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Risk assessment in theatres

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VOL: 97, ISSUE: 38, PAGE NO: 38

Sue Lamont, RGN, is theatre projects and resources coordinator, Leicester General Hospital

At the end of October last year I came across the dreaded initials ‘CNS’ for the first time. A document half-an-inch thick explained that the initials stood for the Clinical Negligence Scheme for trusts, a system that requires the identification of any equipment in a health care setting for which the operator has specialist training.

As a theatre projects and resources coordinator at Leicester General Hospital, responsible for health and safety and risk management in all operating theatres, I soon realised that the CNS had significant implications for my colleagues and me.

There is a huge amount of equipment in operating theatres and the CNS requires us to make schedules of it all. In addition, it requires risk assessments, definitions of the authorised users in generic groups, and an analysis of training needs for each item of equipment used in main theatres, day case units and endoscopy clinics. The task seemed enormous, and we had to have it all done by the end of February this year.

At the time, Leicester General Hospital was amalgamating with two other local hospitals to become the University Hospitals of Leicester NHS Trust. It therefore seemed sensible to contact colleagues at these sites, and our first meeting took place just after Christmas.

All agreed that the timescale was tight, but obtaining our equipment list was comparatively simple and, thanks to an excellent database in our department of medical electronics, all we had to do were the risk assessments.

Making the assessments

Early in the new year I started to think about how assessment information could be collated, preferably on one sheet of paper for each piece of equipment.

I began with the hospital’s risk assessment form and used a simple five-point plan in which severity/consequences were multiplied by likelihood to give a single score ranging from one (low) to 25 (high). This form seemed to have possibilities for adaptation.

However, risk assessment on its own would not be enough, so with the help of Mark Weston, the theatre training coordinator, I began to tackle the concept of training assessments. After much brainstorming we came up with eight training levels and five supervision levels. These were to be multiplied in the same way as the risk rating to give a training rating. We developed this by adding the training rating to the risk rating to give ourselves a priority score.

When we put certain target pieces of equipment through this process they came out in roughly the areas of low, medium or high priority that we would have expected.

This was a good start, but the CNS adviser said we could not simply do one risk assessment - we had to do a risk assessment for the patient, the user, and the impact on the service if the equipment failed. In addition, we had to state generic user groups for each item of equipment.

By adding another two lines to the risk rating section, documenting three risk ratings was comparatively simple. However, trying to make this mesh with the scoring system was more complicated.

Initially, I took an average of the risk rating, but that skewed the priority scores until they no longer fitted into the correct categories. Eventually, we took the highest risk rating and this seemed to solve the problem.

We then added a section to the form that covered the item of equipment and identified the user groups, plus a column for comments. At our next theatre group meeting, everybody felt the set-up was probably the most sensible way forward, despite its apparent complications.

To make things doubly clear, and so that anybody reading the forms would know exactly what our thinking was, we devised a definition sheet. Initially, this simply explained the definitions for training levels, supervision and the priority score. But as we carried out the assessments we added a user section to explain the different levels of use for each piece of equipment.

For example, an operating department assistant checks the anaesthetic machine, but it is the anaesthetist who uses it with the patient. We made it clear that the training rating was for nursing and theatre staff only.

It was obvious we also needed some summary sheets, so we produced another form that summarised all individual sheets of paper on one line. We had sheets for each of the three priority groups: high, medium and low. This reduced the documentation for all the equipment in the whole area to six sheets of paper.

The final score

Once the forms had been designed, assessing the equipment was comparatively simple and took about five minutes for each item. We achieved what was asked of us with a couple of weeks to spare.

By the end of March we passed our level-one CNS assessment. The next stage is for the trust to go for level-two, which means its training coordinators must compile detailed programmes to match our training assessments.

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