The Operating Theatre Journal

Tuesday, 20 August 2013

Mother-of-two back from the dead after 42 MINUTES in Australia thanks to high-tech machine that kept blood flowing to her brain



  • Vanessa Tanasio, 41, was rushed to hospital in Melbourne after heart attack
  • Paramedics tried to revive her she was declared clinically dead at hospital
  • But thanks to a machine that kept blood flowing to her brain, she came back
  • She was today smiling and chatting to mother and children, 11 and nine
  • She said: 'For someone who's been dead an hour, I feel tremendously well'



Read more: http://www.dailymail.co.uk/news/article-2397052/Mother-dead-42-MINUTES-Australia-thanks-high-tech-machine-kept-blood-flowing-brain.html#ixzz2cVWdN0iF

Friday, 16 August 2013

Surgical Safety Checklist is no magic bullet to prevent unsafe surgery, say researchers



A widely promoted checklist to reduce complications and deaths during surgery is not straightforward to implement in either high- or low-income countries, says new research. It is especially unlikely to be used as intended in countries where the electricity supply is unreliable, there is a lack of basic materials such as gauze, and shifts can last for up to 36 hours.

A study carried out by Dr Emma-Louise Aveling and Professor Mary Dixon-Woods in the Department of Health Sciences at the University of Leicester, and Peter McCulloch in the Nuffield Department of Surgical Science at the University of Oxford, has compared how the checklist was used in operating theatres in two English hospitals and one sub-Saharan African hospital.

The results of the study, which was funded by a Higher Education Innovation Fund Impact Award, the Wellcome Trust, and the Department of Health Policy Research Programme, are published today in BMJ Open, an open-access online journal. They are likely to foster debate worldwide. Policy-makers and the World Health Organization have supported the checklist since it was reported to have reduced the rate of deaths and complications by more than a third across eight diverse hospitals in different countries in a 2009 pilot study.

Dr Aveling, who carried out the field research, says: "An important feature of the checklist is its claim to universality: it is meant to be as simple to use in a rural hospital in Namibia as it is in a private medical centre in New Zealand."

Now used in 1,800 institutions worldwide, the checklist combines checks for technical items such as administering of antibiotics and use of pulse oximeters (a device that is attached to the finger to measure oxygen to the brain) with non-technical items such as team introductions.

Use of the checklist has been mandatory in UK hospitals since 2010. But so-called 'never events' - patient safety incidents that the checklist is designed to catch - have continued to occur in the UK and around the world.

The research team conducted extensive observations in operating theatres in the UK and an African country, and interviewed clinicians and managers to see whether the checklist was used at all, used properly and used fully. They found some similarities between the UK and African settings. Though many staff welcomed the checklist, they did complain about some items. And not all staff were wholly enthusiastic, or they were very resistant to using the checklist properly. If these individuals were in senior positions or very powerful in their local environments, their attitudes could undermine checks designed to promote teamwork and reduce hierarchies.

Dr Aveling says: "The checklist was designed not only to improve patient safety by increasing the reliability of technical steps, but also by strengthening communication. But if checklist implementation is not handled well, it is precisely where technical and communication issues are most problematic that the checklist, by itself, is least likely to resolve them."

The research found that in the UK settings use of the checklist was high, although not 100%, for most procedures. In the African setting it was highly inconsistent - there, during staff shortages, emergencies or busy periods, the checklist was abandoned altogether. Checkboxes were ticked without tasks such as equipment counts being undertaken.

Differences were particularly marked where material resources were concerned: there was a limited range of antibiotics and no hospital policy regarding their administration; there were also too few pulse oximeters yet operations were rarely cancelled if one was not available.

Dr Aveling commented that: "Things we take for granted in the West - reliable sterilisation, the availability of basic equipment - are rare in some low-income countries. This made the checklist difficult to implement and use correctly and completely."

Particularly disquieting was the finding that poor checklist implementation in low-income countries might not only fail to reduce patient safety risks, but introduce new risks for staff and patients.

The researchers cite the case of two staff members at the African hospital who were threatened at gunpoint and then arrested after a patient died during surgery from lack of oxygen to the brain. No pulse oximeter had been available, even though the checklist stipulates its use. Criminal charges were brought against one of the accused, who was not provided with legal representation for some weeks.

Professor Dixon-Woods, who is a Wellcome Trust Senior Investigator in Society & Ethics, says: "Without adequate resources, efficient systems, and the right culture in place, hospitals adopting the checklist can introduce new risks for their staff and their patients. It is disturbing that the checklist can encourage unethical behaviour, as staff feel under pressure to tick the boxes even though they cannot comply. The principles underlying the surgical checklist are good ones, but only now are we waking up to the serious challenges associated with implementation. On its own, the checklist is no magic bullet."

The team has made a number of recommendations that it hopes will make the checklist more effective across the world: surgical teams should be trained together on the use of the checklist, not separately within their disciplines; collection and feedback of data has to be improved, with further support if necessary; and senior staff need to be called on to act as 'champions' of the checklist where there is resistance to use. Most importantly, the checklist needs to be part of a broader, institution-wide campaign to improve patient safety, not just introduced in isolation.

Thursday, 15 August 2013

MODERNISATION OF HIV RULES TO BETTER PROTECT PUBLIC


Public protection against HIV will be strengthened under new plans to help people get diagnosed and treated earlier, Chief Medical Officer Professor Dame Sally Davies announced today.

Outdated rules designed to combat the threat of AIDS in the 1980s, when attitudes were very different and risks were less understood, will be modernised in line with the most recent science.

The changes mean that:
  • people will be able to buy HIV self-testing kits once the kits comply with regulations; and
  • doctors, nurses and other skilled healthcare workers with HIV who are undergoing treatment will be able to take part in certain medical procedures from which they are currently banned.

Up to 100,000 people have HIV in the UK but around a quarter are living with it undiagnosed. These changes will give people more choice on how to get tested and therefore get treatment earlier, which will reduce the risk of new HIV infections.

Following independent scientific advice, the Department of Health will lift the ban on healthcare workers with HIV being able to carry out certain dental and surgical procedures. Strict rules on treatment, monitoring and testing will be in place to safeguard patients.

This change will bring the UK in line with most other Western countries. Under the new system, patients will have more chance around one in five million of being struck by lightning than being infected with HIV by a healthcare worker. There is no record of any patient ever being infected through this route in the UK. There have been just four cases of clinicians infecting patients reported worldwide and the last of these was more than a decade ago.

The changes announced today could reduce that risk even further because healthcare workers will be more likely to get tested themselves and therefore less likely to potentially put people at risk.

Because of the stigma attached to HIV, some people are reluctant to use existing testing services and as a result half of HIV infections are discovered late, meaning they are harder to treat.

Removing the ban on the sale of self-testing kits will make it easier for people to get tested as early as possible and get the best treatment available.

If a test indicates a positive result people are advised to get a follow-up confirmatory test at an NHS clinic. Clear information about how to interpret the result and what to do afterwards will be included with the kit.

Chief Medical Officer Professor Dame Sally Davies said:
Many of the UKs HIV policies were designed to combat the perceived threat at the height of HIV concerns in the 1980s and have now been left behind by scientific advances and effective treatments. It is time we changed these outdated rules which are sometimes counter-productive and limit peoples choices on how to get tested or treated early for HIV.
What we need is a simpler system that continues to protect the public through encouraging people to get tested for HIV as early as possible and that does not hold back some of our best healthcare workers because of a risk that is more remote than being struck by lightning.
Public Health Minister Anna Soubry said:
HIV continues to be a serious health issue but we know that for a number of reasons some people are reluctant to come forward and get an HIV test in person.
"By removing the ban on the sale of self-testing kits and cutting red tape that stops healthcare workers from treating patients we are bringing the UK in line with most other Western countries. We want to make it even easier for people to test themselves as early as possible and get the best treatment available.

Deborah Jack, Chief Executive of NAT (National AIDS Trust) said:
We welcome these changes to the guidance on HIV positive healthcare workers undertaking exposure-prone procedures and the removal of the ban on self-testing as we believe it is vitally important that policies are based on up-to-date scientific evidence and not on fear, stigma or outdated information.

Allowing healthcare workers living with HIV to undertake exposure-prone procedures corrects the current guidance which offers no more protection for the general public but keeps qualified and skilled people from working in the career they had spent many years training for. We know people are already buying poor quality self-testing kits online which is why NAT have campaigned for a change in the law. Legalisation is an important step to ensure they are regulated, accurate and safe.

The British Dental Associations scientific adviser Professor Damien Walmsley, said:
Dentists in the UK comply with rigorous infection control procedures to protect both patients and the dental team against the risk of transmission of blood-borne infections. 
 
Todays announcement brings England into line with nations including Sweden, France, Canada and New Zealand, and is good news for patients and HIV-positive dentists alike. We look forward to seeing its implementation.

Decided on a case-by-case basis, HIV-infected healthcare workers may be allowed to undertake certain procedures, if they are:
  • ï·         on effective combination antiretroviral drug therapy (cART);
  • ï·         have an undetectable viral load; and
  • ï·         are regularly monitored by their treating and occupational health physicians.


Both policies will be in place from April 2014. Public Health England will now put in place a programme to register and monitor healthcare workers who have HIV and ensure they are able to perform certain procedures when appropriate.

MHRA issues warning to diabetics about faulty blood glucose test strips


 
The Medicines and Healthcare products Regulatory Agency (MHRA) today asked people with diabetes not to use certain lots of a specific type of blood glucose test strip because a fault in some of the strips may mean that people could overestimate the amount of insulin they need to take.
 
The test strips affected by the manufacturing fault are called the GlucoMen LX Sensor blood glucose test strips. They are used with the GlucoMen LX and GlucoMen LX PLUS blood glucose meter and they are manufactured by Menarini in Italy.
 
Just over 1.7 million test strips in the affected lots were sold to pharmacies in the UK between October and November 2012. The fault means that some of the test strips may give inaccurate readings and therefore people could potentially overestimate the amount of insulin they need.
 
The manufacturing fault has now been resolved and there is currently no evidence that any patients in the UK have been adversely affected by any faulty test strips.
 
People can check if they have the affected test strips at home by looking for the lot numbers below on the tubs of test strips:
 
  • Lot 3212219249, expiry date 31-08-2014
  • Lot 3212214249, expiry date 31-08-2014
 
While they havent been sold in the UK since November 2012, its possible that some of the unused faulty blood test strips may still remain in peoples homes. People can get alternative test strips. Other lots of these test strips are not affected and they can continue to be used.
 
John Wilkinson, the MHRAs Director of Medical Devices, said:
 
People who have GlucoMen LX Sensor blood glucose test strips from these specific lots at home should not use them. The manufacturing fault in these test strips could give a misleading reading that may result in people overestimating the amount of insulin they need to take.
 
This fault has been resolved and the two affected lots of faulty test strips have not been sold in the UK since November. There is no evidence that any patients in the UK have been adversely affected by the faulty test strips.
 
If people have the faulty test strips at home they can telephone the manufacturers Menarini on 0800 243667 who will provide free replacements. If they have questions, they can contact their GP, diabetes clinic or another healthcare professional who can give them advice about what alternative test strips they can use.
               
                The MHRAs Medical Device Alert can be viewed here

Hospira Intravascular Product Recall Gets Class I Status


The product has been linked to one patient death whose therapy was delayed because of the problem.
It is not the only recent Class I recall for Hospira. In May, FDA gave that designation to the company’s GemStar Infusion System, which reportedly has battery problems that can result in power loss.
FDA has also pointed out manufacturing problems in the company’s facility based in Rocky Mount, NC. The company recently announced it was working to resolve a variety of manufacturing problems in that and other facilities located across the globe. "While we continued to make progress in supply recovery and in advancing our quality-improvement initiatives, we still have work to do to reinforce our foundation," the company’s CEO F. Michael Ball.

Wednesday, 7 August 2013

The Operating Theatre Journal August 2013

Read these top stories, and more, online after a simple registration or signin to the otjonline website:

Junior Doctor Changeover Likely to Drive August Reduction in Quality and Safety of Patient Care

Connected Health Empowers Patients and Providers

Global Expert Publishes World-leading Safety Plan for NHS

Nurse Betty Finally Retires - at 80!

Monday, 5 August 2013

NHS Gets Own Price Comparison Website

A price comparison website is being created to help the NHS in England save millions of pounds in the way it purchases good and services.

Full Story ...