Staff attitudes to and compliance with the use of a surgical safety checklist.

OBJECTIVES: To investigate staff attitudes to the use of a surgical safety checklist in a small animal operating room and to gain insight into barriers to use. MATERIALS AND METHODS: A questionnaire was designed and used to assess attitudes of 36 operating room personnel to the checklist. The checklist was retrospectively audited on 984 patients over an 8-month period to investigate compliance. RESULTS: Responses were obtained from 100% of operating room personnel. Attitudes to the checklist were positive, with 83.4% agreeing that it improved teamwork and 100% agreed that the checklist improved patient safety, reduced error and was best practice. Most personnel (94%) believed that a completed checklist was used for every procedure. Several barriers were highlighted, including issues of hierarchy and team-working and lack of training. 984 checklists were used during the study period with 83 (8.4%) being fully completed. CLINICAL SIGNIFICANCE: Surgical safety checklists have potential to improve patient safety in veterinary operating rooms. However, appropriate design and implementation are critical and surgeons should endeavour to support checklist use.

Safety culture: the Nottingham Veterinary Safety Culture Survey (NVSCS).

Safety culture is a vital concept in human healthcare because of its influence on staff behaviours in relation to patient safety. Understanding safety culture is essential to ensure the acceptance and sustainability of changes, such as the introduction of safe surgery checklists. While widely studied and assessed in human medicine, there is no tool for its assessment in veterinary medicine. This paper therefore presents initial data on such an assessment: the Nottingham Veterinary Safety Culture Survey (NVSCS). 350 pilot surveys were distributed to practising vets and nurses. The survey was also available online. 229 surveys were returned (65 per cent response rate) and 183 completed online, resulting in 412 surveys for analysis. Four domains were identified: (1) organisational safety systems and behaviours, (2) staff perceptions of management, (3) risk perceptions and (4) teamwork and communication. Initial indications of the reliability and the validity of the final survey are presented. Although early in development, the resulting 29-item NVSCS is presented as a tool for measuring safety culture in veterinary practices with implications for benchmarking, safety culture assessment and teamwork training.

We need to talk about error: causes and types of error in veterinary practice.

Patient safety research in human medicine has identified the causes and common types of medical error and subsequently informed the development of interventions which mitigate harm, such as the WHO's safe surgery checklist. There is no such evidence available to the veterinary profession. This study therefore aims to identify the causes and types of errors in veterinary practice, and presents an evidence based system for their classification. Causes of error were identified from retrospective record review of 678 claims to the profession's leading indemnity insurer and nine focus groups (average N per group=8) with vets, nurses and support staff were performed using critical incident technique. Reason's (2000) Swiss cheese model of error was used to inform the interpretation of the data. Types of error were extracted from 2978 claims records reported between the years 2009 and 2013. The major classes of error causation were identified with mistakes involving surgery the most common type of error. The results were triangulated with findings from the medical literature and highlight the importance of cognitive limitations, deficiencies in non-technical skills and a systems approach to veterinary error.

Photodynamic therapy (PDT) for lung cancer: the Yorkshire Laser Centre experience.

BACKGROUND: The Yorkshire Laser Centre team have been engaged in photodynamic therapy (PDT) since 1990. In this article we review our experience in bronchoscopic PDT for lung cancer and outline our current indications and results. METHODS: 160 patients in 2 groups entered into a prospective study: Group A (N=144) were symptomatic with advanced inoperable disease and with presence of >50% bronchial obstruction. Group E (N=16) with early stage cancer and presence of superficial lesion confined to bronchial tree. All patients had standard investigation and work-up bronchoscopy and biopsy confirmation of cancer by cyto-histology. PDT method was intravenous administration of 2mg/kg BW of Photofrin (Porfimer Sodium) followed by bronchoscopic illumination of 630nm laser light. RESULTS: There was no treatment-related mortality. Nine patients (5.6%) presented with skin photosensitivity reaction and another eight with respiratory complication. Group A: Symptom relief was achieved in all. This was matched by significant improvement in bronchial opening (58.1%). Survival was 9.6 months (mean) and 5 months (median), respectively. This was greater in patients with better performance status and lower stage of disease. Group E: Every patient had a complete response to treatment, some after two treatments. Survival in this group was 75.4 months (mean) and 69 months (median). CONCLUSIONS: Bronchoscopic PDT is indicated in both advanced and early stage lung cancer. In the former it provides symptomatic relief in all and survival benefit in some; in the latter it achieves long survival and potential cure.

A clinical trial of the efficacy and acceptability of D-fenfluramine in the treatment of neuroleptic-induced obesity.

Twenty-nine overweight schizophrenic patients maintained on depot neuroleptic injections who wished to lose weight took part in a double-blind, placebo-controlled trial of 30 mg D-fenfluramine. All subjects received dietary advice. Sixteen patients completed the 12-week trial. Rate of weight loss was significantly greater in those taking D-fenfluramine. Side-effects were reported, but no deterioration in mental state was noted.