THE ROLE OF THE SPECIALIST NURSE IN PAEDIATRIC CATARACT SURGERY

1. THE ROLE OF THE SPECIALIST NURSE IN PAEDIATRIC CATARACT SURGERY Glenda Lucia Morales Bajar Ophthalmology Clinical Nurse Specialist University Hospital Coventry and Warwickshire NHS Trust, UK

2. Learning outcomes for theatre nurses 1. Discuss the role and responsibilities of an Specialist Ophthalmic Nurse (SON) in providing safe care 2. To become aware of Risk assessment and safety culture in Theatre i.e. biometry measurements, IOL checks, WHO checklist. 3. Maintain a safe and clean working environment 4. Communicate clearly – verbally and written and to maintain therapeutic communication to patients. 5. Carrying out scrubbing role competently 6. Work within the confines of the law/ policies 7. Report any issues/concerns and document 8. Apply evidence based care and the 6 C’s.

3. Overview of nurses' role in the operating theatre • Prepare theatre environment for surgery • Ensure availability of equipment / instruments • Ensure equipment in safe working order • Risk assessment environment e.g. temperature • Reduction of risks & control of infection – maintain asepsis and aseptic practice in operating theatre. • Sound knowledge & skills (competency). • Education & assessment of staff: on-going • Effective communication - address patients’ concerns - record keeping/ documentation • Evidence based care including research / rationale • Clinical Audit - standard monitoring

4. Priorities of SON: • Improve safety • Improve quality • Improve efficiency • Reduce waiting • Cope with high demands • Monthly audits • Achieve financial stability

5. Patient journey in the operating theatre • Holding bay / patient sitting area • Anaesthetic room • Operating theatre • Recovery room or • Back to ward or Day Unit

6. Paediatric Ophthalmic theatre set-up: • All procedures performed under GA • Always first on the operating list are the youngest ones , IF NOT a dedicated paediatric ophthalmic list • Parent / carer and nurse in anaesthetic room during induction • Normally gas induction

7. Role of nurse during peri-operative stage: • Professional judgement & critical thinking • Technical knowledge To help: • Plan, implement & evaluate patient care • Monitor patient’s physical and emotional wellbeing • Informed consent • Assess any risks • Manage resources

8. Role of nurse during peri-operative stage: • Maintain sterile environment • Promotes health to patient - reduce patient’s anxiety - constant re-assurance - health promotion • Sterile role – scrub nurse • Unsterile role – Assist multi-disciplinary team during surgical procedure • Recovery of patient

9. Safety Precautions and Hazards • Hazards: sharps e.g. Blades, needles, drugs, Laser • General Safety Precautions: • Theatre apparel • Shoes non-slip, antistatic • Safe disposal of sharps and waste • Ventilation within ranges • Scavenging – gasses • Equipment maintenance • PPE

10. Seven Steps to Patient Safety • Build a safety culture – Team Briefing, WHO checklist (brief, sign-in, time-out, sign-out), Trust/Departmental policy, guidelines. • Lead and support your staff – education and training, collaboration, effective clear communication, good leadership • Integrate your Risk Management activity – risk assessment: staffing/skill-mix, surgical consent, operative marking • Promote reporting - DATIX • Involve and communicate with patients and the public – Duty of Candour • Learn and share safety lessons - Governance • Implement solutions to prevent harm - protocols

11. SURGICAL NEVER EVENTS • Development of NatSSIPs • concept of “Never Events” – UK 2009 – list of 8 adverse patient safety events serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented • core surgical Never Events: wrong site surgery and retained instrument post-operation • 2010 Never Events Framework extended the scope to include retained swabs and throat packs; Mandatory introduction of the WHO Surgical Safety Checklist. • 2012 - The Never Events policy framework added a third core surgical Never Event (wrong implant/prosthesis) and redefined the retained instrument event as “retained foreign object post-operation”.

12. SURGICAL NEVER EVENTS • 2013, NHS England’s Surgical Services Patient Safety Expert Group commissioned a Surgical Never Events Taskforce • The report, published in 2014, NatSSIPs/LocSSIPs • Never events data: https://improvement.nhs.uk/resources/never-events-data

13. Reported never events in ophthalmic theatres

14. The introduction of the WHO Safer Surgery Checklist was a great step forward in the delivery of safer care for patients undergoing operations-

15. Biometry: What to look for ?

16. The smooth running of the theatre list: • Teamwork - multidisciplinary • Leadership – building and strengthen – skilled • Patient centered care – concerns addressed • Effective communication / verbal, written, body language • Happy staff (confident, good morale) • Culture of learning / training • Right skill mix • Audit – measure quality and impact of care

17. Compassion in Practice - DHNursing, Midwifery and Care Staff Our Vision and Strategy Commitment Care Courage PATIENT Compassion Communication Competence

18. Reference list: • The association for Perioperative Practice (2013) Sharps: Guide to best practice for safe handling of surgical sharps. Harrogate: AfPP. • Care Quality commission (2016) The fundamental standards. Online available from: www.cqc.org.uk/content/fundamental-standards. Assessed August 2018. • Care Quality Commission (CQC) (2015) Regulation 20: Duty of Candour. Available at http://www.cqc.org.uk/sites/default/files/20150327_duty_of_candour_guidance_final.pdf (Accessed: August 2018) • Dampies L (2009) Ophthalmic theatre practice In Watkinson S (2009) Issues in ophthalmic practice: Current and future challenges. Keswick, Cumbria: M&K Publishing. • Department of Health (2001) Building a safer NHS for patients. Implementing an organisation with a memory. On-line available from: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4058094.pdf. Accessed 2019. • Department of Health (2012) Compassion in Practice. Nursing, Midwifery and Care staff. Our Vision and Strategy. On-line available from: www.commissioningboard.nhs.uk. Accessed 2019. • National Reporting and Learning System (NRLS) (2003). Available at http://www.nrls.npsa.nhs.uk/report-a-patient-safety-incident/about-reporting-patient-safety-incidents (Accessed: 28 February 2018). • NHS Improvement (2015) National Safety Standards for Invasive Procedures (NatSSIPs). Available at https://improvement.nhs.uk/resources/national-safety-standards-invasive-procedures (Accessed: 23 February 2018). • NHS Improvement (2018) Never Events reported as occurring between April 2016 and 31 March 2017 – final update. Available at https://improvement.nhs.uk/resources/never-events-data (Accessed: 28 February 2018). • Rothrock J.C (2010) Alexander’s care of the patient in surgery. 14th edition. St Louise Missouri: Elsevier Mosby • Safer Surgery in Ophthalmic Theatres. Powerpoint presentation of Raquel Villanueva (2019) • Stollery R (2003) Ophthalmic Nursing. 2nd Edition. Oxford: Blackwell Science Ltd.

19. Thank you