The Operating Theatre Journal March 2022

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?
6 THE OPERATING THEATRE JOURNAL www.otjonline.com
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