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Nurse develops guidance to help prevent theatre ‘never events’

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A cardiac theatre sister at King’s College Hospital in London has become the first nurse in the world to design a theatre manual to help prevent “never events”.

Minija Joseph created the manual, which helps cardiac theatre nurses identify the different types and sizes of equipment and how to prepare them, to reduce the risk of wrong implant incidents.

”I developed my own rudimentary guidance many years ago” 

Minija Joseph

She worked with device manufacturer LivaNova to design a simple, illustrated manual, which details every aortic valve, mitral valve, tricuspid valve and repair device.

Ms Joseph said: “There are hundreds of surgical cardiac devices in an array of sizes, all with different preparation instructions.

“To help my nursing colleagues identify the correct device and preparation techniques for each surgical procedure, I developed my own rudimentary guidance many years ago,” she said.

“As more and more nurses commented on how useful it was, I decided to contact one of the main cardiac device manufacturers to see if they would be interested in developing guidance that would benefit nurses in other cardiac centres,” she said.

“To my delight, they thought it was a good idea and decided to bring me on board to help develop the instructions, as well as the look and feel of the manual, so it could be of maximum help to theatre practitioners,” said Ms Joseph who, hopes it will be issued globally to enhance patient safety.

King’s College Hospital NHS Foundation Trust

Nurse pioneers guidance on preventing ‘never events’

Minija Joseph

Ms Joseph, who has worked at King’s College Hospital NHS Foundation Trust since 2007, received no fee for her work on the manual, insisting that patient safety was her sole driver.

She now plans to work with other device manufacturers to produce similar manuals for their products.

Meanwhile, LivaNova is to send copies of the manual to all cardiac centres around the world where they supply devices.

Dr Geraldine Walters, the trust’s director of nursing, said, “This is a wonderful example of a King’s nurse going the extra mile to safeguard patients – both within the trust and further afield.

Mr Max Baghai, a consultant cardiothoracic surgeon who supported Ms Joseph with the project, added: “It’s the first time that a document like this has been produced by a theatre nurse to benefit other theatre practitioners.

“It will aid all theatre colleagues to use the correct device for each procedure, which is another positive step forward in patient safety,” he noted.

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Readers' comments (1)

  • Thus demonstrating we nurses need to be less modest and let our true talents,knowledge and expertise shine through.
    Nurses are pioneers and leaders- congratulations

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