the surgical first assistant - the royal college of ...aims of the afpp sfa toolkit to facilitate...

The Surgical First Assistant

Susan Hall RGN MSc (Clinical Sciences)

Session objectives

RCS England SFA presentation 2

To provide delegates with an

understanding of the three levels of

surgical assistance

To explore the paperwork needed to

establish a Surgical First Assistant Post

To outline the current educational

pathways

◦ Costs

◦ Tools


What do you

mean you have

to go to the

ward NOW!!

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


Levels of surgical assistance

as outlined by the PCC

Scrub Practitioner

◦ Risk assessed minor cases only

SFA

◦ Risk assessed

◦ Role specific Job Description

◦ Non interventional assistance

SCP

◦ Risk Assessed

◦ Role Specific Job Description

◦ Masters Level education

◦ Interventional Assistance

◦ Delegated elements of pre & post operative care


Surgical First Assistants

(SFAs)

6

‘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

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.’

7 RCS England SFA presentation

Establishing an SFA post

requires:

8

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


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

Legal considerations (ii)

‘the standard of care of the SCP must be

that of the medical role which she [sic] is

replacing’ Dimond 2015


Education and Training

11

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


History of the AfPP SFA Toolkit

2003 – Toolkit 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 Toolkit


Aims of the AfPP SFA Toolkit 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


14

Strongly agree

18%

Agree

82%

The SFA toolkit is well constructed

Strongly agree

18%

Agree

82%

The contents of the toolkit have given me

confidence in the SFA role


15

Strongly

agree

36%

Agree

64%

The contents of the SFA toolkit supported

my education & training needs

Strongly agree

9%

Agree

82%

Neither agree

nor disagree

9%

My mentor & Clinical Supervisor found the

toolkit easy to use


Training Costs

The AfPP SFA Toolkit

◦ Members £100

◦ Non members £130

◦ TIME

Academic modules

◦ £1600

◦ TIME


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


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?


The SFA & 7 – day working

SFAs remain part of

the theatre team

Conflict between

staffing of the

operating list and

provision of surgical

assistance

Non interventional

nature of the work

Availability to free

surgical trainees for

learning

opportunities


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?


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).

the surgical first assistant - the royal college of ...aims of the afpp sfa toolkit to facilitate...

Documents