The Operating Theatre Journal March 2022

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%)