A CLINICAL GOVERNANCE

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A CLINICAL GOVERNANCE FRAMEWORK FOR THE
DEVELOPMENT OF THE ADVANCED SCRUB PRACTITIONER
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Setting The Scene

• Risks including the dual role
• Current Guidance
• Definition
• Your own accountability
• Employers responsibilities

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NATN Guidance
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Reflection
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Have I failed in my duty of care to the patient?
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The main issues of concern include

• Clarification on the role and definition of the
  First assistant
• Legal implications of the Dual role/accountability
  
• Competencies for a First assistant
• Availability and access to validated training
• Formulation of a local policy to support first
  assisting within the operating theatre
• Job description / specification and clinical
  grading
• Professional Indemnity insurance required
• How to implement the role effectively.

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The Perioperative Care Collaborative September
2003Position Statement
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POSITION STATEMENT ON THE ROLE OF THE FIRST
ASSISTANT (ADVANCED SCRUB PRACTITIONER) IN THE
INDEPENDENT SECTOR(August 2003)
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Definition Advanced Scrub Practitioner
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A Surgical Practitioner/Assistant is a
Perioperative practitioner working both in and
out of the operating room, who undertakes
specified surgical intervention, either under
direct, indirect or proximal supervision.
NASSP 2002
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Advanced Scrub Practitioner Specification

• Enhancing communication link between theatre,
  patient and ward including pre-operative
  assessment and post- operative care evaluation.
• Assisting with patients positioning including
  tissue viability assessment
• Skin preparation prior to surgery
• Draping
• Skin and tissue retraction
• Handling of tissue and manipulation of organs for
  exposure or access
• Handling instruments
• Male/female catheterisation

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Advanced Scrub Practitioner Specification

• Cutting of sutures and ties
• Assisting with haemostasis in order to secure and
  maintain a clear operating field.
• Use of suction
• Indirect application of electro-cautery under
  supervision
• Camera holding for minimal invasive access
  surgery
• Use and maintenance of specialised surgical
  equipment relevant to area of working
• Assistance with wound closure
• Application of dressing
• Transfer of patient to Post Anaesthetic Care Unit

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The Dual Role
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Captain of the Ship Doctrine?
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So what is my key message to you?
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Pace yourselves for this role
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• Policy
• Accountability
• Competency
• Employers Responsibility

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Accountability

• 6.2 To practice competently, you must possess
  the knowledge, skills and abilities required for
  lawful, safe and effective practice without
  direct supervision. You must acknowledge the
  limits of your professional competence and only
  undertake practice and accept responsibilities
  for those activities in which you are competent
• NMC Code of Professional Conduct June 2002

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Competency -How do you achieve this?

• Greenwich University
• Manchester University
• John Moores University

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Employers Responsibility

• Job Description
• Job Specification

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Strategic Planning
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Be Proactive in managing the risk Dont stay on
automatic pilot and accept the situation
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Have Confidence in Yourself