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  T o provide delegates with an understanding of the three levels of surgical assistance  T o explore the paperwork needed to establish a Surgical First Assistant Post  T o outline the current educational pathways ◦ Costs ◦ Tools RCS England SFA presentation 2

What do you mean you have to go to the ward NOW!! RCS England SFA presentation 3

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 RCS England SFA presentation 4

Levels of surgical assistance as outlined by the PCC  SCP  Scrub Practitioner ◦ Risk Assessed ◦ Risk assessed minor cases only ◦ Role Specific Job Description  SFA ◦ Masters Level education ◦ Risk assessed ◦ Interventional Assistance ◦ Role specific Job Description ◦ Delegated elements of pre & post operative care ◦ Non interventional assistance RCS England SFA presentation 5

Surgical First Assistants (SFAs) ‘The role undertaken by a registered practitioner who provides continuous, competent and dedicated assistance under the direct supervision of the operating surgeon throughout the procedure, whilst not performing any form of surgical intervention’ Perioperative Care Collaborative 2012 RCS England SFA presentation 6

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 .’ RCS England SFA presentation 7

Establishing an SFA post requires:  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 RCS England SFA presentation 8

Legal considerations ‘ 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 RCS England SFA presentation 9

Legal considerations (ii) ‘the standard of care of the SCP must be that of the medical role which she [sic] is replacing’ Dimond 2015 RCS England SFA presentation 10

Education and Training  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 RCS England SFA presentation 11

History of the AfPP SFA T oolkit  2003 – T oolkit 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 oolkit RCS England SFA presentation 12

Aims of the AfPP SFA T oolkit  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 RCS England SFA presentation 13

The SFA toolkit is well constructed Strongly agree 18% Agree 82% Strongly agree 18% Agree 82% The contents of the toolkit have given me confidence in the SFA role RCS England SFA presentation 14

The contents of the SFA toolkit supported my education & training needs Strongly agree 36% Agree 64% Neither agree nor disagree Strongly agree 9% 9% Agree 82% My mentor & Clinical Supervisor found the toolkit easy to use RCS England SFA presentation 15

Training Costs  The AfPP SFA T oolkit ◦ Members £100 ◦ Non members £130 ◦ TIME  Academic modules ◦ £1600 ◦ TIME RCS England SFA presentation 16

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 RCS England SFA presentation 17

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? RCS England SFA presentation 18

The SFA & 7 – day working  SFAs remain part of  Non interventional the theatre team nature of the work  Conflict between  Availability to free staffing of the surgical trainees for operating list and learning provision of surgical opportunities assistance RCS England SFA presentation 19

Take home message  All institutions anticipating significant changes to their work pattern should strongly consider increasing its workforce of properly trained non medically qualified surgical assistants  What will give you most ‘bang for your buck? ◦ An SFA? ◦ An SCP? ◦ Both? RCS England SFA presentation 20

References & Resources 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). RCS England SFA presentation 21