The extent to which chaperone policies are used in acute hospital trusts in England.

OBJECTIVE: To determine whether the Ayling Inquiry's recommendations (2004) concerning chaperone policy implementation in acute hospital trusts in England has been implemented. METHODS: A quantitative questionnaire based on the Ayling Inquiry was posted to medical directors of all acute hospital trusts in England during December 2005 to March 2006 to determine whether their trusts had implemented the inquiry's recommendations by 1 December 2005. The same questionnaire was resent between December 2007 and March 2008 to determine whether their trusts had implemented the inquiry's recommendations by 1 December 2007. RESULTS: The total response rates were 59.4% and 47.7% for the first and second cohorts, respectively. The percentage of trusts having a chaperone policy increased from 41.3% in December 2005 to 56.5% in December 2007. By the end of 2007, 17.3% had accredited training for chaperones, 57.7% had a management lead and 71.2% of trusts formally investigated a breach of the chaperone policy, the latter being a fall from 88.4% in December 2005. Informing patients verbally of the policy was the most common method of distributing the information in both cohorts. By 1 December 2007, 50.0% of trusts did not use any resources towards their chaperone policy. Of the trusts without a chaperone policy by 1 December 2007, 52.5% intend to start a policy. CONCLUSION: Despite a public inquiry, only a small majority of acute trusts in England have a chaperone policy in place, which may have severe medico-legal repercussions in the future. Commencing a chaperone policy is a must for acute trusts and regular auditing necessary to ensure recommendations be maintained.

Escort accompanying discharge after ambulatory surgery: a necessity or a luxury?

PURPOSE OF REVIEW: There is a growing demand for greater efficiency in ambulatory surgery. The patient population is increasingly sick which is also undergoing more advanced and complex surgery. This creates a danger in discharging patients without meeting the criterion of requirement of a responsible adult as an escort to accompany the patient home. The purpose of this review is to examine the most recent findings to determine whether an escort for patient discharge is necessary. RECENT FINDINGS: Recent studies have outlined the risks of discharging patients without escort after ambulatory anesthesia. There are three aspects that deter discharge of patients without an escort: medication used in general anesthetics or sedation; regional anesthesia; and surgical factors. All these can affect the cognitive, memory and psychomotor function of the patients, deeming them unable to perform normal daily activities such as driving. SUMMARY: Both clinicians and patients may have underestimated the risks associated with discharging patients without an escort after ambulatory anesthesia. There should be greater awareness of this problem. Patient discharge without an escort after ambulatory surgery under general anesthesia, sedation or premedication can potentially be dangerous and is not recommended.

Texas passes first law for safe patient handling in America: landmark legislation protects health-care workers and patients from injury related to manual patient lifting.

On June 17,2005, Texas Governor Rick Perry (R) signed into law Senate Bill 1525, making Texas the first state in the nation to require hospitals and nursing homes to implement safe patient handling and movement programs. Governor Perry is to be commended for this heroic first stand for safe patient handling in America. The landmark legislation will take effect January 1, 2006, requiring the establishment of policy to identify, assess, and develop methods of controlling the risk of injury to patients and nurses associated with lifting, transferring, repositioning, and movement of patients; evaluation of alternative methods from manual lifting to reduce the risk of injury from patient lifting, including equipment and patient care environment; restricting, to the extent feasible with existing equipment, manual handling of all or most of a patient's weight to emergency, life-threatening, or exceptional circumstances; and provision for refusal to perform patient handling tasks believed to involve unacceptable risks of injury to a patient or nurse. Manually lifting patients has been called deplorable, inefficient, dangerous to nurses, and painful and brutal to patients; manual lifting can cause needless suffering and injury to patients, with dangers including pain, bruising, skin tears, abrasions, tube dislodgement, dislocations, fractures, and being dropped by nursing staff during attempts to manually lift. Use of safe, secure, mechanical lift equipment and gentle friction-reducing devices for patient maneuvering tasks could eliminate such needless brutality. Research has proven that manual patient lifting is extremely hazardous to health-care workers, creating substantial risk of low-back injury, whether with one or two patient handlers. Studies on the use of mechanical patient lift equipment, by either nursing staff or lift teams, have proven repeatedly that most nursing staff back injury is preventable, leading to substantial savings to employers on medical and compensation costs. Because the health-care industry has relied on people to do the work of machines, nursing work remains the most dangerous occupation for disabling back injury. Back injury from patient lifting may be the single largest contributor to the nursing shortage, with perhaps 12% of nurses leaving or being terminated because of back injury. The US health-care industry has not kept pace with other industries, which provide mechanical lift equipment for lifting loads equivalent to the weight of patients, or with other countries, such as Australia and England, which are more advanced in their use of modern technology for patient lifting and with no-lifting practices in compliance with government regulations and nursing policies banning manual lifting. With Texas being the first state to succeed in passing legislation for safe patient handling, other states are working toward legislative protection against injury with manual patient lifting. California re-introduced safe patient handling legislation on February 17, 2005, with CA SB 363, Hospitals: Lift Teams, following the September 22, 2004, veto of CA AB 2532 by Governor Arnold Schwarzenegger, who said he believes existing statutory protection and workplace safety standards are sufficient to protect health care workers from injury. Massachusetts HB 2662, Relating to Safe Patient Handling in Certain Health Facilities, was introduced December 1, 2004. Ohio HB 67, signed March 21, 2005 by Governor Bob Taft (R), creates a program for interest-free loans to nursing homes for implementation of a no-manual-lift program. New York companion bills AB 7641 and SB 4029 were introduced in April, 2005, calling for creation of a 2-year study to establish safe patient handling programs and collect data on nursing staff and patient injury with manual patient handling versus lift equipment, to determine best practices for improving health and safety of health-care workers and patients during patient handling. Washington State is planning re-introduction of safe patient handling legislation, after WA HB 1672, Relating to reducing injuries among patients and health care workers, was stalled in committee in February, 2005. Language from these state initiatives may be used as models to assist other states with drafting safe patient handling legislation. Rapid enactment of a federal mandate for Safe Patient Handling No Manual Lift is essential and anticipated.