UNCONFIRMED MINUTES OF A MEETING OF THE STANDARDS COMMITTEE HELD ON FRIDAY 16 APRIL 2010 AT 10.30 AM AT 21 PORTLAND PLACE, LONDON W1B 1PY PRESENT: Dr Isabeau Walker Chairman Dr Richard Birks President Dr Iain Wilson President Elect Dr Andrew Hartle Honorary Secretary Elect Prof Robert Sneyd Vice President Dr Val Bythell Council Member Dr Ranjit Verma Council Member Group Captain Neil McGuire Military Representative Dr David Scott Mr Terry Longman Dr Stephen Wilson Dr John Stevens Dr Steve Fenlon Dr Ali Diba Dr Harvey Livingstone Invited to attend Mrs Chloë Hoy PA to Executive Officers / Secretariat Co-ordinator 1. APOLOGIES FOR ABSENCE These were received from Dr Ian Johnston (Honorary Treasurer), Dr Steve Yentis (Editor-in-Chief, Anaesthesia), Dr Ellen O Sullivan (Honorary Membership Secretary), Dr Bernie Liban (Council Member), Dr Mansukh Popat (Council Member), Dr Kathleen Ferguson (SSC Representative), Dr Hannah Gill (GAT Representative), Dr Philip Bickford Smith (), Dr Peter Murphy (), Dr Patrick Magee (Standards Representative) and Dr William Boaden (). 2. CHAIRMAN S REMARKS The chairman, Dr Walker, welcomed everyone to the meeting, and introductions were made. 1
3. TO APPROVE THE MINUTES OF THE MEETING OF THE STANDARDS COMMITTEE HELD ON 17 APRIL 2009 The minutes were approved. 4. MATTERS ARISING FROM THE MINUTES Item 4, Funding Dr Walker reported that the issue of funding was still ongoing. It was agreed that standards work was very important to the NHS. Dr Birks had written to Professor Sir Liam Donaldson in 2009 and had included copies of previous correspondence on the subject; his letter had been acknowledged but he had not received an official response. Dr Birks agreed to write again after the new government was formed. Action point: Dr Birks to write to the new CMO after the new government is formed. He would also copy in Sir Liam who was now NPSA Chairman. Item 7, N2O/entonox misconnection Dr Scott gave some background information about this matter for those not present at the last meeting. Recently another near-miss regarding entonox misconnection to a nitrous oxide outlet had occurred at Dr Scott s Trust. The error was possible as components of the connection were made of plastic that became worn with time, making it possible to insert an entonox pipeline into a nitrous oxide outlet. Mr Longman reported that manufacturers were unwilling to change the standard to mandate metal-only components as this was deemed design restrictive. There would be another BSI committee meeting the following week and this would be the main item on the agenda. Dr Scott reported that Dr Yentis had been contacted with regard to putting an article in Anaesthesia about this issue; however, an article had gone into an obstetric journal instead. Dr Bythell suggested putting something in Anaesthesia News instead. Dr Stevens suggested asking Mr Clive Bray at MHRA to look into the matter before he demitted office. Dr Scott reported that he had spoken with Mr Doug McIvor already. Action points: Dr Scott to liaise with Dr Bythell with regard to putting an article into Anaesthesia News. Dr Walker to contact Mr Bray and Mr McIvor. 5. ANAESTHETIC GAS SCAVENGING SYSTEMS Dr Walker was extremely grateful to Dr Tony Nightingale for originally noticing this error in the standard. MHRA had recently issued an alert, and ISO would issue an amendment to the standard in due course. Dr Hartle remarked that this was an excellent example of the importance of standards work. He expressed his gratitude to Mr Longman, Barema and MHRA for their work on this. He and 2
Dr Walker would write an article about this matter for Anaesthesia News after the general election. There would be an ISO meeting in New Zealand in June, and Dr Bill Boaden would attend. AAGBI Council had agreed to fund his expenses. Since the alert was released, Mr Longman had received a couple of enquiries from anaesthetists who wished to know where they could obtain the valves referred to. He had put them in touch with the relevant people. Action point: Dr Walker to communicate formally with Dr Boaden regarding his attendance at the ISO meeting. 6. REPORTS a) From the Chairman of the Safety Committee Dr Hartle reported that the work of the Safety Committee was steadily increasing; because of this, the committee would now meet three times a year instead of two. SALG was going from strength to strength. The incident reporting e-form had gone live and the regional e-form roadshows had been well attended. Incident reporting was now increasing. NPSA issued two linked alerts in November 2009 about neuraxial connectors; Dr Hartle explained these in detail for the committee s benefit. There were two devices that had already been subjected to clinical trials by Dr Tim Cook, and further trials were underway. It was anticipated that there might be as many as six of these devices on the market by 2013, and the AAGBI, RCoA and the NPSA External Reference Group were monitoring the situation closely as the diversity of these devices could potentially be dangerous. This was a complicated issue as there were obviously considerable commercial interests from the manufacturers. Dr Hartle had emailed all the AAGBI s specialist societies to ask if/how this alert would affect their area of practice. This issue was discussed at length by the committee. Dr Stevens noted that it was likely that the connector proposals from B-Link (UK) Ltd (a company of which Dr Bickford Smith was a director) would go forward as the ISO proposal for neuraxial non-luer connectors. At this point, Dr Birks left the meeting. b) From NPSA Representative As Dr Bell was not present at the meeting, there was nothing to discuss. c) From Standards Committee members Dr Walker thanked members for their reports and invited a summary from those present. Mr Longman gave a summary of his report, which included a list of committees of which he was a member, and a list of projects he was involved with. One major project was Anaesthetic Workstations; a large number of comments had been received on their draft standard which would be discussed at the ISO meeting in June. Another major project was Anaesthetic Machines for 3
Developing Countries. This was at committee draft level and would also be discussed at the June ISO meeting. Dr I Wilson noted that it had taken a long time to develop this standard and asked whether it would be helpful for the WFSA to support what had been done so far; Mr Longman replied that it would. A WFSA representative in attendance at the ISO meeting would be very helpful, but was unlikely to happen in practice. Dr Walker would speak to Dr Boaden in advance of the meeting to ensure he was aware of this project and the issues surrounding it. Group Captain McGuire suggested that it would be helpful if it was clear that the standard did not refer to the military. This was discussed by the committee and it was suggested that Group Captain McGuire should wait until the draft standard had been published before submitting an official comment. The Anaesthetic Workstation and Tracheal Tube projects were briefly discussed with regard to paediatric issues. Dr Walker reported that the APA had been concerned with the suggestion that manufacturers were considering removing the auxiliary common gas outlet from newer generations of anaesthesia machines; the auxiliary common gas outlet was essential to allow for the use of a T-piece in place of the circle system. Mr Longman did not think that this was under discussion as an amendment to the anaesthetic workstation standard, but he would look in to this. Dr Walker also remarked that the cuff position on paediatric tracheal tubes was very variable and wondered if this had been discussed as part of the tracheal tube standard; Mr Longman would find out if this was the case. Action points: Dr Walker to speak to Dr Boaden in advance of the ISO meeting. Mr Longman to look into whether the tracheal tubes standard covered paediatrics (as detailed above). Dr Scott gave a summary of his report. He was currently on six BSI committees and went through each in turn. Some of the main points discussed were: A call for comments for the Breathing Tubes standard had had no response. Dr Scott had withdrawn from the project to standardise nomenclature for the description of ventilator modes. Dr Scott had submitted a large number of comments on the Endotracheal Tubes standard, but he anticipated that some of them would not be adopted. He asked the committee to endorse one particular comment he had submitted regarding restriction of the radius of curvature of tubes; this was agreed. The Electromedical Equipment committee had a vast remit, and a major revision of IEC 60601.1 was underway. Dr Scott felt that much of it was not feasible in practice. There would be a meeting held the following week; Dr Scott would attend and defend his position. Dr Scott had been presented with a Pask Certificate by the AAGBI in September 2009. He thanked those from the Standards Committee who had supported him. Dr Stevens gave a verbal report, including an update on breathing system filters; the updated standard would consider the effects of water penetration on performance of filters. The standard for automated non-invasive blood pressure 4
monitors had now been agreed. Dr Stevens reported that there would be a BSI committee on robots. Two parts of this would be of interest to anaesthetists: medical care robots and personal care robots. Anyone with an interest or experience in robotics would be welcome to sit on the committee. Dr Wilson raised a concern regarding readings from automated NIBP monitors where the anaesthetist might forget to change the NIBP from manual to auto. At present, most machines would display the same blood pressure reading indefinitely, misleading the anaesthetist and possibly giving them a false sense of security. Dr Scott said that this was a matter for the manufacturers. Dr Hartle agreed to bring this to the Safety Committee. Action point: Dr Hartle to bring the issue of NIBP displays to the Safety Committee. In their absence, Dr Bickford Smith and Magee had circulated written reports to the committee. Much of the content of Dr Bickford Smith s report had been considered previously. Dr Magee s report was received just before the start of the meeting so was not considered in detail. 7. ANY OTHER BUSINESS The three most recent people to join the Standards Committee were Drs Diba, Fenlon and Livingstone. Dr I Wilson suggested that they might wish to represent the AAGBI on BSI standards committees. Dr Stevens emphasised the importance of liaising with their Trusts to gauge their level of support, especially regarding time to attend standards meetings and funding for this work. Action point: Dr Stevens and Mr Longman to discuss the relevant BSI committees with Drs Diba, Fenlon and Livingstone. Dr Walker to write to the secretary of BSI (Ms Susan Marshall) to propose Drs Diba, Fenlon and Livingstone as representatives of the AAGBI. 8. DATE AND TIME OF NEXT MEETING This would be decided at a later date. 5