OT nurse.pptx

OT nurse.pptx

1. OT NURSE

2. 1.Entry of OT

3. Entry to OT ENTRY TO UNRESTRICTED AREA Remove the outside chappal and wear OT foot wear ENTRY TO SEMI RESTRICTED AREA Remove outside cloth and wear OT dress as per colour code Wear Mask and Cap ENTRY TO RESTRICTED AREA Entry allowed only with complete OT attire Wash your hands immediately

4. 2.DUTIES & RESPONSIBILITIES OF RECEPTION NURSE   A person responsible to receive patient from surgical ward, and determine patient is well prepared and safe for operation is the reception nurse. The reception nurse looks after the following:

5. Prepare for the completeness of reception area materials and equipment according to the standard of practice. Monitor Damp dusting of all reception area and Equipment. Check the operation list of the day Call patient from the ward as according to the list schedule ahead of operation time . Receive patient from the ward. Provide Nebulisation if there is pediatric patient. Attach all operative notes and surgical checklist with patient’s file Check all consent forms which is signed by patient and relatives Coordinate with circulating nurses, surgeons and anesthetist for plan of care in a particular patient

6. 10 . Receive blood, medication or any requested items. Counter check for accuracy and inform anesthetist and circulating nurse or any operating room team members. 11 . Confirm the correct patient and surgery according to written consent and operating room list scheduled. 12 . Check patient's surgical preparation for operation according to operating room check list. 13. Provide comfort and safety to patient while waiting for patient to be sent into operating room. 14. Keep noise to a minimum in the waiting area. 15. Administer medication as per anesthetist orders and record accordingly.

7. 16. Check and confirm status of the next case in each operating room to call for the next case 17. Answers calls, relay messages and coordinate with all operating room team members. 18. Inform and seek advice from operating room head nurse or supervisor for any immediate problem and difficulties that may arise. 19. Inform anesthetist, surgeon, circulating nurse and operating room staff of any changes made in a particular patient. 20 . Make rounds to all rooms in operating room check for tidiness and keep in contact with operating room personnel.

8. 1. SCRUB NURSE A person who is responsible for maintaining the integrity, safety and efficiency of the sterile field throughout the operation is the scrub nurse .

9. The scrub nurse ensures the following:   1 . Confirm the type of surgery as according to O. R List prior to induction of patient. 2. Assess for: 2.1 correct patient with written consent according to type of surgery. 2.2 Patient’s history of any allergies. 2.3 Correct preparation of patient according to documentation of patient’s OR check list. 2.4 Functioning of Electrical Surgical Unit, suction machine and other necessary machines/equipment that may be required.

10. 3 . Prepare for the completeness of materials & equipment according to the required surgery and surgeon preference. 4. Perform the surgical hand scrub as per standard of practice. 5. Don a sterile gown and gloves according to aseptic technique. 6. Open the inner sterile set and assemble the sterile instrument and accessory sterile items on mayo tray and trolley according to standards of practice. 7. Receive all the remaining instruments and supplies from the circulator. 8. Perform surgical count with the circulator personnel, as per standard of practice. Check the count board for correction of count

11. 9. Assemble the surgical blade (scalpel blade) to the correct scalpel handle using needle holder 10. Prepare sutures according to surgeon preference. 11. Gown and glove surgeon if necessary. 12. Assist in skin cleaning preparation of patient as per standard of practice. 13. Assist in draping procedure aseptically as per standard of practice. 14. Secure drape, suctioning and electrosurgical cord with towel clip and drape the end part to circulator. 15. Bring mayo stand into position over the patient after draping is completed. 16. Ensure the mayo tray is not resting directly on the patient. 17. Place the Electrosurgical unit pin in the quiver or its container when not in use. 18. Pass instruments to surgeon in a firm, decisive, proper position and safe manner.

12. 19. Pass and receive the scalpel from the surgeon in the kidney dish. Do not pass the scalpel to hand directly. 20. Place the skin knife away from the sterile working field 21. Pass ringed instrument in a working position. 22. Retract tissue gently if required. 23. Mount the tape or ligatures using an appropriate size artery forceps when required. 24. Remove artery tips as directed by surgeon and gently releasing the artery grip when the ligature begins to ligate the bleeder’s tissue. 25. Cut suture with tip of stitch scissors as directed by surgeon. 26. Assist in tissue coagulating by pressing the electrosurgical controls according to surgeon’s preference

13. 27. Clean the Electrosurgical tip free from Escher before handling to surgeon. 28. Assist surgeon in suturing. 29. Attach each needle 1/3 of the curve from eye onto a needle holder and close firmly 30. Pass the needle holder by holding both needle holder and the suture material. 31. Anticipate surgeon’s requirements throughout the procedure. Keep one step ahead of surgeon in passing instrument sutures, sponges and handling of specimen. 32. Identify all specimens with the surgeon and handle surgical specimens according to standard of practice. 33 Maintain the neat and orderly sterile field of operative field mayo tray and instrument trolley at all times

14. 35. Maintain strict aseptic technique and watch for any break in the technique throughout the procedure : 35.1 Remove all contaminated used instrument and pass to circulator nurse as standard of practice e.g. bowel surgery. 35.2 Acknowledge if sterile field contaminated and reestablished sterility. 35.3 Change glove at once if contaminated 35.4 Discard a piece of suture material, tubing or sponge if falls over edge of the sterile field without touching the contamination area. 35.5 Keep hands at table levels when at rest .

15. 36 Clear off the operative field and mayo tray as time permits 37. Perform 2nd surgical count sponges, sharps and instruments with circulating nurse when surgeon begins closure of any open cavity. 38. Perform final count of sponges, sharps and instruments with circulating nurse when surgeon starts the wound closure. 39. Connects drainage equipment if used on completion of surgical procedure. 40 Apply dressing to the surgical wound by non-touch technique. 41. Assist in removing the drapes from the patient. 42. Dispose of sharps in sharp container 43. Tidy used trolley and throw rubbish into appropriate bags.

16. 44. Separate sharps and fine instruments from heavy instruments and place them neatly on trolley 45 Cover the soiled instrument before sending to CSSD 46. Remove gown and gloves as per standard of practice. 47. Wash hand immediately after removing glove 48 Complete and check documentation of the peri -operative care plan, record and sign surgical count sheet.

17. CIRCULATING NURSE   A person who is responsible to assist the scrub nurse by providing the sterile needed for the operation, maintaining the Integrity of the sterile area patient throughout the operation is the circulating nurse. The circulating nurse ensures the following

18. 1. Confirm the type of surgery as according to O. R List prior to induction of patient. 2. Assess for: 2.1 Correct patient with written consent according to type of surgery patient’s history of any allergies 2.2 Correct preparation of patient according to documentation of patient’s OR check list. 2.3 Functioning of Electrical Surgical Unit, suction machine, operating table and other necessary machines and equipment that may be required

19. 3. Prepare for the completeness of operating room, materials & equipment according to the required surgery, surgeon reference and standard of practice. 3.1 Prepare the correct position of operating table and always check that operating table is always locked. Gather all the necessary operating table’s accessories as needed in the patient’s positioning 3.2 Ensure operating light for focus, intensity and movement. 3.3 Ensure functioning of suctioning apparatus, Electrical Surgical Unit and other electrical equipment. 3.4 Arrange machines and equipments to maintain the integrity of sterile field 4. Fasten the Scrub Nurse, surgeon and other sterile team member's gown. 5. Check the sterile equipment for its expiry date, sterility and integrity of package before opening to the Scrub Nurse

20. 6. Assist the Scrub Nurse in the preparation of sterile field by providing sterile supplies and opening of sterile package as required 7. Provide the required solutions or medication as required and check with scrub nurse or surgeon to confirm the correct drug, dosage and expiry date. 8. Perform 1st surgical count with Scrub Nurse as per standard of practice. Check the count board for correction of count. 9. Collect the right patient when the operating room is prepared. 10. Assist in the safe transfer of patient on to the operating table 11. Remain with patient during induction and intubation.

21. 12. Assist in the positioning of patient as accordance to the type of surgical procedure and standard of practice. Position the patient upon the anesthetist‘s approval 13. Place the Electrical Surgical Unit conductive pad on the patient as according to standard of practice. 14. Assist in the application of the tourniquet to the patient if required and as standard of practice 15. Expose the operative site 16. Turn on the operating light and assist in the focusing on the operative site. 17. Connect suction and Electro Surgical Unit cord to the machine as required

22. 18. Place stools and kick bucket in the suitable place. 19. Be alert and anticipate the needs of sterile surgical team. 20. Collect and separate discarded sponges by using forceps or glove. Place on moisture proof surface and where visible to scrub nurse. 21. Wear gloves to handle any blood stained equipment/items or body fluids according to universal precautions. 22. Stay in the operating room all the time and ensure there is always a replacement when have to leave. Inform Scrub Nurse upon leaving. 23. Monitor the operating room traffic flow and observe any unauthorized personnel in and out of the operating room. Limit the number of personnel inside the operating room.

23. 24. Check that operating room doors are kept closed at all times. Keep noise and conversation to a minimum 25. Observe the sterile field for any break in aseptic technique. Report immediately if detected. 26. Anticipate the requirements of Scrub Nurse and Surgeon throughout the procedure. 27. Perform 2nd surgical count sponges, sharps and instruments with scrub nurse when surgeon begins closure of any open cavity. 28. Attend to the surgical specimen according to the standard of practice. 29. Perform final count of sponges, sharps and instruments with circulating nurse when surgeon starts the wound closure

24. 30. Assist in the connection of drainage equipment if used on completion of surgical procedure. 31. Check that patient’s dressing and drainage tube are well secured if any. 32. Assist in removing the drapes from the patient. 33. Put on the patient’s gown and cover with blanket. 34. Remove the Electrosurgical conductive plate and tourniquet if used. Check for skin integrity. 35. Open neck and back closure of sterile gown of surgeons and scrub nurse. 36. Check and complete the recording of all necessary docu ments.

25. 37. Supervise and assists with safe transfer of patient to recovery room or intensive care unit 38. Pass over complete information to the recovery room nurse or intensive care unit nurse regarding the patient’s intra – operative care. Check that all charts, X-ray folders and other records are completely endorsed. 39. Send specimen to laboratory as per standard of practice. 40. Check operating room is clean and ready for the next procedure.

26. RECOVERY NURSE A person who is responsible to provide immediate post operative care to patient in the recovery room/area is the recovery nurse.   The recovery nurse performs the following duties:

27. 1. Prepare for the completeness of recovery room, materials and equipment according to the standard of practice 2. Check for functioning of suction machines lighting and other equipments are in a working condition. 3. Ensure Damp dusting of all recovery room surfaces and equipment. 4. Note the time of arrival on receiving the patient. 5. Assess air exchange status, color of the patient and attach pulse oximeter

28. 6. Administer oxygen therapy via mask until discharge from recovery room unless contraindicated by the Anesthetist: Adult --- 5 Litres per minute, Children up to 12 years: 2 Litres per minute 7. Connect patient to all necessary hemodynamic monitoring equipment 8. Receive a verbal complete handing over report about patient’s operation from the respective OR personnel. 9. Confirm the patient identification with OR personnel and with the identification band. 10. Check all patient’s documents for completion upon receiving patient from OR. 11. Assess the level of patient’s consciousness. 12. Assess for any complain of pain from patient.

29. 13. Monitor the patient’s vital signs every 5 minutes 14. Observe any signs of bleeding from wound sites and drainage tube. 15. Administer medication as per Anesthetist orders and record accordingly 16. Ensure patient is in comfortable position and as according to anesthetist and surgeon’s order: 17. Supine position for patient with epidural catheters 18. Carry out post operative orders such as IV fluids or blood transfusion as ordered and provide the necessary care for IV therapy

30. 19. Notify Anesthetist or surgeon concern of any significant changes in patient’s condition 20. Determine patient readiness for discharge example stable vital signs, present of gag reflex, able to swallow or cough and inform Anesthetist. 21. Inform respective ward to fetch patient after Anesthetist’s approval 22. Check availability of patient’s documents with patient’s operation notes written up. 23. Give complete verbal report to the ward nurse including procedure done and the condition of the patient at time of transfer.  

31. After completing Work Hand Over everything to next shift nurse Wash hand Discard Mask and Cap in an appropriate bin Change the dress and chapel Leave the OT