- POLICY FOR SCRUB PRACTITIONERS UNDERTAKING THE DUTIES OF SURGICAL FIRST ASSISTANT. (Formerly the Advanced Scrub Practitioner or First Assistant to Surgeon ). Approved By: Date First Approved: 11 th July 2005 Trust Reference: B23/2005 Version: Supersedes: Author / Originator(s): Name of Responsible Committee/Executive Director: Policy and Guideline Committee V3 Latest Review Date May 2016 Next Review Date: May 2019 Policy for Scrub Practitioners Undertaking the Duties of a First Assistant or Advanced Scrub Practitioner 2005 Jo Hollidge Head of Nursing Jane Aires ODP Practice Development Coordinator Justine Cadwallader ITAPs Education Lead Jo Hollidge Head of Nursing and Phil Walmsley Interim CMG Manager 1
CONTENTS Section 1. Introduction 3 2. Policy Aims / Statement of Intent 3 3. Policy Scope 3 4. Definitions of Role 4 5. Roles and Responsibilities 4 6. Policy Statements, Standards, Procedures 6 6. Policy Summary for Scrub Practitioners undertaking the role of Surgical First Assistant 7. Education and Training Requirements 7 8 Process for Monitoring Compliance 8 9. Equality Impact Assessment 9 10. Legal Liability 9 11. Supporting References, Evidence Base and Related Policies 9 12. Process for Version Control, Document Archiving and Review 10 Page 7 Appendices Available from the ITAPS education team and stored on the ITAPS & CSI education team shared drive. One Two Surgical First Assistant Competency Package Surgical First Assistant Log book Three Surgical First assistant Competency Package and Log Book Completion Statement Review Section Due to the changes in practice and the 2012 Peri Operative Collaborative Position Statement re Surgical First assistant (formally the Advanced Scrub Practitioner) this policy, which has undergone a major re-write, needs to be read as a new policy and not a revision of the 2005 policy due to the 2011 Royal College of Surgeons of England call for greater clarity in relation to titles and roles of practitioners assisting surgeons. KEY WORDS Surgical First Assistant, Scrub Practitioner 2
INTRODUCTION 1.1 This policy sets out the University of Leicester (UHL) NHS Trust s Policy and Procedures for the adherence to the Perioperative Care Collaborative Position Statement to call for greater clarity in relation to roles and responsibilities of Surgical First assistants. 1.2 It enables a standardised way of working across all Surgical First Assistants within the Trust to ensure they provide competent and dedicated assistance under the direct supervision of the operating surgeon throughout surgical procedures; whilst not performing any form of surgical intervention. 1.3 The policy distinguishes the role from that of the scrub practitioner who may provide assistance on an as required and risk assessed basis for minor procedures, within the context of and without compromise to the scrub role. 1.4 The policy defines that the Surgical First Assistant must be aware of their own and others accountability when performing the role. 2 POLICY AIMS / STATEMENT OF INTENT This policy aims to: 2.1.1 Ensure that safe standards of practise are adhered to by all staff within UHL undertaking the role of Surgical First Assistant. 2.1.2 Ensure patient safety by identifying that all Surgical First assistants (SFA) must have successfully achieved a programme of study that has been benchmarked against nationally recognised competencies; underpinning the knowledge and skills required for the role. 2.1.3 The Surgical First Assistant role within UHL will only be undertaken by a Registered Nurse or Registered Operating Department Practitioner (ODP) who has successfully completed the SFA modules via a local accredited University or via the accredited UHL in house course. 2.1.4 Assistant Surgical Practitioners/Advanced HCAS must not undertake this role. 2.1.5 The Nurse or ODP acting as the scrub Practitioner must manage the intra operative care required by the patient and must not assume the additional duties of the SFA. Minor surgery can be risk assessed on a case by case basis to consider if the dual role is safe to undertake to ensure patient safety. 2.1.6 The Surgical First Assistant role is to only be undertaken as described within this policy in line with the Perioperative Care Collaborative Position Statement. 2.1.7 The Surgical First Assistant role is limited to the above and it must not get confused with the Surgical Assistant role which is a dedicated role undertaken at Masters level and sits within the direct management of the specific surgical teams. 3 POLICY SCOPE 3.1 This policy applies to those that can occupy the role of the Surgical First Assistant. The role can been undertaken by Registered Nurses/Midwifes, Operating Department Practitioners/third year student Operating Department Practitioners and Dental Nurses who are employed by the University Hospitals of Leicester NHS Trust working within the operating departments. 3
4 DEFINITION OF ROLE 4.1 Scrub Practitioner The term for the authorised professional, who assists the Operating Surgeon, handing the surgical instruments and other items. In practice this role is performed by a registered practitioner who can be a Registered Nurse, Midwife, Operating Department Practitioner and Health Care Assistants who have undertaken the extended scrub role. This can also include students working under the direct supervision of a registered practitioner. 4.2 Scrub Practitioner with additional completed competencies A scrub practitioner who simultaneously dual roles between the handling of surgical instruments and other items, providing assistance to the operating surgeon, under their direct supervision throughout a minor surgical procedure as agreed by prior risk assessment. This role requires documented completion of agreed objectives within the scrub log book and final sign off with the proficiency statement. 4.3 Surgical First Assistant: The SFA can be defined as the role undertaken by a registered practitioner who provides continuous, competent and dedicated assistance under the direct supervision of the operating surgeon throughout a surgical procedure, whilst not performing any form of surgical intervention. This role can be undertaken after completion of appropriate training. 5 ROLES AND RESPONSIBILITIES 5.1 The Executive Lead for this policy is Julie Smith, Chief Nurse 5.2 Clinical Management Group Senior Management Team are responsible for: 5.2.1 Ensuring that all staff who wish to undertake this role are made aware of this policy 5.2.2 Ensuring staff who are undertaking this role have complied with the application process 5.2.3 Ensuring that all registered Practitioners within the CMG have the appropriate education and competence to safely carry out the SFA role 5.2.4 Ensuring all SFA s competencies are recorded on Euhl upon completion. 5.2.5 Ensuring compliance with any associated audit of clinical practice, appraisal and competence 5.3 Matron/Theatre Team Leaders are responsible for: 5.3.1 Ensuring patient safety within the operating theatre environment by making sure that authorised staff have received the appropriate training, supervised practice and assessment of competence in the role of the SFA. 5.3.2 Through the appraisal process ensure that accurate and up to date log books recording the SFA activities are held and completed by the staff carrying out the role. Should the practitioners Personal Development Plan (PDP) highlight deficiencies in practice the Trust has a right to stop any practice that it may deem unsafe until such 4
a time that the practitioner can provide evidence that they have updated and brought their practice up to those standards recognised by the Trust. 5.3.3 Contribute to all audit requirements 5.3.4 Should the service be abused, in relation to the supplying of a SFA, it will be at the Matrons discretion to withdraw the support from those who are not seen as using the service appropriately. 5.4 Practitioners undertaking the role of Surgical First Assistant are responsible for: 5.4.1 The practitioner will be required to take appropriate action to attain the roles and responsibilities laid down by the Perioperative Care Collaborative (PCC) position statement and the Royal College of Surgeons (Table 1) and the expectation of the trust stated within this policy 5.4.2 Requesting authorisation from their Team Leader to undertake the SFA role. 5.4.3 Maintaining competence and undertake any refresher training as necessary. 5.4.4 Maintaining a logbook of the cases with which they have been involved as a SFA they must be willing to surrender this to the Trust when requested. 5.4.5 SFA can transfer their skills to new specialities following agreed educational development support. This should normally include ensuring that general scrub competencies for new specialities are completed as a foundation before the expansion into the SFA role. 5
6 POLICY STATEMENTS, STANDARDS AND PROCEDURES 6.1 Table 1 sets out a number of explicit roles and responsibilities Table 1: Comparison between the roles and responsibilities of the scrub practitioner and Surgical First Assistant. Roles and responsibilities Enhancing the communication link between theatre, patient and ward, including preoperative assessment and postoperative care evaluation Involved in the team completion of the Surgical Safety Checklist team brief and debrief Assisting with patient positioning, including tissue viability assessment Scrub Practitioner Surgical First Assistant Skin preparation prior to surgery Draping as required Application of dressings as required Male urethral catheterisation, providing training has been undertaken and evidence of competency can be displayed Use and maintenance of specialised surgical equipment relevant to area of working Assist in the transfer of patient to postoperative anaesthetic care unit Cutting of superficial sutures e.g. skin sutures Superficial skin and tissue retraction Assistance with superficial wound closure Cutting of deep sutures and ligatures under direct supervision of the operating surgeon - Nerve and deep tissue retraction (NB retractors should not be placed by the SFA but by the operating - surgeon) Handling of tissue and manipulation of organs for exposure or access - Assisting with haemostasis in order to secure and maintain a clear operating field including indirect - application of surgical diathermy by the surgeon Use of suction as guided by the operating surgeon - Camera manipulation for minimal invasive access surgery - Assistance with wound closure - 6
6.2 POLICY SUMMARY FOR SCRUB PRACTITIONERS UNDERTAKING THE ROLE OF SURGICAL FIRST ASSISTANT The following policy summary affects all practice within all theatre areas within the Trust. To be used in departments in conjunction with the main policy attached. 1. Provision of a Surgical First Assistant (SFA) is at the Matrons or their designates discretion. It is dependent on the department having adequate and safe skill mix on the day, in each theatre. Consideration has to be made regards all other service needs required by theatres. The scrub practitioner undertaking the role of SFA must be an additional member of the theatre team. 2. Should the service be abused, in relation to the supplying of SFA, it will be at the Matrons discretion to withdraw the support from those who are not seen as using the service appropriately. 3. All practitioners must have attained the appropriate competencies to carry out the role of SFA through a Trust recognised institution. Presently these are the University Hospitals of Leicester NHS Trust in partnership with De Montfort University OR the UHL in-service competency package, with accompanying log book. 4. The practitioner is accountable for their actions at all times in accordance to their relevant Professional Code of Conduct. They must always act to identify and minimise any risk and maintain their duty of care to the patient. 5. The practitioner should not undertake a role that they do not feel competent to perform. 6. SFA can transfer their skills to new specialities following agreed educational development support. This should normally include ensuring that general scrub competencies for new specialities are completed as a foundation before the expansion into the SFA role. 7. As per scrub competency log book, the SFA role can be undertaken for the procedures outlined by the framework. Each practitioner must complete the full log for their speciality prior to undertaking the SFA training and SFA competency package. 8. The practitioner may not participate as an SFA in anything deemed as invasive or participate in procedures outside of those detailed in the table in section 3 of this policy summary. The Trust will not take vicarious accountability or responsibility for those practitioners who decide to practice outside of the competences deemed as safe practice within the role of SFA. 7 EDUCATION AND TRAINING REQUIREMENTS 7.1 Nurses / Midwives/ Operating Department Practitioners preparing for this expanded role will undertake advanced training and assessment under the supervision of a Consultant Surgeon. 7.2 Prior to undertaking the role of SFA, successful completion of a Higher Education Institute module - Advanced Scrub Practitioner (formerly First Assistant to Surgeon) which is recognised by the University Hospitals of Leicester NHS Trust or successful completion of the UHL in-service competency package and logbook or appropriate equivalent evidence (dental nurses only). 7
7.3 The practitioner must accept responsibility for updating knowledge, skills and competence required in order to fulfil the role and keep an active logbook. 7.4 The practitioner must accept full responsibility and accountability of the role. 7.5 Be familiar with and demonstrate an understanding of the following appropriate documents, The Perioperative Care Collaborative position statement, Surgical First Assistant (PCC 2012) HCPC Standards of conduct, performance and ethics. (HCPC 2012), NMC Standards of conduct, performance and ethics. (NMC 2008). 8 PROCESS FOR MONITORING COMPLIANCE Element to be monitored SFA must have completed training and associated competencies as identified in the policy Lead Tool Frequency Reporting arrangements Consultant Surgeon/H on/ Lead Nurse / Matron and Team Leader Appraisal Completion of taught training and Competency packs. Annual with mid-point review. Complete up to one year. Reported to HR / workforce Reported locally at CMG meetings, education and practise meetings and appraisals. Lead(s) for acting on recommendations HoN/Matrons/ Team Leaders Team Leaders/Deputies. Education Team report to TAPS Board. Change in practice and lessons to be shared HR report to ltaps CMG Board and Matrons meeting/ Professional report to CMG Board and Matrons meeting Incident reviews. Weekly Reported via TAPS CMG board and Quality meeting As above As above SFA must be undertaken by the appropriate personnel identified in the policy. DHON, Lead Nurse and CMG Education Team Completion of band 5 Theatre Competency package and Scrub Competency Assessment. Complete up to one year. Reported locally at site meetings, education and practise meetings and appraisals. Team Leaders/Deputies. Education Team report to TAPS CMG Board. Team Leader / Matron Meeting Logbook audit DHON, Lead Nurse and Team Leader Appraisal Annually Reported locally at site meetings, education and practise meetings and appraisals. Team Leaders/Deputies. Education Team report to TAPS CMG Board Team Leader / Matron Meeting and CMG Education Team 8
9 EQUALITY IMPACT ASSESSMENT The Trust recognises the diversity of the local community it serves. Our aim therefore is to provide a safe environment free from discrimination and treat all individuals fairly with dignity and appropriately according to their needs. As part of its development, this policy and its impact on equality have been reviewed and no detriment was identified. 10 LEGAL LIABILITY The Trust will generally assume vicarious liability for the acts of its staff, including those on honorary contract. However, it is incumbent on staff to ensure that they: Have undergone any suitable training identified as necessary under the terms of this policy or otherwise. Have been fully authorised by their line manager and their Directorate to undertake the activity. Fully comply with the terms of any relevant Trust policies and/or procedures at all times. Only depart from any relevant Trust guidelines providing always that such departure is confined to the specific needs of individual circumstances. In healthcare delivery such departure shall only be undertaken where, in the judgement of the responsible clinician it is fully appropriate and justifiable - such decision to be fully recorded in the patient s notes. It is recommended that staff have Professional Indemnity Insurance cover in place for their own protection in respect of those circumstances where the Trust does not automatically assume vicarious liability and where Trust support is not generally available. Such circumstances will include Samaritan acts and criminal investigations against the staff member concerned. Suitable Professional Indemnity Insurance Cover is generally available from the various Royal Colleges and Professional Institutions and Bodies. For further advice contact: Head of Legal Services on 0116 258 8960 11 SUPPORTING REFERENCES, EVIDENCE BASE AND RELATED POLICIES 11.1 This policy has been reviewed and revised in line with the latest NHSLA Guidance - NHSLA Risk Management Standards for NHS Trusts providing Acute, Community, or Mental Health & Learning Disability Services and Independent Sector Providers of NHS Care 2011/12; Version 1; published by the NHS Litigation Authority January 2012. Also using the NHSLA s suggested template Policy for the Development and Implementation of Procedural Documents (RM08) published March 2008. 11.2 Related Policies a) Equal Opportunities Policy b) UHL Clinical Audit Policy The contents of this policy reflect best practice and amalgamation of professional guidance from national bodies representing Surgeons, Anaesthetists, Operating Department Practitioners and Nurses (see references to these documents). 9
The policy will be reviewed no less that every 2 years or sooner in response to any clinical risk issues identified. References Perioperative Care Collaborative November (2012). Position statement Surgical First Assistant (formerly the Advanced Scrub Practitioner ). Health and Care Professions Council (2016). Standards of Conduct, Performance and Ethics. Nursing Midwifery Council (2015). The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives. Health and Care Professions Council (2012). Standards of Proficiency Operating Department Practitioners. Related Policies UHL Policy for the Radiological Identification and Location of Misplaced Theatre Swabs and Other Items (Trust Reference C110/2005) UHL Surgical Safety Policy (Trust Reference B40/2010) UHL Policy and Procedures Cleaning and Decontamination for Infection Prevention and Control (Trust Reference B5/2006) UHL NHS Trust Hand Hygiene Policy (Trust Reference B32/2003) UHL NHS Trust Personal Protective Equipment for Infection Prevention Guideline (Trust Reference B10/2012) UHL NHS Trust Waste Management Policy (Trust Reference A15/2002) 12 PROCESS FOR VERSION CONTROL, DOCUMENT ARCHIVING AND REVIEW 12.1 This document will be uploaded onto SharePoint and available for access by Staff through INsite. It will be stored and archived through this system. 12.2 This Policy will be reviewed every three years or sooner in response to clinical or risk issues.. 10
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