Management Station 2
Instructions for the Management Station
You have 5 minutes to go through this scenario.
These scenarios work best when used as a pair. One person can act as the examiner and the other as the candidate.
Candidate Instructions
You are the orthopaedic CT1 assisting your consultant with a total knee replacement. You notice that the wrong leg has been marked to what you have read in the notes. Knife to skin has not occurred yet.
Examiner Instructions
This scenario can be attempted in pairs or individually. The candidate has 5 minutes for this whole scenario. Prompts are provided in the boxes below to encourage the candidate to finish each question on time.
Questions
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How would you approach this situation?
How would you approach this situation?
Prompts
Encourage to follow a structured answer here. Prompt the candidates along each category if they are struggling for time or for answers. It is essential that patient safety is identified and addressed immediately.
Key issues:
The key issues here are patient safety and honesty and integrity.
Patient safety:
This case clearly poses a risk to patient safety, and as such this should be identified as a priority.
This is a potential never event as identified in the ‘2018 Never Events policy and framework and Never Events list’.
It is therefore important to flag this to the consultant and the rest of the team.
Seek information:
I would seek more information on what has occurred.
I would check the consent to see which site has been consented for, check the notes to see which site has the pathology and has been discussed to be operated on, and finally I would correlate this with which site has been marked and which site the team were planning to operate on.
It is important to involve all members of the team here.
Initiative:
If there is any ambiguity here, then it is important to wake the patient up.
The patient will have to be informed of what has occurred, and it will be important to have a duty of candour discussion with the patient.
A clinical incident form will also have to be filled in after the incident to ensure that lessons can be learnt and this does not happen again.
Escalate:
This situation will immediately have to be escalated to the senior members of the team, particularly the consultant and the theatre manager. The anaesthetic consultant is also a good person to involve.
Support:
It is important to be both open and honest with the patient. An apology should be offered during the duty of candour discussion, and support services should be provided for them. PALS can be offered as an avenue should the patient wish.
Support should also be offered the team members present, in particular the nursing and theatre team colleagues.
Reschedule the patient for surgery if they are keen to proceed.
Changes:
I would reflect on the situation during debriefing at the end of the list, and also with my education supervisor.
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What exactly is a duty of candour discussion? (**Knowledge tutor**)
What exactly is a duty of candour discussion? (**Knowledge tutor**)
Prompts
Note there is both a organisation duty of candour and a professional duty of candour. Elicit whether candidates know the distinction between the two.
The organisation duty of candour is a statutory duty and applies to any organisation to inform those affected about incidents that have caused harm and/or death.
The professional duty of candour requires every healthcare professional to be open and honest with patients when something goes wrong. It involves telling the patient, apologising, offering appropriate solutions and explaining fully the short and long term effects of what has happened.
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Can you identify any other never events and the measures taken to prevent them?
Can you identify any other never events and the measures taken to prevent them?
Prompts
Identify at least 2 examples and associated prevention measures.
Transfusion of incompatible ABO blood group- this can be prevented by hand writing the labels on the blood bottles and local policies involve 2 different people bleeding the patient at 2 different times to prevent any error.
Feeding through misplaced NG tube- this can be prevented by having only the radiologist report a CXR for confirmation of correct placement.
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What is the WHO surgical safety checklist?
What is the WHO surgical safety checklist?
Prompts
Elicit whether candidates know some of the checklist criteria in each section.
It is a 19-item checklist designed by the World Health Organisation, and is now mandatory during any surgery in the NHS. It is designed to maximise patient safety and prevent wrong site surgery.
It is composed of 3 main sections:
Sign in– Before induction of anaesthesia: this involves confirming the patient’s identity, procedure and consent.
Time out– Before skin incision: this involves again checking the patient’s identity, procedure, consent and site. Additionally, antibiotic prophylaxis, glycaemic control, displaying of essential imaging are all discussed.
Sign out– Before the patient leaves the room: this involves checking the instrument and swabs counts, and any key concerns for recovery