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

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