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Safety Newsflash! Retained Guidewires.

17 Sep, 17 | by cgray

guidewires

If you’re a member of the Royal College of Emergency Medicine in the UK, you may have noticed an email pop up in your inbox recently, a safety newsflash on retained guidewires. RCEM put these out every few months, containing helpful and brief information in the crusade against events that should never happen, as well as some things to look out for when seeing patients. Examples of previous newsflashes include a reminder to think about AAA in patients with abdominal pain, and to remember that some oral dentures don’t show up on X-ray.

In this most recent installment, RCEM look at retained guidewires, which comes under number three on the NHS England list of never events – “retained foreign object post-procedure”. You might not think it’s common, and you’d be right – this has only happened eight times in emergency departments across the UK in the last two years, but that’s still eight too many. It makes up half of the reported never events in EDs.

With more and more emergency physicians utilising advanced skills to insert lines and chest drains in the resus room, it becomes so important to make sure we’re not causing patients harm through additional procedures to remove wires we’ve left behind.

So how do we do this?

RCEM’s advice follows that of the National Reporting and Learning System (NRLS), a branch of the National Patient Safety Agency. The aim is to make line insertion a standardised two-person task. Generally you can just put a line or drain in on your own, but having a second person as an observer, to witness and document guidewire removal, creates redundancy, with the aim of improving safety and focus on the task at hand

The NRLS advocate three measures to stop guidewires being left behind. The first is a standardised process where both the operator and observer see the guidewire removed, say it’s been removed, and document its removal. This may just be done in the notes, but I have seen in a trust I’ve worked in a sticker that comes pre-packaged in all arterial and central line kits with tickboxes and space to sign to standardise the documentation as well. It works very well, and putting it in the line packs makes it easy to remember to get an observer and complete the sticker to insert into the notes. This documentation is also audited.

The second measure is to emphasis guidewire control through training and education. We need to embed this as a mandatory step in all our lines or drains, just as we always clean the skin, or apply a dressing. It’s an important step, and should be emphasised not only to trainees being signed off to insert lines, but also to more senior doctors who have been putting them in for years.

Lastly, the NRLS is working with manufacturers to develop new ways to prevent guidewire retention.

RCEM has taken this and advocated a standardised procedural checklist for all invasive procedures. You can see this below.

 

invasive procedure checklist

 

Guidewire control is crucial, and if you’re not inserting these on a regular basis it can be all too easy to lose that control and lose your guidewire. Make sure you take steps to avoid this never event. Get an observer. Use the RCEM checklist, or your own trust one. Be safe for your patients.

vb

Chris

 

Don’t forget to check out the other safety newsflashes on the RCEM website.

#FOAMed, credentials and a view from the college (sort of).

10 Dec, 16 | by scarley

156r09lpI found an amazing tweet on my timeline today that taught me many things. Firstly, I was not aware that students were publishing their own theses online and as an open access resource (this is fantastic), and secondly the topic in question is of great interest to me and everyone here, that is the development of #FOAMed.

Chris Walsh is a super chap who is head of e-learning at the Royal College of Emergency Medicine. He is an extremely intelligent man with a strong academic track record, initially in the humanities, and now also in the field of medical and digitial education.

He has now published his MSc thesis online looking at the development, current state and future direction of e-learning resources for the RCEM.

Click here to read the thesis online.

I am very interested in the view from a senior member of the college as my relationship with the college over e-learning has been difficult at times. As an advocate of #FOAMed I’ve always struggled with the requirements to meet the limitiations and restrictions of an overarching organisation whilst maintating the freedom, speed and open discussion that #FOAMed creates. This is a theme in the thesis and I found Chris’s analysis of #FOAMed as a dialogic process fascinating. This work also aludes to the changing relationships between organisations, traditions, curricula, members, technology and delivery. It’s complex and fascinating.Chris has used a mixed methods technique to look at the impact and future direction of e-learning for the College and for #FOAMed. The perspective is clearly from his position, and thus the influence of the College perspective is very clear, but there are many interesting elements for any producer or consumer of #FOAMed.So what are the main themes? Obviously this is my interpretation and you really should read the whole document.

    #FOAMed is here to stay.#FOAMed engages and invigorates elements of the EM community but some are not engaged.There is a desire amongst some for credentialing of activity related to #FOAMed (though the strength There is some confusion between e-learning and #FOAMed type activities and credentialing.The RCEM is developing a system to credential #FOAMed learning.There is a belief and understanding that #FOAMed will be incorporated into formalised learning and continuous professional development.

There are many other questions too of course. This study is based on small samples and almost all the interviews were conducted with those involved in college work. The survey data was sought through social media spaces which is good as they are #FOAMed consumers, but also limits the findings to those who are already engaged in this style of learning. The perspective is thus largely one of the college establishment and as a result may be a self-fulfilling one. However, I’m not sure that matters that much as the project is really aimed at those groups as opposed to those who are not currently engaged with College resources. It does therefore study a specific, but relevant

So. Follow the link above to read the thesis (or at least read the abstract), follow Chris Walsh on his twitter account, and if you feel inclined I’m sure he would be delighted to hear your thoughts.

My final question is in regard to the proposed credentialing of #FOAMed activity into an online CPD portfolio.

The question is whether users will be able to record activity from non RCEM #FOAMed sites, or will it be limited and paywalled by the college. As a #FOAMed advocate I’m clearly keen to support learners to be able to record #FOAMed CPD from any blog or podcast.

That may not be a decision that Chris will personally make, but I’d love to know the answer (and hope it’s the right one).

The bottom line is that this is a great piece of work that takes our understanding of College based learning further and deeper than we have previously seen.

vb

S

 

The weekend effect. Part 1.

28 Oct, 16 | by scarley

the-weekend-effect

Chris Moulton VP of the Royal College of Emergency Medicine and Ellen Weber discuss the weekend effect. This is well worth a listen to get behind the headlines and politics of a controversial meme in healthcare.

What is it? Is there an effect and what can we do about it?

Click on this link to read more about the paper on Chris Gray’s blog.

 

vb

S

 

Help set UK EM research priorities

24 Sep, 16 | by scarley

the-james-lind-research-priority-setting-exercise-needs-you-to-get-over-the-line

Hopefully you already know about the James Lind Alliance 1–4. If not have a look at the St.Emlyn’s blogs and podcasts, but in brief the Royal College of Emergency Medicine is working with the JLA to set the most important research priorities in emergency medicine. The process has been running since the middle of last year and after a lot of work led by Professor Jason Smith and Richard Morley we are down to the last 60 questions.

We need your help in prioritising the final questions.

We need professionals and the public to follow this link to a survey that will finalise a list of questions that will then go through to a final round in January where the top 10 research priorities will be set.JLA flyer for download

We need everyone to help complete the survey, both patients and professionals.

FOLLOW THIS LINK  – https://www.surveymonkey.co.uk/r/JLAEMPSP

Download this flyer and share in your department. Show it to friends, family, patients, professionals and get everyone involved.

Past processes have shown that if the JLA recommends a research priority then it significantly increases the likelihood of getting the projects funded. In other words this really matters and could shape UK EM research for the next decade.

So please. Have a look and complete the survey today.

Thanks

S

@EMManchester

On behalf of the JLA steering group.

1.
James Lind Alliance and RCEM needs you. stemlynsblog.org. http://stemlynsblog.org/james-lind-and-the-rcem-needs-you-and-you-and-you-st-emlyns/. Published October 2015. Accessed September 24, 2016.
2.
James Lind Alliance: Emergency Medicine. jla.nihr.ac.uk. http://www.jla.nihr.ac.uk/priority-setting-partnerships/emergency-medicine/. Published 2015. Accessed September 24, 2016.
3.
Smith JE, Morley R. The emergency medicine research priority setting partnership. Emergency Medicine Journal. 2015;32(11):830-830. doi: 10.1136/emermed-2015-205353 [Source]
4.
James Lind Alliance Update. stemlynsblog.org. http://stemlynsblog.org/james-lind-alliance-update-st-emlyns/. Published December 2015. Accessed September 24, 2016.

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