1. Medical Ethics In The Operating Room Medical Ethics In The Operating Room a Reminder

2. Medical Ethics In The Operating Room Objectives A reminder to us all Why ethics ? Examples of some existing problems. Examples of some practical solutions. Conclusions & Suggestions.

3. Medical Ethics In The Operating Room Why Ethics ?

4. Medical Ethics In The Operating Room Why Ethics ? In medicine we deal with confidential issues (related directly to people’s lives, history, behavior, body, health & disease). Patients put their trust in medical professionals & expect high ethical standards.

5. Medical Ethics In The Operating Room Why Ethics ? Health providing teams are expected to know & maintain a high level of ethical standard. Most ethical issues are standard. Some special ethical issues are related to: –religion, culture, …etc Deficiencies in practical application of known ethical standards exist.

6. Medical Ethics In The Operating Room Why Ethics ? Ethical issues are always of concern to the public. Any breach of ethical standards leaves harmful effects shaking the confidence in the system. ( media controls the public opinion)

7. Medical Ethics In The Operating Room

8. Current Situation

9. Medical Ethics In The Operating Room Current Situation Written ethical standards: –? not widely applied in all hospitals. –? not known and/or not fully applied to all personnel using the Operation Room.

10. Medical Ethics In The Operating Room Role of Hospitals

11. Medical Ethics In The Operating Room Role of Hospitals Provide the best medical treatment as well as ethical standards. Leading hospitals & institutes should: –Apply the highest ethical standards, –Teach them to the future generations of medical personnel.

12. Medical Ethics In The Operating Room Some Ethical Issues In OR

13. Medical Ethics In The Operating Room Some Ethical Issues in The OR I.Exposure of body. II.Dress. III.People gathering and traffic. IV.Noise. V.Comments and behavior. VI.Honesty. VII.Consent.

14. Medical Ethics In The Operating Room I. Exposure of body

15. Medical Ethics In The Operating Room Exposure of body Parts of body should not be exposed to others ( governed by religion ) –men : from umbilicus to knees. –ladies : all body. Exceptions are allowed when necessary according to a definite need. Exposure of some body parts is often necessary, depending on procedure.

16. Medical Ethics In The Operating Room Exposure of body - Examples Preparation for anesthesia Chest auscultation & inspection. Insertion of folly catheters.

17. Medical Ethics In The Operating Room Exposure of body - Examples Patient’s transfer to & from: –Operating table, –Recovery, –The ward.

18. Medical Ethics In The Operating Room Exposure of body - Examples Positioning of patient. Application of tourniquet. Cleaning & draping. Removal of draping & tourniquet. Application of cast.

19. Medical Ethics In The Operating Room Exposure of body Whenever exposure is necessary, it should be : Limited to parts needed only. In the presence of limited number of people. For the shortest period of time.

20. Medical Ethics In The Operating Room Exposure of body –when necessary Limited to parts needed only. Often over exposure takes place !

21. Medical Ethics In The Operating Room Exposure of body - when necessary In the presence of limited number of people. Often too many people around (Drs. / Nurses / Technicians / Students/ workers) Often unnecessary

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23. Exposure of body - when necessary For the shortest period of time. Not to call in the cleaners early (to save time). Do we really apply this ?

24. Medical Ethics In The Operating Room A sign “Female patient” or “Do Not Enter” outside of the operating room. Suggestion

25. Medical Ethics In The Operating Room II. Dress

26. Medical Ethics In The Operating Room Dress - patient A single piece, Does not expose selected parts only, Does not cover well behind, often torn strip ends, Ladies: –Sleeves short, –Head, face and neck cover not adequate. Not good for both sexes, Not descent by any standard !

27. Medical Ethics In The Operating Room Dress - patient Underwear  by some policies should be removed ( even if operation is at neck ! ). Problems with patient’s underwear : –uncleanliness / metal parts / nylon ? Solution: –ensure and allow clean underwear. –Provide proper disposable underwear.

28. Medical Ethics In The Operating Room Suggested Patient’s Dress

29. Medical Ethics In The Operating Room Suggested Patient’s Dress Criteria Should provide adequate cover according to local standards (religion). Should provide adequate local ( selective ) exposure. Should allow quick & practical wide exposure in emergency situations. Should look descent.

30. Medical Ethics In The Operating Room Suggested Patient’s Dress

31. Medical Ethics In The Operating Room Suggested Patient’s Dress

32. Medical Ethics In The Operating Room Suggested Patient’s Dress

33. Medical Ethics In The Operating Room Suggested Patient’s Dress

34. Medical Ethics In The Operating Room Dress - staff Lady staff  Drs., nurses, students. Does not meet required standards regarding : –Design, –Width & length, –Areas covered ( head & body), –Practicality. ( ask our lady colleagues ! )

35. Medical Ethics In The Operating Room New Staff’s Dress Suggested and designed by our lady colleagues

36. Medical Ethics In The Operating Room Suggested Staff’s Dress Proper head cover. Proper neck cover. Proper forearm cover. Buttons on side. Wide. Comfortable.

37. Medical Ethics In The Operating Room Suggested Staff’s Dress Sleeves can be rolled up above elbow for draping. Fixed by press button on strips pulled from inside.

38. Medical Ethics In The Operating Room Lady Surgeons Scrub Area

39. Medical Ethics In The Operating Room Scrub Area ManLady

40. Medical Ethics In The Operating Room Scrub Area

41. Medical Ethics In The Operating Room III. People’s gathering & traffic

42. Medical Ethics In The Operating Room People’s gathering and traffic Often too many people in the corridors, receiving area & OR  causes inconvenience to patients & staff. Problem related to : - behavior of staff & students. - limited space. (Both should be discussed & improved)

43. Medical Ethics In The Operating Room People’s gathering & traffic Traffic at the receiving area

44. Medical Ethics In The Operating Room IV. Noise

45. Medical Ethics In The Operating Room Noise Patients coming to OR are worried  need privacy, silence & reassurance. Noise should be kept to minimum.

46. Medical Ethics In The Operating Room Noise

47. Medical Ethics In The Operating Room V. Comments & Behavior

48. Medical Ethics In The Operating Room Comments & Behavior Jokes & laughing: –Loudly, –In front of patients, –In a language not known to them ! –Before anesthesia, –During procedure with local/spinal anesthesia.

49. Medical Ethics In The Operating Room Comments & Behavior Comments & remarks on patient’s: –Disease, –Body shape or weight, –Behavior …etc. That would not be said if patient is awake

50. Medical Ethics In The Operating Room Comments & Behavior Patients might see instruments before anesthesia: –Scissors, –Drills, –Scopes, –Saws.. etc

51. Medical Ethics In The Operating Room Comments & Behavior

52. Medical Ethics In The Operating Room Comments & Behavior In the OR, in front of others before or after anesthesia In the receiving area or in the corridors!

53. Medical Ethics In The Operating Room VI. Honesty

54. Medical Ethics In The Operating Room Honesty Patients often ask who performed surgery The answer should be honest & concentrate on : –Concept of team work. –Quality is assured. –Supervised by the consultant / senior staff. –Teaching / training does not reduce standards.

55. Medical Ethics In The Operating Room Honesty Tell the truth ! What went wrong. Complications. Unexpected incidence.

56. Medical Ethics In The Operating Room VII. Consent

57. Medical Ethics In The Operating Room Consent Should not be taken in the operating room !

58. Medical Ethics In The Operating Room Conclusions & Suggestions Ethical issues are sensitive & important. Ethical standards according to religion and culture  must be met. Deficiencies exist in the application of some ethical standards. Need to revise policy of patient’s dress & the ladies dress  to meet local ethical standards.

59. Medical Ethics In The Operating Room Preserve Patients’ dignity during all phases of transportation. Patients should not be exposed unnecessarily regarding: –The area exposed, –The duration of exposure, –The number of people present during exposure. Patient examination if needed  should be inside the operating room only, with privacy & limited exposure. Conclusions & Suggestions

60. Medical Ethics In The Operating Room During patient positioning & preparation  should only allow those whose presence is absolutely necessary : Allow other staff and students in only after the patient is draped. (not just for lady patients) Conclusions & Suggestions

61. Medical Ethics In The Operating Room The consultant surgeon  is responsible to ensure all medical staff are aware of & follow the OR ethical guides (especially regarding female patients). The charge nurse of every OR  should have the authority to limit the number of personnel in the OR during preparation & surgery especially for female patients. Conclusions & Suggestions

62. Medical Ethics In The Operating Room Further work & discussion is still required. Conclusions & Suggestions