Langley and Warren v Glandore Pty Ltd [1997]: Critical Analysis of Perioperative Ethics and Negligence

In this analysis we will discuss about langley & warren v glandore pty ltd  and below are the summaries point:- The case of 'Langley and Warren v Glandore Pty Ltd [1997]' highlighted ethical and negligence concerns in the perioperative environment. The judgment revealed the responsibility of surgeons and nurses in a surgical negligence case involving a left-behind surgical sponge. The case emphasized the importance of following ethical standards and ACORN Standard statements for perioperative care.  

LANGLEY AND WARREN V
GLANDORE PTY LTD

Table of Contents
Table of Contents.................................................................................................................2
Background of case ‘Langley and Warren v Glandore Pty Ltd [1997]’..............................3
Critical Analysis of Case ‘Langley and Warren v Glandore Pty Ltd [1997]’ and
assessment of principles of law and ethics in the perioperative environment.....................3
Assessment of evidence on the basis of which implication of perioperative nursing care
could be analyzed................................................................................................................5
Discussion relating to opportunities which are be accessed I order to improve
perioperative nursing care while practicing.........................................................................6
Practices which could provide assistance in improving perioperative nursing care
practices...............................................................................................................................7
Conclusion...........................................................................................................................8

Background of case ‘Langley and Warren v Glandore Pty Ltd [1997]’
The key measurement benchmark for hospitality section in present era of competitive
threat and common movement are efficiency, effectiveness, and productivity in provided
service and operations. Therefore it is necessary for them to provide more quality based
and patient friendly environment. With regards to it, perioperative service area is the
main and significant department that participates to obtain this objective (Thorell and
et.al 2016). Medical doctors are eventually liable for services provided to the patients by
all the professional including nurse is a myth. In other words it can be stated that a
significant misconception relating to doctor’s liability for services provided by nurses and
lack of knowledge relating to legal concept of vicarious liability exist due to certain
barriers of nursing practices. The judgment of case law ‘Langley and Warren v Glandore’
has revealed profound ethical, negligence and accountability concern relating to
Perioperative nurses which might be challenged on a daily basis. Present essay
emphasizes on critical analysis of specified case ‘Langley and Warren v Glandore Pty
Ltd [1997]’ and discussion relating to principles of law and ethics in the perioperative
environment. Further, emphasis has been made to ascertain the opportunities available for
improving perioperative nursing care in their own practice.
Critical Analysis of Case ‘Langley and Warren v Glandore Pty Ltd
[1997]’ and assessment of principles of law and ethics in the
perioperative environment
The case law ‘Langley and Warren v Glandore’ in which decision was made in favour of
two surgeons Langley and Warren, who were held solely negligent as they left a surgical
sponge in patient Glandore’s abdomen post Hysterectomy surgery (Watson, 2009). The
specified case was present before appeal of court and decision was made that both
circulating and instrument nurses were also responsible for the negligence. It can be

assessed that ethics relating to perioperative surgery have not been followed by the
medical team in present case. The ethics relating to perioperative surgery required the
medical team to follow the ACORN Standard statement in appropriate manner. The
incident relating to leaving a surgical instrument is not less than a hypothetical nightmare.
However the same can be prevented through complying with best principles provided
from the ACORN (Australian College of Operating Room Nurses) standard management
of accountable items and other ethical provisions which are being applied in surgery and
procedures. The presence of sponge (item left while operation) was observed after
initiating of painful symptoms to manifest themselves. Further it was removed through
another operation after ten months of first operation. Johnstone and et.al. (2016) asserted
that the judgment held the nurses and the employees of the hospital were also responsible
along with the doctors for negligent conduct as they are a team and required to be
responsible together.
Gott, (2016) stated that captain of the ship has been entertained with the moment in sun
and now the same is dying out as courts concluded that surgeons are not captains of the
ship, the reason behind same is the conduct which happens in an operating room are not
in total control of surgeon as operative team is a collaborative venture in which each
member participate through presenting their expertise and talent.
The case law has enforced to assess the relationship between ethics and multidisciplinary
team work with close attention. Professionals are provided with host of code of conduct,
specific occupational ethical framework (Johnstone, 2015). Thus, same can be complied
on a mandatory basis in order to avoid specified kind of negligence as well as improving
perioperative nursing care practices. The case has enforced to emphasize on guidelines as
well as policies which should be complied by pre-operative staff in order to offer safest
and maximum quality standard of care to patients. As the decision of case has proved
that nurses are also liable in case of negligence as they are part of the team. The specified
accountability is governed by standards internal to nursing and other standards of
medical. Daly, Speedy and Jackson, specified that it can be concluded that no legal
provision exist on the basis of which it can be claimed that medical practitioners are
responsible for carelessness of nurse as they are responsible as a team and not on
individual basis. In the incident of any negative conclusion professional indemnity
insurance provides shield for nurse and client. Thus in case of any negligent conduct by

nurse practitioner, the same will be covered under vicar (Atkins and et.al.2017). ious
liability or personally as well as independently responsible.
Assessment of evidence on the basis of which implication of
perioperative nursing care could be analyzed
Langley and Warren v Glandore Pty Ltd is not the only case law which represent the
carelessness of nurse conduct or the fact that nurse practitioner are independently
responsible for their conduct. In can be assessed that in present case, the negligent
behavior of medical team which comprises failure to follow standard care, lack of,
improper or unproductive compliance with the required standards or provisions. Wilson
and et.al. (2016) specified that the same incident can be decrease only in case nurse
practitioner complies with required procedure and standards in appropriate manner. The
ACORN standard relating to ethics which are required to be followed by nurses along
with whole team requires assuring that two nurses should be available at surgical count.
Further it has been specified in the standard that the list available on each instrument tray
required to be checked and signed by sterilizing department technician or authorized
person prior to sterilization. The standard requires that item of each instrument tray
should be counted by two nurses. One of them is required to be a registered nurse and
another requires to be documented on the APD. Lastly the instrument tray list is required
to be retained in order to provide assistance for further investigation. It can be accessed
that ethics relating to perioperative surgery were not followed by medical team in case of
Langley and Warren v Glandore Pty Ltd. Ethics relating to perioperative surgery requires
health service organization to be responsible for having standardized instrument tray
along with corresponding tray list which provide assistance in documenting and counting
the instruments used in surgery. Further it has been specified in Standard Statement 6
Optimizing the perioperative service is a critical step towards better quality of care as
well as success of the organization. In the existing scenario, uniform processes are a
recognized part of efficiency focused work, which is generally expected by all the people
in their daily life. Before starting of surgery, there are several activities which are
required to be complete by the staff. This may consist of calling the family members
before the surgery, some questions, lab test, completion form and many other related

activities (Carli, and Scheede-Bergdahl, 2015). This is significantly comprehensive
system with a mass of distinct activities that required to be synchronized, so that surgery
takes place in a sound standard and on timely manner. Therefore, it is no wonder that
there is plenty of inadequacies and variable contained within each process (Dogan and
et.al 2015). In reality, minor inadequacies are not considered by the staff members,
because they are mainly concentrated on the main objective in order to provide the
superior quality of service to the patient. Although, if it is keenly review and evaluated, it
has been observed that, there is several opportunities available to the hospitals in order to
enhance their efficiency, staff satisfaction, increase patient and even improve their quality
of control (Desebbe and et.al 2016).
Discussion relating to opportunities which are be accessed I order to
improve perioperative nursing care while practicing
The main objective of surgical count is assure that the items which have been utilized
during surgical process are removed and accounted in appropriate manner on completion
of procedure. Due to same reason it is believed as ‘gold standard’ to manage the relevant
risk (Jarvelainen, Cooper and Jones, 2018.)
The Surgical count can be referred as manual process which asserts that it is compulsory
to count the materials which have been used on sterile field during surgeries. Forrester
(2017) specified that it leads to prevent inadvertent retention in patients. In accordance
with provisions of The Australian College of Operating Room Nurses (ACRON)
‘surgical count should be accomplished by two nurses; one of them should Registered
Nurse and both of them should ensure to count individual item aloud and should have
whilst view on them at the same time’. It can be assessed that in case same provisions
would have been complied in appropriate manner in case of Langley and Warren v
Glandore Pty Ltd. than negligence of advertent retention of items in patient after surgery
would not have happened. Steenhagen, (2018) asserts that at completion of surgery or
any other procedure it is necessary to assure that ascertainment of instrument nurse and
circulation nurse are documented on tray list in accordance with health organization
policy guidelines and returned with the instrument in accordance with required procedure
for reprocessing. Further, the provisions also specify that absorbent accountable items

should be used so that the risk relating to being retained in patients body could be
reduced (Waller and et.al. 2015).
The procedure of surgical count provided as per ACORN standards asserts that a
minimum of three counts should be completed in order to assure the accountable items in
quantity. The procedure should be accomplished by two nurses and the initial count
should be performed prior to the count of surgical process. Moreover, in any case if the
counting procedure is interrupted than same should be initiated from the beginning of
specific item. Lastly, final count should be performed after commencement of closure of
the cavity or wound. The key limitation relating to counting standard or procedure is the
prescriptive nature of procedure and lack of clarity relating to specification that what
constitutes as accountable item in accordance with standards of provision provided in
ACORN. It has been specified in Standard Statement 4 of ACORN standards that a
minimum of two procedural counts should be performed in case accountable items are
used as well as documented in APD. Repetition of counting of accountable item is
believed as a risk management process which provides assistance to assure the accurate
count. Incompliance with same does lead to non-compliance with ethics which are
required to be followed by medical practitioner. The two nurses which does the work of
surgical count in which one is instrument nurse is require to be responsible for count is
not require to behave as surgical assistance where a body cavity is opened. Though, in
any emergency case it does provide assistance to the surgery team than the doctor is
required to provide additional time to nurse for accomplishing surgical count procedure.
The perioperating service could be improved through compliance with above specified
standard as it will eventually lead to increase the accuracy of surgical count procedure.
Practices which could provide assistance in improving perioperative
nursing care practices
Perioperative assessment testing can be referred as a significant procedure as it plays
fundamental role to analyze patient before surgery in order to gather information on the
basis of which risk assessment and pre-operative decisions are made (Pham and
et.al.2016). The specified procedure is conducted before delivery of aesthetic care, prior

to surgical and non-surgical procedures. Compliance with above specified testing
procedure could lead to ascertain the risk factors which are related to intra- as well as
postoperative complications. Quick ascertainment of high-risk patient could result in
decrease in pre- and postoperative mortality and morbidity to significant extent.
Compliance of pre-operative assessment testing procedure could provide appropriate
opportunity to improve perioperative nursing care in significant manner.
Medical practitioners are also required to have knowledge relating to safety features,
capabilities and limitations of equipment which are used along with the manner in which
they are required to be destroyed. It can be accessed from the case that it is very
necessary for nurse to have common knowledge standard in order to accomplish their
conduct in appropriate manner. This kind of misconduct or negligence could be
decreased if general act such as connection of tubes, the material which are applied are
rechecked on a constant manner at each operation or surgery (Lynn and Brownie, 2015).
For instance it has been specified in 3.7 standard statement of ACORN that ‘open and
count multiple like items as per their original packaging’ could lead to provide an ease in
order to ascertain early and discrepancy between expected number of accountable items
in that package and actual no. of items. Further, it has been asserted in standard 3.8 that
standard practice in the event of discrepancy between expected and actual package of
content could lead to decrease the extent of negligence conduct in significant manner
(Page and et.al 2016).
Conclusion
Through application of the lean technique in the health care companies, operational
excellence can be improved. Along with lean technique, quantitative analysis
simultaneously with the interview and qualitative observation also lead towards the
obtaining operational excellence (Damen and et.al.2018). The combination of lean
techniques with the analytical and assessment technique, the organization can depict the
whole image of the journey of patient, discover the main reason of ineffectiveness and
detect the gaps for further enhancement. Operative sanctions for application and
sustainment can then be built to adjacent performance gap (Biertho and et.al 2016).

The counting procedure specified by ACORN Standards requires minimum three counts
of all accountable items. Further the same is required to be performed every time the
items are used during surgery procedure. The same is to be performed by two nurses so
that the extent of assurance relating to the procedure could be enhanced. (Davies and
et.al., 2017). Thus, it can be assessed that management personal are required to ascertain
and implement the scheduling practices in order to provide services in appropriate
manner and to sustain the regularity of team membership. On the basis of the above
analysis, it has been evaluated that, application of the above specified methods directed
towards enhancing the perioperative nursing care. It also helps in providing the superior
level of quality care to every patient. Further, the compliance of perioperative nursing
standard guide relating to the conduct of count provided in ACORN provision will
prevent or reduce the no. of cases relating to error in counting of surgical items.
Moreover, through complying these specified procedure nurses and other member of
surgery team would be able to ascertain their role and responsibilities in order to
accomplish the same ethically. The perioperative nursing care facility could be improved
through compliance with the standards relating to ethics in mandatory form. Further an
enhanced level of service can be attained if nurses as well as medical practitioner which
works as a team comply with the procedure of surgical provided in the provision of
ACORN Standard.

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