IFPN Member Country Editorials

ACORN September 2018 Journal EDITORIAL
Posted: Thu, Sep 6th 2018 at 03:36:48



of missed care:

Implications for

the perioperative


Missed care is often described as  an ‘error of omission’ and refers to nursing care that is needed

but delayed, partially completed or not completed at all1. There is an increasing weight of evidence

pointing to missed care as a  widespread phenomenon that poses  serious implications for patient


The prevalence of missed care is reported in a review and metaanalysis of the literature, where the

authors found between 55 and 98 per cent of nursing staff missed one or more cares2. Missed care is strongly  associated with poorer patient satisfaction3 and, more recently, has been linked to a seven per cent increase in the odds of a patient dying within 30 days of admission to hospital4.

In a study of 1300 hospitalised patients, Baker and Quinn5 found a failure to provide fundamental

nursing interventions such as oral  care, head elevation and deep breathing resulted in an increased

incidence of hospital-acquired  pneumonia. A recent systematic review reported associations between

missed care and medication errors, bloodstream infections, pneumonia, urinary tract infections, nosocomial infections, patient falls and pressure ulcers6. In the context of perioperative nursing, Duff7 reports missed care in the perioperative environment including a frequent failure to record temperature and provide forced-air warming. Predictors of missed care include youth (<35 years), qualification level, absenteeism within the last three months, limited professional experience and workplace type8. Same-day missed care events can also lead to further missed care events due to the accrual of work  demands across shifts9. As causes of missed care are still emerging,

identifying simple, cost-effective solutions for reducing missed care has proved elusive. Increasing

nursing time was reported to have no effect on lowering missed care incidence in one multisite US

study10. However, in a Korean study, increasing nursing hours lowered rates of missed care11. A train-the trainer intervention reduced missed care in a North American study although the authors relied on self reported survey data12. Improving the knowledge13,14, educational level15,16 and research literacy17,18 of perioperative nurses.


The Australian College of Perioperative Nurses (ACORN) is one of the leading global voices in setting

standards within the perioperative environment19–22 yet, based on the literature about missed care, it is

likely that many of these standards are not met during routine care each day. Clinical standards are typically effective as the sum of their parts and rarely work when implemented as a series of missed components of care. Future standards development in the perioperative setting must account for the issue of missed care by acknowledging mechanisms and processes for assuring full implementation wherever possible.


Although solutions are still being sought, it would be naive to think the issue of missed care can be

solved by introducing a single tool, another checklist or even a budgetary injection. The reality

is that perioperative nurses practice in an increasingly complex environment. Issues such as missed

care require an acknowledgement of this complexity by continuing to search for and communicate

effective, stakeholder-informed solutions in environments where quality improvement processes are

embedded, iterative, recursive and ongoing.

References  Refer  to ACORN Journal


Associate Professor Nicholas Ralph

PhD, MClinPrac (Perioperative Nursing), RN

Journal Editor

Bianca Viljoen

School of Nursing and Midwifery, University

of Southern Queensland

2018 The SAFE Operating Room Course
Posted: Mon, Jul 30th 2018 at 19:15:04
AfPP  Journal of Perioperative Practice    Viewpoint article   2018 Vol28(7&8)

The SAFE Operating Room course
Mona Guckian Fisher
Ethiopia / Education / Communication / Change
Provenance and Peer review: Unsolicited contribution; Peer reviewed; Accepted for publication 30 September 2017.
I had the privilege together with my colleague Tracey
Williams, Vice President AfPP, to be part of a faculty
delivering education and support at the Black Lion
Hospital in Addis Ababa, Ethiopia (4-8 September 2017).
This was the first multidisciplinary course held to deal
with this area and, in addition to ourselves, our faculty
included surgeons from the Royal College of Surgeons
and anaesthetists from the Association of Anaesthetists
of Great Britain and Ireland.
The course described everyday features of teamwork,
which was the major focus of this course programme.
Most of us had never met previously and it is a great
tribute to the team that all the sessions were delivered
and provided in a cohesive friendly and
appropriate manner.
All the delegates, comprising surgeons, anaesthetists,
and nurses, undertook a pre-course skills assessment
and an identical measurement post course. The
multidisciplinary sessions provided interactive
opportunities for small numbers of delegates as a
team to participate and explore topics such as
leadership skills, communication, situational
awareness, decision making in practice, common
errors in surgery, the WHO checklist in action,
anaesthesia safety checks, the sterile environment and
standards for counting swabs and instruments;
management of sharps and their disposal, general risk
management, management of controlled drugs, airway
management, sepsis, dealing with major haemorrhage,
cardiac arrest, positioning of patients, anaesthetic
toxicity, anaphylaxis, conflict in the OR, IV fluids,
recovery, pain management, morbidity and mortality,
procurement, quality improvement cycles, infection
prevention, decontamination and teamwork to name
but some of the materials provided. The aim was to
educate all of the team to strengthen the knowledge
and response whenever issues arise, which are
currently often managed by a single team member.
International and local faculty, SAFE Operating Room course;
Tracey Williams (eighth from left) and Mona Guckian Fisher
(ninth from left)
Each day started with a lecture introducing various
elements on providing a SAFE OR, ending on the last day
with a group discussion allowing delegates to express
and feedback on their personal and team commitments
to change.
SAFE OR was developed as a concept by the Association
of Anaesthetists of Great Britain and Ireland (AAGBI) and
the World Federations of Anaesthesiologists (WFSA).
Originally it started as two anaesthesia courses, one in
obstetrics and the other in paediatrics which have been
successfully delivered in a number of countries, 59
courses in all and more than 2000 delegates trained.
The anaesthetists considered that a whole team
approach would produce better outcomes and provide
the broad spectrum of perioperative care to the
Independent Consultant, Immediate Past President AfPP, President
Corresponding author:
Mona Guckian Fisher, Independent Consultant, Immediate Past President
AfPP, President Elect-IFPN.
Email: mona@guckianfisher.com
Journal of Perioperative Practice
2018, Vol. 28(7 & 8) 175–176
! The Author(s) 2018
Reprints and permissions:
DOI: 10.1177/1750458918780924
attendees. To this end, the Royal College of Surgeons
England (RCSEng), Royal College of Nursing (RCN) and
the Association for Perioperative Practice (AfPP) were
approached, and in terms of this course the rest is
now history.
This team was led by Professor Vivian Lees and
supported by surgeons Tony Clayson and Sarah von
Roon from the Royal College of Surgeons. Consultant
Anaesthetists, Isabeau Walker, Iain Wilson and Tei
Sheraton provided the anaesthetic support on the
course and were joined by Stephen Ttendo a Ugandan
consultant anaesthetist who was part of the team for
this course. We were also privileged to be joined by our
US colleague and LIFEBOX representative Jared
Forrester, currently working in Ethiopia, who inspired
delegates with an update on the work that has been
completed and is ongoing by the Foundation.
Recognising the need for teams of multi-disciplinary
professionals to work together in order to achieve good
outcomes for patients is not something new. It is
however, something that in practice even back here in
the UK we fail to recognise as of greatest necessity to
understand and fully commit.
Delegates with tutor Tracey Williams (bottom left)
Ethiopia has many challenges, some indeed not too
unsimilar to our own back at home. There are many
similarities in terms of patients who need the provision
of safety and good outcomes. The scenarios were very
powerful and I recall with great amusement the one on
conflict management and resolution led by our
orthopaedic and trauma surgeon Tony. He was very
convincing in terms of displaying conflict in the OR. The
message was powerful and persuasive as were the
options and solutions offered in respect of the
challenges presented.
It is unquestionably a necessity in all healthcare settings
to learn from each other and work together with clear
objectives and focus. This course provided that on this
occasion, and in my view the content is also entirely
suitable for healthcare professionals to undertake at
home or in any international setting. Teams that train
together perform well together and I hope that this
concept will gain more ground in the UK than is currently
the case.
Addis Ababa is a city under change in terms of its
infrastructure, and there appeared to be lots of building
and development underway which gives the impression
of some prosperity in the future. However, it has to be
said that this is a poor country and it makes the system
we have here in the UK look like next century innovation
in terms of supplies and practice. It is quite amazing how
these doctors and nurses perform so adequately with so
little. We were made very welcome by the hospital
authorities and the healthcare professionals we met,
and our stay and input was fully supported and
endorsed by the Ministry of Health in the country. Staff
from hospitals outside the capital were also invited to
take part on the course, and this provided a wider
representation on experience and educational needs.
The final day allowed the opportunity for training and
dialogue for a selection of delegate attendees to become
part of the training faculty so that the course can be
cascaded throughout the country. The course
programme and all educational materials will be
provided to the local faculty to facilitate this. Faculty
members are currently engaged in the necessary
updates and re-writing of modules for the future. There
is one more visit planned for early 2018 which will give
the local faculty the opportunity to work with the UK
team and associates, and prepare them for the future
events where they will take the course forward on
their own.
I am humbled with the experience of meeting and
working alongside these quiet, kind, gracious and
wonderful people and I look forward to returning in
the future.
Well done Team SAFE OR-UK, this was one very
worthwhile experience.
No competing interests declared
Posted: Wed, Jul 25th 2018 at 07:01:57
Change will not come if we wait for some other person or some other time. We are the ones we've been waiting for. We are the change that we seek.
Barack Obama
Powerful and thought provoking words Barack Obama said. It seems it is always easier to wait for someone or something to effect the change we want to see.
Reflecting on the year that was 2017, a few things have changed within ORNAC. Our conference in Niagara was the first that was planned with the help of a conference management company. Another change at the conference was the use of social media, in particular the ORNAC app. That was such a wonderful and exciting change, even though it was a steep learning curve for some of us “seasoned” OR nurses not used to this technology!!  2016 we held our first AGM “on the road” in Charlottetown PEI. Taking the AGM on the road offers our members the chance to attend an AGM in their neck of the woods. British Columbia you are next!! We will be in Richmond BC May 9th to 13th for the spring board meeting and AGM/education day. Looking forward to seeing many of you for a day of filled with great educational sessions and off course participating in the AGM. Save the date now.
Going back to the topic of change, how can we be the change we seek? To effect change one has to be involved. Whatever it is you want to see ORNAC being, doing, becoming, you need to be a member to take part and be the change agent. ORNAC is an organisation of members, for members, by members. We need each other so that our voices are magnified as we advocate for our patients and ourselves.  The impact our collective voices would have would resonate so far and wide. Let’s make ORNAC stronger.
So talk to your co-workers, friends and colleagues. Encourage them to join ORNAC and be part of the change and voice. Show pride in belonging to your professional association. Let your patients know you belong to the association that works on the standards that keep them safe during their perioperative journey.
What changes do we want to see within ORNAC? Email president@ornac.ca and share your thoughts, ideas on how together we can make ORNAC a force to be reckoned with. Let’s share our vision of a new and improved ORNAC will look like.
Posted: Wed, Jul 25th 2018 at 07:00:27
Start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible.
-          Saint Francis of Assisi
Spring. One word that brings so much hope, promise and new beginnings. I hope wherever you are spring has arrived after a very long cold winter that seemed it would last all year.
The arrival of spring reminded me that I have been on this adventure for a year now.  It feels much longer as so many things have happened. I thought I would take a few moments to look back over the past year for ORNAC.
I made a number of commitments at the start of my term. I committed to encouraging membership engagement and participation in ORNAC. This was the goal behind a member survey, sent to all members in April, requesting input prior to ORNAC’s strategic planning session. This session took place in May and I will share the results of this important plan for ORNAC’s future in my next message.
Holding our AGM on the Road, in years when we do not host a national conference, has provided another great way to engage with members.  This year’s AGM was in Richmond, BC, in May and was accessible to all members via web conferencing. The AGM was also accompanied by an exciting education program. Our travelling AGM will bring future ORNAC AGMs to different parts of the country and the on-line access will further encourage member engagement with ORNAC.
Inspiring and encouraging teamwork on the Board was also one of my commitments. At the May Board Meeting we included a teamwork session for all Board Members. This set the stage as the board headed in to the strategic planning session the following day with their new teamwork strategies fresh in their minds. Only great things can be achieved when we work as a team. 
To support ORNAC’s sustainability we have implemented several cost-cutting measures. It is crucial that your Board and Executive are fiscally responsible with your finances. The financial report was presented at the AGM and posted on the website to ensure full transparency from your Board and Executive. Visit www.ORNAC.ca to review this report and please do not hesitate to contact me with any questions.
The ORNAC Journal is now available to members in electronic format as well as in print. Going forward and transitioning, in the future, to a solely on-line version of the journal will ultimately save our association significant costs involved in printing and mailing the current journal. It will also bring us in line with modern publishing approaches as utilized by many associations. Visit the member portion of the website to view this electronic journal and see how easy it is to view and use.
As I start the second year of my term I will continue to work on fulfilling my commitments to the members. Meeting these goals will require the involvement of you, the membership, to help ORNAC fulfil its mission and vision. United we can do the impossible!
As we continue planning for the 2019 National Conference, in Halifax, NS, we are reaching out to all members to submit abstracts, volunteer, or register to attend. I am excited, and hope you all are too, about this awesome conference and look forward to seeing you there next year. In the meantime, enjoy spring and take time to reflect, rejuvenate, and refresh all areas of your life.
ACORN WINTER 2018 JOURNAL President's message
Posted: Thu, Jul 5th 2018 at 01:34:37
Sarah Bird 2016–2018  President’s report
As outgoing president, I would like to say a huge and grateful thank you to the tremendous hard-working volunteer directors who in the past 18 months have worked so hard to achieve so much. It has been a privilege to work with you all. I know many are staying on to continue their contributions to the College and I know that this new work will continue at a high standard. Many thanks to the staff at ACORN for their support behind the scenes. They pick up new requests and project concepts from the board and assist us to ensure that the ideas happen. Under the hard-working dynamic guidance of Wendy Rowland, our Executive Officer, we have achieved many new services for our members in the past 18 months. I personally thank Wendy for her professionalism and hard work while I have been president. I would also like to thank the members who continue to be active in their local associations, who continue to want to learn and ensure we uphold safe clinical practices to provide all our patients with the best surgical outcome. I am leaving the ACORN board to take on the role of secretary of the International Federation of Perioperative Nurses (IFPN), an organisation who has had and continues to have close ties with ACORN. I leave you with the words of Nelson Mandela – ‘It always seems impossible until it’s done’.
REBECCA EAST 2018–2020  President’s report
What an honour it is to be writing my first president’s report. I cannot begin to share how grateful I am to be elected by my colleagues to represent our members. The college has seen some influential presidents serve and continue to lead in the perioperative arena. I wish to congratulate Sarah Bird on a very well-served term and wish her all the best with her next opportunity as International Federation of Perioperative Nurses (IFPN) secretary. Sarah will continue to do great work for our specialty. I am very lucky to be serving with a number of 2016–2018 directors who have remained on the board for the 2018–2020 term and I’m delighted to have the new directors join us. The incoming board are very keen to continue the great work of the 2016–2018 board and with the continuity provided by the directors who are serving an additional term I feel we have a good start to our two-year term. Each director brings their own individual qualities that will provide the college with some great leadership. What we all have in common, however, is a commitment to serving the members and representing our country well. In the words of John Quincy Adams: ‘If your actions inspire others to dream more, learn more, do more and become more, you are a leader’. My dream is that at the end of our 2018–2020 term, the Board of Directors and I will have lead our college well and inspired ACORN members to dream more, learn more, do more and become more.
AFPP February President Meassage
Posted: Sat, Jun 23rd 2018 at 17:26:37

The theatre ‘cockpit’ – lessons from aviation
Adrian Jones (left) and John Nolan

The successful performance of surgery requires the completion of a series of complex tasks by highly motivated individuals, operating as part of a cohesive team.
The same is true of the flight cockpit, with which parallels have increasingly been drawn, but transposing and utilising the vast experience that aviation can offer us requires a genuine understanding of the processes used and not simply a superficial adherence to box-ticking exercises and checklists.
As with flight, the surgical perioperative period can be divided into three phases consisting of the preparation, the operative procedure and the closure; corresponding with aviation's preflight checks and take-off, the flight phase itself and the preparation for, and completion of, the landing.
The 'pre-flight' phase for surgery should be carried out formally and without distraction as it offers a real opportunity to identify potential problems and avoid major error. The tone is set for the whole procedure and the various roles of all team members are defined. Any possible 'bad weather' and its potential effects are clarified and contingency arrangements can be confirmed.
Implementing the principles of 'crew resource management' at this stage empowers otherwise quiet individuals to speak up and voice anyconcerns that they may have, at any stage during the procedure.
Checklists can usefully be individualised by teams who understand the surgery being undertaken (making them 'aircraft specific') and they should be relevant and concise. Their primary role is to protect the patient (rather than the hospital) from harm and its consequences. They should represent the switching on of a heightened level of observation and awareness of all members of the team, a state which should then continue until the procedure has been completed.
Throughout the surgery, there are opportunities for staff to interrogatesystemsandprocessesthatappeartobefunctioning satisfactorily. We do this when we drive by checking our petrol gauge, rather than allowing the tank to run dry. Planes and our carsareservicedregularlywithpartsbeingrepairedorreplaced before being allowed to fail, in a way that surgical instruments and equipment often are not. Where possible, longer procedures should offer staff members the opportunity of rest periods so that they are able to remain attentive, focused and engaged whilst within the active operating environment.
In preparation for landing, the sterile flight cockpit is characterised by an intense focus on a small number of clearly defined and important tasks and noise levels are minimised. Air traffic will limit transmissions to avoid distracting pilots and the formal implementation of a similar discipline toward the end of surgery reduces the risk of retained instruments and swabs, and other never events. This is a critical time in the procedure and there should be no tolerance of distracting and potentially disruptive conversation during completion of the 'pre-landing' surgical checklist.
There are of course many differences between the operating theatre and flight cockpit, and the flight crew have an obvious vested interest in avoiding adverse events! For the theatre team, often exposed to complex procedures under increasingly difficult circumstances, it is an opportunity to exercise their true professionalism and nothing less is acceptable.
Norfolk and Norwich University Hospital NHS Foundation Trust
The authors have worked together on a weekly basis, as both colleagues and friends for over 23 years and these thoughts represent a distillation of a series of their more recent conversations.
Wishing you many successful and safe surgical pathways for 2018!
Adrian Jones Surgical Care Practitioner and President AfPP Email: president@afpp.org.uk
John Nolan Orthopaedic Surgeon and Pilot
Find AfPP on Facebook www.facebook.com/safersurgeryuk
EORNA President Message 2017
Posted: Fri, Jun 22nd 2018 at 17:23:42
EORNA Presidentís message
Dear Colleagues

It is a great pleasure and an honor to have this opportunity to send you this message.

First of all, I would like to congratulate the out-going president, Mrs. Caroline Higgins, for her dedication and commitment to the role during her tenure in the post. Caroline served EORNA for two terms and worked hard to promote EORNA and perioperative nursing.
On behalf of the Board of Directors of EORNA I wish her continued success and happiness in her future projects and look forward to her continued contribution to EORNA. Gratitude is also extended to the Irish association INMO, for their contribution and support during her six years in office.

I would like to welcome the new officers:
- Mrs. Jana Wichsova, the new vice president from Czech Republic,
- Mrs. Aina Hauge, the new secretary from Norway
- Mr. Manuel Valente the new treasurer from Portugal

A huge thank you also and my best wishes to:
- Mrs. Merja Fordell, from Finland, the immediate past vice president,
- Mrs. Ahuva Friedman and Mrs. Yael Edry, from Israel, who served for two terms as secretaries
- Mrs. Charmaine Betzema, from The Netherlands, immediate past treasurer

It is a great pleasure for me to work and serve EORNA with you and the new executive officers and to continue keeping contact with immediate past officers who will share with us their rich experience and knowledge.

Dear EORNA Board, Chairs and officers, we shall have much to do together.
Excellent work has already been done. Let us continue developing EORNA and collaborating with other organizations and Industry to enhance perioperative care and patient safety in Europe and beyond. Let us develop educational opportunities for members and share our experience and knowledge.

The EORNA Competency document was launched in Copenhagen, in 2009 and has had very positive feedback. In Rome, during the 7th EORNA Congress, was launched the new book “Position Statements and Guidelines for Perioperative Nursing Practice”, Part 1. I would like to thank all our colleagues who have worked hard to achieve that. We look forward to have the Part 2 of this book published.

As you know, EORNA organizes the European congress for perioperative nursing. From now on, EORNA Congress will be held every two years, instead of every three years. Thanks to your hard work and commitment, the seven past congresses have encountered great success and have contributed considerably to the development of perioperative care and patient safety. They have also greatly facilitated the rich exchange of experience and networking among attendees from over 40 countries.

The 8th EORNA Congress is now being prepared with a new highly motivated team. We wish them every success in their work. Please save the date and join us again in Greece next year, 4 – 7 May 2017. I encourage you to visit EORNA website were detailed information is available. http://eornacongress.eu/

Every 15th of February, we celebrate the European Perioperative Nurses Day. Each year a special theme for the day is chosen by the Board members and it is widely observed, through a variety of initiatives in each country by EORNA members.

EORNA is member of the International Federation of Perioperative Nurses (IFPN) and of the European Specialist Nurses Organizations (ESNO). EORNA developed also a collaborative partnership with some European and world organizations. This collaborative partnership is built on shared visions and goals as quality patient care, patient safety, healthy workplace… Board members receive the newsletter of each organization.

Dear Colleagues, dear friends, I look forward to working with all of you, officers, chairs and Board member in the best interest of your national associations you are representing. Let us have our voice being heard and continue together in our endeavors to develop and provide the best and more secure perioperative care to the patient.

May Karam
EORNA President.
PNC NZ Mission Statement
Posted: Fri, Jun 22nd 2018 at 17:21:37

Mission Statement

The Mission of Perioperative Nurses College (PNC) NZNO is to support and promote the safe and optimal care of all patients undergoing operative and other invasive procedures.

This is achieved by promoting high standards of nursing practice through education and research.

PNC support and adhere to the NZNO standards of nursing practice, principles of the Treaty of Waitangi and the vision and direction provided by the International Federation of Perioperative Nurses.


ACORN Vision and Values
Posted: Fri, Jun 22nd 2018 at 17:18:28

About us

The Australian College of Perioperative Nurses (ACORN) is a registered health promotion charity that serves the patient, the community and the perioperative profession to promote the prevention and control of disease.


Our vision

ACORN’s vision is for Australian patients to receive the safest, highest quality perioperative care in the world.

ACORN works to achieve this vision by:

  1. publishing evidence-based ‘best practice’ standards for perioperative services reviewing these standards regularly
  2. advising other organisations and industry stakeholders about perioperative policy, procedures and practice to help advance the health and welfare of the community
  3. encouraging research into perioperative nursing to increase knowledge and learning in the perioperative nursing field and improve patient care
  4. promoting educational opportunities for perioperative nurses
  5. holding biennial national conferences to promote best practice and discuss and address current challenges in perioperative nursing practice.

Our values

ACORN’s work is underpinned by our values.

We achieve results through inclusion and collaboration with our volunteers and partners and as we work toward shared goals.

We provide services of a high quality and fulfill our members’ expectations with integrity and credibility.

We work with our state-based associations in partnerships based on openness, honesty and respect.

We communicate effectively and are professional, ethical and transparent.

We ensure that our services remain contemporary, creative, responsive and effective.

AORN Mission Statement
Posted: Fri, Jun 22nd 2018 at 17:16:09

This is What We Believe In


Our mission is to promote safety and optimal outcomes for patients undergoing operative and other invasive procedures by providing practice support and professional development opportunities to perioperative nurses. AORN will collaborate with professional and regulatory organizations, industry leaders, and other health care partners who support the mission.


AORN will be the indispensable resource for evidence-based practice and education that establishes the standards of excellence in the delivery of perioperative nursing care.


COMMUNICATION: Open, Honest, Respectful
INNOVATION: Creative, Risk Taking, Leading Edge
QUALITY: Reliable, Timely, Accountable
COLLABORATION: Teamwork, Inclusion, Diversity
April 2018 President Elect Interview
Posted: Fri, Jun 22nd 2018 at 17:05:15

Patient safety in the perioperative environment: An interview with Mona Guckian Fisher


With thehttp://www.wfsablog.org/patient-safety-in-the-perioperative-environment-an-interview-with-mona-guckian-fisher SAFE-T Summit fast approaching, the WFSA are interviewing some of our speakers as part of our SAFE-T Summit blog series to learn more about their contributions to global surgery and anaesthesia safety.

FOAN Ghana visit 2018
Posted: Fri, Jun 22nd 2018 at 17:02:18
Ghana 2018
On January 13th 2018 Kate Woodhead and Diane Gilmour, accompanied by Mary Knight (FoAN Canada) flew to Accra for a week, to provide an update to nurses in Ghana on patient safety and risk management across differing specialities and on different sites. 
We were hosted by the Medical and Surgical Skills Institute (MSSI) on the main hospital Korle -Bu site in Accra- and use their modern purpose built facilities. 
Our goal was to deliver two x two days courses focussing on more general aspects of patient safety followed by the final day specialising on perioperative patient safety and in total 163 nurses benefited from the education which was provided. 
The patient safety and risk management programme focussed not only on clinical aspects (patient identification, medication errors, falls, HAIs, safe surgery) but also covered communication, teamwork, documentation, accountability, principles of human factors, stress and fatigue.  
The first course was based at MSSI and attended by 54 nurses from all aspects and grades of nursing.  The delegate evaluations of the 2 days reflect that overall they enjoyed the mix of clinical and theoretical aspects; they found the programme well organised and planned; with relevance to their own practice. In fact throughout the evaluations positive feedback on all of the sessions was noted by one person or another.  Not only did they comment on the content many praised us as facilitators, how we had worked well as a team, and how we interacted with each other throughout the sessions. What will they do differently as a result- many acknowledged that they needed to put the theory into practice now but that they had gained the knowledge to do this through this course.  
“The topics were well presented and have given me more knowledge to impact as a manager”  
“I will assess the health risk of every client; effective communication among colleagues”
“To motivate my staff who are patient safety conscious and develop a forum to make reporting of such occurrences easier” 
The course was then repeated at Kumasi on the Wednesday and Thursday.  This involved a 30 minute flight for us but a 5-6 hour journey by road for some of the MSSI team who bought the necessary presentation equipment with them. The ride from the airport to the hotel (at night) was a journey through African street life – bustling full of market stalls, people selling their wares, food being cooked – a sight to wonder at.   
The course at Kumasi was held in the local hospital where in the middle of the grounds is a museum displaying African artefacts of the local people and a “Sword in stone” with details of the legend behind it. Interesting to hear of the culture and history of the local area.  
Again different backgrounds and grades of nurse attended- this time just 13 in number- but a few had travelled some distance to be there.  Although a smaller group who interacted well with each other and contributed within the groups, the evaluations reflected similar themes. 
 And then back to Accra. On the Friday our final day we were to deliver a perioperative safety programme. On the Monday, earlier in the week we, as were MSSI, were unsure of the numbers coming so were very surprised, but delighted, to have 96 delegates turn up for the day. 
The day focussed on updating delegates on the surgical checklist, latest on surgical site infection, human factors, decontamination, risks, management of normothermia, bullying. We were joined by Joel one of the local Ghanaian Clinical Ambassadors who presented on surgical smoke.  Whilst this was a large group they interacted, shared experiences and generated much discussion and debate. The evaluations again reflect a well organised, strong educational programme, highlighting patient safety and one which provided the nurses with the skills and knowledge to go back to their areas, supporting them to make a difference.  
 Whilst the programmes had been patient focussed the evaluations and reflections illustrated how the delegate themselves would make a difference in their environment – it was encouraging though that there were a couple about the patient themselves.  
“Empowering patients to speak of anything bothering them”
“Place my patient first”
“Keep my patient safe”
As with many African countries the main hospital structure and building showed signs of extensive wear and tear and in need of repair. During our visit to the operating theatres at Korle- Bu it was interesting, and encouraging, to see that there was evidence of new equipment- such as beds, trollies, patient warming, operating lights and diathermy machines- having been introduced although it is likely that this had been donated by companies.  The surgical site checklist was prominently displayed on the theatre walls. 
Ghana was not all work and we did manage to visit a school and orphanage for the street children in Accra, supporting them with donations for mosquito nets, pens and paper, and then a cultural market.  
Our thanks to Kwame (Director MSSI) and his team for their support not only to the education programme but also to the FoAN team (they were our drivers, our guides and our friends). 
As a team, Mary, Kate and I, reflected on our week, its success, how we had worked as a team and what would we do this differently next time round.  A job well done and on our return we received a note of thanks from Kwame and the chair of the MSSI Board of Directors which I think sums up our week in Ghana
Dear FOAN team,
I want to take this opportunity to express the sincere appreciation of the MSSI Staff for you recently teaming up with MSSI Ghana to train health professionals across the country on " Patient safety and Risk Management" and "update in theatre practices" Courses. We were impressed with the passion with which you taught these courses coupled with your preparedness to travel all the way to Kumasi to replicate these courses for the northern sector as well.
We indeed learnt a lot from your devotion to work. We also still continue to receive feedback from participants as to how much practical the courses were and the fact that they will make a big impact towards the provision of quality healthcare in their facilities.
We want to say a big thank you to the whole team as we look forward to a stronger collaboration in the future. Thank you
Diane Gilmour 
Trustee, Friends of African Nursing, February 2018

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