4 Implementation and audit

4 Implementation and audit

NICE has developed tools to help organisations implement this guidance (listed below). These are available on our website.

  • Costing report and costing template to estimate the savings and costs associated with implementation.

4.1 Implementation

4.1.1 There may be a number of ways of ensuring that instruments stay together within sets. The Committee did not review any data on the effectiveness of specific systems. It is the responsibility of individual Trusts to ensure that effective systems are in place.

4.1.2 Consideration should be given to packaging those instruments that normally come into contact with high-risk tissues (brain, retina, optic nerve) in separate sets to those that do not (for example, instruments used only for approach and closure).

4.1.3 Enough instruments should be purchased to ensure that the practice of using supplementary instruments is abolished and that all instruments stay within their sets. This will involve a one-off cost of purchasing sufficient instruments to incorporate into sets, so that those frequently required as supplementary are routinely available. Additional instruments will also need to be purchased to allow for immediate availability of replacements if instruments in sets are found to be defective or if they become unsterile during procedures. If high-quality, single-use instruments become available, these may be introduced as alternatives.

4.1.4 The Committee was not aware of the availability of single-use accessories for neuroendoscopy. Until such instruments become available, reusable accessories should be used only once and disposed of.

4.1.5 Neurosurgical units should purchase sufficient rigid neuroendoscopes suitable for autoclaving to allow these to be used in preference to flexible neuroendoscopes whenever possible. The neuroendoscopes should be suitable for autoclaving, and they should be thoroughly cleaned and autoclaved after each use.

4.1.6 Neurosurgical units should purchase or allocate new instruments and neuroendoscopes for exclusive use on children born after 1 January 1997, as described in section 3.2.9. Ophthalmic surgery units should similarly set aside new instruments for children born after 1 January 1997 who have posterior eye operations.

4.2 Audit

4.2.1 Evidence on the effectiveness of preventing instrument swapping should be collected and assessed in a systematic way. The Institute will review this evidence when it reviews the guidance.

4.2.2 Any problems relating to the performance of single-use instruments should be documented and transmitted to the Medicines and Healthcare products Regulatory Agency and the National Patient Safety Agency, as appropriate.