Jeremy Groves, Consultant in Intensive Care

Local Safety Standards for Invasive Procedures. A few weeks ago, in my then capacity as clinical lead for the North Trent Critical Care Network, I received an email from Tim Wenham, a much respected colleague in Barnsley.  He wanted to know if any of the other units in the Network had considered putting ‘LocSSIPs’ in place, and if so, could they share their practice.  Now, much to my chagrin, I hadn’t a clue what he was talking about and duly Googled it.  Once I had found out, I passed his request on to my Network colleagues.

LocSSIPs are Local Safety Standards for Invasive Procedures and arise from a framework document produced by NHS England’s Patient Safety Domain and the National Safety Standards for Invasive Procedures (NatSSIP) group.  The document describing NatSSIPs can easily be found in a web search1 and, in essence, describes a framework to promote safe practice.  It aims to build on the positive aspects of the WHO Safer Surgery Checklist acknowledging that checklists alone are not enough and a team trained in a safety culture with safe practice at the fore of their thinking.

NatSSIP and LocSSIP – what is it?

The NatSSIP aims to provide a skeleton for the development of LocSSIPs.  The thinking being that each institution is different, will have their own approach and that one overarching inflexible, centrally driven dictat for a particular procedure would not work.  The NatSSIP outlines the key elements for a LocSSIP, among them: governance, documentation, handovers, briefing, procedural verification, and sign in and out.

Can LocSSIP be used in critical care?

An invasive procedure is defined as anything that requires making a hole in the skin to gain access to the inside of a patient’s body (inserting a tube in to a blood vessel is the example given), or gaining access to a body cavity without cutting into the body (bronchoscopy) and using electromagnetic radiation (laser eye treatments).  So one can see where these safety standards would find a place in our working environment: intubation, central line insertion, broncoscopy, insertion of chest drains and percutaneous tracheostomy are the ones that spring to mind.

Why doesn’t the Joint Standards Committee (JSC) produce some guidance?

That was my first thought and I emailed Gary Masterson, who co-chairs the JSC, to that end.  The JSC did consider the document.  However the emphasis here is on ‘local’ as intimated above so it went no further.  Now to a certain extent I take their point.  However I am not a great believer in reinventing the wheel and, after a bit of discussion, we came up with this thought: Why not create a web based repository, sourced from organisations who have developed full LocSSIPs, accessible to all?

quote2“Why not create a web based repository, sourced from organisations who have developed full LocSSIPs, accessible to all?” 

While all organisations may be different, many are similar and I for one wouldn’t have thought that Barnsley’s check list for a percutaneous tracheostomy would be that different to Chesterfield’s.  But if Chesterfield doesn’t yet have one it could easily adapt Barnsley’s.  Similarly with the structure of a complete LocSSIP document for insertion of a CVC line.  The idea is not unique and Peter Bamford and Ged Smith, trainees in the Mersey region, are working on some examples that should appear in JICS and then on the ICS & Faculty websites.

We need your help: A critical care LocSSIP repository

So, here’s the thing.  If you think the idea of a critical care LocSSIP repository is a good idea, and you and your organisation are prepared to share your documentation, send it to info@ics.ac.uk.

The aim is not for organisations to take a document in its entirety and immediately start using it.  One can see clinical governance committees having sleepless nights and lawyers rubbing their hands in glee at that.  No, it would be to provide examples of what has worked in a particular environment with the aim of taking an exemplar document and adapting it for local use after it has been through all the appropriate local governance processes, as outlined in the NatSSIP document.  It could save a huge amount of work and potentially result in a superior product.

The Society will collate any responses it receives and post them in a structured fashion (with full attribution) on the ICS website.  It won’t be endorsing any particular approach but we hope it will speed the introduction of LocSSIPs into UK critical care practice.

Read more about NatSSIP here.

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