concepts of peri-operative nursing / organization of the...
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Concepts of Peri-operative nursing / Organization of the OR Team
Sylvia Wong
Department Operations Manager
Operating Theatre Services ,
Queen Mary Hospital
Chairperson (2012 – 2014)
Association of Hong Kong Operating Room Nurses
History of Perioperative Nursing • First introduced at 1873 • Identified as nursing specialty by 1889 • Importance of asepsis and sterilization of instruments and
supplies for invasive procedures
Scrub Person 1. Wash hands aseptically 2. Donned a sterile gown and
gloves 3. Assist during surgery • organizing instrument; and • passing them to the surgeon
Circulator 1. Outside the sterile surgical field 2. Managed the OR 3. Maintain contact with those
outside the OR
Perioperative Nusing
• Specialty that works with patients who are having operative or other invasive procedures.
• Work closely with surgeons, anaesthetists and / other supporting staff
• Perform preoperative, intraoperative, and postoperative care primarily in operating theatres
Wikipedia, last read at 1 Oct 2012
Perioperative Nursing Roles
Circulator • Provide nursing care during surgery • Observes for breaches in surgical asepsis • Coordinate the needs of the surgical team • Manage the environment during surgery
Perioperative Nursing Roles
Scrub • Works directly with the surgeon within the
sterile field • Pass instruments, sponges and other
items needed during the procedure.
Perioperative Nursing Roles
Perianesthesia • Providing nursing care to patients
undergoing or recovering from anaesthesia – Preoperative assessment – Post anaesthesia care unit – Ambulatory care – Pain management
Perioperative Nursing Roles (HAHO)
Nursing practices that address the needs of patients, their families, and significant others that are required during the pre-operative, intraoperative and postoperative phases.
Philosophy of Perioperative Care
• It is a dynamic, cognitive, behavioral and technical process directed towards provision of quality patient care before, during and after surgical intervention.
• Interactive process in building trust with patients and significant others
• Teamwork among various health care teams to provide quality service
Philosophy of Perioperative Care
• Distinct functions for: – Provision of safe physical environment – Protect patients from high-risk events – Initiates continuous awareness of the dignity
of persons – Attend to patients’ physical, psychological,
spiritual and social needs.
Goal of Perioperative Nursing Practice
Ensure quality patient care
To achieve patient’s optimal level of wellness and functional status before, during and after surgical intervention.
Framework of Perioperative Nursing : The TRUST Model
Teamwork
Risk Management
Utilization
Specialty Competency
Target outcome
Teamwork
Teamwork implies both intra-departmental and interdepartmental
1. Coordinate comprehensive care
2. Works in collaboration with other health professionals to meet client’s need
Teamwork
Risk Management
Risk Management involves issues that have impact on the safety of client and staff
Risk Management
• Report and investigate incidents so that lessons can be learned – Advanced Incident Reporting System (AIRS) – Near miss
• Mistakes and error should not be replicated
• Ensure concerned parties are “risk aware” and active in managing risks
Adverse Events
• Patient focused – Intrinsic to the patient with unknown
cause(s) – Reactive, manage instantly to ensure
patient survival • Process or system error
– Extrinsic to the patient and focused on the organisation
Adverse Events
1. Aspiration 2. Haemorrhage 3. Reaction to blood
transfusion 4. Cardiac arrest 5. Respiratory arrest
1. Allergies (drug/ latex) 2. Mislaid swab or
instrument 3. Faulty medical
equipment 4. Wrong site surgery 5. Wound infection
Clinical Risks
• Pressure Ulcers • Deep Vein Thrombosis • Hypothermia • Wound infection • Diathermy burn
Teamwork
Risk Management
Specialty Competency
Specialty Competency = Excellence of Client Care
Specialty Competency
• Obtain knowledge and skills to fulfill the functions/activities of a perioperative nurse
• Individualized assessment and care • Initiate appropriate nursing interventions based
on the interpretation from the assessment (reference to departmental guidelines or standard of care)
• Evaluate nursing interventions • Documentation
Teamwork
U = Utilization of evidence-based nursing knowledge
Risk Management
Specialty Competency
Target Outcome
U U
U
Teamwork
Target Outcome includes both Service and Client Outcome
Risk Management
Specialty Competency
Target Outcome
U U
U
What do our patients want? • Friendliness, courtesy, thoroughness, intelligence,
sense of humor and trustworthiness • Pain management • Temperature maintenance • Setting up the surgical position • Performing the anaesthesia and operation • Skills in the recovery room • Adequacy of information: involve in decision making
concerning their treatment, consider their personal views and opinions
• Avoid disturbance of colleagues who are devoted to their own conversations during care
Organization of the OR Team • Surgeon • Anaesthetist • Nurse
– Anaesthetic – Scrub – Circulate – Recovery
• Supporting Staff – Scrub technician (Theatre Assistant) – Anaesthetic Assistant – Internal cleansing – Portering
RN / EN APN / NO WM DOM
NC
Fellowship for RN
Target Outcome
Risk Management
Teamwork Specialty Competence
RECIPROCAL COLLABORATION
Utilization
SMART in TRUST Model
SPECIALTY COMPETENCE
TARGET OUTCOME
Specialty Competent
• Expert clinical
advise & consultation
• Expert clinical
practitioner
• Enhancement of patient need &
services
• Provision of expert Knowledge by EBP, Professional training & development • Develop corporate & hospital wide training for professional development
• Sustain the quality of patient care by governance of specialty standards & service Improvement • Change agent for service delivery • Enhance the patient safety by risk reduction strategies
Facilitation of effective & mutual communication & collaboration with different stakeholders
Mastery Ahead Reciprocal Collaboration Target Outcome
Service Efficiency • Facilitate on reducing the duration/length of stay • Streamline the pre-admission / anaesthetic assessment of ASA 1 / 2 operative patient by peri-operative /anaesthetic nurse
SMART model for Nurse Consultant in Anaesthetic Care
Quality & Safety • Maintain the post-operative patient in normothermia • Reduce the post-operative patient’s pain scale to acceptance level through pain assessment after nursing / therapeutic intervention • Prevent the occurrence of intra-operative pressure ulcer development below stage 2 • Conduct at least one risk reduction strategies yearly
Service Effectiveness • Adverse events occur in relation to anaesthesia and PACU at lowest rate • Ensure medication safety • Increase patient satisfaction rate
Team Building Team expertise by training & competency assessment
Specialty Competent
• Expert clinical
advise & consultation
• Expert clinical
practitioner
• Enhancement of patient need &
services
• Provision of expert Knowledge by EBP, Professional training & development • Develop corporate & hospital wide training for professional development
• Sustain the quality of patient care by governance of specialty standards & service Improvement • Change agent for service delivery • Enhance the patient safety by risk reduction strategies
Facilitation of effective & mutual communication & collaboration with different stakeholders
Mastery Ahead Reciprocal Collaboration Target Outcome
Quality & Safety • Overall high compliance rate for audit • Conduct at least one risk reduction strategies yearly • Adverse events occur at lowest rate • Implication of EBP Service Efficiency • Facilitate the duration /length of stay by multidisciplinary collaboration • Maintain turnover rate within 20 minutes • Reduction of surgery cancellation rate by pre-operative confirmation & education
Service Effectiveness • Maintain the theatre at international standard in item of physical parameters & aseptic technique • Ensure drug identification in sterile field • Increase patient satisfaction rate Team Building • Team expertise by training & competency assessment • Enhance cross- disciplinary collaboration
SMART model for Nurse Consultant in Peri-operative Care
Specialty Competent
• Expert clinical
advise & consultation
• Expert clinical
practitioner
• Enhancement of patient need &
services
• Change agent for service delivery
• Provision of expert Knowledge by EBP, Professional training & development
• Sustain the quality of patient care by governance of specialty standards & service Improvement • Enhance the patient safety by risk reduction strategies • Enhance the patient need & services by implementation & evaluation of different techniques, treatments, technologies and programmes
Facilitation of effective & mutual communication & collaboration with different stakeholders
Mastery Ahead Reciprocal Collaboration Target Outcome
Quality & Safety • Overall high compliance rate to audit and SOPs • Conduct risk reduction strategies for quality improvement yearly • Conduct research project for application of EBP
Service Efficiency • Reduce waiting time in specialty clinic by early intervention from nurse-led clinic • Increase discharge rate in pain clinic • Reduce medication use • Reduce repetitive AED attendance due to pain problems • Shorten the duration of hospitalization
Service Effectiveness • Adverse events occur at lowest rate • Increase patient satisfaction rate • Ensure adequate training for new staff
Team Building • Facilitate team expertise by training & assessment • Enhance cross-disciplinary collaboration to sustain the services quality & patient safety • Establish system to enhance quality improvement
SMART model for Nurse Consultant in Pain Management
Conclusion
• TRUST is the core of perioperative nursing – Our framework of nursing care – Our core to obtain the trust from our patients,
colleagues, anaesthetist, surgeons
• SMART is our future directions
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