Nail Surgery - Pre Op Assessment + Staff Requirements

Question 1

In NHS GGC, staff involved in the delivery of LA and nail surgery procedures should undertake what training?

Answer 1

Basic Life Support

Anaphylaxis Management

Clinical Waste and Sharps Disposal

Question 2

What guidelines should podiatrists administering LA and nail surgery be aware of?

Answer 2

NHS GGC or other local Infection Control Guidelines

Scottish Executive Health Department: A Good Practice Guide on Consent for Health Professionals in the NHS Scotland

College of Podiatrists - Code of Conduct

College of Podiatrists - Standards for Clinical Practice

Question 3

Why do we undertake pre-op assessments of nail surgery candidates?

Answer 3

To gather essential information about a patient’s health status before undergoing surgery

This ensures the safety and success of the procedure

Question 4

What does a nail surgery pre-op assessment involve?

Answer 4

Outlining…
The reason for referral
The presenting clinical condition and needs of the patient
Your rationale for offering surgery to the patient
The suitability of the patient for any proposed procedure

Obtaining an accurate medical, surgical and pharmacological history
Identification of any relevant social factors

Making Clear…
That informed consent has been obtained
A clear plan has been established and agreed with patient
A clinical outcome has been agreed and identified

Physical Assessment - Palpation of pedal pulses, in every patient even if no risk factors for arterial insufficiency are present

Question 5

How does NHS policy define valid consent?

Answer 5

For consent to be valid it must be voluntary and informed, and the person consenting must have the capacity to make the decision

Voluntary - The decision to consent or not to consent must be made by the patient and not influenced by medical staff, friends or family

Informed - The patient must be given all the information about what the treatment involves, including the benefits and risks, whether there are reasonable alternate treatments and what will happen if the treatment does not go ahead

Question 6

What should a podiatrist performing a nail surgery do to ensure accountability and responsibility?

Answer 6

Use individual professional judgement.

Be accountable for individual decisions and actions

Apply knowledge, clinical reasoning and skill to each individual situation.

Understand the risks associated with the substances used, especially local anaesthetic agents and phenol.

Be aware of the patient’s current assessment, suitability and risk related to the planned procedure

Keep clear and accurate records of all medicines administered, ensuring written entries and signatures are clear, legible and written in black ink.

Obtain informed consent prior to any treatment being given.

Explain the nature, purpose, extent and risks of any treatments proposed to be given to the patient, and give information on available alternatives.

Ensure no action or omission on their part or within their sphere of responsibility, is detrimental to the interests, condition or safety of patients or clients.

Acknowledge any limitations in knowledge and competence, and should decline technical duties or clinical decision making responsibilities unless able to do so in a safe, skilled and competent manner.