Variability in local pressures under digital tourniquets

2013 ◽  
Vol 39 (6) ◽  
pp. 637-641 ◽  
Author(s):  
S. D. Middleton ◽  
P. J. Jenkins ◽  
A. Y. Muir ◽  
R. E. Anakwe ◽  
J. E. McEachan
Keyword(s):  
Force Sensor ◽  
Pressure Effects ◽  
Application Time ◽  
Surgical Glove ◽  
Surgical Gloves ◽  
National Patient Safety Agency ◽  
National Patient ◽  
Safe Limits ◽  
Local Pressures ◽  
The Uk

The UK National Patient Safety Agency issued a rapid response report in 2009 following reports of complications related to digital tourniquet use and inadvertent retention. In their guidance, they recommend the use of CE marked digital tourniquets and advise against the use of surgical gloves. There are a number of different commercially available non-pneumatic digital tourniquets, but little clear data relating to their comparable physical properties, clinical efficacy or safety. The aim of this study was to investigate the variability of pressures exerted by non-pneumatic digital tourniquets. A Tekscan FlexiForce® force sensor was used to measure applied force and to calculate the surface pressures under: the Toe-niquet™; T-Ring™ and surgical glove ‘roll down’ tourniquets in finger models. The lowest mean pressures were produced by the larger glove sizes (size 8) (25 mmHg), while the highest pressures were produced by the Toe-niquet (1560 mmHg). There was a significant overall difference in pressures exerted under tourniquets when comparing tourniquet type ( p<0.001) and finger size ( p<0.001) with these techniques. It is difficult to anticipate and regulate pressures generated by non-pneumatic tourniquets. Safe limits for application time and surface pressures are difficult to define. Further work is required to model the pressure effects of commercially available digital tourniquets and to identify which are most effective but safe.

scholarly journals Alcohol skin preparation causes surgical fires

2012 ◽  
Vol 94 (2) ◽  
pp. 87-89 ◽  
Author(s):  
B Rocos ◽  
LJ Donaldson
Keyword(s):  
Fire Risk ◽  
World Health ◽  
Training Curriculum ◽  
Skin Preparation ◽  
Us States ◽  
National Patient Safety Agency ◽  
The Us ◽  
National Patient ◽  
Health Organization ◽  
The Uk

INTRODUCTION Surgical fires are a rare but serious preventable safety risk in modern hospitals. Data from the US show that up to 650 surgical fires occur each year, with up to 5% causing death or serious harm. This study used the National Reporting and Learning Service (NRLS) database at the National Patient Safety Agency to explore whether spirit-based surgical skin preparation fluid contributes to the cause of surgical fires. METHODS The NRLS database was interrogated for all incidents of surgical fires reported between 1 March 2004 and 1 March 2011. Each report was scrutinised manually to discover the cause of the fire. RESULTS Thirteen surgical fires were reported during the study period. Of these, 11 were found to be directly related to spirit-based surgical skin preparation or preparation soaked swabs and drapes. CONCLUSIONS Despite manufacturer's instructions and warnings, surgical fires continue to occur. Guidance published in the UK and US states that spirit-based skin preparation solutions should continue to be used but sets out some precautions. It may be that fire risk should be included in pre-surgical World Health Organization checklists or in the surgical training curriculum. Surgical staff should be aware of the risk that spirit-based skin preparation fluids pose and should take action to minimise the chance of fire occurring.

5 Standard iv infusion concentration in paediatric and neonatal units: a national survey

2018 ◽  
Vol 103 (2) ◽  
pp. e2.45-e2
Author(s):  
Nanna Christiansen
Keyword(s):  
Patient Safety ◽  
National Survey ◽  
Response Rate ◽  
Improve Patient Safety ◽  
National Standards ◽  
List Type ◽  
National Patient Safety Agency ◽  
National Patient ◽  
National Consensus ◽  
The Uk

AimThe National Patient Safety Agency in the UK has advocated the use of standard concentration (SC) infusions to improve patient safety and care.1 National standards have been adopted for infusions in the adult critical care setting however practice in paediatric and neonatal settings still varies and presents a challenge.2,3 This study is part of a multi-professional collaborative working towards a national consensus on SC infusions in paediatric and neonatal care. The study aims to explore the practice of standardised concentration usage for Intravenous (IV) infusions in paediatric and neonatal units in the UK, specifically:How many units use standardised concentration for IV infusions.Evaluate the variation and overlap of continuous IV infusion concentrations in practice.Assess what devices are used to administer these infusions.How standardised infusions are provided.MethodThe study used a quantitative descriptive survey design via an online self-administered questionnaire. Paediatric and neonatal intensive care units in the UK were surveyed through pharmacy, nursing, and medical networks to describe current practice. Data was collected for 25 days and analysed using SPSS.ResultA total of 194 NICUs and 39 PICUs were surveyed. Responses were received from 71 units: NICU 46 (65%); PICU 17 (24%) and 8 other (11%), giving an overall response rate of 30.5%.Twenty-eight units (40%) have established SC for IV infusions, 18 units provided information on presentation of SC infusions. Forty-six different medication infusions were standardised. Considering the differences in concentration, weight-bands, diluents, volume and presentation, there were 273 variations for these drugs. Taking only the concentration into account, there were 137 variations presented. The average number of variations per medication was 3 (range 1 to 14).15 units (53.6%) use ‘smart’ pumps for administration of SC infusions and 3 (10.7%) use other computer software for infusion rate calculations. Infusions are most commonly prepared on wards (81.3%) or in pharmacy (12.3%).ConclusionThe study is limited by the response rate; however the results suggest that 59% of paediatric and neonatal units in the UK use conventional weight-based methods for IV infusions. A third of units have established some SC with a wide variation of concentrations in this sample. Just over half of the units use ‘smart’ pump technology and over three quarters of SC infusions are prepared on the ward.Further data collection is required to acquire a fuller picture of SC infusions used in UK PICUs and NICUs. This data can then be used as the basis of a national consensus statement on SC infusion, facilitating adoption across the NHS.ReferencesNPSA Patient Safety Alert 20: Promoting safer use of injectable medicines2007. London: The National Patient Safety Agency.MacKay MW, Cash J, Farr F, et al. Improving paediatric outcomes through intravenous and oral medication standardisation. J Pediatr Pharmacol Ther2009;14:226–35.Phillips MS, Standardising IV. Infusion concentrations: National survey results. Am J Health Syst Pharm2011;68:2176–82.

Administration of Oral Medication

Nursing OSCEs ◽  
2012 ◽  
Author(s):  
Fiona Creed
Keyword(s):  
Primary Care ◽  
Primary Care Trust ◽  
Medication Administration ◽  
National Patient Safety Agency ◽  
Medication Administration Errors ◽  
National Patient ◽  
Medicine Administration ◽  
The Uk ◽  
Risk Processes ◽  
Professional Judgement

Medication administration is a key skill and it is vital that you are able to demonstrate safety in all aspects of the medication administration process in order to avoid harm or death to your patient. The NMC (2004, 2010) reiterates this point, highlighting that the administration of medicines is an important aspect of a nurse’s professional practice. They argue that it is not simply a mechanistic task, but one that requires thought, exercise and professional judgement. Studies suggest that medicine administration is one of the highest risk processes that a nurse will undertake in clinical practice (NPSA 2007b; Elliot and Lui 2010). Medication administration errors are one of the most common errors reported to the National Patient Safety Agency (NPSA). Indeed in a 12-month period in 2007, 72,482 medication errors were reported with 100 of these causing either death or severe harm to the patient (NPSA 2009). The frequency of these errors has led to a number of changes in the medication administration process. Alongside these important recommendations, most higher education establishments will want to ensure safety of medicine administration and may test this vital skill using an OSCE to ensure that you are adequately prepared for safe administration of medication in practice. There are a number of important laws and key documents that relate to the administration of medication and it is important that you understand these as they all impact upon your practice when administering medication to a patient. You may also be tested on your knowledge in relation to these areas so it is important that you have read these. Important documents you will need to know include: ● The laws that relate to medication in the UK, ● NMC Standards for Medicines Management (2010) (www.nmc-uk.org), ● Local policies related to hospital/Primary Care Trust (PCT) regulation of medication (refer to local guidance). There are a number of laws that influence the manufacturing, prescription, supply, storage and administration of medication. Whilst you will not need to study the intricacies of these laws you will need to understand the main issues each law covers.

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