SINGING FROM THE SAME HYMN SHEET Address to SATS Study Day 29 June 2013 Dr Sue Armstrong

WHAT IS THE PROBLEM? “There seem to be great differences in certain standard procedures such as “Swab counting” that are practiced in the different Government and Private hospitals. This causes confusion, and risks to staff and patients.”

What is the difference between standards and standardization? A standard is an ideal or exemplar that carries some authoritative weight and is used for the purpose of comparison. Standardization is the “best application of consentual wisdom in order to promote coordination and mutually consistent decisions.”

ROLE AS THEATRE NURSE Maintaining the safety of patients Talking to or reassuring patients Preserving the patient’s dignity Making patients comfortable Mardell A (1998) How theatre nurses perceive their role: a study. Nursing Standard. 13, 9, 45-47

Maintaining the safety of patients Creating a standard for this aspect Deciding how it will be measured

WHAT IS A STANDARD? A standard is an ideal or exemplar that carries some authoritative weight and is used for the purpose of comparison.

WHAT ARE CRITERIA? Criteria are items or variables which enable the achievement of a standard and the evaluation of whether it has been achieved or not.

WHAT IS AN INDICATOR? An indicator is a measurement tool which has a reference point against which value judgments can be made.

Group think Create a standard for the maintenance of patient safety A standard must have a subject; an activity and a condition or reason.

Standardization of these elements Who decides? What level of standardization? Is it necessary only when a product or process is introduced or always? How do we make sure it happens – or should we?

Standards, guidelines & protocols “Practice guidelines are necessary, written policies responsible for maintaining order & facilitating the smooth running of the operating theatre environment.” Dousis et al 2008

Clinical practice guidelines Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (Institute of Medicine, 1990).

Clinical practice guidelines They define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients. The statements contain recommendations that are based on evidence from a rigorous systematic review and synthesis of the published medical literature.

The purpose of guidelines to help clinicians and patients make appropriate decisions about health care. Guidelines attempt to do this by: Describing a range of generally accepted approaches for the diagnosis, management, or prevention of specific diseases or conditions.

The purpose of guidelines Defining practices that meet the needs of most patients in most circumstances. The recommendations are not fixed protocols that must be followed. Responsible clinician's judgment on the management of patients remains paramount. Clinicians and patients need to develop individual treatment plans that are tailored to the specific needs and circumstances of the patient.

Protocol Specific guidelines peculiar to a particular health care institution.

The reality of the situation Nurses trained in different NEI’s Agency nurses Stock and equipment changes Evidence changes

Principle based nursing A principle is a law or rule that has to be, or usually is to be followed, or can be desirably followed,lawrule or is an inevitable consequence of something, such as the laws observed in nature or the way that a system is constructed.

Principle based nursing The principles of such a system are understood by its users as the essential characteristics of the system, or reflecting system's designed purpose, and the effective operation or use of which would be impossible if any one of the principles was to be ignored.

Where to from here?

Questions / suggestions Thank you