provided

an initial review of existing advice from

respected bodies, such as the Scottish Health

Technologies Group (SHTG) and National

Institute for Health and Care Excellence

(NICE), as well as multiple clinical studies.

The summary of evidence broadly categorises

the available evidence into four categories:

Diagnostic accuracy, Diagnostic work-up and

time-to-treatment, Clinical Outcomes, Safety

and Cost. Below are some of the findings in

the existing evidence:

• The mean time from consultation to biopsy

was 17.4 days for the operative endoscopy

and 1.3 days for outpatient. [i]

• Diagnostic work-up times for outpatient

flexible endoscopic biopsies were quicker

compared to rigid laryngopharyngoscopy,

with 16 days for rigid laryngopharyngoscopy,

versus 2 days for flexible endoscopic

biopsies. [ii]

• Time-to-treatment for outpatient flexible

endoscopic biopsies were quicker than rigid

laryngopharyngoscopy, with waiting times

of 41.5 days for rigid laryngopharyngoscopy

versus 27 days for flexible endoscopic

biopsies. [ii]

• The SHTG found the average resource saving

per annum over five years of implementing

outpatient biopsies was in excess of

£400,000 for NHS Scotland alone. [iii]

• A systematic review of 13 studies reported

lower costs for outpatient endoscopic

transnasal surgery when compared to

theatre-based procedures. The costs of

flexible endoscopic laryngopharyngeal

biopsies ranged from €57 to €110, whereas

costs for biopsies obtained under general

anaesthetic varied between €822 and

€1,101. [iv]

• Outpatient biopsy was generally found to be

safe with low complication rates and the

procedure appeared to be well-tolerated by

most patients. [iii]

Better Outcomes for Everyone

Early detection and diagnosis, alongside

timely intervention, is essential for improving

outcomes for suspected cancer patients.

The COVID-19 pandemic has had a marked

impact on the ability of the healthcare system

to deliver care, with both the number of

patients awaiting treatment and waiting times

for treatment, growing. The possibility of

outpatient laryngeal biopsy reducing the time

to diagnosis, whilst reducing healthcare costs

and freeing valuable theatre capacity, has

never been of greater value to the NHS and

its patients.

“This appraisal represents a really positive

step forward for patients with suspected

laryngeal cancer. Outpatient biopsy not only

has the potential to reduce the anxious wait

that patients face for a confirmed diagnosis,

but it can also avoid the need for a more

invasive procedure under general anaesthetic,

all whilst helping reduce costs for the

healthcare system. We are delighted to see

how Health Technology Wales seek to evaluate

these innovative approaches, with the view to

benefitting patients across Wales.

We very much look forward to the results of

the full appraisal.“

Alex Zervakis, General Manager

Health Economics & Market Access, Olympus

UK & Ireland

To read the Topic Exploration Report on

Laryngeal biopsies in the Outpatient setting

in people with suspected head and neck

dysplasia/cancer, published by Health

Technology Wales, please head to: www.

healthtechnology.wales/reports-guidance/

outpatient-laryngeal-biopsy/

[i] Lee et al (2018)

[ii] Schutte et al (2018)

[iii] Healthcare Improvement Scotland

[iv] Schimberg et al (2019)

For more information, visit www.olympus.

co.uk and follow us on LinkedIn and Twitter.

Discover more about our Laryngology,

Head and Neck - ENT Solutions:

https://www.olympus.co.uk/medical/en/

Products-and-solutions/Medical-specialities/

Ear-nose-throat/Area-Page-Laryngology.html


The next issue copy deadline, Friday 25th March 2022

All enquiries: To the editorial team, The OTJ Lawrand Ltd, PO Box 51, Pontyclun, CF72 9YY

Tel: 02921 680068 Email: admin@lawrand.com Website: www.lawrand.com

The Operating Theatre Journal is published twelve times per year. Available in electronic format from the website, www.otjonline.com

and in hard copy to hospitals throughout the United Kingdom. Personal copies are available by nominal subscription.

Neither the Editor or Directors of Lawrand Ltd are in any way responsible for the statements made or views expressed by the contributors.

All communications in respect of advertising quotations, obtaining a rate card and supplying all editorial communications and pictures to the Editor

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Operating Theatre Journal is printed on paper sourced from Forest Stewardship Council (FSC) approved paper mills and is printed with vegetable based inks. All paper and ink waste is recycled.

Journal Printers: The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD


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LocSSIPs – An Audit of NHS England Hospital Trust Operating Theatres

Authors:

and harmonisation with the WHO checklist, have brought about positive results

Nigel Roberts, University Hospitals of Derby and Burton Stephen Wordsworth, University of Derby

in the form of a reduction in the overall number of reported ‘never events’, albeit

Keywords:

National Safety Standards for Invasive Procedures (NatSSIPs), Local Safety

in only

Standards

two of the

for

of

Invasive

three surgical

Procedures

never events

(LocSSIPs),

categories

Never

(retained

Events, Patient

foreign

Safety, World Health Organisation (WHO) Surgical Safety Checklist. objects and wrong implant/prosthesis). Figure one details the latest number of

Abstract:

reported ‘never events’ by type between April 2015 – March 2020. From this

This paper is part of a literature review undertaken by the lead author towards the award of Doctor of Philosophy (PhD).

data it would be simple to conclude that for the latest reporting period there is

This paper addresses information raised as part of an audit of NHS

some

Figure

reduction

one details

in ‘never

the

events’

latest number

in two of

of

the

reported

categories,

‘never

but

events’

over time

by type

this

hospital operating theatres in England. The aim of the audit was to between April 2015 – March 2020. From this data it would be simple to

establish how many hospital Trusts are using LocSSIPs routinely, as part represents conclude only that marginal for the improvement. latest reporting Whereas, period during there the is some same reduction time frame in

of a strategy to reduce surgical ‘never events’ from occurring in the the incidents ‘never events’ involving two wrong of site the surgery categories, have actually but over increased. time this represents

peri-operative setting. Responses were divided into the seven regions only marginal improvement. Whereas, during the same time frame the

identified by NHS England. The audit revealed that a majority of Trusts incidents involving wrong site surgery have actually increased.

responded, and in so doing we were able to identify that a number of Figure one – Never event final data, April 2015 – March 2020 (excluding wrong

Trusts are yet to implement LocSSIPs routinely within the peri-operative

Figure one – Never event final data, April 2015 – March 2020

tooth

setting. Whilst the intention is not to establish whether this has led to

(excluding extraction) wrong tooth extraction)

the increased presence of never events, it has facilitated a broader

engagement in the literature, as well highlight some possible reasons

NHS England never event data

why compliance has not yet been universally achieved. Furthermore, following the implementation of

the audit is intended to be an exploratory approach to inform a more

NatSSIPs/LocSSIPs

in-depth doctoral research study intended to improve patient safety in

the operating theatre, inform policy making and quality improvement.

186

Introduction and background context

NHS England’s 2015 National Safety Standards for Invasive Procedures APRIL 15 - MARCH 16 APRIL 16 - MARCH 17 APRIL 17 - MARCH 18 APRIL 19 - MARCH 20

(NatSSiPs) was published on the 7th September 2015. The intention

Wrong site surgery (Tooth/Teeth removed) Wrong implant/prosthesis

was that the mandatory introduction of the WHO (2013) surgical safety

Retained foreign object post procedure

checklist and the refinement of the three surgical ‘never events’; wrong

site surgery; wrong implant or prosthesis and retained foreign object This data can then be represented by region and over time (see fig2).

post procedure, would lead to a significant reduction in the incidence of This Whereby data can it then is possible be represented to see by the region stubborness and over of time the (see data fig2). to improve

‘never events’ in the NHS in England. Despite these initiatives the data

Whereby

regionally.

it is possible to see the stubborness of the data to improve

would suggest that this has not been the case, and a marked decrease Figure two – Continuation of never events post LocSSIPs implementation by

regionally. Figure two – Continuation of never events post LocSSIPs

region. implementation by region.

in ‘never events’ has not materialised. Earlier the Patient Safety Expert

Group commissioned a ‘Surgical Never Events Taskforce’ to examine

the reasons for the persistence of these patient safety incidents. The

report published in 2014 advocated the development of high-level

national standards referred to as National Safety Standards for Invasive

Procedures (NatSSIPs). Importantly, the introduction of NatSSiPs was

intended to be complemented by the introduction of more

Sensitivity:

localised,

Internal

specific and detailed standards identified as Local Standards for Invasive

Procedures (LocSSIPs). The then Director of patient safety stated that

“The NatSSIPs do not replace the WHO Safer Surgery Checklist. Rather,

they build on it and extend it to more patients undergoing care in our

hospitals”. (NHS England, 2015). Logically, LocSSiPs in turn extend the

principal of standards development, not by means of replacing one

for another, but as a means of refinement and reach. To put this into

context the chair of the NatSSIPs group (Harrap-Griffiths) stated that

they had been created to bring together national and local learning

from the analysis of never events, serious incidents and near misses

in a set of recommendations intended to enable NHS organisations to

provide safer patient. NatSSIPs set out broad principles of safe practice

and advise healthcare professionals on how they can implement best

practice, such as through a series of standardised safety checks and

education and training. LocSSIPs are intended to be created by multiprofessional

clinical teams and their patients and are intended to be

developed, implemented and revised against a background of education

in human factors and team working (NHS England, 2015). Kilduff et al

(2017) study sort the views of UK medical and nursing undergraduate

experience of the surgical safety checklist and concluded that current

training did not meet the standards set by the WHO.

Similarly, Wali et al (2020) commented that despite the LocSSIP being

a clinical team activity, current methods used to deliver the training

did not incorporate the clinical setting, teamwork, or communication.

Nurses, dentists, and students all received teaching in their separate

groups and no current method of training demonstrated the shared

team responsibility that is essential for effective implementation of the

checklist. That is not to say that some innovative educational activities

have attempted to address this and attempts to ‘borrow’ from other

safety critical industries such as F1 motor racing have been used to

simulate learning designed to improve team working, communication

and human factors (Abbott and Wordsworth, 2014).

Overall, we conclude that to a point, the introduction of NatSSIPs/

LocSSIPs, and harmonisation with the WHO checklist, have brought

about positive results in the form of a reduction in the overall number

of reported ‘never events’, albeit in only two of the of three surgical

never events categories (retained foreign objects and wrong implant/

prosthesis).

simulate learning designed to improve team working, communication and

human factors (Abbott and Wordsworth, 2014).

Overall, we conclude that to a point, the introduction of NatSSIPs/LocSSIPs,

146 143 147

107 114 102 101

59 53 63 47

In order to try to understand this in more detail a literature review was

In order to try to understand this in more detail a literature review was carried

carried out in order to get behind the numbers in order to surface and

out understand in order to why get behind this may the numbers the case in order from to surface the perspective and understand existing why

this studies may or be research. the case from the perspective existing studies or research.

Literature review

Radcliffe (2016, p65) stated that the “organisational steps to underpin

Literature review

the safe delivery of care, and the sequential steps are a logical sequence

Radcliffe of steps (2016, that should p65) stated be performed that the “organisational for every procedure steps to underpin or operating the safe

delivery list for of every care, patient”. and the sequential Radcliffe steps (2016) are further a logical claimed sequence that of steps ‘nurses that

should be proactive in this by becoming involved in their development

should

and implementation’.

be performed for

Given

every

the

procedure

principles

or operating

of how these

list for

are

every

intended

patient”.

Radcliffe to be implemented (2016) further we claimed would that contest ‘nurses why should this is be restricted proactive in to this just by

becoming

nurses. Collaboration

involved in

across

their development

other registered

and

roles

implementation’.

including ODPs,

Given

and

the

medical staff seems to be essential, not to mention other important

principles contributors of how to these patient are safety intended including to be implemented Health Care we Assistants would contest (HCA), why

this all of is whom restricted can to all just play nurses. a part in Collaboration encouraging across an open other culture registered in raising roles

concerns relating to patient safety?

including ODPs, and medical staff seems to be essential, not to mention other

Bhandari’s (2016) stated that the NatSSIPs are in fact closely aligned to

important contributors to patient safety including Health Care Assistants (HCA),

the core foundations and the purpose of the NHS. In that patient safety

all lies of at whom the core can all of patient play a part care. in Bhandari encouraging (2016) an went open on culture to advocate in raising

concerns for the use relating of existing to patient frameworks safety? already in place such as the WHO

checklist, teamwork and human factors and non-technical skills to be

incorporated into local planning to improve patient safety specifically

Bhandari’s during invasive (2016) procedures. stated that the NatSSIPs are in fact closely aligned to the

core The foundations denouement and by the Bhandari purpose (2016) of the is NHS. interesting In that patient and pertinent, safety lies some at the

five years after the introduction of both national and local safety

core of patient care. Bhandari (2016) went on to advocate for the use of existing

standards human factors and non-technical skills are still being reported

frameworks in the literature already as in areas place such of concerns as the WHO as factors checklist, that teamwork consistently and human lead

to ‘never events’. Central to this the literature points to the need for

further exploration and understanding of the barriers that exist, and

how they can be overcome. Is it the approach to standards, or they fact

that non-compliance is more likely to be a factor?


Sensitivity: Internal

100

50

0

NHS England Trusts by region - Surgical 'never event' data

post NatSSIPs/LocSSIPs implementation.

April 2015 - March 2020

London (22 )

South West

(15)

South East

(20)

Midlands (21) East (15) North West

(22)

North East &

Yorkshire (21)

April 15 - March 16 April 16 - March 17 April 17 - March 18 April 19 - March 20

Tingle (2016) argues that we are still a very long way from saying that

the NHS has a patient-centric culture and that it is a generally safe place

to be treated. Relating this cultural factor to the WHO checklist, Tingle

(2016) makes the point that others involved in safety critical industries

such as pilots, have had to undergo a similar cultural shift, and in

fact, by themselves checklists are not enough to guarantee safety. At

the time Tingle (2016) was also optimistic that NatSSIPs and LocSSIPs

would lead to improved safety. This view was also further postulated

by Findlay et al (2018) who felt that NatSSIPs, as an extension of the

WHO safer surgical checklist could help improve patient safety during

invasive procedures.

Building on the application of one to develop the other, Coates and

Carrie’s (2019) research stated that NatSSIPs were designed to help

facilitate the synthesis of LocSSIPs, like the WHO checklist, are

intended to promote procedural safety. The authors point to the fact

that LocSSIPs are aimed at invasive for which the WHO checklist is not

suitable, as well as the fact that LocSSIPs allow for customisation to

the specific requirements of the procedure or department. The Coates

and Carrie study used the WHO surgical checklist as a template, largely

due to staff familiarity. They also adopted/reviewed their LocSSIPs

based on guidance available through NHS Improvement and in so doing,

concluded that LocSSIPs, are now an essential safety aspect to support

procedures performed in the clinical setting (2019).

Patient safety in Dentistry

It is worth noting that wrong tooth extraction was first included as a

‘wrong site surgery’ ‘never event’ in 2012. However, since February

2021, this is no longer the case (BDA, 2021 and NHS Improvement, 2021).

Whilst there is some contention around this decision, a number of

studies related to dental extraction ‘never events (Renton et al (2017),

Woolcombe et al (2019), Renton et al (2020), Wali et al (2020), Liew and

Beech (2020) and Cottam and Gerrard (2021), have variously pointed to

the positive impact of a multi-disciplinary approach to patient safety;

as well as teamworking, education and the introduction of roles such as

safety champions. Similarly, Brennan et al (2016) make the point that an

open, blame-free culture encourages better teamwork ergo improved

patient safety. In relation to the role of ongoing education, Tagar et al

(2019) feel that involving staff in the development of policy through

action learning rewarded staff with a sense of ownership over the

policy, thereby improving staff buy-in and compliance with the change.

Taking the principle of engagement, a step further, a study based

on a public survey carried out by the General Dental Council (GDC)

(2017), demonstrated the importance of interventions that minimise

adverse events through the inclusion of patient perspectives on wrong

site surgery. If the removal of wrong tooth extraction from the never

events list, was in some way intended to represent a down grading of

the impact of such events, this is not necessarily supported by public

opinion. Based on a 2017 survey, the General Dental Council (GDC)

concluded that in the case of wrong dental extraction, 95% of public

respondents felt that the GDC should either issue a reprimand (23%), or

apply a suspension from practice (51%) to dental surgeons. Furthermore,

nearly a quarter of respondents indicated that such errors should lead

to the dental surgeon being struck of from the register (fig3.)

Figure three. Possible actions to be taken following wrong tooth

Figure extraction three. Possible actions to be taken following wrong tooth extraction

Public opinion on actions following wrong tooth extraction (GDC, 2017)

23%

21%

5%

51%

Dentist receive a suspension

Struck of from the register

Reprimand

No Action necessary

Liew and Beech (2020, p421) make an interesting point and seem to

suggest a difference in adoption of safety initiatives stating that, “in

medicine this has manifested itself in a swift change in patient safety,

but dentistry has somewhat lagged behind. Whilst the distinction

between medicine and dentistry appears arbitrary, singling out dental

surgery may well be a borne out of a long-standing concern for the

apparent stubbornness of the incidents related to dental ‘never

events’, to improve. A more cynical view could also point to the fact

that this may be the reason for the removal of wrong tooth extraction

from the agreed list of ‘never events’. However, we argue that this reclassification

may well impact negatively on the fact that never event

classification in dental surgery has acted both as a both a catalyst for

research and implementation of further patient safety initiatives.

Audit methodology

In our thinking the review of the ‘never event’ data and the literature

more generally, acted as the catalayst for furhter enquiry. We viewed

the removal of wrong dental extraction and the work around the

paucity of any tangible impact to improve the statstics as a challenge

to try to understand why this was the case. Put simply the intention for

the audit was to try to establish the level of compliance with NatSSIPs

and LocSSIPs, as well as surface any key themes and patterns from the

emergent data. Of the 223 NHS Trusts in England (Kingsfund, 2021),

only 157 NHS Trusts have operating theatres (Supporting Facilities Data,

2019/20). Across seven separate regions (see Figure 4) there are a total

of 3,282 operating theatres (See table 1.)

Figure four – – NHS England by by region

Region

Number of Trusts

London 23

Southwest 21

Southeast 22

Midlands 25

East 18

Northwest 26

Northeast & Yorkshire 22

Total 157

Table 1 provides greater details of the number of Trusts and the

Table number 1 provides of operating greater theatres details of by the region. number For of the Trusts purposes and the of the audit

we then choice to purposefully reduce the number of Trusts and

number of operating theatres by region. For the purposes of the audit we then

operating theatres. The total number of Trusts included in the audit

choice was reduced to purposefully by twenty-one. reduce the This number gave of a Trusts new total and operating of 136 Trusts theatres. with The

total

2,918

number

operating

of Trusts

theatres.

included

Table

in the

two

audit

details

was

the

reduced

number

by twenty-one.

of Trusts by

This

region and the number of operating theatres.

gave

Table

a

One

new

–

total

NHS

of

England

136 Trusts

Trusts

with

by

2,918

region

operating

and the

theatres.

number

Table

of operating

two details

Table

theatres.

One – NHS England Trusts by region and the number of

the operating number theatres. of Trusts by region and the number of operating theatres.

Area Number of Trusts Number of Operating Theatres

Given the very fact that dentistry provided one of the highest volumes

London 22 512

of surgical interventions (Renton et al 2017), it is not such a surprise Southwest 15 275

Given that this the very should fact statistically that dentistry increase provided the one number of the of highest ‘never volumes events’. of

Southeast 20 438

surgical According interventions to Pemberton (Renton et et al al (2017) 2017), this it is accounts not such for a surprise 6 to 9% that of this all

‘never events’, and equates to approximately 25% of all wrong site

should statistically increase the number of ‘never events’. According to Midlands 21 524

surgical ‘never events’. Other factors such as the fact that dental

Pemberton surgical interventions et al (2017) this are accounts often performed 6 to 9% under of all ‘never local anaesthetic

events’, and East 15 272

equates may also to contribute approximately to 25% these of incidences. all wrong site Whilst surgical wrong ‘never site events’. surgery Other in Northwest 22 366

dentistry may not appear to be as significant as the loss of a Sensitivity: limb, but Internal

factors such as the fact that dental surgical interventions are often performed

as a source of injury and stress and it may well be symptomatic of more Northeast & Yorkshire 21 531

under endemic local problems anaesthetic in may both also the contribute process, and to these incidences. environment, Whilst in which wrong

Total 136 2918

site occurs. surgery in dentistry may not appear to be as significant as the loss of a

limb, but as a source of injury and stress and it may well be symptomatic of

Find out more 02921 680068 • e-mail admin@lawrand.com The rational for Issue excluding 378 the total number March of Trusts 2022 from the audit 7 by twentyone

was due to the following

more endemic problems in both the process, and the environment, in which it

reasons:

East

Short answer is yes, we do have some NatSSIPs and

LocSSIPs

The rational for excluding the total number of Trusts from the audit by

twenty-one was due to the following reasons:

a) Nine Trusts were not yet in existence between April 2015 – March

2020 at the point that LocSSIPs where first introduced

b) Six Trusts were excluded as a result of only appearing to have

one operating theatre therefore meaningful data was difficult to

ascertain.

c) Two of the Trusts are non-NHS

d) We removed the data from a further Trust because of a possible

conflict of interest

e) Three Trusts did not provide any contact details

In order that both Trusts and individual respondent’s comments remain

confidential In order that responses both Trusts have and been individual anonymised respondent’s and responses comments presented remain

by confidential region only. responses Table have 3 (below) been provides anonymised further and responses details of presented the number by

and scale of responses to the audit by the number of Trusts responding

region only. Table 3 (below) provides further details of the number and scale of

by region, as well as details of the timings of the responses during the

audit responses period. to the audit by the number of Trusts responding by region, as well

In total, 136 NHS England Trusts were asked to participate. This

was undertaken by email and phone calls to each Trust. Each Trust as details of the timings of the responses during the audit period.

Table three – NHS England responses to LocSSIP question during

responded positively to participation. This equates to 87% of NHS

the period of the audit.

Table three – NHS England responses to LocSSIP question during the period of the audit.

further England set Trusts of four that reminder have emails operating were theatres sent regularly as part of weekly their intervals routine for a

period

emergency

of a month.

patient

The

services.

Region Number Responses Percentage

Trust contact details were obtained from the NHS UK

of Trusts by region of responses

by region

Theatre Managers/Matrons were contacted by email and asked to

site (NHS Services Directory, 2021).

simply confirm whether they had adopted NatSSIPs/LocSSIPs in their

departments. A further set of four reminder emails were sent at

Results regularly weekly intervals for a period of a month. The Trust contact

details were obtained from the NHS UK site (NHS Services Directory,

Six Trusts stated that LocSSIPs are not currently in use, this comes some six

2021).

years after their initial implementation. Interestingly between April 2015 and

Results

March Six Trusts 2020 stated data inclusive that LocSSIPs of the three are main not surgical currently categories, in use, this indicates Sensitivity: comes that Internal

23 some separate six years never after events their occurred initial implementation. the 6 Trusts that Interestingly do that do not between currently

April 2015 and March 2020 data inclusive of the three main surgical

utilise LocSSIPs.

categories, indicates that 23 separate never events occurred at the 6

Trusts that do that do not currently utilise LocSSIPs.

Figure 55 –– Never Never Events Events at at Trusts Trusts not not utilising utilising LocSSIPs LocSSIPs

6

4

2

0

Combined number of 'never event's' occuring at Trusts

that do not use LocSSIPs - April 2015 - March 2020

April 2015 - March 2016 April 2016 - March 2017 April 2017 - March 2018 April 2019 - March 2020

Southwest

As a reminder 136 NHS Trusts were invited to participate in the audit.

79 trusts responded, which represents an average response rate of 58%.

During the course of five email reminders, with follow-up calls, most

regions returned response rates in excess of 50%.

Discussion

We don’t have specific LocSSIP or NatSSIP paperwork as a

trust yet, despite me begging! We are part of a Southwest

group which were trying to get it simplified and uniform for all

trusts. It stalled because of covid.

The literature to support a greater understanding of the impact on the

implementation of LocSSIPS is still emerging. Our review to date is not

intended to be exhaustive, but allowed us to begin to frame further

questions, identify some of the contextual issues and plan for further

doctoral level investigations. The use of a simple audit was borne out

of our curiosity to see to what extend LocSSIPS are being utilised across

England since their introduction.

Sensitivity: Internal

Contextually we can anticipate that Invasive procedures in the NHS and

Wrong Site Surgery Wrong implant/prosthesis Retained foreign object post procedure indeed in healthcare globally will continue to rise, in part as a result

Although the number of incidents may appear small, this indicates of the advancement of new supportive technologies, such as robotics

that 23 separate ‘never events’ took place in the 6 Trusts that do not and enhanced minimally invasive approaches. Furthermore, access to

Although use LocSSIPs the number but did of respond incidents to the may audit appear (see small, fig 5). this Interestingly indicates that the 23 such treatments is being made more readily available to a different

patient groups whose needs and longer-term rehabilitation can be more

separate

results show

‘never

that

events’

for the

took

period

place in

in

the

question,

6 Trusts that

the

do

prevalence

not use LocSSIPs

of wrong

but

site surgery in these hospitals is not only consistent over time, but is complex and demanding. Whilst in this regard clinical outcomes, quality

did the respond most common to the audit category (see of fig ‘never 5). Interestingly event’ to the have results occurred. show From that for the the of life, and indeed life expectancy can be improved and extended,

period nationally in question, available the data prevalence for the same of wrong period, site surgery where it in is these assumed hospitals that is

this is only the case if surgery takes place within optimum conditions.

LocSSIPs are being used, the prevalence of wrong site surgical never Taking all other factors into consideration the number of never events

not only consistent over time, but is the most common category of ‘never event’

events is also apparent (see fig 1). Interesting, despite the fact that continues to remain a constant yet stubborn patient safety concern.

to the have audit occurred. was undertaken From the nationally to identify available the utilisation data for the of same LocSSIPs, period, during where

Whilst it was not our intention to undertake comparison, we found that

it the is course assumed of the that audit LocSSIPs period are respondents being used, who the indicated prevalence that of LocSSIPs wrong site of the Trusts that responded, the prevalence of wrong site surgery was

were not in use also unsolicited, provided some qualitative comments

surgical the most common (and persistent) never event across the Trusts not

(Table 2).

never events is also apparent (see fig 1). Interesting, despite the fact

utilising LocSSIPs. We also acknowledge that However, we are not yet in

that Table the two audit –– responses was undertaken by by Trusts to

Trusts categorised identify the

categorised by utilisation region by region as of to LocSSIPs, why as LocSSIPs during

to why are the a position to draw further conclusions as the effectiveness of LocSSIPs

course LocSSIPs not utilised. of the are audit not utilised. period respondents who indicated that LocSSIPs were not in preventing wrong site surgery never events, given that these are

also proving difficult to reduce in the vast majority of Trusts where

in Region use also unsolicited, Comments provided by Trust some identifiable qualitative by comments region (Table 2).

they are used. In acknowledging that the response rate was 58%, we

cannot claim to know how many other Trusts are not utilising LocSSIPs,

East Use NatSSIPs. LocSSIPs being looked at.

that said given the timing and context in which the audit was carried

out we appreciate that other priorities could have impact on ability

Midlands No.

and willingness to participate. Nevertheless, were perhaps surprised

to discover that 6 Trusts who responded, acknowledged that they were

sitivity: Internal Northeast No, we don’t have them in theatres.

yet to implement LocSSIPS.

&

In reality, this is more complex, and it would appear that only two

Yorkshire

NHS England Trusts, one in the Midlands and one in Yorkshire and the

North East currently have no plans to implement LocSSIPs. Regionally

Northeast Not in theatres. Why you’ve not had many responses is only London would appear to be utilising LocSSIPs in all Trusts that

&

probably due to understanding of terms Natssips/Locssips. We took part. Beyond that it, would appear to be the case that they are

Yorkshire would probably say no. But we do a team brief, the who surgical

implemented sporadically and therefore without a strategic approach

and without a system of compliance and quality improvement.

safety checklist we also do a stop before you block checklist as

well

The audit has also raised questions as two why there is no universal

coverage, perhaps we have begun to reveal such standards are not yet

East Short answer is yes, we do have some NatSSIPs and

fully understood, and that the term itself or at least the abbreviation is

misleading. Whilst there may be tacit acceptance that a range of safety

LocSSIPs

measures are in place, specific records and dedicated paperwork may

not be a feature of their implementation.

Southwest We don’t have specific LocSSIP or NatSSIP paperwork as a

8 trust yet, despite me begging! We are THE part OPERATING of a Southwest THEATRE JOURNAL www.otjonline.com

group which were trying to get it simplified and uniform for all

Number of

responses

3 rd

December

2021

Number of

responses

by 10 th

December

2021

Number of

responses

by 17 th

December

2021

Number of

responses

by 24 th

December

2021

Number of

responses

by 12 th

January

2022

Number of

responses

by 28 th

January

2022

London 22 11 50% 4 0 4 1 1 1

Southwest 15 11 73% 1 5 0 0 0 5

Southeast 20 11 55% 6 2 3 0 0 0

Midlands 21 10 48% 5 2 1 1 0 1

East 15 6 40% 4 0 0 2 0 0

Northwest 22 15 68% 7 1 3 2 1 1

Northeast &

Yorkshire

21 15 67% 3 2 4 1 1 4

Total 136 79 30 (22%) 12 (9%) 15 (11%) 7 (5%) 3 (2%) 12 (9%)

Conclusion

To conclude there is still much work needed to ensure that LocSSIPs are

accepted and used when an invasive procedure is taking place in the

operating theatre. As the audit has shown, there are still six Trusts yet

to implement LocSSIPs and the audit hints that this is more complex

than simply just non-compliance. It is not possible to say from this study

whether the lack of compliance leads to greater risk of never events

occurring, certainly those that particularly involve wrong site surgery.

Whilst statistical analysis is important, the audit hints that a greater

qualitative understanding is needed of the factors that impact upon

the persistence of ‘never events’. Given the paucity of the current

literature, examples from never events in Dentistry suggest that the

stubbornness of the data to improve as acted as a catalyst for further

investigation. It would be of concern if the re-classification and removal

of dental surgical never events stifles further critical enquiries possibly

at the expense of data manipulation.

Our intention is not to single our Trusts for criticism based on noncompliance

and uptake of LocSSIPs without greater appreciation of

context. Murphy (2016) has pointed to poor communication and lack

of leadership as being common factors in the causation of procedural

mishaps. Rather than criticism, the focus needs to shift from simply

understanding adverse events, to the introduction of measures that will

prevent their occurrence.

The application of LocSSIPs must ensure that the clinical approach to

safety is the same, irrespective of the location, time, and resources

available. Similarly, Radcliffe (2016) affirms that such standards aim to

minimise risks of variation in practice, moreover safety standards are

aimed at embedding best practice by minimising the risk of variation,

maximising consistency, and therefore ensuring harmonisation across

organisations.

the risk of variation, maximising consistency, and therefore ensuring

tion across organisations.

Figure six – Triad for LocSSIPs implementation (NHS Commissioning

Board, 2014)

– Triad for LocSSIPs implementation (NHS Commissioning Board, 2014)

Harmonise

Standardise

Educate

Wali et al (2020) paper conclude that high quality training is integral

to ensuring that LocSSIPs are not mistaken for or treated as a tick-box

exercise. Atul Gawande’s (2012) checklist manifesto describes how the

surgical safety checklist “provides reminders of only the most critical

and important steps, the ones that even the highly skilled professionals

using them could miss. Likewise, collaborate and interdisciplinary

approaches do not always feature in the literature, and we would

conclude that teamworking and team learning are essential to effective

implementation (see fig 6.)

(2020) paper conclude that high quality training is integral to ensuring that

are not mistaken for or treated as a tick-box exercise. Atul Gawande’s

ecklist manifesto describes how the surgical safety checklist “provides

of only the most critical and important steps, the ones that even the highly

fessionals using them could miss. Likewise, collaborate and interdisciplinary

Strong

leadership in

patient safety

s do not always feature in the literature, and we would conclude that

ing and team learning are essential to effective implementation (see fig 6.)

Communication

Standardisation

of processes

have prioritised a model to ensure that key areas and emergent themes

Staff

feedback

Monitoring of

compliance

e both on-going, and further research in relation to implementation,

e, development and ultimately the success of LocSSIPs.

Harmonisation

Evaluation and

sharing of

lessons from

incidents

Empowerment of

teams

Provision of

training and

Education

Finally, we have prioritised a model to ensure that key areas and

emergent themes that require both on-going, and further research in

relation to implementation, compliance, development and ultimately

the success of LocSSIPs.

If we needed to remind ourselves, that LocSSIPs are designed to enable

knowledge, skills and attitude required to make invasive procedures

safe; we should not lose sight of the fact that this is concerned with

reducing the number of ‘never events’ and ultimately reducing patient

harm. We realise along with Radcliffe (2016), that these standards alone

cannot prevent ‘never events’ from occurring, but when combined with

the staff education, the promotion of teamwork, and human factors

training, that these measure must go some way to ensure that the triad

designed to standardise, educate and harmonise is complete (see fig 6).

References:

[1] ABBOTT, H., and WORDSWORTH, S. 2014

Improving Safety Culture: a profession in the fast lane.

Journal of Operating Department Practice, 2014 2 (5) 231-235

[2] BHANDARI, R. 2016

National safety standards invasive procedures (NatSSIPs):

its relevance to oral and maxillofacial surgery.

British Journal of Oral and Maxillofacial Surgery, 2016. 54 (10) e122

[3] BRENNAN, P.A., MITCHELL, D., A., HOLMES, S., PLINT, S., PARRY, D. 2016

Good people who try their best can have problems:

recognition of human Factors and how to minimise error.

Br J Oral maxillofac Surg, 2016. 54, 3-7

[4] BRITISH DENTAL ASSOCIATION 2021

Wrong tooth extraction removed from never evets list

https://bda.org/news-centre/latest-news-articles/wrong-tooth-extractionsremoved-from-never-event-list

[Accessed 28th August 2021]

[5] COATES, M., L., CARRIE, S. 2019

A local safety standard for invasive procedures for out-patient

endonasal procedures performed under local anaesthetic:

a template from Newcastle Upon Tyne hospitals.

Journal of Laryngology and Otology.2019. 133 (5) 441-444

[6] COTTAM, S., GERRARD, G. 2021

An audit to assess the quality of treatment records for IV sedation

Story behind the cover, 2021. 37. 40

[7] FINDLAY, D., COHEN, J., BARRIE, J., NAYLOR, K., TULLY, R. 2018

Improving the quality of CVC documentation through introduction of a new

proforma – a retrospective case note audit

Anaesthesia, 2018, 73 (2) 21

[8] GDC PUBLIC AND PATEINT SAFETY SURVEY, 2017

https://www.gdc-uk.org/about/what-we-do/research/patient-and-public-survey

[Accessed 10th December 2018]

Referenced by: WALI, R., HALAI, T., KOSHAL, S. 2020

WHO surgical safety checklist training: An alternative approach to training in

local safety standards for invasive procedures.

European Journal of Dental Education, 2020. 24 (1) 71-78

[9] KILDUFF, C., LEITH, T., DRAKE, T., FITZGERALD, J. 2017

Surgical safety checklist training: a national study of undergraduate medical

and nursing student teaching, understanding and influencing factors.

Postgrad Med J, 2017. 94 (1109) 143-150

Referenced by: WALI, R., HALAI, T., KOSHAL, S. 2020

WHO surgical safety checklist training:

An alternative approach to training in local safety standards for invasive

procedures.


[10] LIEW, J., BEECH, A., N. 2020

Implementation of ‘Local Standards for Invasive Procedures

(LocSSIPs)’ policy: not merely a tick-box exercise in patient safety

British journal of Oral and maxillofacial Surgery, 2020. 58 (4) 421-426

[11] MURPHY, J., F., A. 2016

Safety standards for invasive procedures

Irish Medical Journal, 2016. 109 (3) 366-367

[12] NHS, 2020

Never events reported as occurring between 1 April 2019 and 31 March 2020 –

Final update. https://www.england.nhs.uk/wp-content/uploads/2021/01/Finalupdate-NE-1-April-2019-31-March-2020.pdf


[13] NHS ENGLAND, 2014

Standardise, educate, harmonise: commissioning the condition for safer Surgery.

Report of the NHS England Never Event Taskforce.

https://www.england.nhs.uk/wp-content/uploads/2014/02/sur-nev-ev-tf-reppdf

[Accessed January 2020]

Referenced by: LIEW, J., and BEECH, A., N. 2020

Implementation of ‘Local Standards for Invasive Procedures (LocSSIPs)’ policy:

not merely a tick-box exercise in patient safety


[14] NHS ENGLAND 2015

National Safety Standards for Invasive Procedures

https://www.england.nhs.uk/wp-content/uploads/2015/09/natssips-safetystandards.pdf

[Accessed 6th October 2021 & 1st December 2021]


References continued:

[15] NHS ENGLAND, 2019-20

Supporting facilities data, operating theatres in NHS organisations in England,

quarter 3 2019-20

https://www.england.nhs.uk/statistics/statistical-work%20areas/cancelledelective-operations/supporting-facilities-data/

[Accessed 30th November 2021]

[16] NHS ENGLAND AND IMPROVEMENT 2019


Final update.

https://www.england.nhs.uk/wpcontent/uploads/2020/08/Annual_NE_

report_1_April_2017_to_31March_2018_FINAL_V5.pdf


[17] NHS IMPROVEMENT, 2017


Final update.

https://www.england.nhs.uk/wp content/uploads/2020/08/NE_data_report_1_

April_2015_-_31_March_2016_FINAL_v2.pdf




Final update.

https://www.england.nhs.uk/wp-content/uploads/2020/08/Never_Events_1_

April_2016_-_31_March_2017_FINAL_v2.pdf


[19] NHS IMPROVEMENT, 2020.

Patient safety. https://improvement.nhs.uk/improvement-hub/patient-safety

[Accessed 19th January 2020]

Referenced by: LIEW, J., and BEECH, A., N. 2020 Implementation of ‘Local

Standards for Invasive Procedures (LocSSIPs)’ policy: not merely a tick-box

exercise in patient safety



Never Events list 2018, first published January 2018 (Last updated February

2021)

https://www.england.nhs.uk/wp-content/uploads/2020/11/2018-Never-Events-

List-updated-February-2021.pdfm


[21] NHS UK 2021

NHS Services Directory

https://www.nhs.uk/Services/Trusts/Overview/DefaultView.aspx?id=1748

[Accessed 30th November 2021]

[22] PEMBERTON, M., N., ASHLEY, M., P., SAKSENA, A. ET AL 2017

Wrong tooth extraction: an examination of ‘never events’ data.

British journal of Oral and Maxillofacial surgery, 2017. 55, 187-188

Referenced by: LIEW, J., and BEECH, A., N. 2020

Implementation of ‘Local Standards for Invasive Procedures (LocSSIPs)’ policy:

not merely a tick-box exercise in patient safety British journal of Oral and

maxillofacial Surgery, 2020. 58 (4) 421-426

[23] RADCLIFFE, T. 2016

Say never to never events

Nursing Standard, 2016. 30 (19)64-65

[24] RENTON, T., MASTER, S., PEMBERTON, M. 2017

Patient safety in dentistry

Dental update, 2017. 44 (10) 947-956

[25] RENTON, Y., CHOHAN, P., TAGAR, H. 2020

An update on patient safety in Dentistry

Dental health, 2020. 59 (5) 29-32

[26] TAGAR, H., DEVINE, M., OBISESAN, O. 2019

How to create local safety standards for invasive procedures (LocSSIPs) by

Engaging the team in patient safety.

British Dental Journal, 2019 226 (2) 144-151

[27] TINGLE, J. 2016

Safety standards for invasive procedures and use of anaesthesia

British Journal of Nursing, 2016. 25 (3) 182-183

[28] WALI, R., HALAI, T., KOSHAL, S. 2020

WHO surgical safety checklist training:

An alternative approach to training in local safety standards for invasive

procedures.


[29] WOOLCOMBE, S., KAZMI, A., TAGAR, H. 2019

Preventing wrong tooth extractions

Dental nursing, 2019. 15 (12) 614-618

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outpatient. Performing around

5,200 procedures a year - SWLEOC

is one of the largest orthopaedic

centres in the UK and Europe. It is

also a shoulder surgery specialist

centre, with sub specialities in

soft tissue, spine, foot and ankle

procedures.

The new operating theatre adds a

sixth facility to the five theatres

already in place within SWLEOC.

A key requirement for the

teaching hospital was integrated

theatre communication, enabling

clinical teams to interact and

share video with staff and

students in an observation area

(referred to as ‘the fishbowl’).

At the heart of the theatre is the

high capacity Merivaara OpenOR

open architecture management

system, which integrates

operating theatre devices, data

and image management for

rapid display of surgical imagery.

OpenOR is connected with

surgical lights, monitors and

cameras within the theatre. Any

media related to the patient can

be stored and managed through

the system including footage and

snapshots from surgery.

OpenOR is a scalable solution

tailored to fit the requirements

of any hospital. It integrates PACS

and hospital systems for patient

worklists and data integration,

and the system is vendorneutral,

so it does not limit the

connection of image sources from

specific manufacturers. Video is

connected via a simple plug and

play function. The over IP-based

audio and video management

capability provides flexible video

routing between sources and

displays, allowing live procedures

to be viewed and streamed

outside the operating theatre to

any given location.

The Second Annual

Operating Theatres Show

THE KIA OVAL, LONDON

11TH OCTOBER 2022

Save 20% with code OTJ20

www.igpp.org.uk/otj

View the agenda today

Bender UK Managing Director

Gareth Brunton explains: “With

our background in hospital critical

care power, turnkey theatre

projects and more recently a

full clinical product capability in

partnership with Merivaara, the

OpenOR technology has been

a natural progression for our

hospital business unit team.”

Bender UK supplied theatre

equipment including the new

CP924 glass touchscreen theatre

control panel, 24-inch DICOM

compliant Bender PACS with glass

fascia membrane keyboard, and

two 55-inch 4K in-wall glass fascia

viewing panels.

Merivaara Q-Flow LED operating

lights with a wireless HD camera

were selected due to the bestin-class

colour-rendering and

optimised airflow, with unique

dynamic obstacle compensation

to deliver optimum illumination to

the surgical site. The ring-withina-ring

design of the Merivaara

lights ensures uninterrupted

clean air flow from the canopy

- an important requirement for

orthopaedic surgery to help

minimise the risk of infection.

Bender UK has an excellent

aftersales capability with full

training and familiarisation

service provided by consultant

Steve Coleman who took the

Epsom theatre team through a

step-by-step introduction, so they

were fully conversant with the

technology.

Epsom Hospital is managed by the

Epsom and St Helier University

Hospitals NHS Trust along with the

nearby St Helier Hospital. Both

teaching hospitals play key roles

in the education and training of

future doctors, nurses and health

professionals. The two hospitals

work in partnership with St

George’s Hospital and St George’s

Medical School in South London to

deliver high quality education and

research.

Ken Macdonald, Electrical

Design Engineer for the Trust

commented: “ We now have a

fantastic theatre that I know the

client is more than happy with, all

the surgeons and the clinical staff

too, and that goes right down to

us as the Trust engineers.

“The system is probably the most

up to date and cutting edge. It

provides the team with such a

better facility, with the ability

to record for training purposes,

allowing the consultants to talk to

‘the fishbowl’ during operations.

“It was delivered with confidence

for us as the client. Questions

that were asked of Bender during

the commission received answers

that were exemplary.”

Epsom Hospital is one of eight

OpenOR projects completed by

Bender UK in 2021. The theatre

was officially handed over for use

in July 2021.

For more information on Bender

UK integrated theatre capabilities

and products and service for

the healthcare sector, email:

internalsales@bender-uk.com

or call 01229 480123.



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into helping family doctors recognise potential sepsis and ensure that

patients rapidly receive appropriate assessment and treatment.

“We have produced a toolkit, in partnership with NHS England, which

brings together existing guidance, training materials and patient

information to encourage us all to ‘think sepsis, talk sepsis and treat

sepsis’.

“We Join are us pleased from 27 to to be 28 working September with 2022 NHS England at Edgbaston raise Stadium awareness in

and Birmingham improve outcomes for the for inaugural patients. Infection It really 360 could Conference, save lives.” where

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Anna and its Crossley, part in combatting Professional new Lead and for existing Acute, pathogens. Emergency & Critical

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WANTED

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NEW ZEALAND?

Accent Health Recruitment NZ is currently arranging skype and

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The boarders are open for essential health workers

Accent HR offer FREE assistance with:

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* Relocation Advice - From overseas to New Zealand

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wrand.com Issue 316 January 2017 7


INTS2022

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Neurotrauma Symposium

Improving lives after neurotrauma through research

17–20 July 2022

Pre-symposium-courses scheduled for 17 July

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SHARE Conference 2022

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The Sustainable Healthcare,

Academic Research and

Enterprise (SHARE) conference

The will Sustainable take place online, Healthcare, Academic Re

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6th Co-hosted 2022. by Brighton and

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Learn completing more: the https://bit.ly/3IYy9KE

online form.

Where Are You Now?

Did YOU train as a Technician, ODA or ODP? City & Guilds, NVQ ?

Where has you career path taken you?

Are you still in theatres or have you moved to pastures new?

We’d love to hear from you regards your career path, which we

hope can inspire others.

Please send us your career path in around 500 words which we’ll

publish in a future issue of The OTJ. We won’t use your name when

publishing your career summary, just let us know your initials or

even a pseudonym (unless you give us permission to use your name).

We look forward to sharing you progression since qualifying with

our readers.

Please send your summary in an email with ‘Career’ in the subject

heading to: admin@otjonline.com


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A one-stop resource for ALL your theatre related Career opportunities

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and Clinical Advisers

83 AUDIT REPORT Waitematā District Health Board Annual Report 2018/19


Dydd Gwyl Dewi Hapus!

Fideo animeiddiedig BSH - Deall Eich Calon a Methiant y Galon

Gwyliwch yma

• Leading heart failure society launches animated video to educate on

heart function – in six different languages

• Engaging video illustrating normal and abnormal heart function

• 2 minutes 54 seconds of stylised imagery with voice over

• Available in English and 6 more languages and with closed captions:

o Welsh, Gujarati, Bengali, Punjabi, Urdu and Polish

• Designed for use by anyone who needs to educate on heart function

• 36,000 people in Wales have been diagnosed with heart failure by

their GP

• ‘Freedom from Failure’ – The F word’ and raise public awareness of

the common symptoms of heart failure to motivate early seeking

of medical advice to improve outcomes - The F Word is Failure

#TheFWord #FreedomfromFailure

On Tuesday 1st March 2022 the British Society for Heart Failure (BSH),

the professional association for heart failure care in the UK,launched

an animated video, just under 3 minutes in length, in Welsh, English

and 5 more languages for use by those who need to educate on heart

function. Intended for health care professionals across healthcare

settings, it is equally applicable for student use and for self-education.

Of the 340,000 people in Wales who are living with the daily burden

of heart and circulatory disease, around 36,000 have been diagnosed

with heart failure by their GP[i]. Estimates which include diagnoses at

hospital suggest that there are thousands more people living with the

condition across the country. And with the population in Wales aged 65-

84 set to rise by 22% and those over 85 by 62%[ii] by 2030, heart failure

will increase, too.

Chronic heart failure is a condition where the heart is unable to pump

blood around the body properly. It usually occurs because the heart

has become too weak or stiff. Ejection fraction (the percentage of the

blood within the ventricles that is ejected during the cardiac cycle)

is one of the most important measurements of heart function. When

the pumping action of the heart is weak it is referred to as HFrEF -

heart failure with reduced ejection fraction and when it is stiff and

does not relax properly, it is referred to HFpEF - heart failure with

preserved ejection fraction. For HFrEF, there are many drug treatments

that improve survival and this year we have seen the first treatments

emerge for people with HFpEF.

Produced as part of the ‘Freedom from Failure – the F Word’ 5 year

strategy, the animated video adds to a repository of resources

provided by BSH to make heart failure a national priority. It must not

be underestimated that the risk of death from heart failure is higher

than for some of the most common cancers[[ii]] therefore heart failure

should be recognised, detected and treated with the same urgency as

a disease as malignant as cancer[[iii]]. People with heart failure should

be encouraged to seek understanding of and actively self-manage their

condition. Self-care includes physical activity, avoiding excessive salt

intake, maintaining a healthy body weight, avoiding excessive alcohol

consumption and not smoking. It is also important to recognise changes

in symptoms and know when to contact a health professional.

BSH Chair, Professor Roy Gardner, Consultant Cardiologist, Heart Failure

Specialist, Golden Jubilee Hospital, Glasgow commented: “Heart

failure is arguably the biggest success story of modern day medicine,

we have made extraordinary progress over the last 2 decades. And

whilst it remains a burdensome, often debilitating condition, with

appropriate management it is possible for people to live well with

heart failure. Outcomes can be dramatically improved through earlier,

faster diagnosis and expediting optimal treatment onto guideline

recommended therapies[[v]]. This is an important aim of the care we

provide as Heart Failure Specialists.”


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Medtronic announces launch of NuVent

Eustachian tube dilation balloon

Single-use device treats Eustachian tube dysfunction during office procedures

Medtronic plc (NYSE: MDT), a global leader in healthcare technology,

recently announced the launch of the NuVent Eustachian tube

dilation balloon, which has been cleared by the U.S. Food and Drug

Administration (FDA) for the treatment of chronic, obstructive

Eustachian Tube Dysfunction. The NuVent balloon enables surgeons

to deliver treatment in an outpatient or office setting. It features a

flexible balloon section that allows customized placement based on

patient anatomy.

Medtronic NuVent Eustachian tube dilation balloon

“Patients who suffer from Eustachian Tube Dysfunction often

experience pain, pressure, and hearing difficulties, so it’s important to

address their illness quickly,” said Dr. Boris Karanfilov, a rhinologist and

head of the Ohio Sinus Institute in Dublin, Ohio.

“Balloon dilation restores proper Eustachian tube function and reduces

these symptoms, plus the ability to perform the procedure in the office

makes it both convenient and efficient.”

It is estimated that 4.6% of adults in the United States experience

Eustachian Tube Dysfunction.1 It occurs when the Eustachian tube,

which links the back of the nose to the middle ear, fails to open or

close properly. As a result, the tube is unable to perform its primary

functions, which are protecting the middle ear from pathogens,

equalizing air pressure on either side of the eardrum, and helping

drain secretions from the middle ear cleft. This may result in pain,

hearing difficulty, and/or a feeling of fullness in the ears. If not treated,

patients may also suffer damage to the middle ear and eardrum.2

“Patients with persistent Eustachian Tube Dysfunction – especially

those who experience frequent pressure changes, like airline travelers

and divers – often require more than nasal sprays and oral medication

to treat the condition,” said Dr. Sina Joorabchi, an otolaryngologist at

South Florida Ear, Nose, and Throat Associates. “The NuVent balloon

provides an effective, minimally invasive treatment option that can be

administered in the office.”

“As office-based procedures for ENT conditions increase, we look

forward to introducing more innovative technologies designed

specifically for this setting,” said Vince Racano, president of the Ear,

Nose, and Throat business, which is part of the Neuroscience Portfolio

at Medtronic. “The NuVent balloon is another important product

within this expanding portfolio.”

For more information on Medtronic (NYSE:MDT), visit www.Medtronic.

com and follow @Medtronic on Twitter and LinkedIn.

References

1. Shan A, Ward B, et al. Prevalence of Eustachian tube dysfunction in adults in

the United States. JAMA Otolaryngol Head Neck Surg 2019; 145(10):974-975.

doi:10.1001/jamaoto.2019.1917

2. Hamrang-Yousefi S, Ng J, Andaloro C. Eustachian Tube Dysfunction. [Updated

2021 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls

Publishing; 2021 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK555908/

Please quote ‘OTJ’


Operating theatres

finally reopen after

Covid closures

The operating theatres in Navan hospital will

return to full capacity on March 7th, following

closures that have been in place for several

months due to Covid-19.

There has been disquiet among staff at the

length of closures of the theatres, particularly

in light of Health Minister, Stephen Donnelly’s

commitment last week to cut waiting lists.

In a statement issued this week hospital

management said: “The hospital makes every

effort to avoid any disruption and is working to

ensure that the safest, quality patient care be

provided at all times.”

Staff at the hospital had expressed concern

that general surgery theatres at the hospital

were still closed this week.

A member of staff pointed out that the general

surgery theatres had closed three times during

the pandemic.

“We were fine with that at the height of

the pandemic. The theatre nurses were

redeployed around different departments in

the hospital and we were all happy to do that

during the pandemic, but the theatres should

be up and running now,” she said.

“It is frustrating as waiting lists are growing as

the theatres are closed.”

The statement from the hospital said that

health care services nationally continued to

experience immense pressures in relation to

staff availability due to Covid.

“However, patients requiring essential

and time-sensitive treatment continue to

be prioritised, including those on cancer

treatment.

“The effect of the pandemic to date on non-

Covid care is very much acknowledged. Our

Lady’s Hospital, Navan has made every effort

to minimise the impact of the pandemic this

included the prioritisation of time-sensitive

treatments at all times and the use of a

range of measures to increase capacity when

feasible, including extended working days,

outsourcing, virtual assessments, clinical

guidance updates, new clinical pathways and

adoption of new technologies.

“One theatre in Our Lady’s Hospital, Navan

in currently not fully operational. However, it

will return to full capacity on March 7th.

“The hospital makes every effort to avoid any

disruption and is working to ensure that the

safest, quality patient care be provided at all

times.

“Hospital Management would like to thank the

public for their patience and support at this

time,” the statement concluded.

THE

Source: Meath Chronicle

New MRI method will better inform surgical

decisions for babies born with a heart defect

A novel 10-minute MRI scan could help surgeons better plan for a congenital heart

defect

Researchers from the School of Biomedical Engineering & Imaging Sciences have identified a novel

non-invasive 10-minute MRI scan of tracking the health of the aorta to better inform surgical

decisions and patient monitoring, particularly for congenital conditions such as hypoplastic left

heart syndrome (HLHS).

Published in the Journal of Cardiovascular Translational Research, the research focuses on the

aorta, the main artery that receives the blood of each heartbeat and distributes it to our body.

The large arteries, particularly the aorta, serve as a conduit to transport the blood from the

ventricles to the body, and as a reservoir of blood that fills during systole (period of contraction

of the ventricles of the heart that occurs between the first and second heart sounds of the

cardiac cycle) and recoils during diastole (the phase of the heartbeat when the heart muscle

relaxes and allows the chambers to fill with blood).

The researchers developed a non-invasive comprehensive way to study these two functions along

the aorta from a 10-minute MRI scan, replacing the need of invasive catheterised methods that

were not even close to report the rich spatial information the new method can provide.

“A child born with HLHS presents a unique anatomy and each clinical decision needs to be

tailored to it. This is very challenging. In this context, our key objective is to deliver non-invasive

technology that assesses the health and function of our main vessels. With such technology,

surgical processes can be tailored to alleviate existing problems or can be evaluated and further

improved by studying the impact of previous procedural choices.”

– Dr Adelaide De Vecchi, Lecturer, School of Biomedical Engineering & Imaging Sciences

HLHS is a birth defect where babies are born with an under-developed left part of the

heart. Currently, immediately after birth, babies require staged surgical palliation – a series

of procedures that save the life of the babies and that aim to maximise life expectancy and

relieving complications.

As part of these procedures, surgeons also need to enlarge the aorta so that it can accommodate

the entire cardiac output.

Despite numerous patients now surviving the staged palliation procedure, they live with only

half of their heart – a single ventricle instead of two – and are thus more likely to have cardiac

complications over time.

It is paramount to minimise the presence of unfavourable blood flow conditions, such as those

caused by sub-optimal surgical reconstructions of the aorta.

There is also increasing evidence that significant neurodevelopmental issues associated with

HLHS may be triggered by these cardiac factors.

“With our novel method, we now have the ability to evaluate with unprecedented detail the

blood flow pathophysiology of the aorta artery through the conduit and reservoir functions.”

– Dr Alessandro Faraci, Research Associate, School of Biomedical Engineering & Imaging Sciences

“In the future this will even allow us to guide the definition of optimal strategies for surgical

and clinical treatment.”

– Mr Joao Filipe Fernandes, Research Student, School of Biomedical Engineering & Imaging

Sciences

King’s College London.


The Association for Perioperative Practice (AfPP)

Thanks to AfPP I have a greater understanding of the

perioperative environment and what I can do to make myself

a better practitioner. Every practitioner should be a member.

Selina, AfPP Member and Clinic Nurse

Join

today from

£5

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*

AfPP is the UK’s leading membership organisation dedicated to all theatre practitioners. We’re

committed to improving patient care and safety through developing, providing and promoting leading

standards in perioperative practice. Our aim is to help you become the best practitioner you can be.

Take a look at what membership of AfPP gives you:

Professional Development

Online Education: Webinars and online resources to help you

become a better practitioner and gain CPD hours.

Networking: Online member discussion forums and regional

teams to share information and best practice.

The Journal of Perioperative Practice: Our highly respected

peer reviewed Journal, delivered FREE 10 times a year.

EBSCO Health: FREE access to the leading provider of evidence

based clinical decision support solutions, healthcare business

intelligence, and peer-reviewed medical research information.

Annual Conference: Guaranteed to educate, challenge

and inspire you. Reduced delegate rates for members.

Support & Advice

Professional Advice Service: Specialist clinical support

and advice from experienced healthcare professionals

available FREE.

Wellbeing and Mental Health Support: FREE membership

to Togetherall, a 24/7 online service, providing a supportive

community, information and self-help resources.

Medical Professional Liability Insurance: Created for

practitioners working in and around operating theatres.

Premium is in addition to AfPP membership fee.

*£5 per month refers to Student Membership. £8.75pm Registered, £7.25 pm Non-registered.

Join today www.afpp.org.uk or call 01423 881 300

@SaferSurgeryUK

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 a wholly owned subsidiary company, registered in England number

3102102. AfPP, Daisy Ayris House, 42 Freemans Way, Harrogate HG3 1DH T: 01423 881300 F: 01423 880997 W: afpp.org.uk

Nothing routine about routine operations

The BBC recently reported that, as of the end of November 2021, more

than six million people were waiting for routine operations in the UK.

This was the first time this figure had been hit in the history of the NHS

and demonstrated the scale of the backlog in routine operations caused

by the COVID-19 health crisis and its knock-on effect on the wellbeing of

the nation.

The number – which represents not far short of ten percent of the entire

UK population – covered a reporting period before the Omicron variant

of COVID-19 threw the NHS under additional pressure over the festive

period. The next reported number is likely to be higher still.

An international fight for healthcare

Pre-pandemic, the UK Government aimed to offer those that needed nonurgent

surgery a procedure within 18 weeks. In 2018, it was reported that

hospitals achieved this around 88 percent of the time. This demonstrates

that, even before COVID-19, many patients were waiting a significant

amount of time for surgery.

This is not an issue unique to the UK. Research conducted by the

Organisation for Economic Co-operation and Development (OECD)

suggests that waiting times for “elective” or non-emergency surgery have

increased across the economies surveyed, with median wait times for

cataract surgery averaging 92 days. For hip replacement, it was 113 days,

and for knee replacement, it was 189 days. In Poland, patients can wait

almost 250 days on average for cataracts surgery, while in Estonia hip

replacement patients are waiting on average 282 days2. The healthcare

crisis is a global phenomenon.

Magnifying existing issues

In 2020-2021, The King’s Fund – an independent charitable organisation

working to improve health and care in England - reported that the United

Kingdom spent £192 billion on health and social care. This was some £50

billion more than the previous year and represents approximately 10.2

percent of the country’s GDP. This is by no means out of sync with other

countries. Indeed, it is close to the average figure reported by the OECD.

Despite this increase in spending, and the NHS vastly increasing the

number of tests and treatments offered in the summer of 2021 in response

to the COVID-19 backlog, elective surgery waiting lists continued to rise.

The reality is that the COVID crisis has brought into sharp focus an issue

that has developed over decades. The global population has been growing

older and living longer and the proportion of people retired, compared

to those in work, has increased exponentially. Across the world, whether

countries deploy a national healthcare service or not, the demand for

healthcare is growing just as the number of people that are in work and

can pay for it is falling.

The pandemic has acted as a perfect storm to accelerate these issues,

with overstretched healthcare workers having to focus on the immediate

crisis at the cost of the wider wellbeing of the population. Furthermore,

the nature of the virus has led to thousands of healthcare workers having

to isolate for periods to avoid this risk of further transmission, leaving less

people to carry out both routine and emergency procedures.

The burden of delay

For each of the six million people on a waiting list in the UK, there is

nothing routine about their condition. Patients waiting for a cataract

operation suffer with sensitivity to light and glare as well as clouded,

blurred or dimmed vision. They may struggle to see well at night. This

can impact people’s ability to work and therefore support themselves

and their family. Those waiting for a hip or ankle replacement can be in

constant pain. Many are unable to walk, leading to issues around lack of

social contact and independence.

The burden of delay is not limited to the individual. If people are unable

to work because of their condition, they may require increased access to

benefits systems, adding to the overall national cost of a condition. If

their condition means reducing their working hours, they will be paying

less taxes. They are likely to need more GP and hospital appointments.

Prolonged delays to surgery may lead to other conditions such as obesity

through lack of movement or mental health issues caused by loneliness.

While a hip replacement operation may cost somewhere between £10,000

to £15,000, it is not unreasonable to estimate the total impact on the

economy of such an operation as comfortably double this – and grows as

delays increase.

This is not to say that healthcare systems are not doing everything

they can to reduce this burden. Healthcare professionals have a history

of challenging the status quo to improve patient outcomes. Surgery

techniques have radically changed to deliver better healthcare outcomes

and doctors are constantly looking to speed recovery to avoid issues of

bed blocking and increase the volume of elective operations.

Innovation breeds new solutions

Perhaps the biggest opportunity to address these challenges to healthcare

systems’ capacity comes in combining technology with medicine in a bid

to generate better patient outcomes.

The medical technology (MedTech) sector has seen substantial growth

in recent years – a trend that is expected to continue. The European

medical technology market is estimated to be worth more than £102.5

billion, with Germany, France, and the United Kingdom leading the way

in research, development, and implementation of new medical devices.

Indeed, prior to the pandemic in 2019, the total annual revenue of

the global MedTech industry stood at £370.9 billion — representing an

increasing share of the overall global healthcare sector. By 2025, the

global medical devices industry is expected to reach a valuation of

£440.5billion, growing at an average of 5.4 percent per year.

This trend has been accelerated by the pandemic. As COVID-19 challenged

the traditional healthcare processes it forced healthcare systems to

quickly implement new solutions, such as tele-consultations and the

increased use of remote monitoring to manage patients. This helped

demonstrate the transformative potential of technology to healthcare

systems.

MedTech can have a significant impact driving transformation around

how care is provided, enabling healthcare professionals to focus on the

critical. For example, remote monitoring can provide doctors with alerts

that inform them of patients’ vital signs, but healthcare professionals will

still need to interpret these.

Faster recovery, more capacity

One of the areas with most potential is MedTech devices that empower

patients’ faster recovery. Devices that reduce swelling, for example, or

heal wounds more quickly, can enable patients to manage an increased

part of post operative recovery at home. This has several positive

outcomes. For the healthcare system, reducing time spent in hospital

recovery reduces bed blocking and can free up extra capacity to perform

more operations.

Faster recovery after surgery also reduces the risk of patient complications.

Immobile patients are at a higher risk of blood clots, known as venous

thromboembolism (VTE). Around 55 – 60 per cent of all VTE cases occur

during or following hospitalisation , resulting in approximately 25,000

deaths in England each year alone.

Sustained time in hospital can also increase risk of infection. According

to the World Health Organisation, healthcare associated infections are

the most frequent adverse event in healthcare delivery worldwide. 10

percent of patients in developing countries and seven percent in developed

countries will acquire at least one healthcare associated infection during

their time in hospital. Perhaps most importantly, patients that are using

MedTech devices to hasten recovery are playing a significant role in their

own wellbeing.

MedTech empowering improved patient wellbeing

Like many industries, COVID-19 has turbo charged a trend in healthcare

that was already manifesting. Hospital waiting lists for routine operations

were growing before the pandemic, but the impact on the healthcare

crisis has hastened the need to generate meaningful positive change. If

any positive has come from the pandemic it is that change that would

ordinarily have taken a decade has been implemented in weeks or months.

The challenge now is to create healthcare systems that can address not

only current needs, but future ones and effectively manage the backlog

of elective surgery. The MedTech industry has a critical part to play

in delivering the ingenious solutions that will help healthcare systems

manage demand today and tomorrow.

REFERENCES

BBC News. [Internet]. 2022. https://www.bbc.co.uk/news/health-59972628

The Guardian. 2018. Available from: https://www.theguardian.com/society/2018/jul/13/nhsoperation-waiting-lists-reach-10-year-high-at-43m-patients

World Population Review. [Internet]. 2021. https://worldpopulationreview.com/countryrankings/health-care-wait-times-by-country

The King’s Fund. [Internet]. 2022. Available from: https://www.kingsfund.org.uk/audio-video/

key-facts-figures-nhs

NHS England. [Internet]. 2021. Available from: https://www.england.nhs.uk/2021/09/nhsdelivers-millions-of-routine-treatments-in-toughest-summer/

SRG Talent. [Internet]. 2021. Available from: https://www.srgtalent.com/blog/why-vcs-arerushing-to-invest-in-medtech-innovation

Thrombosis Statistics. [Internet]. 2018 [accessed 2018 Oct]. Available from: https://www.

thrombosisuk.org/thrombosis-statistics.php

House of Commons Health Committee. The prevention of venous thromboembolism in

hospitalised patients. London: The Stationary Office. [Internet]. 2005 [accessed 2018 Oct].

Available from: https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/99/99.

pdf

World Health Organisation. Health care-associated infections. Available from: https://www.

who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf



Discovering the many more pages available online @ www.otjonline.com

Vygon acquires Macatt Medica, Peruvian

distributor of single-use medical devices

Takeover will enable Vygon to build on its presence in

South America, particularly in enteral nutrition sector

Vygon, a specialist single-use

medical devices group, on the

8th of March announced the

acquisition of Macatt Medica, a

distribution company located

in Lima, Peru.

The company distributes the

majority of Vygon’s products

in Peru, including a wide range

of enteral nutrition products.

The financial terms of the

agreement have not been

disclosed.

With this acquisition, Macatt Medica will become a fully owned

subsidiary; boosting Vygon’s presence in South America. Its 21

employees will be joining Vygon’s staff.

“We are delighted that Macatt is joining the extended Vygon family

and, in particular, that this will enable us to strengthen our presence

on the market for active medical devices,” said Michel Hanania, vice

president for the Latin America region at Vygon.

“This product range will complement the one that we have developed

alongside our branch in Colombia, in the area of single-use ‘consumable’

products, which will enable us to offer a comprehensive range of

products to our South American client base.”

“It’s a big step forward for Macatt to become Vygon’s Peru subsidiary;

we are already working closely, distributing its products; this takeover

is a natural progression for our company,” said Manuel Catalan, CEO of

Macatt Medica.

“This acquisition is an opportunity for Macatt to boost its presence

on the distribution market for enteral nutrition products, while at the

same time becoming part of a group which shares the same values as

us.”

Founded in 1997, Macatt Medica has been distributing Vygon products

since 2010. Its turnover rose to €1.7 million ($1.9M) in 2021.

New Sustainable

Anaesthetics Course

• Part I: Self-study perio

• Part II: 4 hour online w

• Part III: Sustainable H

Our new three-part ‘Introduction to Sustainable Anaesthetics’ course

outlines how the health system is vulnerable to, but also contributes

to, climate change Further and information ecological : degradation, https://bit.ly/OTJCSH322

examines the

specific contribution of anaesthetics to carbon emissions and other

environmental impacts and explores how to develop a more sustainable

approach to the practice of anaesthetics and the operating department,

whilst maintaining or improving quality of care.

• Part I: Self-study period April 13th

• Part II: 4 hour online workshop May 4th

• Part III: Sustainable Healthcare Cafes

New Sustainable Anaesthetics Course

Further information : https://bit.ly/OTJCSH322

www.facebook.com/TheOTJ

Our new three-part 'Introducti

course outlines how the healt

also contributes to, climate ch

degradation, it examines the s

anaesthetics to carbon emiss

impacts and explores how to

approach to the practice of an

department, whilst maintainin


VIDEO KILLED THE MEDICO-LEGAL WAR

Innovation in Informed Consent Model Could save NHS Millions

An evolution in the way we focus

and retain information needs

to lead to a significant shakeup

in the current informed

consent model, today warns the

UK’s sole surgical trade union.

Modernising the approach could

potentially save the Health

Service a significant percentage

of the billions spent every year in

medico-legal claims.

The Confederation of British

Surgery (www.cbsgb.co.uk);

the only trade union to be

recognised under UK law to

protect the welfare of surgeons

and anaesthetists; reiterates

the importance of ensuring

patients sufficiently absorb the

information they require to make

an informed decision prior to

undergoing a surgical procedure.

It also highlights technological

advances that can make this

easier on today’s overwhelmed,

shorter attention spans.

According to consultant plastic

surgeon and CBS President Mark

Henley;

“Per the landmark Montgomery

ruling in 2015, the medical

profession must offer jargon-free

explanations of every procedure,

along with all its risks and sideeffects,

whether the likelihood

of complications occurring is

minimal or not. This process can

take some time and repetition,

and patients may be at risk of

‘zoning out’ as this is traditionally

offered verbally in an unfamiliar

environment to them (such as

a hospital or clinic), alongside

printed material such as leaflets.

If patients don’t fully understand,

or fail to remember, the risks

of the procedure, they could

conceivably have given consent

for something that could pose

dangers to their health.

“The NHS pays out billions

annually for clinical negligence

claims, of which the vast majority

pertain to ‘failure to warn’.

Just as we seek to modernise

the Health Service in terms of

technology, we also should bring

our communication approaches

into the 21st century.”

This law was established when

Nadine Montgomery was awarded

£5.25 million following the birth

of her baby boy, who was starved

of oxygen. Montgomery argued

that had she been informed of all

the risks of her pregnancy, she

would have opted for an elective

caesarean. Since this ruling,

doctors and surgeons are no

longer permitted to omit details

of even the smallest risks when

obtaining consent.

Instant gratification, such as

that offered by social media

videos, has clearly impacted our

attention span, decreasing it by

33%[1] over recent years, and we

absorb less than a fifth of verbal

information and under half of

all written information,[2] with

time-consuming repetition being

the only proven way of ensuring

this information will sink in[3].

This is of particular concern in

hospital and clinic settings where

the risks of surgical procedures

are offered in the form of verbal

or written information.

Dimitris Reissis is a plastic surgery

Registrar and member of the

British Association of Plastic,

Reconstructive and Aesthetic

Surgeons (BAPRAS). He has

created the MySurgery (www.

mysurgery.me) app which offers

consent information via an

interactive experience. He says;

“Research shows that people

are far more likely to absorb

information if it is offered in the

form of digestible video[4] which,

when applied to a medical setting,

not only guarantees a higher level

of crucial information retention

— giving patients the tools they

need to make informed decisions

about their surgical procedures —

but also potentially saves the NHS

a percentage of the £8.3billion[5]

they currently pay out for clinical

negligence claims, of which 86%[6]

of the surgical claims pertain to

‘failure to warn’.”

A pilot study of informed

video consent in spinal surgery

confirmed the potential benefits

of using such a method, with

80% of patients reporting that

the video consent model ‘helped

to address their preoperative

concerns’.[7]

Dimitris, who is also President

of the Plastic Surgery Trainees

Association (PLASTA) adds;

“The way patients are asked

to provide consent for their

treatment currently is often

poorly informed and inefficient.

Despite the best efforts of

doctors and the medical team,

patients can only retain a fraction

of verbal and written information

provided to them, particularly

in the unfamiliar and timepressured

environment of the

hospital clinic. Many patients

therefore sign their consent form

without having fully considered

the important information that is

appropriate for them in view of

their own personal circumstances

and personal priorities, even if

this is not evident at the time.”

MySurgery one of the latest

digital platforms introduced to

help patients fully understand

and retain information about

their treatment and potential

risks of their upcoming surgical

procedures, and is currently in

use at the Royal Free, Chelsea

and Westminster, Mid and South

Essex and North Central London

hospitals, across specialties such

as urology and hernia surgeries.

Dimitris continues:

“Humans need to be able to

repeatedly access information

in order to retain it and, in the

case of surgical procedures,

must be given the opportunity to

ask questions and highlight any

concerns they may have. These

points, along with the fears I have

surrounding the impact of patients

not fully understanding risks,

forms the cornerstone of my work

in developing the MySurgery app.

We developed MySurgery after

spending a lot of time speaking

to and learning from patients

and doctors about the most

effective way to improve patient

understanding and retention of

information. The result is what

informed consent should look like

in the 21st century.”

Mark Henley concludes;

“Studies show that video is a

superior way to view and retain

information, and it is encouraging

to learn that some hospitals have

already implementing these new

technologies as a means of giving

patient information in a simplified

way, which they can access

away from the clinical setting

to duly consider and ‘refresh’

their memory. In this age of bitesize

information and shortened

attention spans, I would urge our

profession to consider optimising

their approach to informed

consent to ensure patients are

able to understand what is

often very complex, but vital,

information and avoid costly

medico-legal claims.”

CASE STUDY

Julie Roberts, a 59-year-old

volunteer coordinator and

freelance teacher from Fulham

recently underwent a carpal

tunnel decompression procedure

at Chelsea Westminster hospital

on 30th September. Julie was

given information about the

procedure via the MySurgery app.

She says:

“I have had two carpal tunnel

procedures—the first time I was

given the risks and information

verbally, and the second time,

they used the video app. For both

surgeries, it was crucial that I

understood the operation and the

risks involved, which meant that

prior to the first, I found myself

Googling and watching operations

on YouTube, which is less than

ideal!

“When I had the most recent

procedure, I found the MySurgery

app a much better alternative;

it gave me the information in a

digestible format and avoided

the last-minute stress of feeling

as though I didn’t have all the

information I needed. The way

it was presented was clear

and concise, making it easy to

process. The video model of

consent feels more empowering; I

felt more confident and in control

of the decisions I was making.”

[1] https://time.com/3858309/

attention-spans-goldfish/

[2]https://www.mysurgery.me/

[3]https://www.psychestudy.com/

cognitive/memory/ebbinghausforgetting-curve

[4]https://www.popvideo.com/blog/

looking-at-the-facts-why-videocontent-has-the-highest-retentionrate

[5]https://resolution.nhs.

uk/2020/07/16/nhsresolutions-annual-report-andaccounts-2019-20/

[6] https://core.ac.uk/download/

pdf/82628201.pdf

{$NOTE_LABEL} https://bmjopen.bmj.

com/content/9/7/e027712

We are pleased to accept

clinical articles for publication

within the pages of


Please send for the attention of the

Editor at:

admin@lawrand.com


general surgery planned to be introduced in 2022. We have an exciting opportunity for

experienced theatre staff to join our expanding team. We have opportunities for:

Vacancy

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transfers and fewer items of equipment.

The concept behind Anetic Aid’s QA4 Mobile Surgery System

encompasses all of these aspects combined with a surgical access that

is superior to any other surgical trolley on the market.

Surgical versatility

The QA4 is highly manoeuvrable, with powered positioning options

include the raising, lowering, traversing and lateral tilt of the surgical

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backrest.

To apply or arrange an informal chat with the team contact

sonia.sanghvi@practiceplusgroup.com,

To apply or arrange an informal chat with

or call

the

07580

team contact

018971.

sonia.sanghvi@practiceplusgroup.com, To apply or arrange an informal chat with or call the 07580 team contact 018971.

sonia.sanghvi@practiceplusgroup.com, or call 07580 018971.

It can be used for a wide range of surgical specialisms from

ophthalmology and ENT to orthopaedics, gynae, urology, vascular and

general surgery. This versatility comes thanks to a unique combination

of Build Options, developed to enable purchasers to tailor their QA4

model for particular surgical specialisms, and an extensive range of

Optional Extras and Operating Table Accessories.

The Build Options offered include alternatives to standard head rests

and leg sections which customise the QA4 for specific uses – such as the

Dual-articulating Headrest which includes a specially shaped cushion

and padded neck plate, ideal for ophthalmic procedures.

These specialist Head Rests and Leg Sections, which can easily be

swapped for the standard items, can also be purchased as Optional

Extras, so a single QA4 can be used for multiple specialisms.

Regular operating table accessories are compatible with the QA4 too

– such as Lift-AssistTM Lithotomy Stirrups for gynae procedures, the

Beach Chair for shoulder arthroscopy, and orthopaedic attachments

from multi-part lateral brace and Hip FixTM systems to simple arm

supports and tables.

Other practical features available include department identification

(to help prevent equipment migrating to other parts of the hospital!),

oxygen cylinder brackets and paper roll holders.

All of the QA4’s features and benefits are detailed on our website –

aneticaid.com or call 01943 878647

to find out more.



'Why is it so difficult? – barriers to improving patient safety and learning

from harm’

12th May - Virtual Conference - 1400 - 1715

Despite huge efforts on the part of healthcare professionals to improve patient safety within the

NHS, significant barriers remain. Prominent researchers have argued that it is difficult to ascertain

whether patients are any safer, after the many patient safety campaigns that have been run in the

UK and internationally. This year’s CHFG conference will focus on:

• why, after a number of decades, this problem persists

• the barriers to patient safety improvement

• the possible ways these can be overcome in the future.

Join us for short and lively presentations, questions and panels on the 12th May.

The full programme will be released shortly but you can register now.

Register Now at - https://bit.ly/OTJchfg522

NB: This ticket price is non-refundable. We hope you will understand that the ticket fee is a donation to the good

work of the CHFG and we thank you all for your continued support.

ODP DAY 2022

14th May

Share with our readers what your team has planned for this year’s ODP DAY

And we’ll include your details in our April issue.


Mölnlycke to relocate HQ to GoCo Health Innovation City

In late 2024 Mölnlycke will relocate to brand new headquarters in GoCo Health Innovation City in Mölndal. The new headquarters will have a total

area of 16,000 m2 and will be located in one of GoCo’s prime locations, with capacity for around 800 associates.

Today, Mölnlycke is announcing that the company will move to a newly built headquarters in GoCo Health Innovation City in Mölndal. The move

is scheduled to be completed in late 2024 and will bring together all Mölnlycke’s office-based associates in Sweden in the activity-based office.

Zlatko Rihter, president and group CEO comments:

“We are delighted to take the next steps towards realizing a new head office in world-class. The new headquarters will be built from scratch and

will be entirely based on our needs and will include, among other things, a first-class R&D facility, flexible collaboration spaces and a fantastic

working environment. The relocation to GoCo Health Innovation City also means that we will be even closer and more linked to Gothenburg’s

leading life science cluster, further supporting our R&D intense business and our ambition to become a global leader in medical products and

solution, to serve our customers even better.”

The new headquarters will have a total area of 16,000 m2 and will be located in one of GoCo’s prime locations, with capacity for around 800

associates. The office is designed to establish a new level of flexibility for the company’s working environments, aimed to meet the many different

needs of the employees for collaboration and socializing, as well as platforms for individual focus and project work. As remote work will continue

to be an important part of Mölnlycke’s way of working going forward, the new office is activity-based and tailored to meet the needs of on-site

employees as well as a seamless link for those who work remotely. The new headquarters will have the highest possible environmental rating,

Platinum, according to LEED, which supports Mölnlycke’s ambition within sustainability.

Mölnlycke will be a Founding Partner of GoCo Arena – a meeting place and collaboration platform for the life science sector – which means that

Mölnlycke will be involved in setting the agenda for the use of the arena.

GoCo Health Innovation City is an area in Mölndal with a focus on health and life sciences, bringing together companies, researchers, entrepreneurs

and talent from around the world to share ideas and collaborate to find tomorrow’s health innovations.


Warrington Hospital practitioners

in UK-first graduation honour

Mark Greenhalgh and Christopher Cunliffe have just finished their

Operating Department Practitioner degree course at Warrington Hospital

TWO healthcare professionals say they hope others will follow in their

footsteps after being involved in a UK-first at Warrington Hospital.

Christopher Cunliffe and Mark Greenhalgh have just finished their

operating department practitioner (ODPSource) degree course at the

Lovely Lane site and at Halton Hospital.

What is special about their story however is that they are the first

cohort, consisting of only 19 people, to graduate as ODPs through an

apprenticeship – a first for the whole country.

The apprenticeship created an alternative degree course with on-thejob

training, unlike conventional courses, and they have just accepted

employment at Warrington and Halton hospitals.

“I had worked for the trust for many years as an assistant practitioner

when my manager approached me and told me about a new

apprenticeship scheme,” explained 38-year-old Chris, who lives in St

Helens.

“The idea of doing the apprenticeship was exciting, as it was a new

scheme which opened doors for my career in theatres.

“Being a practical learner, I found learning on-the-job worked well for

me, allowing me to gain a vast amount of knowledge and training in key

areas needed.

“I would not have got this if I studied the conventional way, full-time

at university.”

This was echoed by Mark, 41 and from Warrington, who commented:

“The apprenticeship has given me the chance to chase my dream and

have the security of receiving a wage while leaning at the same time.

“Working three or four days a week in practice and one day at university

gives you lots more practical on-the-job training than other university

courses that I have found to be very beneficial.”

Chris, who has worked at Warrington and Halton hospitals since 2007,

and Mark, since 2010, are hoping to focus on theatre anaesthetics and

are looking forward to their graduation in July.

They are also hoping that more people will follow in your example in

going down the apprenticeship route.

“Training alongside my now peers has been the best experience of my

life, and it is a job that I honestly can say I love to do,” Chris said.

“I get up every morning glad to come to work, as I get to meet and care

for the most interesting people while working with some of the best,

exceptionally talented and funny people I have ever known.

“This is my work family, and I am proud to say that.”

Mark added: “I have really enjoyed this apprenticeship.

“This is a very exciting new course that will give a great opportunity to

hundreds and hopefully thousands of people.

Source: Warrington Guardian Nathan Okell

Panaxia and Neuraxpharm:

First export of medical cannabis

sublingual tablets to France

The first-of-its-kind export is part of the companies’ participation in the

French government’s program to regulate the medical cannabis industry

Both companies have previously issued their premium oils to patients

in France

Panaxia Labs Israel Ltd a global pharma company which develops,

manufactures and markets progressive medical cannabis products in

pharmaceutical quality, and Neuraxpharm Group (Neuraxpharm), a

leading European specialty pharmaceutical company focused on the

central nervous system (CNS), announced recently a first export of

medical cannabis sublingual tablets from Israel to France.

The export is a part of a program by the French government and the

French National Agency for the Safety of Medicines and Health Products

(ANSM) to regulate French medical cannabis industry. It follows the

issue of the companies’ premium oils to patients in France, as part of

the ANSM program.

Dr. Dadi Segal, CEO of Panaxia Israel: “We are glad of another significant

milestone in the implementation of our strategy. We are proud to be,

alongside our partner, Neuraxpharm, part of the spearhead of the

world’s leading cannabis key-players selected for the ANSM program.

In addition, we are the only company in this program to supply medical

cannabis sublingual tablets. According to our predictions, the French

market is expected to become one of the most advanced medical

cannabis markets in the world, which will be a remarkable growth

engine for Panaxia”.

Dr. Pierre-Hervé Brun, General Manager of Neuraxpharm France: “It is

a great achievement for us, together with our partner Panaxia, to have

been selected as one of the few specialists offering medical cannabis on

the French market under the ANSM program. As the only companies in

the program providing medical cannabis sublingual tablets, we are able

to offer our patients a variety of patient-oriented and more easy-to-use

forms of presentation. Going forward, we will continue to work with

Panaxia to pursue our strategy in the fast-growing medical cannabis

sector and bring more in-demand dosage forms and treatments to

market.”

The sublingual tablets, manufactured by Panaxia under EU-GMP

standard, subject to strict clinical standards with the brand name

Naxiva-Panaxir, will be issued to patients participating in the French

prescriptions program, in hospitals and pharmacies all over France.

Medical cannabis sublingual tablets enable a higher level of absorption

of the active substances into the bloodstream (without initial passage

through the liver) and thus, contribute to the effective and rapid relief

to the patient. The tablets also enable physicians to adjust a more

precise treatment routine to the patients.

According to their needs, the level of the dosage as well as the

concentration of the active ingredients can be adjusted. In addition,

it has been proved that the tablets contribute to a better response

to treatment and improved patient satisfaction, mainly due to the

effectiveness of the treatment, the simplicity and accuracy of the

usage.

The ANSM program, which was launched in March 2021, includes about

3,000 patients, who are receiving medical cannabis in France for the

first time. The list of indications compiled by the ANSM includes the

following diseases and treatments: Cancer, certain types of Epilepsy,

Multiple Sclerosis (MS), Palliative Care (treatments to improve the

quality of life of patients with incurable diseases), and pain that does

not respond to conventional treatment.

The market potential in France is very significant, considering only last

year the French government approves the regulatory of the medical

cannabis industry. According to the latest estimates, there are currently

between 300,000 and 700,000 patients in France, who meet the criteria

and may be eligible for a prescription for medical cannabis treatment.

To learn more about Panaxia, please visit: https://panaxia.co.il.

To learn more about Neuraxpharm, please visit:

https://www.neuraxpharm.com.

For further information, please contact: yelena@panaxia.co.il


MAT delivers turnkey UCV operating theatre project for

Walsall Healthcare NHS Trust

The project was delivered successfully in two phases

A twin ultraclean ventilation (UCV) operating theatre project carried out by Medical Air Technology (MAT) for Walsall Healthcare NHS Trust

illustrates the many benefits of a employing a specialist contractor to deliver a total turnkey solution. MAT was brought in to design and refurbish

two new ultraclean operating theatre suites, working closely with the Trust’s estates team under main contractor, Tilbury Douglas Construction.

The project was delivered successfully in two phases, and MAT was thrilled to receive this glowing feedback from Colin Plant, the Trust’s Project

Director:

“Following the final works within theatres 5 and 6, I just wanted to thank you and your team for all of your professional efforts to achieve

completion. The refurbishment of the theatres – including the provision of new ultraclean ventilation systems – is to a high standard, provides

value for money, and of course was completed before the Christmas break, as planned.

“Your efforts have brought a facility and equipment that was well beyond its normal life expectancy up to modern standards – and provided a

top-class environment for patients and staff alike. Well done, and I look forward to working with the team on similar schemes.”

Walsall Manor Hospital – Theatres 5 and 6

The Trust wanted to totally refit two of its operating theatres, upgrading them to ultraclean and replacing the critical ventilation systems, thus

making them suitable for a wider range of surgery, including orthopaedics. To achieve this, MAT installed its energy-efficient ECO-flow 3200

ultraclean ventilation (UCV) canopies, complete with pendants. Bender UK supplied operating lights, theatre control panels, picture archiving and

communication systems (PACS) and IPS/UPS power systems. The theatre suites and exit bay were fully refurbished, with new air handling plant,

heat recovery, ductwork, controls, doors, furniture, sanitaryware, and walls and floor finishes.

The short programme only allowed nine weeks per theatre, with one week between phases. One challenge MAT engineers faced was the difficult

high-level access to the plantroom and theatres, which was reached via a scaffold across a courtyard. However, this did not prevent the project

from progressing smoothly and being delivered on time and to budget.

Benefits of a Total Turnkey Solution

A total turnkey installation streamlines process and saves time and money. It eliminates the problem of having to deal with multiple suppliers

and delivers a solution that is immediately ready to use on completion. Customers benefit from a more personalised service and a designated

account contact. Issues are addressed as a whole, not in parts, avoiding the inconvenience of coordinating an array of often disparate trades and

equipment. In short, it makes everything easier for the customer, as well as being more cost-effective.

A Specialist Contractor

MAT designs, manufactures and installs bespoke critical ventilation systems and turnkey project solutions for new build and refurbishment

projects. As a specialist contractor with many years’ experience, we are passionately committed to improving patient protection and end-user

safety in demanding clinical, research and drug production arenas. We have extensive experience of working in live environments and understand

the challenges around delivering a project within an operational scenario.

In addition, MAT FM provides a range of competitively priced and highly effective service and maintenance packages for all core products and

turnkey solutions offered by MAT or other suppliers, ensuring that equipment is maintained, serviced and validated correctly for optimum

performance.

Source: Cleanroom Technology


Delivering just what the doctor ordered with ERP/MRP

Medical equipment supply can be literally a matter of life and death.

The high levels of control and visibility required are only achievable if

grounded on a competent Enterprise/Manufacturing Resource Planning

(ERP/MRP) system, writes Sara Duff, UK Business Development Manager

at MRPeasy.com.

The pandemic has thrust the manufacture and supply of medical

equipment into the spotlight. As health authorities scrambled to secure

PPE and ventilators, or to kit out ‘Nightingale’ hospitals, we gained

some understanding of the complexities involved.

Definitions vary, but medical technology can cover anything from

syringes and scalpels produced in their millions, at relatively low cost,

through to X-ray machines and diagnostic scanners worth hundreds of

thousands. A high degree of variety is characteristic. Even surgical

instruments that have, in their basic form, been around for generations

exist in profusion to suit specific procedures and the preferences of

different medical schools and individual clinicians. Only recently the

Royal College of Surgeons called for the development of smaller,

lightweight instruments to prevent strain and fatigue in surgeons during

a particular procedure. Rates of innovation are high – the sector made

13,795 filings with the European Patent Office in 2018, almost 8% of the

total.

The UK market for medtech is the sixth largest globally, worth £12 billion

a year, and with a healthy export business (Euro 5.9 bn) especially to the

EU and US. While the market is driven by around 53 large companies (of

over £50 million turnover), 84% of an estimated 3,942 companies in the

sector are either SMEs or small specialist divisions of larger companies.

For these in particular, the market presents acute challenges, both

technical and commercial, which ERP/MRP can help them meet.

Technically, medtech is often working at the bleeding edge of the

science: design and production may barely have escaped the lab.

That can make component supply uncertain, and may also mean that

manufacturing procedures and processes are subject to frequent

revision, which systems must be able to accommodate. More generally,

medtech demands the very highest manufacturing and quality

standards: tolerances, surface finishes, material composition and purity

as well as functionality. Quite often quality must be assured by 100%

inspection rather than statistical sampling, and of course QA and test

results must attach to the individual item ID and follow it through to

the clinician’s hand or, in the case of items such as prosthetics and

implants, much longer.

The design and manufacture of many medtech devices and equipment

is highly regulated – the UKCA mark is replacing CE certification post-

Brexit, but the rules are essentially the same – so there is a large

community of specialist test, assurance and certification houses which

have their own stringent requirements for process control and visibility.

There may be similar requirements to assure adherence to clean room

and other hygiene protocols, not just in manufacturing but throughout

the supply process. Not to be neglected, similar requirements may

extend to packaging, which particularly for single-use devices may form

an integral part of the product. And given the exotic nature and high

value of some of the materials used in medtech, even scrap and waste

flows may require rigorous planning and control.

Connetika, for example, is a manufacturer of miniature fluidic

components and systems for the health sector and elsewhere. Established

in only December 2019 and immediately faced with pandemic-induced

demand, the company selected MRPeasy, particularly for its capabilities

in lot tracking, which was direly needed, and production scheduling, as

well as for its competitive pricing.

A further consideration in medtech manufacturing is that production

often requires high levels of scarce skills and specialist processes

and equipment: whether in-house or through sub-contractors, these

resources have to be planned and scheduled efficiently.

Commercially, too, SMEs in this sector face challenges. Given the high

value of many devices, neither vendors nor health providers can afford

to maintain large stocks. Meanwhile demand forecasting, especially for

more specialist items, given the diversity of product variants can be

very difficult, a situation made worse as the pandemic has disrupted

the ‘normal’ throughflow of patients for many conditions. Yet stockouts,

even of short duration, are unacceptable with people’s health at

stake. Manufacturers therefore have to offer a fast and agile response to

demand. That requires the ability to reschedule swiftly and accurately

across a range of products, which may have complex multi-level Bills of

Material and where as we have seen, actual manufacturing is only one

part of the process that has to be planned and controlled.

One typical MRPeasy user in the medtech sector reports the benefits

of time savings resulting from using the cloud-based system’s Product

Configurator feature, together with the Gantt charts that allow the

Production Manager to move the schedule around and see what’s going

on for a couple of days in advance. “It’s amazing how much time the

software saves me,” the latter says. “Whenever I do any production

processing, everything flows really nicely.” He also highlights the value

of the CRM module, which shows a pipeline view of status of orders that

the salesforce can use. “This way, they do not have to call me whenever

they want to know when orders are ready to go out.”

As medical science and technology develops, the cost of medtech rises

inexorably, but the buyers, be they a tax-funded health service, or the

insurers in other models, constantly push back on price, so both to

satisfy their customers and for their own bottom line, manufacturers

need to display ultra-efficient waste-free processes. Given the high

value of much medtech, production and delivery delays not only

threaten patients: they can be seriously damaging to the cash flow of

smaller companies, while with health budgets under pressure, securing

timely payment can also be an issue. It is essential that there should

be robust and accurate linkage of production and shipping to, on the

one hand, procurement and on the other, to accounting and invoicing

processes.

Despite these challenges, the UK medical equipment sector continues

to boast many highly innovative, indeed world-leading, companies of

all sizes. But the environment in which they operate is not getting

any easier. Basing their processes and systems around an ERP/MRP

implementation that is fully proven in service; offers the necessary

range of functionalities either in itself or in support of more specialist

routines; and is easy to install, learn and use with a minimum of external

support will allow companies to continue to thrive. Many medtech

manufacturers have already discovered that MRPeasy’s affordable, payfor-use,

cloud-based approach is indeed just what the doctor ordered.

For further information, visit: MRPeasy.com


PORTSMOUTH WINS £300K TO SUPERCHARGE

POST-COVID NURSING TRAINING

Nursing students at Portsmouth are being given a boost in learning,

thanks to a £300,000 grant to help train them in the wake of the Covid

pandemic shutting some doors to learning.

Simulated learning has been shown to help nursing students gain the

practice and experience needed to develop into superb nurses, while

protecting patient safety.

The University of Portsmouth was awarded the funding to update its

already rich suite of simulation software and facilities for nursing and

allied health professional students which has made it a leader in the

field.

which is the industry leading software for studying anatomy and

dissecting the human body.

Simulation-based education gives students time to practice technical

and communication skills in a safe and supported learning environment.

Paid actors are used as patients alongside the software.

Together, the excellence in simulated learning at Portsmouth gives

students opportunities to make mistakes, learn and then repeat any

given situation as many times as is necessary to be fully competent

upon graduation.

Dr Ryder said alongside an ongoing need for more nurses and allied

health professionals, Covid has made traditional placements extremely

difficult or even impossible.

Statutory and regulatory bodies including the Nursing and Midwifery

Council have had to consider how simulated placements can support

current and future learners and how it can be increased to meet the

country’s needs for qualified frontline staff.

Last year, Portsmouth undergraduates did a two-week simulated

placement which included meeting patients, dealing with angry or

anxious people, and those with mental health issues.

The students who attended reported feeling much better prepared to

go into their first NHS placement a few weeks later.

Source: University of Portsmouth

Endoscopic surgery of herniated discs

demonstrates statistically significant

pain relief and cost effectiveness

compared to open procedures

Anatomage in action - it is the industry-leading software for

studying anatomy

Simulation has been in greater demand since the Covid pandemic put

increased pressure on the NHS being able to offer student placements.

Leader of Nursing at Portsmouth, Dr Isobel Ryder, said: “Simulationbased

education provides a valuable opportunity to better prepare the

future nursing and allied health professional workforce. Portsmouth has

been a leader in this field for a number of years.

“Our nursing programme was the first to gain accreditation from the

Association of Simulated Practice in Healthcare (ASPiH).

“By embracing the best opportunities to embed simulation-based

education in our programmes, we are able to support students to

deepen their understanding, enrich existing placement learning and

improve patient safety.”

Portsmouth has been a leader in this field for a number of years

Dr Isobel Ryder, Leader of Nursing

The £300,000 grant comes from Health Education England.

The funds will be used to deliver a one-off six-week simulated placement

for Adult and Mental Health Nursing students in their second and third

years. These are the students most likely to have seen opportunities for

frontline learning curtailed by Covid.

The placements will include working with standardised patients on

Portsmouth’s simulated wards and community settings.

Students will work in shifts and be responsible for handover of patients

and ward rounds, as well as working effectively with radiography,

operating department practitioner and paramedic science students.

The course will teach them about the leadership structure in healthcare

and how to manage emergencies and complex patients.

Portsmouth’s existing simulation facilities include realistic mock-ups of

home, GP and hospital settings. It includes the Anatomage,

A team of physicians, led by neurosurgeon Dr. B.S. Harhangi from Erasmus

Medical Center in Rotterdam, recently published a study demonstrating

considerable relief for patients with herniated discs after using the

MaxMoreSpine© System. For the first time, a scientific study compares

outcome and cost-effectiveness of the two leading surgical procedures

for the treatment of spinal disc herniations. One of the procedures is

minimally invasive and requires only a very small incision into the skin

to remove the prolapsed disc material by an endoscopic procedure. The

second method is known as an open microscopic approach. A total of

682 patients were included into the study, ranging from 18 to 70 years

of age.

“The results are clearly in favor of the minimally invasive endoscopic

surgical method. Patients can be treated on an outpatient basis under

local anesthesia and return home around 2 hours after the procedure. In

contrast, using the microscopic method, patients must undergo general

anesthesia and typically require several days in the hospital prior to

returning home nearly pain-free,” said Dr. Gadjradj, who performed his

PhD thesis under supervision of scientific leader Dr Sanjay Harhangi and

which has led to the study that is just published in the highly regarded

British Medical Journal. (https://www.bmj.com/content/376/bmj-2021-

065846).

All hospitals involved in the study utilized the MaxMoreSpine©

endoscopic system. This technology is developed, manufactured and

distributed by Munich-based Hoogland Spine Products GmbH. The

medical device company was founded in 2006 by the Dutch spine

surgeon Dr. Thomas Hoogland, who had over 35 years of experience,

performed more than 13.000 endoscopic spine procedures and was a

pioneer in this field. The global market size of patients undergoing

spinal surgery of herniated discs is more than 1 million annually.

“The study result presented by Dr. Harhangi’s team clearly supports and

validates my father’s work in the field of minimally invasive treatment

of herniated discs and the high quality of the endoscopic system,

which is nowadays used by surgeons worldwide”, says Jaap Hoogland,

Managing Director of Hoogland Spine Products GmbH. After the loss

of his father seven years ago, Jaap Hoogland continued the legacy by

further developing the endoscopic spine technology.

Contact: Jaap Hoogland, Hoogland Spine Products GmbH

j.hoogland@max-more.com www.max-more.com


STATE OF THE ART OPERATING

THEATRE COMPLEX INSTALLS

WILSON FLOWGRIDS

Robot-assisted surgery becomes a reality

in outpatient care - private practice in

Wiesbaden opts for Versius

Sensing Precision were recently appointed to supply University Hospitals

Dorset NHS Foundation Trust with their Wilson Flowgrids as part of the

transformation of Poole Hospital.

A new state of the art theatre suite extension incorporating 8 new

theatres was identified as a priority for the trust, with each theatre

requiring a Wilson Flowgrid for both its supply and extract ventilation

system.

Sensing Precision were then able to manufacture and deliver sixteen

Wilson Flowgrids, (pictured) some of which also required honeycomb

flow straighteners that provide an array of straight passageways, which

reduce turbulence while minimising pressure drop.

Environmental sustainability is central to the building development –

The new theatre block will be constructed to a BREEAM ‘Very Good’

standard – Which represents performance equivalent to the top 10% of

buildings in the UK.

The new theatre build will be an extension to the existing hospital

building comprising a brand-new purpose built five storey tower.

Construction of the new theatre block commenced in January 2021

with completion planned for 2023.

The Versius® Surgical Robotic System

~ Versius is now being used for outpatient surgery for the first time

~ Andre Serebrennikov, Wiesbaden, Germany, believes that precise

robot-assisted surgery will prove its benefits in outpatient surgical

procedures

~ The surgical practice intends to expand its portfolio with Versius

and initially plans to use it for hernia surgery

CMR Surgical (CMR) – a global surgical robotics business – announced

today that the Versius® Surgical Robotic System has been installed

in an outpatient surgical practice for the first time in Europe. Andre

Serebrennikov, Resident Surgeon and Partner at the Center for

Ambulatory Robotic Surgery Surgical-Orthopaedic Practice Wiesbaden-

Biebrich in Germany, initially plans to perform outpatient hernia

surgery with the assistance of Versius.

Further indications that robotic assistance may also be suitable for in

outpatient surgery will then be evaluated.

The completed building will incorporate a four-table ‘barn’ theatre.

The term ‘barn’ theatre refers to a design where the main surgical area

is large and open-plan, with each patient treated in adedicated space

with an ultra-clean air canopy over each station.

There will be screens in place to maintain patient privacy and dignity

whilst in this area.

This open plan working supports optimisation of space allowing larger

theatre areas that provides a high quality working environment, with

more natural lighting.

Mr Richard Hartley, a consultant orthopaedic surgeon at the facility

commented. “We have an exciting opportunity to create, on a single

floor at Poole hospital, a collection of operating theatres designed to

support orthopaedic surgery including four large theatres within one

space which will ensure we provide great care to patients and a state of

the art working environment for staff.”

The ultra-clean air canopy over each station creates a positive pressure

around each operating table and acts as a barrier between each theatre

area reducing the risk of cross contamination.

Wilson Flowgrids with their inherent accuracy is integral to this

ventilation process. Screens can be used to both protect patient privacy

and dignity and also to further prevent the risk of cross contamination.

In addition to the four-table ‘barn’ theatre, the plans include a further

four new theatres in the extension and refurbishment of the existing

theatres and ward areas. This will create two dedicated surgical floors

with a total of fifteen theatres on the Poole site.

The total programme of works runs up to 2026 and forms part of the

£250m transformation and development plans for University Hospital

Dorset sites.

www.sensing-precision.com

“We are entering new territory as practising surgeons here, and we

believe that our patients will benefit immensely from robot-assisted

surgery. During the pandemic, we have seen that surgical procedures

in hospitals have had to be rescheduled at short notice.

Being able to offer surgical interventions that are possible on

an outpatient basis will help alleviate the burden on the wider

healthcare system, and ensure patients are getting the care they need

as soon as possible.”

The key factors for Andre Serebrennikov in choosing Versius were its

high level of precision, versatility and modular design.

“Even more than in a hospital, the surgical robot must offer maximum

mobility and modularity given the spatial conditions in a practice in

two senses: mobility of the entire system and mobility of the arms.

Therefore, Versius was the obvious choice for us.”

The Versius system is not restricted to one location, and can be

moved from room to room easily. The four individual bed side units

mean that Versius provides surgeons with freedom of port placement

to best suit the needs of each patient.

Per Vegard Nerseth, Chief Executive Officer of CMR Surgical said:

“We are delighted that Versius is now available for outpatient

surgery, helping to bring the benefits of minimal access surgery to

more patients. The introduction of Versius in an outpatient setting

is testament to its small, modular form, and we believe it can add

tremendous value in outpatient surgery practices, as it does for

hospital surgery departments.

We are proud that the first installation of Versius in an outpatient

practice took place in one of the most respected healthcare systems

in the world.”

Further information - www.cmrsurgical.com

www.cmrsurgical.com



Council and Hospital honour nurses

involved in historic birth of world’s

first IVF baby

Guerbet expands

portfolio with

microcatheters

and guidewires for

interventional imaging

and embolization

Guerbet a global leader in medical imaging,

announces it will more than double its line

of microcatheters and launch a new line of

guidewires, resulting in a broad range of

interventional imaging and embolization

solutions available.

Oldham Council and Oldham Care Organisation have unveiled a new commemorative plaque at

The Royal Oldham Hospital to honour two nurses who played pivotal roles in the birth of the

first IVF baby.

Louise Brown is the world’s first in-vitro fertilised (IVF) baby - born at The Royal Oldham Hospital

on 25 July 1978, exactly 30 years after the NHS was created.

The two nurses did not have their names engraved on the original plaque installed over 40 years

ago, and the hospital and Council wanted to put the record straight and shine a light on the

whole team involved in this historic medical breakthrough.

David Jago, Chief Officer at Oldham Care Organisation, which runs The Royal Oldham Hospital,

has worked with Cllr Zahid Chauhan, Oldham Council Cabinet Member for Adult Social Care &

Health, to formally recognise everyone involved.

Cllr Chauhan first brought the issue to light after being made aware of the two nurse’s

contributions. He then vowed to ensure they would get a formal acknowledgment for their work.

David said:

“We are immensely proud of The Royal Oldham Hospital’s heritage and the significant contribution

the hospital has played in providing local healthcare to the families and communities of Oldham

borough and neighbouring areas since the NHS was created.

“Everyone would fully recognise that IVF was a ground-breaking contribution to medical science

and has helped hundreds of thousands of couples and families across the world since.

“We have installed this commemorative plaque to recognise not only the crucial role that Jean

Purdy played but also that of Sister Muriel Harris, and to ensure our history is not forgotten.”

Cllr Chauhan said:

“I’m proud that we can fully recognise the contributions of Ms Purdy and Sister Harris to this

major medical milestone. Their vital work should be properly remembered.

“IVF treatment has changed many lives so it’s only right that all of those involved in its pioneering

development get the recognition they fully deserve, right here in Oldham.

“A big thank you to everyone who’s supported the campaign to correct this historic injustice. I’m

glad that as we approach International Women’s Day on Wednesday 9 March this week, we can

finally get this plaque up in their honour.

Jean Purdy was a nurse embryologist and Sister Muriel Harris was an operating theatre

superintendent, both of whom played a significant part in the development of IVF and the birth

of Louise Brown.

Both worked alongside and closely with biologist and physiologist Dr Robert Edwards and

obstetrician and gynaecologist Mr Patrick Steptoe on this historic achievement in medical

science.

The company obtained its original offering

of 18 references of SeQure® and DraKon

microcatheters as part of their acquisition

of Accurate Medical Therapeutics in 2018. It

received the CE mark in April 2019, and was

FDA cleared in 2018. Guerbet now expands

the portfolio, adding 20 versions for a total

of 38, and launching a new line of Axessio

guidewires with two diameters. A limited

market evaluation began in the United

States during the fourth quarter of 2021,

paving the way for a commercial launch

rollout in Q2 2022 in select markets.

“The positive feedback we’ve received

during the limited market release of our line

extension has reinforced Guerbet’s decision

to expand available tools to the healthcare

professionals for various embolization

procedures,” affirms David Hale, Chief

Executive Officer. “This year marks our

40th anniversary in interventional radiology.

We’re proud of that, but we consider it

just the beginning. We’ve never been

more dedicated to continuous growth and

innovation to help interventional radiology

physicians to meet an even greater number

of patient needs.”

Both the SeQure® and DraKon technologies

offer interventional radiologists optimized

navigation capabilities which is expected

to enable access to difficult anatomies and

reach farther. Additionally, SeQure® is the

only reflux control microcatheter enabling

a fluid barrier technology for flow directed

embolization. The new models are designed

to deliver more targeted treatment and use

a wider range of beads, from extra-small to

large[1],[2].

“Innovation means everything to us, because

it means everything to our physician partners

and to their patients,” explains Jean-

François Blanc, Senior VP, Interventional

Imaging. “The more we see the results, the

more we see opportunity to improve lives,

and we just want to keep pushing forward.

With strategic acquisitions that helped

create a unique toolkit of microcatheters

and this latest portfolio extension, we’re

advancing options for the interventional

radiology community.”

Guerbet offered a Digital Launch Event

to introduce the line extension on March

12th, 2022. Find information on the event,

including replays, peer learning, and ondemand

content:

https://launchevent.guerbet.com


STUDENTS BECOME ‘SURGEONS FOR THE DAY’

AT OPERATING THEATRE LIVE

In February, many of our Science, Health & Social Care, Physical Education and Sports Science students became ‘surgeons for the day’ at the

Operating Theatre Live event here at The Sixth Form. This immersive surgical experience, facilitated by MED-SOC, gave students the opportunity

to carry out dissection procedures in a realistic clinical environment.

Students participated in the dissection of real organ specimens including a head, brain, lungs and heart. They also worked on a digestive tract

which showcased the stomach, liver, gall bladder, pancreas and intestines. The day was rigorously academic with students receiving an awardwinning

insight into how the body works and the challenges faced by the next generation of medical professionals.

Our students had a great day getting hands-on experience whilst also developing those key skills needed to work as part of a multi disciplinary

team such at team work and communication!

Harmeet Singh, who studies A Level Biology, Chemistry and Mathematics, was really positive about the experience and said:

“When it comes to gaining knowledge, it’s not always about reading things in books or seeing them on screens, it’s about putting them into

practice and being able to do it yourself and we had the most brilliant opportunity to attend MED-SOC (Operating Theatre Live) last week.

The event was very insightful for everyone, and it was a great way to visualise what a medical career can entail and what activities we might

encounter. I personally attended the event to explore different career options available in medicine and to gain an insight in the medical field.

Performing dissection ourselves was a great opportunity to learn more about how a human body functions by having an encounter with the

different organs themselves.

Performing the dissection live really puts things in perspective for students, especially those who are hoping to become a surgeon or are

exploring other medical careers. It’s important for us to have these experiences and I think it’s great that we had this brilliant opportunity

especially after the obstacles that COVID-19 has caused over last two years. It was something new and fresh for everyone. Practical knowledge is

very important, and it’s wonderful that The Sixth Form gave my peers and I this great opportunity to attend this event.

Thanks to the team for providing us with this amazing experience. It was extremely informative and exciting!”

B6 would like to express a huge thank you to all the team from MED-SOC for delivering this invaluable experience to our students.

Source: The Sixth Form Bolton

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The Operating Theatre Journal March 2022

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