The Surgical First Assistant Susan Hall RGN MSc (Clinical Sciences) - - PowerPoint PPT Presentation

The Surgical First Assistant

Susan Hall RGN MSc (Clinical Sciences)

Session objectives

RCS England SFA presentation 2

 T

• provide delegates with an

understanding of the three levels of surgical assistance

 T

• explore the paperwork needed to

establish a Surgical First Assistant Post

 T

• outline the current educational

pathways

• Costs
• Tools

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What do you mean you have to go to the ward NOW!!

Perioperative Care Collaborative

 RCN perioperative forum  AfPP  College of Operating Department Practitioners  British Association of Day Surgery  Independent Healthcare Advisory Service  British Anaesthetic and Recovery Nurses

Association

 +/- co-opted members from other healthcare

groups

 +/- observers from other healthcare groups

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Levels of surgical assistance as outlined by the PCC

 Scrub Practitioner

• Risk assessed minor cases
• nly

 SFA

• Risk assessed
• Role specific Job

Description

• Non interventional

assistance

 SCP

• Risk Assessed
• Role Specific Job Description
• Masters Level education
• Interventional Assistance
• Delegated elements of pre &

post operative care

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Surgical First Assistants (SFAs)

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‘The role undertaken by a registered practitioner who provides continuous, competent and dedicated assistance under the direct supervision of the

• perating surgeon throughout the procedure, whilst

not performing any form of surgical intervention’

Perioperative Care Collaborative 2012

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The Perioperative Care Collaborative (PCC) (2012)

‘The PCC recommends that any perioperative

practitioner who participates in the role of Surgical First Assistant (SFA) must have demonstrable comprehensible skills and an underpinning knowledge beyond the standard level of knowledge expected of a qualified perioperative practitioner.’

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Establishing an SFA post requires:

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 Risk assessment  Robust management and supervisory structure  Update of post-holders’ job descriptions  Collaboration between professional groups  Opportunities to maintain skills

• Relating to area of registration
• SFA specific

 Appropriate educational framework  Clear structure for booking SFA services  Opportunities for CPD  Opportunities for skills assessment

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Legal considerations

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‘if such situations arise where a nurse [sic] is expected to undertake tasks for which she [sic] is not trained, this must ultimately be referred to nurse management. If this proves ineffective then the nurse may need to take advantage of the whistle blower’s protection’

Dimond 2015

Legal considerations (ii)

‘the standard of care of the SCP must be that of the medical role which she [sic] is replacing’

Dimond 2015

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Education and Training

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 NIL  In – house courses  In-house course with academic input from Higher Education

Institutions (HEI)

 AfPP SFA toolkit  AfPP SFA toolkit with academic input from HEI  BSc in Operating Department Practice

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History of the AfPP SFA T

• olkit

 2003 – T

• olkit developed by the National

Association of Assistants in Surgical Practice (NAASP)

 2012 NAASP merged with AfPP  2012 Publication of the Perioperative Care

Collaborative’s position statement on the Surgical First Assistant (SFA)

 2013 AfPP published the Surgical First

Assistant Competency T

• olkit

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Aims of the AfPP SFA T

• olkit

 To facilitate patient safety by:  Providing a training programme containing

clinical and theoretical elements

 Providing a structured framework that will

enable practitioners to build a portfolio of evidence

 Facilitating an understanding of legal and

ethical conflicts and issues of professional accountability

 Providing an appreciation of risk assessment  Exploring the delivery of evidence based care

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Strongly agree 18% Agree 82%

The SFA toolkit is well constructed

Strongly agree 18% Agree 82%

The contents of the toolkit have given me confidence in the SFA role RCS England SFA presentation

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Strongly agree 36% Agree 64%

The contents of the SFA toolkit supported my education & training needs

Strongly agree 9% Agree 82% Neither agree nor disagree 9%

My mentor & Clinical Supervisor found the toolkit easy to use RCS England SFA presentation

Training Costs

 The AfPP SFA T

• olkit
• Members £100
• Non members £130
• TIME

 Academic modules

• £1600
• TIME

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DELEGATION

It is the responsibility of the person delegating the task to ensure that the person to whom they are delegating is suitably:

 Trained  Competent  Sufficiently experienced to

perform the task safely It is the responsibility of the delegating practitioner to ensure that appropriate supervision is provided

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Frequently asked questions

 Can an SFA suture wounds?  Can an SFA inject local anaesthetic into

post surgical wounds?

 Can an SFA operate orthopaedic power

tools?

 Can a perioperative practitioner who is

also an SFA ‘camera hold’ when scrubbed to pass instruments?

 Why not, if I as the consultant am willing to

take responsibility?

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The SFA & 7 – day working

 SFAs remain part of

the theatre team

 Conflict between

staffing of the

• perating list and

provision of surgical assistance

 Non interventional

nature of the work

 Availability to free

surgical trainees for learning

• pportunities

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Take home message

 All institutions anticipating significant

changes to their work pattern should strongly consider increasing its workforce

• f properly trained non medically qualified

surgical assistants

 What will give you most ‘bang for your

buck?

• An SFA?
• An SCP?
• Both?

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References & Resources

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Association for Perioperative Practice, 2013. AfPP voluntary code of professional conduct for registered practitioners working in advancing roles. Harrogate: AfPP. Bolam V Friern Hospital Management Committee (1957). Bolitho V City and Hackney Health Authority (1997). Dimond, B., 2015. Legal Aspects of Nursing. 7th ed. Harlow: Pearson. General Medical Council, 2013. Good Medical Practice. [Online] Available at: www.gmc-uk.org Hall, S., Quick, J., Hall, A. & Jones, A., 2014. Surgical Assistance: who can help?. Annals of Royal College of Surgeons of England (Suppl), July, Volume 96, pp. 244 - 246. Health Care Professions Council, 2015. Aims and vision. [Online] Available at: http://www.hpc- uk.org/aboutus/aimsandvision/ Nursing & Midwifery Council, 2015. The Code: Professional standards of practice and behaviour for nurses and

• midwives. London: NMC.

Perioperative Care Collaborative, 2012. Position Statement. Surgical First Assistant (formerly the 'Advanced Scrub Practitioner'). Perioperative Care Collaborative. Quick, J. & Hall, S., 2014. The Surgical First Assistant: are you compliant?. Journal of Perioperative Practice, September, 24(9), pp. 195 - 198. Quick, J., Hall, S. & Jones, A., 2015. Are you prepared to take the risk: extending governance for perioperative roles. Journal of Perioperative Practice, September, 25(9), pp. 169- 172. Royal College of Surgeons of England, 2011. Surgical Assistants. Position Statement. Royal College of Surgeons of England, 2014. Good Surgical Practice. London: Royal College of Surgeons of England. Wilsher v Essex Health Authority [1988] 1 AC 1074 (1988).