Journal of Perioperative Practice PROCUREMENT GUIDE. January / February 2014 Volume 02 Issue

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1 PROCUREMENT GUIDE

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3 03 Contents Welcome to your January 2014 Guide 05 Could pre-warming prove heart-warming for procurement teams? 09 Inadvertent postoperative hypothermia: a common but preventable side effect of anaesthesia and surgery 11 Inadvertent perioperative hypothermia 12 Enhanced recovery: a better journey for patients, a better deal for the NHS. Has it fulfilled the potential? 15 Trip hazards and hygiene 16 Single use no compromise 18 Overcoming the many problems of subjective monitoring 19 Health Care Supply Association 43rd Conference: Manchester November 2013 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: March 2014 Instruments May 2014 Infection Prevention July 2014 Day Surgery September 2014 Airway Management November 2014 Safety January 2015 Recovery Contact Information: Advertising, Sponsorship & Partner Packages. Frances Murphy Media Manager Open Box M&C T: E: francesmurphy60@yahoo.com Editorial Chris Wiles Head of Publishing / Editorial AfPP T: 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 Media Manager Open Box M&C T: E: francesmurphy60@yahoo.com

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5 05 Patient Warming Could pre-warming prove heart-warming for procurement teams? Compelling evidence points to the value of warming operating room patients, with both passive and active warming techniques resulting in better outcomes in terms of infection control, blood loss, serious cardiac episodes and recovery time. Stopping the temperature drop associated with anaesthesia and reduction in metabolic heat production can have significant cost implications for a healthcare provider, and the process of pre-warming, rather than only starting active heat transfer in the operating room (OR), could be the key. Clinicians have long recognised the problem: unwarmed patients typically can become hypothermic, experiencing a loss in core body temperature of up to C in the first hour after the induction of anaesthesia, which impairs thermoregulation by lowering the thresholds at which the body s own warming mechanisms start to work. Without pre-warming, heat is redistributed from the core to the periphery of the body through a process called vasodilation, which allows warmer blood from the core of the body to flow to peripheral and cooler parts. This lowers the core body temperature while increasing temperature in the periphery, and the result is redistribution hypothermia. Studies (Sessler 1997) show that unwarmed patients can experience a drop in core body temperature of up to 3 C in the first three hours. That heat loss is even greater if the operating room is cold and is also exacerbated where operations involve large open wounds. The BARRIER EasyWarm blanket from Mölnlycke Health Care is a perioperative warming solution that allows for preoperative warming and can be carried through the entire procedure. The blanket uses a simple chemical reaction to generate heat and actively prewarm mainly the periphery of the body, to ensure less core-toperiphery heat redistribution upon the induction of anaesthesia. It pays to avoid this inadvertent patient hypothermia, which can prolong both the time spent in the post-anaesthesia care unit and the overall in-hospital stay. Hypothermia can directly affect patients fitness for discharge, and time in the recovery room can be increased by an average of 40 minutes for patients with around 2 C hypothermia (Lenhardt et al 1997). In monetary terms, there are obviously consequences when perioperative hypothermia leads to poorer clinical outcomes and longer hospital stays, so could a new system of active prewarming make inroads into both cost control and patient care? The BARRIER EasyWarm blanket from Mölnlycke Health Care is a perioperative warming solution that allows for pre-operative warming and can be carried through the entire procedure. The blanket uses an exothermic chemical reaction to generate heat and actively pre-warm mainly the periphery of the body, to ensure less core to periphery heat redistribution upon the induction of anaesthesia. Each single-use blanket has a set of 12 self-heating pads, inserted into pockets, which activate the moment a pack is opened and which gradually warm up, becoming fully heated in 30 minutes. The blanket then maintains an average of 44 C for up to ten hours without any additional equipment. It can be split to suit the surgical procedure; for upper body surgery, for instance, the patient s lower body can still be warmed throughout. There have been various studies into the benefits of active warming. One showed that patients treated with pre-warming before surgery maintained a normothermic temperature (36.5 C) one hour after induction of anaesthesia (Hynson et al 1993). The non pre-warmed control group became mildly hypothermic, losing C in core body temperature. At the end of surgery, the temperatures of the pre-warmed patients were stable and not hypothermic, while those of the control group were just above 35 C. There are already some wellestablished procedures for warming patients in the minutes leading up to surgery, and during the procedure itself. Passive warming aims to reduce heat loss without additional heat being added to the body, and techniques can be as simple as advising patients to stay warm before surgery. The temperature in the operating room itself can be increased, or warmed cotton blankets placed over the patient, and while every little bit helps, none of these techniques is fully effective in preventing inadvertent perioperative hypothermia (Horn et al 2012). Active warming - the actual transfer of heat from an external source to the body - gives patients a higher core body temperature after surgery than patients who undergo passive or no warming at all (Block et al 1998, Hynson et al 1993, Just et al 1993) and these active intraoperative warming techniques can include blankets and mattresses using forced air or heated fluid systems. But there are challenges with both. Active warming techniques used intraoperatively are usually started after redistribution hypothermia has already

6 06 Patient Warming occurred. This means that patients could potentially be exposed to hypothermia before active-warming techniques are initiated, and points to pre-warming being the key to preventing heat loss. Adam Harwood, a Mölnlycke Health Care marketing manager for BARRIER EasyWarm, said: There is no doubt there can be significant cost implications for a healthcare provider due to the adverse consequences associated with hypothermia. This could be in terms of blood transfusion (Rajagopalan et al 2008) requirement, the treatment of surgical site infections or possibly cardiac events (Frank et al 1997). Prolonged recovery time is another factor. A longer stay in hospital inevitably increases costs. In the clinical guidance for managing inadvertent perioperative hypothermia, the National Institute for Health and Care Excellence (NICE) has estimated the cost of an additional hour of postanaesthesia care unit stay and the unit cost of bed day to be 44 GBP and 273 GBP, respectively (NICE 2008). In a busy surgical unit, it can really start to add up. There can be significant cost implications for a healthcare provider due to the adverse consequences associated with hypothermia So if patient warming is potentially a win-win in terms of better outcomes and lower costs, can active pre-warming, rather than waiting until a patient is actually in the OR, help avoid the temperature drop more effectively and positively impact on cost and patient benefits? Adam Harwood says: We believe this is a new approach to active warming. We have been working with OR staff in hospitals to assess the blanket s benefits and ease-of-use and the results have been really encouraging, with feedback from both clinicians and patients very positive. It s a very simple approach and not reliant on any additional equipment, which makes it perfect for mobile use in and around the OR. The heat pads work when exposed to air as a result of an exothermic reaction and use of the blanket does not impede regular core temperature monitoring in the operating room. Because it goes on working when surgery is finished, it helps maintain body temperature and that could improve post-op patient comfort. The evidence for pre-warming is compelling, given what we know about hypothermia and its impact on patient outcomes, but what clinical and medical teams need is a reliable and simple solution with the flexibility of design to translate across multiple adult patient groups and many different surgical needs. What clinical and medical teams need is a reliable and simple solution BARRIER EasyWarm is an innovation for pre-warming which could be a good procurement decision, potentially saving costs because of better recovery times. Keeping patients warm is a fundamental. It s no surprise that a patient feeling chilly as they wait for the OR can suffer discomfort and a feeling of increased anxiety. To address this, passive pre-warming is better than nothing, but BARRIER EasyWarm brings the active warming process to the patient, with highly predictable results. And let s not forget the finance and procurement teams: when you look at the potential consequences of patient hypothermia, the blankets could prove to be heartwarming for them too. For further information ukmarketing@molnlycke.com References Bock M, Muller J, Bach A, Bohrer H, Martin E, Motsch J 1998 Effects of preinduction and intraoperative warming during major laparotomy British Journal of Anaesthesia 80 (2) Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, et al 1997 Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial Journal of the American Medical Association 277 (14) Horn EP, Bein B, Bohm R, Steinfath M, Sahili N, Hocker J 2012 The effect of short time periods of pre-operative warming in the prevention of peri-operative hypothermia. Anaesthesia 67 (6) Hynson JM, Sessler DI, Moayeri A, McGuire J, Schroeder M 1993 The effects of preinduction warming on temperature and blood pressure during propofol/ nitrous oxide anesthesia Anesthesiology 79 (2) , discussion 21A-22A Just B, Trevien V, Delva E, Lienhart A 1993 Prevention of intraoperative hypothermia by preoperative skin-surface warming Anesthesiology 79 (2) Lenhardt R, Marker E, Goll V, Tschernich H, Kurz A, Sessler DI et al 1997 Mild intraoperative hypothermia prolongs postanesthetic recovery Anesthesiology 87 (6) National Institute for Health and Care Excellence 2008 Inadvertent perioperative hypothermia: The management of inadvertent perioperative hypothermia in adults [CG65] [Internet] org.uk/cg65 Rajagopalan S, Mascha E, Na J, Sessler DI 2008 The effects of mild perioperative hypothermia on blood loss and transfusion requirement Anesthesiology 108 (1) 71-7 Sessler DI 1997 Mild Perioperative Hypothermia New England Journal of Medicine 336 (24)

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9 09 Patient Warming Inadvertent postoperative hypothermia: a common but preventable side effect of anaesthesia and surgery Brrr it s cold. That is probably what a lot of our patients would say to us when they arrive in the recovery area. Temperature management and the prevention of inadvertent postoperative hypothermia is of paramount importance within theatres but an area of practice that we seem to struggle with. Despite the availability of a wide variety of warming devices we frequently seem unable to get the balance right. Inadvertent postoperative hypothermia is a common but preventable side effect of anaesthesia and surgery and one that the recovery practitioner will encounter on a daily basis. Hypothermia is much more than just a physically uncomfortable experience, yet despite a plethora of evidence to support the use of warming devices, maintaining normothermia still appears to be low in the order of priorities in clinical practice. Perioperative hypothermia is defined as a drop in the patient s core temperature below 36 degrees Celsius. Research studies have outlined the impact of hypothermia on surgical outcomes and highlighted the heightened risks to the patient of postoperative infections. Even a drop in core temperature of only one or two degrees below normothermia can have severe consequences for the patient and lead to a prolonged recovery time (Lenhardt et al 1997). Hypothermia also effects the action of many of the drugs commonly used during surgery, such as muscle relaxants and the drugs commonly used to reverse them. These drugs may have a prolonged duration of effect or even a delayed onset of effect. Hypothermia increases the patient s risk of developing cardiac arrhythmias and this may have serious implications for the patient with existing cardiac disease. Clinical guidelines for the management of inadvertent perioperative hypothermia in adults (NICE 2008) identify a need for assessment and management of patients at risk of developing or suffering from hypothermia. The patient that enters the recovery area with a low core temperature may have been hypothermic before they even arrived in theatre and this calls for more robust systems of assessing and dealing with this preventable postoperative complication. The NICE guideline (NICE 2008) recommends the use of forced air warming for those patients with a core temperature of 36 degrees Celsius or lower in the hour before surgery and recommends that this method of warming continues throughout the surgery and the recovery period. This proactive approach to achieving and maintaining normothermia may on the surface appear to be a costly intervention in terms of equipment and consumables, but the resultant effect on delayed discharge and postoperative complications may render this a cost effective intervention. Ensuring patient safety and the need for fundamental standards of compliance with a patient centred focus are key issues highlighted in the wake of the Mid Staffs enquiry and form part of the recommendations from the Francis report (Francis 2013). As registered practitioners we have a requirement to promote and achieve the highest standards of care. For the patient however their overall focus will be on the care they received from the staff and how comfortable they felt postoperatively. The patient may not be aware of the implications of postoperative hypothermia but they will feel its effects as it has a negative impact on the overall patient perioperative experience. It increases the patient s risks of developing postoperative complications and indeed increases the risk of patient mortality Whilst these are serious safety issues for the patient, for the recovery practitioner there are the more immediate adverse affects of hypothermia to be considered and dealt with. These include the physical effects such as shivering, making accurate monitoring difficult, along with increased pain and discomfort for the patient. Hypothermia also effects the action of many of the drugs commonly used during surgery, such as muscle relaxants and the drugs commonly used to reverse them. These drugs may have a prolonged duration of effect or even a delayed onset of effect. Hypothermia increases the patient s risk of developing cardiac arrhythmias and this may have serious implications for the patient with existing cardiac disease. The patient will lose body heat in four ways namely: Radiation- that is heat passing from the patient s body to the colder environment, this can account for up to 60% of the body heat that is lost. Convection- heat that is lost

10 10 Patient Warming from the effect of cold air moving across the patient and absorbing heat from the patient s body accounting for another 20-30% heat loss. Conduction- transfer of heat from the body to a colder object that the body is in contact with, such as a cold patient trolley. Evaporation- moisture lost from the body for example from the surgical wound. (McNeil 1998) There are a variety of methods available to the recovery practitioner to treat or to prevent further loss of body heat, including warming intravenous fluids, humidification of supplementary oxygen and applying extra blankets to the patient. As identified within the NICE guideline, one of the most effective methods of reheating the patient is the use of a forced air warming device. Forced air warming is effective because not only does it provides a direct heat source from the warm air it also makes use of convection by moving the warmed air across the patient s body surface (Knappel 2012). This method of warming is fast and efficient especially if it is utilised to proactively manage the patient s temperature throughout their perioperative journey. In recovery the immediate goal is to keep the patients warm and to restore a core temperature above 36 degrees Celsius to those patients who are cold on arrival in recovery. Achieving normothermia and then subsequently keeping the patient warm will reduce the risks associated with perioperative hypothermia and will result in a shorter recovery time. Preventing the adverse outcomes associated with hypothermia requires a team approach at every stage of the perioperative journey. Hypothermia should not be seen as the recovery practitioner s problem but as a challenge for all theatre practitioners. Karin Colbeck Practice Educator, Main Theatres, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust Sandra Phillips Training & Development Coordinator, Main Theatres, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust References Francis QC R 2013Mid Staffordshire NHS Foundation Trust Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry - Executive summary London: Crown Copyright Available from: report Knappel A 2012 Inadvertent perioperative hypothermia a literature review Journal of Perioperative Practice 22 (3) Lenhardt R, Marker E, Goll V, Tschernich H, Kurz A, Sessler D, Narzt E, Lackner F 1997 Mild intraoperative hypothermia prolongs postanaesthetic recovery Anaesthesiology 87 (6) McNeil BA 1998 Addressing the problems of inadvertent hypothermia in surgical patients Part 2 Self learning pack British Journal of Theatre Nursing 8 (5) National Institute for Health and Clinical Excellence 2008 Management of inadvertent perioperative hypothermia in adults Available from: www. nice.org.uk/cg65 [Accessed November 2013]

11 11 Patient Warming Inadvertent perioperative hypothermia Up to 70% of surgical patients develop hypothermia perioperatively. Inadvertent hypothermia can be caused by a cold operating theatre, anaesthetic effects, exposure to the environment and administration of cold intravenous or irrigation fluids. The adverse effects of unplanned hypothermia include increased blood loss, morbid cardiac events, impaired wound healing and increased mortality. Preventing unplanned hypothermia increases patient comfort and prevents associated complications. It can be achieved by simple preventative measures (Burger & Fitzpatrick 2009, Lynch et al 2010). What is meant by inadvertent perioperative hypothermia? Core body temperature is regulated in the conscious patient by the thermoregulatory system. In response to changes in the body s temperature, the hypothalamus acts as a thermostat, increasing body temperature by vasoconstriction or decreasing body temperature through vasodilatation (Weirich 2008). Researchers estimate that 50-90% of surgical patients experience hypothermia during surgery. There are two contributing factors to inadvertent perioperative hypothermia: anaestheticinduced and environmental. General anaesthetic inhibits the thermoregulatory system and as a consequence prohibits cellular metabolism; this results in the Core body temperature is regulated in the conscious patient by the thermoregulatory system. In response to changes in the body s temperature, the hypothalamus acts as a thermostat, increasing body temperature by vasoconstriction or decreasing body temperature through vasodilatation. body being unable to produce heat. The environment (cold operating room temperature) determines the rate at which metabolic heat is lost by radiation and convection from the skin, and by evaporation from the surgical site (Kurz 2001). Redistribution temperature drop develops immediately after induction of anaesthesia as a result of internal core to peripheral redistribution of body heat. This occurs due to anaesthesiainduced vasodilatation and reduced thermoregulatory vasoconstriction (Paulikas 2008). Normothermia is defined as a core body temperature between 36 and 38 C; hypothermia is a core temperature below 36 C. A drop in core body temperature of just 1.5 C is associated with many post operative complications (Weirich 2008). Effects of hypothermia The major complications of perioperative hypothermia are as follows: surgical wound infection, increased length of stay, increased blood loss, increased blood transfusion, morbid cardiac events, duration of muscle relaxants, shivering, recovery stay and thermal discomfort (Kurz 2008). The study by Kurz (1996) highlighted that in 200 patients studied there was a 19% rate of surgical wound infection in hypothermic patients as opposed to a 6% rate in normothermic patients. The same study showed that hypothermic patients had an average hospital stay of two days longer (cited in Kurz 2008). Shmied et al s (1996) study showed that hypothermic patients had an average of eight units of blood transfused compared to one unit in the normothermic group (cited in Kurz 2008). Frank et al s (1997) study highlighted an 8% rate of ventricular tachycardia in hypothermic patients compared to 2% in the normothermic group, and a 6% rate of morbid cardiac events in the hypothermic group compared to 1% in the normothermic group (cited in Kurz 2008). Frank et al s (1997) study highlighted an 8% rate of ventricular tachycardia in hypothermic patients compared to 2% in the normothermic group, and a 6% rate of morbid cardiac events in the hypothermic group compared to 1% in the normothermic group (cited in Kurz 2008). Methods used to combat hypothermia There are various methods available to combat perioperative hypothermia and their efficacy has been tested in the research. Yet there still continues to be confusion about the best method for maintaining normothermia in the perioperative environment. Some of these methods include: Forced air warming Mediwrap Heated gel pads IV fluid warming Warming irrigation fluids Theatre temperature Prewarming References Burger L, Fitzpatrick J 2009 Prevention of inadvertent perioperative hypothermia British Journal of Nursing 18 (8) Kurz A 2001 Prevention and treatment of perioperative hypothermia Current Anaesthesia and Critical Care Kurz A 2008 Thermal care in the perioperative period Best Practice and Research Clinical Anaesthesiology Lynch S, Dixon J, Leary D 2010 Reducing the risk of unplanned perioperative hypothermia AORN Journal 92 (5) Paulikas C 2008 Prevention of unplanned perioperative hypothermia AORN Journal 88 (3) Weirich T 2008 Hypothermia/ warming protocols: why are they not widely used in the OR? AORN Journal 87(2) This is an extract from Inadvertent perioperative hypothermia: a literature review by Abigail Knaepel published in the Journal of Perioperative Practice 22 (3) The full article is available from AfPP s article archive.

12 12 Recovery Enhanced recovery: a better journey for patients, a better deal for the NHS. Has it fulfilled the potential? The National Enhanced Recovery Summit in April 2012 launched a significant change in health care delivery, all patients should now fall into two distinct surgical categories: enhanced recovery a defined journey of care leading to safe, time-framed discharge and rehabilitation or ambulatory care, surgical interventions with discharge to home within a 24 hour period. So how has this journey developed in the intervening months? Has this opportunity to deliver care differently become a reality for the consultant led extended surgical teams you support? Has the challenge to plan perioperative care, deliver and assess patient outcomes become a productive, enjoyable experience or has it become all a blur in a healthcare service that just now appears to the public as losing its focus? Let s remind ourselves what the NHS Improvement procurement guide (2012 National Enhanced Recovery Partnership) aims for this new patient care pathway and experience were. What is enhanced recovery? Enhanced recovery of patients undergoing surgery is a relatively new concept in the UK. It is an evidence-based approach involving a selected number of evidence-based interventions which, when implemented as a pathway, demonstrate a greater impact on outcomes than when implemented as individual interventions. Enhanced recovery ensures that the patient plays a vital role as a partner in their own care. It has been applied to colorectal, gynaecology, urology and musculoskeletal surgical specialties, but there is scope for other surgical areas. The principles: The underlying principle is to enable patients to recover from surgery and leave hospital sooner by minimising the stress responses on the body during surgery. It is essential that: The patient is in the best possible condition for surgery for example, identify comorbidities, improve anaemia, address hypertension and stabilise diabetes. Ideally, this is undertaken by the GP prior to referral, or, at the latest, at preoperative assessment. At this stage it is essential that the patient is well informed and understands all the treatment options, and has realistic expectations about the risks and benefits of surgery and the processes involved. It is on this basis, having had the time and support to consider, that the patient can make an informed decision to proceed with surgery. The patient has the best possible management during and after his/her operation to reduce pain, gut dysfunction and immobilisation for example, using the appropriate anaesthetic, fluids and pain relief and minimally invasive techniques where appropriate. The patient experiences the best postoperative rehabilitation. This means rehabilitation services are available seven days a week for 365 days a year, enabling early recovery and discharge as well as a return to their normal activities sooner for example, planned nutrition and early mobilisation after surgery. Care Procurement Elements Optimising the preoperative health state, commencing in primary care Anaesthetic preoperative admission assessment with medical optimisation, risk stratification and discharge planning Informed decision making and managing patient expectations Admission on day of surgery Carbohydrate loading and maximising patient hydration pre-operatively Individualised goal directed fluid therapy Using short-acting anaesthetic agents and minimal access incisions when possible Minimal use of drains/ tubes where no supporting evidence Avoidance of postoperative opiates when possible Active early planned mobilisation Early postoperative oral hydration and nutrition Procedure-specific daily goals Discharge once predetermined criteria met and patient in agreement.

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14 14 Recovery As we approach the 50th year of AfPP s journey, what would our forbears have thought of this current standard of care? Can you share some of the highs and lows of engaging with this process from a personal, team and patient perspective to add to the discussion on emerging evidence (AfPP 2013)? Reflection is a powerful tool to enable positive engagement with change as we seek to ensure, enhance and enable our Association s professional identity (AfPP 2013) that aims: To advance health by improving patient care in perioperative practice Determine standards and promote best practice. References The Association for Perioerative Practice 2013 Search - Enhanced Recovery: Article Archive [online] Available from org.uk/books-journals/journal_ archive [Accessed November 2013] Enhanced Recovery Partnership 2012 Fulfilling the Potential: A better journey for patients and a better deal for the NHS Leicester, NHS Improvement. Available from documents/er_better_journey.pdf [Accessed November 2013] Enhanced recovery information, publications and presentations from Adrian Jones RN-SCP AfPP Trustee

15 15 Product News Trip hazards and hygiene Whilst much has been done to reduce trip hazards and increase hygiene in both laboratory and healthcare environments, there are still some areas where improvement efforts fall noticeably short. There are, however, simple and effective solutions that can help rectify this. An analysis of global outbreak report data from a poster presented at the recent IPS meeting in London, the Scottish National HAI Prevalence Survey suggests that approximately 18 percent of infections are due to contaminated, communally used patient care equipment. 1 Among other things, beds and patient anaesthetic trollies are wheeled around from room to room, whilst any cables, pipes and hoses associated with the equipment become extremely dirty simply by lying around on the floor. Dust, bacteria, blood and spilled solutions are all hygiene issues that must be contended with. When moving intensive care equipment between wards and operating theatres, it is absolutely vital that they are clean if HAIs are to be avoided. However, there does not appear to be any clear policy or guidelines associated with cleaning this communal equipment, in spite of it harbouring the bacteria that cause almost a fifth of infections. Furthermore, the litany of cables, pipes and hoses is a dangerous trip hazard, which is extremely risky in a live operating theatre environment. The Department of Health and Human Service s Slip, Trip and Fall Prevention for Healthcare Workers notes that Exposed cords on the floor, stretched across walkways, and tangled near work spaces can The litany of cables, pipes and hoses is a dangerous trip hazard, which is extremely risky in a live operating theatre environment. The Department of Health and Human Service s Slip, Trip and Fall Prevention for Healthcare Workers notes that Exposed cords on the floor, stretched across walkways, and tangled near work spaces can catch an employee s foot and lead to a trip and fall incident. catch an employee s foot and lead to a trip and fall incident. 2 One possible prevention strategy this publication gives is the use of cord organizers to bundle cords. 3 Indeed, such a solution represents an effective way of reducing both the infection and the patient hazard risks. Custom-made, antibacterially coated cable jackets help tidy up cables, make them less likely to harbour bacteria and easier to clean as well. CableJacketz are made from an extremely durable vinyl coated polyester fabric which is Microbial Resistant!, Flame Resistant, Fluid, Mould and Rot proof. Cablejacketz can be custom made to virtually any diameter required in the clinical environment. Using them can save your hospital or laboratory money in three ways. Firstly, they drastically reduce the amount of time your staff spends untangling and cleaning medical hoses, cables and cords. As a result, their use reduces operating room turnover time between cases by 32-40%, whilst also aiding infection control at the same time. Secondly, they protect hoses, cables and cords, increasing the lifespan of these products and therefore reducing equipment costs. Finally, they eliminate tripping hazards medical equipment hoses, cables and cords represent one of the top three trip hazards in the hospital environment. Given that the USA, Workplace Safety & Insurance Board states that an average trip or fall claim costs $11,771, with additional factors such as staffreplacement, lost productivity, and equipment damages increasing this to as much as $47,084, it is crucial to avoid such a significant, unnecessary outlay. Supplied with a 1 year warranty, CableJacketz are a simple solution to an expensive problem. Queen Victoria hospital, East Grinstead, have just purchased multiple Cablejacketz to compliment new anaesthetic trolleys in theatres. The hospital are very pleased with the investment. Stewart Munro Pentland Medical mail@pentlandmedical.co.uk). References [1] NHS Scotland, Utilising data from the Scottish National HAI Prevalence Survey to estimate the risk of HAI from environmental contamination [2] Department of Health and Human Services, Centers for Disease Control and Prevention, and National Institute for Occupational Safety and Health, Slip, Trip, and Fall Prevention for Healthcare Workers, DHHS (NIOSH) Publication Number , p. 24 [3] Ibid.

16 16 Product News Single use no compromise Bailey Instruments Ltd has designed an innovative range of instruments for single use within ENT available via the NHS Catalogue. High precision steel instruments and newly developed plastic equivalents of speculae and tongue depressors are designed specifically to deliver positive patient experience along with precision control for the clinician. The susoltm ENT range has been developed for ENT specialists from the UK healthcare sector to meet such criteria. Simon Charlesworth Business Development Director says Instrument design rarely changes but our design principle is that single use instrumentation offers the opportunity to bring new ideas to instrument design, function and ergonomics. Single use should not mean compromise and should allow the use of improved design and new construction materials. Call or contact to request samples and further information on our range.

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18 18 Product News Interglobal Surgical Interglobal Surgical are the Exclusive UK distributor of MEGADYNE diathermy products. These solutions are simple to use, offer superior value and improve patient safety. How can we improve your operating theatre: MEGADYNE EZ-Clean tips minimise any delays due to eschar build-up, enabling the surgeon to use the lowest power settings to achieve the desired effect, minimising collateral thermal necrosis. Safer, simpler surgery using the MEGADYNE MegaSoft patient return electrode. Recent recipient of Positive Final NICE Guidance. Completely reusable for 2 years the MegaSoft has the potential for cost savings. Improved Safety with reusable laparoscopic electrodes with unique Indicator Shaft technology. Provide a Smoke Free theatre environment, with the quiet and Comfortable MEGADYNE Ultra Vac diathermy smoke evacuation hand piece. Overcoming the many problems of subjective monitoring Wardray Premise was delighted when they were appointed distributor of the TOF Watch in the UK & Ireland. The TOF Watch offers an accurate and reliable method of objective acceleromyographic (AMG) monitoring of neuromuscular blockade. The TOF watch overcomes the problems associated with subjective monitoring. The TOF Watch can accurately measure the depth of neuromuscular blocking agents (NMBAs)to help assess: 1. onset time of NMBAs; 2. the need for administration of maintenance doses of NMBAs; 3. when to administer reversal agent; and 4. when to safely extubate the patient. Full details of Wardray products are available at or contact the Company s Head Office: Tel: ; Fax: and sales@wardraypremise.com

19 19 Report Health Care Supply Association 43rd Conference: Manchester November 2013 The theme for the conference this year was Towards World Class and Simon Walsh, Chairman of the Health Care Supply Association (HCSA) stated that This conference is recognised as the leading networking and knowledge-sharing event for staff from NHS procurement. The aim was to champion and celebrate the work that NHS procurement under take in order to become recognised as world-class in all that they do; particularly with the support they can offer the NHS with regard to improving efficiency and possibly costs related to supplies. There were also a number of suppliers exhibiting at the conference such as NHS Supply Chain, Shawbrook Asset Finance, Pentax UK Ltd, Xenex Healthcare, IntelliCentrics UK Ltd, BravoSolution, 3M Health Care Ltd, Alexandra Plc to name a few. A series of lectures and workshops were delivered over the two days with some very prominent speakers from the HCSA, NHS Procurement and Executive Trust roles such as: Lord Hunt, President of HCSA, Chairman Heart of England NHS Foundation Trust John Warrington, Deputy Director, Procurement Policy and Research, Procurement, Investment and Commercial Division, Department of Health Tony Whitfield, Executive Director of Finance/Deputy Chief Executive, Salford Royal NHS Foundation Trust and President, Healthcare Financial Management Association (HFMA) I had the pleasure of being invited to attend on the 13th November to deliver a talk on Delivering Care on the Front line to a room full of approximately 200 delegates from all levels of NHS Procurement. This session was to give procurement staff an insight as to what the key pressures currently are on nurses and other healthcare professionals and included the impact of the Francis and Keogh Reports, NHS Constitution and changes in education; demographics and economics have on delivery of care. This was received well by the delegates and prompted some questions at the end of the session. In the evening there was a delicious buffet dinner and a quiz organised by members of the HCSA which was enjoyed by delegates, suppliers and organisers. I was privileged to be able to join in the dinner and quiz and was lucky to be on the winning team coming home with a lovely box of chocolates and bottle of wine. I was unable to stay for the second day of the conference but heard that this was a great success as well ending with a gala dinner in the evening. I would like to thank Simon Walsh, Chair of HCSA for their hospitality and the opportunity to share some insight from the frontline perspective to delegates. Sue Lord President, AfPP

20 20 afpp.org.uk Journal of Perioperative Practice P R O C U R E M E N T G U I D E A V A I L A B L E O N L I N E N O W! The Association for Perioperative Practice is a registered charity (number ) and a company limited by guarantee, registered in England (number ). AfPP Ltd is its wholly owned subsidiary company, registered in England (number ). The registered office for both companies is Daisy Ayris House, 42 Freemans Way, Harrogate, HG3 1DH.