Trip Report November 2010
Trip Dates November 12-26 Team Members Dr. Piotr Blachut (orthopaedic surgeon) Ms. Cindy Findlater (sterilzation technician) Ms. Nancy Henderson (OR nurse) Ms. Fiona James (OR nurse) Dr. Robert Meek (orthopaedic surgeon) Dr. Paul Mercereau (anesthesia resident) Ms. Kirsten Morris (OR nurse) Mr. Nathan O Hara (coordinator) Dr. Brent Weatherhead (orthopaedic resident) Dr. Hamed Umedaly (anesthesiologist) Ms. Kyra Yatkowsky (PAR nurse) The USTOP team was also joined by Dr. Mark Hill, Dr. Peter Lennox and Dr. Asif Pirani from UBC Plastic Surgery.
Activity Academic Activity Bioskills Workshop - November 14, 16 USTOP held a bioskills workshop sponsored by Synthes Canada. The workshop was attended by all of the Makerere Orthopaedic residents and most of the Ward 7 staff. Feedback on the workshop was extremely positive. All cases were done with Ugandan resident invovlement allowing for concurrent teaching. Informal teaching sessions were held on specific procedures with orthopaedic residents. Concurrent clinical teaching on anesthesia procedures was also complimented by several didactic teaching sessions. The trip had specific focus on Post-Anesthetic Recovery training which has since been adopted in regular practice. With the arrival of a new autoclave to Ward 7, an emphasis was placed on ensuring proper sterilization for all surgical equipment. The OR nursing staff offered training around sharps safety, creating a noticable improvement to practices.
Activity...continued Clinical Activity OR Days - 5 On Call Days - 5 Number of Patients Treated 19 Male 15 Female 04 Average Age 20 years (3-53) (Median 24 yrs) Number of Operative Sessions 21 Number of Injuries Treated 25 Ward 7 OR Femoral Nailings 11 SIGN (8) Synthes (3) Tibial Plateau ORIF 2 Tibial Nailing 2 Tibia Ext Fix 1 Knee Disloc Ex Fix 1 Olecranon ORIF 1 Monteggia ORIF 1 Acromial # - ORIF 1 ----- 20 Casualty OR Open tibia Wound Rx / Ex Fix 2 Forearm Amputation / Ext Fix Humerus 1 Open Pelvis / Open Femur Wound Rx / Suprapubic Cath / Colostomy / Ex Fix Femur 1 Repeat Wound Rx 1 --------- 5
Activity...continued A reduction in clinical activity compared to previous visits was caused by a few reasons: 1. Infrastructure Issues Clinical activity was limited due to days without basic infrastructure (water, electricity, oxygen) for the hospital. This delayed the processing of surgical equipment and compromised patient safety. 2. Communication Required to have Patients Available for Procedure Frequent delays were caused by patients not being ready and available for their procedure. 3. Complexity of Cases Compared to previous visits, this trip was involved in more complex cases involving other specialties. This required greater time and therefore decreased the overall volume of procedures for the trip. Future directions Strengths of this visit included the following: 1. Knowledge gained from the bioskills workshop 2. Development of a dedicated post-anesthetic care position, as an attribute to patient care 3. Advancement in caution around proper sharps handling techniques 4. Regaining autonomy of the sterilization of instruments with the arrival of a new autoclave and training for a dedicated operator 5. Eagerness from the residents and nursing staff to participate in clinical and didactic teaching Areas for future improvement 1. Management of equipment inventory to ensure needed equipment is available for procedures 2. Communication to ensure that patients are ready for their surgery, eg. directly transferring from casualty ward or a process of direct admission to ward 7 3. Staff must be available and ready for earlier start times to increase overall surgical volume accomplished 4. Increased supervision of residents in the casualty theatre Discussions on the possibility of one - two trips for 2011 are currently being planned to address these areas.