1. PRPD/DN/DM/PON/2010 1 THE PERIOPERATIVE PATIENT CARE TEAM & ROLES PRPD/DN/DM/PON/10

2. PRPD/DN/DM/PON/2010 2 The Perioperative Team Is subdivided according to the functions of its members: 1. The nonsterile team a. Anaesthesia provider b. Circulating nurse c. Perianaesthesia nurse d. Others (e.g., students, sales representatives, laboratory or radiography personnel) 2. The sterile team a. Surgeon b. First assistant c. Scrub person

3. PRPD/DN/DM/PON/2010 3 Nonsterile Team Members Perianaesthesia Team -Consists of RNs and specially trained patient care assistants -Preoperatively, the RN assesses the patient and documents the findings. -Any information that contributes to the care of the patient in the intraoperative area is communicated to the intraoperative team members.

4. PRPD/DN/DM/PON/2010 4 Nonsterile Team Members cont… Anaesthesia Provider –Is the person responsible for inducing and maintaining anaesthesia at the required levels and managing untoward physiologic reactions throughout the surgical procedure. –is an indispensable member of the perioperative team. –Functioning as a guardian of the patient throughout the entire care period.

5. PRPD/DN/DM/PON/2010 5 Nonsterile Team Members cont… Circulating Nurse –There are 3 major concerns: 1.Care of patient safety and the staff 2.The maintenance of asepsis 3.Allegiance to the scrub nurse –The role involves working very closely with the scrub nurse and being constantly alert to his or her needs in particular.

6. PRPD/DN/DM/PON/2010 6 The Functions of Circulating Nurse 1. Orientation Familiarize self with the geography of the suite and the department, the equipment. Knowing things are and how they work saves time. Outside the suite e.g.: - nearest defibrillator, telephone, fire appliances and the exits. - All the stockrooms: extra instrument, blades, sutures, dressing, disposal bags and stationery. Inside the theatre suite e.g.: - locate all the sterile equipment needed for operations, lotions, the warming cabinet etc. - the major pieces of furniture: the diathermy machine, the lights, the suction and the operating table.

7. PRPD/DN/DM/PON/2010 7 2. Preparing for an operation Test all electrical equipment for safe functioning. Switch on the lights, both the main and operating lights, see all bulbs are working. Switch on diathermy machine, and check that the patient alarm is working. Test to see the suction is working. Report malfunctions immediately to the nurse in charge. Check any additional equipment or furniture is needed for the list e.g. an extra sucker or trolley. See that clean linen, swab and rubbish bags have been put out. Scrub up area check for enough gowns and gloves available, soap, sterile brush dispenser etc.

8. PRPD/DN/DM/PON/2010 8 3. Helping the Scrub Nurse Help the scrub nurse to prepare the sterile equipment for the operation. Open a gown pack and the correct size gloves for the scrub nurse. When the scrub nurse has scrubbed up help him/her into the gown and secure the tapes. 4. Opening extras Open packs of sutures, ties, swab, blades and other extras needed. Check items for sterility. Maintain sterility during opening

9. PRPD/DN/DM/PON/2010 9 5. Checking lotions Prepare lotion for skin preparation - show label on the bottle to the scrub nurse to verify the correct solution and check the expiry date. Pour the lotion into the offered container from a height of at least 15cm. 6. Drugs Prepare the required drugs on the scrub nurse’s trolley, such as an ampoule of local anaesthetic. Check the drug and the expiry date with the surgeon as well as the scrub nurse before it is drawn up for use.

10. PRPD/DN/DM/PON/2010 10 7. Performing the first count Count and record the number of instruments, swabs and needles on the trolley before the operation commences. Check the instruments, use the check sheet from the prepacked tray, and call out the contents. Record any added instruments to the basic tray on the count sheet.

11. PRPD/DN/DM/PON/2010 11 8. Patient safety Positioning the patient. Make sure all limbs are securely positioned. Check that all pressure points are adequately padded. Make sure the diathermy plate is in position, and with good contact with an area of dry skin ensure no contact with metal as burns could occur.

12. PRPD/DN/DM/PON/2010 12 9. Arranging Furniture Help the scrub nurse to arrange the trolleys comfortably. If a mayo table is to be used, move it in over the patient’s feet. Diathermy machine best placed at the foot of the table. Connect the sterile diathermy lead and switch it on. Arrange foot pedal for the surgeon. Connect the suction tubing and switch the suction on.

13. PRPD/DN/DM/PON/2010 13 10. Weighing and Hanging Swabs Hang the soaked swabs up on the swab rack for counting e.g. group of five according to type 11. Hunting for lost swabs Recount discarded swabs. If the swab still missing continue to search in the disposal bins – in the linen and rubbish bins. Final resort – the patient must be x-rayed.

14. PRPD/DN/DM/PON/2010 14 12. Handling Specimens Handle the specimen with great care. Put in the appropriate sized container and label it clearly. Most of the specimens are for histology and can be put into the preservative formol saline. Specimens for microbiology may be left dry or else put into a culture medium.

15. PRPD/DN/DM/PON/2010 15 13. Taking and Giving Messages One of the major function of Circulating Nurse is to act as a link between the scrubbed team and the outside world. Write down all the details of the message accurately. Any messages given regarding the details of patients on the operating list or any changes to the list itself, it is vital to tell the nurse in charge immediately.

16. PRPD/DN/DM/PON/2010 16 14. Closing and Final Counts Two counts are done: 1. When the first cavity is closed. 2. Once the surgeon begins to close the wound, the scrub nurse and circulating nurse need to count all the instruments, swabs and needles again. This is to ensure that nothing has been left at the site of operation. Sign for any counts that have done.

17. PRPD/DN/DM/PON/2010 17 Sterile Team Members Surgeon – the surgeon must have the knowledge, skill and judgment required to successfully perform the intended surgical procedure and any deviations necessitated by unforeseen difficulties. –The surgeon’s responsibilities include preoperative diagnosis and care, selection and performance of the surgical procedure, and postoperative management of care.

18. PRPD/DN/DM/PON/2010 18 Sterile Team Members cont… First Assistant –Under the direction of the surgeon, a qualified first assistant helps maintain visibility of the surgical site, control bleeding, close wounds and apply dressings. –Handles and manipulates tissues and uses instruments to provide haemostasis.

19. PRPD/DN/DM/PON/2010 19 Sterile Team Members cont… Scrub Person/Nurse The Role: –The scrub nurse is a professional nurse concerned with the safety of patients and staff. –The maintenance of asepsis. –Facilitating and coordinating the work of the surgical team. –Being the centre of the action, controlling the team and the course of the operation.

20. PRPD/DN/DM/PON/2010 20 The Role cont…. –Some control over the theatre atmosphere, particularly over the noise level and the number of personnel present. –Preparing in advance – read up ahead on the relevant anatomy & physiology, the operative procedure and ready the tray of instruments. –Scrubbing up – dressed correctly and comfortably, good hand-wash, put on gown and gloves. –Legal responsibility – is to check the right patient to be operated on and patient has consented. –Introducing yourself to the surgeon.

21. PRPD/DN/DM/PON/2010 21 The Role cont…. –Skin preparation – hand the surgeon the receiver of skin cleaning lotion and the mounted sponge- holders. –Draping – aim is to create a large sterile field around the operation site on which to work. Also reduces the danger of introducing infection to the wound from the atmosphere, and also protects the wound from contamination arising from other areas of the patient’s own body. Only the area of skin to be operated on is to be uncovered. –Put the trolley in place and everything needed is within easy reach, prepare the equipment and instrument prior to surgery.

22. PRPD/DN/DM/PON/2010 22 The Role cont …. –Passing of instruments. –On completion of the procedure: two counts are normally done; i) when the first cavity is being closed, ii) when skin is sutured. –Sort out trolley; check the set of instruments, and complete the theatre documentation. The End