COLOUR CODING IN THE PERIOPERATIVE NURSING PRACTICE.

COLOUR CODING IN THE PERIOPERATIVE ENVIRONMENT HAS COME TO STAY ,SOME SENCE OF HUMOUR WILL BE APPRECIATED AT THE RIGHT TIME BY THE PATIENT AND OTHER SURGICAL TEAM MEMBERS.

1. COLOUR CODING IN PERIOPERATIVE PRACTICE NR. SAMBO MN

2. INTRODUCTION A proper prioritisation system of emergency cases allows appropriate timing of surgery and efficient allocation of resources and staff expertise. The implementation of a universal classification of emergency operations will be able to improve the efficiency of OR utilisation during daytime, shorten preoperative delay in patients requiring urgent surgery, as well as enable monitoring for providing emergency surgery services. Conversely, a lack of a proper prioritisation system and delayed surgical intervention has shown to incur significant costs, including an increase in morbidity rates as well as economic impact.

3. INTRODUCTION cont.., Colour coding of cases booked in the OT is another method of classification of urgency. Colour codes provide a common and standardised language among surgical teams and other OT staff. Findings from various studies suggested that the colour coding system significantly shortened the decision-to-surgery interval, indicating that it is an effective tool for communicating the degree of urgency for emergency cases. Although certain cases are posted as non-urgent, prolonged waiting will in turn result in further deterioration of the condition patient.

4. DEFINITION Surgical coding refers to the process of assigning specific codes to medical procedures performed during surgery . Colour coding is frequently used to distinguish safety, caution and danger. In healthcare, red, yellow, blue and green in various gradations have traditionally been used in risk assessment matrices Colour is used to denote both a state of criticality and the priorities of action in the operating room. The colour coding of incident evolution -- from a ‘routine’ or ‘safe’ state through a non-routine state to a crisis, and thence through emergency management to a final outcome.

5. BRIEF HISTORY OF COLOUR CODING Red is the first colour to be distinguishable by the human eye from all other colours in low light conditions ‘stop’ (19 TH Centuery ) Green was the familiar compromise and officially became ‘go’; and yellow, equally distinguishable from both green and red, was chosen as the intermediate; caution to stop. Code Blue’ has in most western healthcare settings become synonymous with cardiopulmonary arrest and emergency resuscitation . In western cultures, black, the colour traditionally worn at funerals, is a symbol of death Colour-coding modelled on the modern traffic light system 

6. CATEGORIES OF CODING IN SURGERY COLOUR RED CATEGORY : Acute Emergency (within 2hrs) DEF : Patient conditions require immediate operation e.g., life threatening situation. failing which life/limb will be lost EG ; Embolectomy for Acute ischaemic limb. operation e.g., life threatening situation Bleeding GIT. failing which life/limb will be lost. Unstable Trauma patient with abdominal /chest/ neuro injuries (blunt/penetrating) Torsion testis Acute extradural haemorrhage , drop in GCS due to surgical lesion. Compartment syndrome. Threatened airway. Immediate threat to life of women or foetus COLOUR YELLOW CATEGORY : Emergency (within 8 hours) DEF : Patient condition which haemodynamically stable that requires operative procedure to be carried out otherwise life is threatened or morbidity increased EG : Suspected traumatic intrabdominal injury Perforated viscus , intestinal obstruction. Necrotising fasciitis Blocked VP shunt, Cerebral abscess, ruptured meningocele . Compound fracture. Perforating eye injuries Leaking ectopic pregnancy

7. CATEGORIES OF CODING cont..; COLOUR GREEN CATEGORY : Urgent (within 24 hours) DEF : Patient conditions which requires operative procedure within 24 hours otherwise there is increased in morbidity EG : Acute Appendix, Abscess, carbuncle, Cholecystitis /empyema, cholangitis, Laceration wound. Chronic subdural haematoma , aneurysm. Infected wound for debridement COLOUR BLUE CATEGORY Semi-urgent (within 72 hours) DEF : Patient surgical pathology is stable and non-emergent but the patient cannot or should not leave hospital without an operation. EG : Secondary suturing, Tracheostomy for prolonged ventilation.

8. CODING DURING SURGERY RED : Bleeding, cardiac arrest, obstruction of the air way, respiratory arrest. Speed and accuracy is needed by all here. Avoid all forms of jokes. YELLOW :During a normal plan case, soft music at the background may be soothing GREEN : can be at the end of a successful surgery BLUE : while suturing, application of cast etc A t the lighter side of surgery, you need a slightly sick sense of humor to make it in the OR. B ecause we spend the better part of our days in high-stress surgeries up to our elbows in blood and guts. During tough times, we sometimes laugh to keep from crying.

9. IMPORTANCE OF CODING IN THE OR This enhanced objectivity of case prioritisation Implementation of a universal standardised classification of cases also helped to improve the efficiency of operating theatre utilisation. T he colour coding i s a useful communication tool among surgeons and OR staff

10. EXCEPTIONS TO CODING IN OR Upgrade of category will be considered by the Surgical team on call with the following patient’s condition: Significant medical/anaesthetic risk from clinical assessment. Extreme of ages: infants; 80yrs old. Waiting time more than double of the recommended time eg . Yellow >16 hours, Green more than 48 hours.

11. Re- categorisation When a yellow, green or blue case is due in theatre (8, 24 and 72 hours after booking, respectively), and cannot be done, the case must be “re- categorised .” The surgeon should then recategorise the case appropriately.

12. HUMOR IN THE OR Both medicine and comedy require bravery, stamina, and a love of engaging with and serving others. However, given that patient health is no laughing matter. Humor as Ice-Breaker Humor Has a Time and Place Humor as Control Humor as Medicine Humor provides numerous benefits for health care practitioners and their patients Humor can be used to establish relationships, relieve anxiety, release anger in a socially acceptable way, avoid or deny painful feelings, and facilitate learning. Perioperative Nurses can use a variety of techniques and resources to increase their use of humor, even if they perceive themselves to be humor-impaired.

13. EMERGENCY ROOM CODING

14. CONCLUSION The use of a colour coding classification significantly shortens Time To Theatre (TTT) by effectively communicating the degree of urgency in managing emergency surgery cases. M astering surgery coding requires continuous learning, practice, and dedication .

15. REFERENCES Buxman , K. (2008). Humor in the OR: a stitch in time?  AORN Journal ,  88 (1), 67+. https:// link.gale.com/apps/doc/A181301490/AONE?u=anon~43b6af20&sid=googleScholar&xid=fcdbb780 Paula, W.(2022).Behind Closed Doors: sometimes you just have to laugh. Out-Patient Surgery.   AORN Journal , https :// www.aorn.org/outpatient-surgery/article/2022-March-have-to-laugh WHO guidelines for safe surgery : 2009 : safe surgery saves lives. WHO/IER/PSP/2008.08-1E

16. REFERENCES Westerman , J (2022).Other Healthcare Professional. https:// opmed.doximity.com/articles/a-good-laugh-goes-a-long-way-using-humor-in-patient-interactions HIAlearn , (2024). offers on-demand, online medical coding education for individuals and groups . V ariantone (2021). 7 Steps for Accurate Surgical Coding. https ://qwayhealthcare.com/blog/7-steps-for-accurate-surgical-coding / Khaw S.K, M ., Teo S.C, Mohamad A.B. (2020).The impact on patients’ time-to-theatre following colour coding classification in emergency operation theatre, Sarawak General Hospital