Marlene Patricia Wightman

That all nursing staff recruited in the Hospital to care for post-operative breast surgery patients should either (i) have sufficient prior experience in caring for surgical patients as to be familiar with the nature and extent of the particular procedures which have been carried out on these patients, have knowledge of the detailed requirements of their care, be aware of known complications which can arise from these procedures and how to recognise them, and have knowledge of and a clear understanding of what action to take and how to implement all necessary procedures and protocols should such complications arise; or alternatively, (ii) in the case of nursing staff recruited without such prior experience, they should be required to undergo a structured and supervised programme of induction on the nature and extent of the particular procedures which have been carried on these patients, be educated in the detailed requirements of their care, be made aware of known complications which can arise from these procedures and how to recognise them, and be given knowledge of and a clear understanding of what action to take and how to implement all necessary procedures and protocols should such complications arise.

Such nursing staff should not be given sole unsupervised responsibility for the care of such patients until they have completed such an induction programme; and (iii) that there should be regular compulsory continuing education of nursing staff who care for surgical breast patients to refresh and confirm their existing knowledge and experience.

That all junior medical staff in the Hospital who provide out of hours cover for the care of post-operative breast surgery patients should either (i) have sufficient prior experience in caring for surgical patients as to be familiar with the nature and extent of the particular procedures which have been carried out on these patients, to be aware of known complications which can arise from these procedures and how to recognise them, and to have knowledge of and a clear understanding of what action to take and how to implement all necessary procedures and protocols should such complications arise; or alternatively (ii) in the case of junior medical staff recruited without such prior experience and who will be required to provide out of hours medical care for such patients as part of their duties, they should be required to undergo a structured and supervised programme of induction on the nature and extent of the particular procedures which have been carried out on these patients, to be made aware of known complications which can arise from these procedures and how to recognise them, and to be given knowledge of and a clear understanding of what action to take and how to implement all necessary procedures and protocols should such complications arise.

Such medical staff should not be given sole unsupervised responsibility for the out of hours medical care of such patients for any period until they have completed such an induction programme; 3.

That a system should be put in place at the Hospital whereby there are both middle and senior grade medical staff on site out of hours on evenings and week-ends providing medical cover for Ward 6; that a clear protocol should be established of the circumstances in which nurses should contact either the junior urology house officer, or such middle and senior grade staff or the consultant on call in the first instance when seeking review of a patient; and that steps should be taken to ensure that any such protocol is made known to all individual nursing and medical staff who will be responsible for the care of patients on the breast unit out of hours at any time.

That a consistent and uniform system of record keeping should be adopted for nursing staff who care for breast surgery patients in the Hospital and that there should be regular inspection and audit of the records of individual patients to ensure that the accuracy and uniformity of the records are maintained.

That patients who have undergone breast surgery in the Hospital should receive their post operative care in a surgical ward for breast patients only.