Journal of Perioperative Practice
PROCUREMENT GUIDE September 2015 01423 881300
Volume 04 Issue 04 www.afpp.org.uk
01423 881300 www.afpp.org.uk
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Journal of Perioperative Practice PROCUREMENT GUIDE September 2015 Volume 04 Issue 04 www.afpp.org.uk
Contents
Welcome to your September 2015 Guide 05 Airway Management:
13 Product news:
09 Anaesthesia:
14 Product news:
11 Product news:
15 Product news:
Safe anaesthetic practice
The good old days
Sch端lke, Halyard Health
DTR Medical, KARL STORZ
Mindray, Distinctive Medical, PROACT
Swann-Morton
Journal of Perioperative Practice Procurement Guide information In print within the AfPP Journal of Perioperative Practice covering national AfPP members, but also with a dedicated print and e-distribution to supplies and purchasing managers. Key Sectors: NHS Supply Chain, Independent Hospitals, Higher Education. Medical Device Companies. Published 6 times a year we will focus on procurement issues in every edition as well as specialist subjects which for the following year include:
November 2015 Safety/Sharps January 2016 Recovery/Patient Warming March 2016 Medical Instruments/Devices/ Equipment May 2016 Infection Control/Prevention, Decontamination July 2016 Consumables
Contact Information: Advertising, Sponsorship & Partner Packages. Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: frances.murphy@ob-mc.co.uk Editorial Chris Wiles Head of Publishing/Editorial AfPP T: 01423 882950 E: chris.wiles@afpp.org.uk
PR & press material. All press releases welcome and we will feature as many as we can in each issue, all press releases need to be submitted to: Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: frances.murphy@ob-mc.co.uk
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Airway Management
Safe anaesthetic practice ‘Airway management is fundamental to safe anaesthetic practice ‘ (RCoA & DAS 2011 p24). Approximately 2.9 million general anaesthetics are administered in the NHS in the UK every year and the majority of these will be straightforward. Complications when they arise may be significant and result in potentially catastrophic outcomes. Familiarity with the location and use of all difficult airway equipment is a key component of proficient, safe anaesthetic practice. In a situation where every second counts, the ability to lay your hands on vital equipment can make all the difference. The Difficult Airway Society (DAS) provide a comprehensive list of equipment that should be contained within a difficult airway trolley (DAT). Difficult airway trolleys should conform to a standardised layout within each organisation as an additional safety measure. This ensures that an anaesthetist or their assistant can confidently access equipment in an emergency situation (DAS n.d.). Fortunately, whilst having the knowledge and equipment to manage an unanticipated difficult airway or anaesthetic emergency is a vital component for safe anaesthetic practice, major events are infrequent (RCoA & DAS 2011). The non-technical skills of the anaesthetic assistant such as communication, leadership, situational awareness and human factors also play a vital role during anaesthetic
Difficult airway trolleys should conform to a standardised layout within each organisation as an additional safety measure. This ensures that an anaesthetist or their assistant can confidently access equipment in an emergency situation (DAS n.d.).
emergency situations (Rutherford, Flin & Mitchell 2012). Technical and non-technical skills are a fundamental requirement of an anaesthetic practitioner. Regular training and updates of these skills are key to maintaining competency with emergency procedures which are infrequently experienced in practice. Human factors training improves the safety culture, enhances team work and provides us with the skills to anticipate what could go wrong (Patients Safety First 2011). There will be very few practitioners who haven’t watched Martin Bromiley’s ‘just a routine operation’ (available via you tube https://www.youtube.com/ watch?v=JzlvgtPIof4) and not reflected on their own practice. Faced with the same situation, what would you have done? The implementation of human factors training, as a result of Martin Bromiley’s experience of learning how his wife Elaine died in March 2005 under tragic circumstances, has given practitioners a deeper insight into situational awareness
and the tools to deal with difficult situations. Human factors training is an essential component for all practitioners involved in delivering safe care for patients. However, with the current financial constraints and staffing issues that are endemic within the healthcare system, it is often difficult to even achieve the mandatory requirements of training let alone human factors training or training for infrequently used equipment and procedures. Time is always a factor, or more importantly, lack of it! It is vital that any new equipment either on trial or in use must be supported by robust and ongoing training (NHSLA 2015). Training with medical devices along with regular updates is vital to provide competent and safe patient care, particularly with those pieces of equipment that are used infrequently. So who is responsible for ensuring that practitioners receive the necessary training that they need to achieve competence, particularly in areas where they do not have frequent exposure? >>
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It is quite clear within the Nursing and Midwifery Council (NMC) The Code: Professional standards of practice and behaviour for nurses and midwives and Standards for competence for registered nurses (NMC 2015a,b), and the Health and Care Professions Council (HCPC) Standards of conduct performance and ethics (HCPC 2008) that we are responsible for ensuring that we remain professionally updated and competent within our own field of practice. However healthcare providers also have an obligation to ensure that their staff meet the requirements of the NHS Litigation Authority, Risk Management Standards (NHSLA 2015) and the Care Quality Commission Essential Standards of Quality and Safety (CQC 2015) in respect of training. The pressures to deliver a service often impact on training provision and increasingly staff are unable to attend training as a result. So how do we address this? This requires a ‘ thinking outside the box’ approach to delivering training and updates. This is particularly important when new equipment is being introduced to the department and for training with infrequently used equipment and procedures. Medical device training and orientation to the location and contents of the Difficult Airway Trolley is part of the induction process of every new member of the anaesthetic team but providing ongoing training and support for the existing staff is also vital. Engaging with the anaesthetists to develop specialist updates and training has produced well attended study days for difficult airway management. This training has allowed us to focus as a department on clinical competence but also communication, human factors and leadership as staff feel more confident within their role in an airway emergency.
Airway Management
Technical and non-technical skills are a fundamental requirement of an anaesthetic practitioner. Regular training and updates of these skills are key to maintaining competency with emergency procedures which are infrequently experienced in practice.
Use of simulation training provides practitioners with the opportunity to experience anaesthetic emergencies in a controlled environment and gives us the opportunity to analyse and reflect on practise. Airway emergencies are thankfully infrequent. Training together and standardising the processes should give us the tools to get it right. Karin Colbeck Practice Educator (Theatres), Lancashire Teaching Hospitals NHS Foundation Trust Refrences Care Quality Commission 2015 Essential standards of quality and safety [online] Available from: http://www.cqc.org.uk/ content/regulations-serviceproviders-and-managers [Accessed August 2015] Difficult Airway Society n.d. Setting up a difficult airway trolley (DAT) [online] Available from: https://www.das.uk.com/ content/difficult_airway_trolley [Accessed August 2015] Health and Care Professions Council 2008 Standards of conduct performance and ethics [online] Available from: http://www.hcpc-uk.org/ publications/standards/index. asp?id=38 [Accessed August 2015] National Health Service Litigation Authority 2015 Risk management standards [online] Available from: http:// www.nhsla.com/Safety/ Standards/Pages/Home.aspx [Accessed August 2015] Nursing and Midwifery Council 2015a The Code: Professional standards of practice and behaviour for nurses and midwives [online] Available
from: http://www.nmc.org.uk/ globalassets/sitedocuments/ nmc-publications/revisednew-nmc-code.pdf [Accessed August 2015] Nursing and Midwifery Council 2015b Standards for competence for registered nurses [online] Available from: http://www.nmc.org.uk/ globalassets/sitedocuments/ standards/standards-forcompetence.pdf [Accessed August 2015] Patient Safety First 2010 Implementing human factors in healthcare [online] Available from: http://www. patientsafetyfirst.nhs.uk/ashx/ Asset.ashx?path=/Interventionsupport/Human%20Factors%20 How-to%20Guide%20v1.2.pdf [Accessed August 2015] Royal College of Anaesthetists and Difficult Airway Society 2011 4th National Audit Project of The Royal College of Anaesthetists and The Difficult Airway Society (NAP4). Major complications of airway management in the United Kingdom. Report and findings [online] Available from: http://www.rcoa.ac.uk/ node/4211 [Accessed August 2015] Rutherford JS, Flin R, Mitchell L 2012 Non-Technical Skills of anaesthetic assistants in the perioperative period: a literature review British Journal of Anaesthesia [online] Available from: http://bja.oxfordjournals. org/content/early/2012/05/10/ bja.aes125.full [Accessed August 2015]
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Anaesthesia
The good old days I have just completed 30 years in the perioperative environment, predominantly doing post-anaesthetic recovery. At the beginning of my theatre career I worked in anaesthetics for a period of time and have witnessed so many changes within the field of anaesthetics and recovery. So here goes with a little reminiscence. An overriding memory of time spent in anaesthetic rooms was the huge Cidex® bucket strategically placed for all of the reusable masks etc. to be put into soak at the end of each case. Airways, masks and endotracheal tubes were all cleaned after each patient by whoever was doing the list. My personal bug bear was having to clean the double-lumen endobronchial tubes – oh what fun! Suction canisters and laryngoscope blades also had to be scrubbed and I guess many of you remember having to do this. I’m sure some of you will be horrified but in the 1980s there was very little single use equipment available. This was a time before laryngeal mask airways (LMAs) and supraglottic devices were invented. Invasive monitoring was very rare in my place of work. In fact any patient who did need an arterial line went straight to intensive care to have their blood gases taken. Can you imagine that scenario today? Patient warming post-operatively was very primitive; we kept blankets on radiators ready for use. There was the occasional foil ‘space blanket’ available for the patient who was extremely cold and warmed IV fluid was unheard of. Can you imagine your recovery area or anaesthetic rooms today without invasive monitoring as
In the 1980s there was very little single use equipment available. This was a time before laryngeal mask airways (LMAs) and supraglottic devices were invented.
standard? No capnography and only glass thermometers as the way of telling what the patient’s temperature is. Maybe in 30 years’ time someone will be writing along the same lines, viewing the equipment we class as standard today as ‘old hat’ and ‘very quaint’. Technology progresses at a fast pace and will continue to do so.
There will be new innovations in perioperative care being introduced all the time. Sometimes it is nice to remember the ‘old days’ but I am thankful that we don’t have to revisit them in our work areas. Ann Conquest Day Surgery Ward Manager and AfPP Trustee
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Detergent choice from schülke
gigasan® ND from schülke is the latest addition to the extensive range of disinfectants and detergents from schülke, which is designed to offer choice, convenience and cost savings. gigasan is a non-enzymatic neutral detergent for the manual cleaning of medical and surgical instruments, including endoscopes and endoscopy equipment. Because of the ultra- concentrated formulation a 5 litre container of gigasan ND can be diluted into 12,500 litres of in-use solution. This makes gigasan ND a highly cost effective neutral detergent and also saves on storage space.
If an enzymatic detergent is preferred, gigazyme® contains enzymes and surfactants for optimum cleaning performance. gigazyme is available in both 2 litre and 5 litre pack sizes.
gigazyme spray foam includes three different enzymes for cleaning and disinfection and is designed to keep soiled instruments moist for a prolonged period of time. www.schulke.co.uk
Whether gigasan or gigazyme is used, gigazyme® ready-to-use spray foam can be used for the immediate pre-cleaning and disinfection of surgical instruments, including flexible endoscopes.
Email: mail.uk@schuelke.com schülke UK Ltd, Cygnet House, 1 Jenkin Road, Meadowhall, Sheffield S9 1AT Tel: 0114 254 3500
Halyard Health sterilisation wrap is now most validated on the market Halyard Health, formerly Kimberly-Clark Health Care, has announced that its sterilisation wrap portfolio has been validated by the US Food and Drug Administration (FDA) for use with all standard sterilisation systems.
As the first manufacturer to receive the 510 (k) clearance from the FDA, the validation covers the Halyard* sterilisation wrap with Kimguard* technology and Halyard QUICK CHECK* dual colour wrap. The following sterilisation modalities are covered by the validation:
Low Temperature STERRAD® Sterilisation Systems STERRAD® 100NX STERRAD® NX STERRAD® 100S STERRAD® 200 STERRAD® 50 STERIS® Sterilisation Systems STERIS® V-PRO 1 STERIS® V-PRO 1 Plus STERIS® V-PRO maX Pre-vacuum Steam Ethylene Oxide (EO) Gravity Steam “Providing innovation in
sterilisation technology was a priority at KimberlyClark Health Care and we will continue to invest in innovation as Halyard Health,” said Karina Engels, Product Manager for Sterilisation & InteguSeal for Halyard Health in Europe, Middle East and Africa (EMEA). “Securing FDA clearance for use of our market-leading sterilisation wrap with each and every sterilisation modality supports our ongoing mission to help clinicians prevent infections and protect patients.” For more information visit www.halyardhealth.co.uk
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DTR Medical
DTR Medical celebrates 10th Year Anniversary as an innovative and multiple award winning medical device manufacturer.
A Wales based medical device company, DTR Medical, sell and market its own brand of sterile single-use surgical instruments, priding themselves on developing new and innovative products that are used throughout ENT, gynaecology, vascular, neurology, orthopaedic, ophthalmology and general surgery.
DTR Medical maintain a close relationship with clinicians to develop single-use instruments that are suitable for new and existing procedures. This relationship facilitates innovation and DTR Medical were awarded the MediWales ‘Innovation Award’ for their Rotating Cervical Biopsy Punch in recognition of its unique design and use of advanced manufacturing techniques. The most recently launched product is a single-use Bone
Trephine used for cleft palate procedures where the need for first time sharpness and eliminating the risk of contamination were essential for Great Ormond Street, who are the lead customer. Successful growth over the past 10 years has enabled DTR Medical to expand into the export market and in recognition of this achievement, DTR Medical were awarded the MediWales ‘Export Achievement
Award in 2014’. Following the 2014 success of DTR Medical, export sales for the company soared to a huge 354%. This theme continued when DTR Medical were shortlisted for the Medilink 2015 UK awards and were delighted with their top three place in the UK for an outstanding overseas trading performance and look forward to continuing this success in the future. www.dtrmedical.com
KARL STORZ Endoskope
KARL STORZ Endoskope is a global endoscopy company with an established and unrivalled reputation for producing the finest quality instruments and accessories.
Our range of Flexible Intubation Video Endoscopes (FIVE scopes) evolves our market leading C-MAC© brand into a Complete Airway Management System (CAMS). The system can be used for routine intubation & training with
a range of familiar MACINTOSH & MILLER blades; for difficult intubation with the C-MAC© D-BLADE and for advanced intubation with the FIVE Flexible Intubation Video Endoscopes. The C-MAC© System – a Single Instrument is NOT a Plan B. KARL STORZ Endoscopy (UK) Ltd Tel: +44 (0)1753 503500 www.karlstorz.com
Product News
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Mindray
Distinctive Medical
Monitoring patients effectively during transfer and transport remains one of the perennial challenges for Healthcare professionals.
As part of the Mindray BeneView Patient Monitoring Solution, BeneView T1 TDS helps you to keep a close watch on all your patients but especially those who need to be moved to other clinical areas. Base-line parameters of 3/5 lead ECG with arrhythmia and ST monitoring, Sp02, NIBP, twin invasive blood pressures, twin temperatures and respiration can be augmented by 12-lead ECG and C02 for sedated/ anaesthetised patients. BeneView T1 TDS transfers all these parameters from the host BeneView T-series monitors and continues monitoring and data collection whilst in transit. When you reach the next clinical area,
simply dock the T1 TDS into the host BeneView and the data from the previous monitor as well as that collected whilst mobile is automatically uploaded. With up to 5 hours battery run time and WLAN options for network connectivity, BeneView T1 TDS takes care of the data whilst you take care of the patient. Call or email to arrange your demonstration. Mindray (UK) Limited Mindray House, Hinchingbrooke Business Park, Huntingdon, Cambridgeshire PE29 6FN www.mindray.com Tel: 01480 416840 Fax: 01480 436588 Email: ukcustomerservice@ mindray.com
PROACT
Following the hugely successful launch of our Difficult Airway and Airway Rescue trolleys in 2013 we have now expanded the range to offer three different colours, 2 sizes of trolley and 2 different standard drawer configurations. Because of the unique way our trolley is made we can alter drawer configurations to suit the equipment you use. Our labels can also easily be re-printed to coincide with new updated guidelines which are forthcoming in late 2015. We have also added 2 new sizes of catheter holders to give you greater space to store catheters and fibreoptic scopes as well poles to mount fibreoptic scope monitors on, allowing you to keep your difficult airway equipment in one place ready for that critical situation.
Interested in our trolleys? We will happily bring one to your site for a demonstration. Call us on 01928 571801 or email info@distinctivemedical.com
PROACT Professional Laryngoscopes ISO7376:2009 Reusable Range: • PROACT Reusable Fibre Optic Autoclavable Smoothline Blades and Handles Disposable Range with the full strength of metal through Handle, Hook and Blade: • Metal Max® Green System Fibre Optic Blades with full range of handles • Metal Max® Conventional meLED Blades with full range of handles • Metal Max® Combi+, complete Handle and Blade with pre-loaded batteries and test-in-bag facility – “Ready in seconds”
PROACT are official distributors for Heine Laryngoscopes offering the Classic+ Fibre Optic Reusable Autoclavable range with Heine handles. All products available either directly or through NHS Supply Chain. Please call on 01536 461981 for further information.
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Swann-Morton
As Swann-Morton continue to offer in-house training in best practice for the attachment, handling and removal of their surgical blades, including their safety engineered devices, in support of the essential requirements of the EU Sharps directive, they have responded to customer demand for the addition of a safety stitch cutter.
Functioning in the same fashion as the existing range of retractable sterile safety scalpels the Stitch Cutter has a high visibility yellow slider to compliment the red body and is now available through NHS supply chain.
As well as within a hospital setting the Stitch Cutters are often used within GP practice, care homes or during domiciliary visits so it is essential that an exposed sharp is not left around after use as there may well be other parties
such as children, residents or even a household pet within the immediate vicinity. With the Safety Stitch Cutter the blade can be retracted away and locked in place to avoid any potential sharps injuries.
Further sharps safety training information and a new suite of training films can be found in the interactive section at www.swann-morton.com