Monthly Archives: February 2024

Operating Room, Patient Safety

Situational Awareness in the OR

Leave a comment

The OR is an environment where the room for error in minimal, time is critical and perfection is expected 100% of the time.

 

 

Situational Awareness that can have a significant impact on the flow of surgery, time & costs.

 

 

Situational awareness encompasses the ability to observe, listen, absorb and act swiftly. 

 

 

A change in the environment can be sudden and simultaneous. Eg, a surgeon may have an uncontrolled bleeding vessel, whilst the anaesthetist is having problems securing a dislodged airway.

 

 

Distractions are the costly, which is why 100% attention should be focused on the patient and care delivery.

 

 

Each OR nurse/tech/ODP, should be aware of the environment in order to work as a team, prioritise and support the care required, in order to stabilise a situation.

 

 

Demonstrating situational awareness is critical to patient safety and team cohesiveness.

 

 

Recognising a change in the environment, and troubleshooting or prioritising a task prior to verbal direction can save time. An instrument nurse/tech/ODP may only need to move their eyes, in a certain direction, in order to communicate a task, to the circulator.

 

A circulator may use verbal and non-verbal communication to the instrument nurse/tech/ODP if there is an observation that is of concern, such as low irrigation fluids, especially if the surgeon has a bleeding vessel.

 

 

 

 

Timing is key and costly.

 

 

 

 

If the need to obtain a bag of fluids is required by the circulator, it is important they obtain direction by the instrument nurse/tech/ODP, as they may prefer the circulator to stay in the OR, due to the case going ‘open’, thus, requiring additional instrumentation & equipment.

 

Situational awareness requires assertiveness, listening to cues and observing minute changes, by all team members.

 

 

 

It can take years to develop & evolve these astute, efficient & life saving skills. 

 

 

 

 

Many senior OR staff have developed these astute skills over the years. Which is why experience and expertise should never be under valued or under estimated.

 

 

 

What does one minute of operating room time cost your organisation?

 

 

Education, Operating Room, Operating Room- Tips, Surgical Equipment, Surgical Supplies, Sutures

A Little About Sutures & Surgical Considerations

Leave a comment

 

About Sutures-Needle Point 

 

  1. Cutting Edge – 2x types- Conventional & Reverse
  • Has 2x opposing sides that slice through tissue
  • Cutting Conventional needles are predominantly used on skin closures

2. Taper Point

  • Needle is flattened or rounded
  • Spreads tissue without cutting, less traumatic, decreased bleeding
  • Widely used in various tissue, muscle, fat, peritoneum

3. Taper Point-Blunt

  • Tapered needle with blunt point
  • Used to prevent needle stick injuries

4. Taper Cut Needle

  • Predominantly used in Vascular & Cardio Thoracic surgery
  • Used on hard calcified tissue and on prosthetic grafts
  • Cutting needle passes through tissue easily and taper point passes through friable tissue

 

 

Surgical Considerations

 

Point sizes of a needle vary, according to the tissue and room or ‘bite’ size required

 

 

Points to consider when choosing a needle holder and loading a suture.

 

  1. Deep cavities require longer needle holders
  2. Thicker tissue may require stronger needle holders
  3. Load suture 1/3 of the distance from the swag
  4. Load suture at a 90 degree angle
  5. Needle should be loaded near the tip of the needle holder
  6. Confirm if the surgeon is right or left handed, load accordingly
  7. Needle holder should hold the needle in place and not move the needle when being used, usually the second clasp will hold in place
  8. Always be mindful of the tissue, the needle size and the length and size of the needle holder. Eg a small needle on a large & heavy needle holder may place pressure on the needle and break it.

 

 

Additional Considerations

 

  • Never give an orthopaedic surgeon a small needle holder, unless they ask for one

 

  • Always collect various size needle holders if unsure of size prior to surgery

 

  • Always confirm the suture type, needle size, needle point prior to opening a suture, they are costly and can be placed in the wrong packet at the end of a long day by a tired team member
Costs, Uncategorized

What is the Cost of Opened & Unused Sterile Supplies?

Leave a comment

According to a John Hopkins study, $15M US is lost in hospitals annually in unused sterile supplies.

 

Another study looking at neurosurgical procedures, identified $968.00US is wasted per surgical case on opened & unused supplies, this equates to a loss of $2.9M US, annually, in neurosurgery alone.

 

Preparation and knowledge on a surgical approach and procedure, may assist the team to determine the number of supplies required.

 

A senior colleague is able to estimate how many sterile packs are required at the beginning of a case, and the number required, on standby.

 

This preparation and forethought, reduces the time the circulator is out of the OR, and is therefore, available, to meet the immediate needs, of the surgical team.

 

Surgical cases vary, and understanding details about a patients medical background may assist the surgical team to identify the number of supplies required.

 

Eg, if a patient has not stopped anti-coagulents, may increase the need for additional items.

 

Communication with a surgeon prior to the surgery and confirming items before they are opened, reduces costs and wastage, however this may also invite unnecessary tension.

 

Situational awareness should be adhered to, at all times.

 

References

https://www.hopkinsmedicine.org/news/media/releases/study_documents_millions_in_unused_medical_supplies_in_us_operating_rooms_each_year

https://thejns.org/view/journals/j-neurosurg/126/2/article-p620.xml

https://kffhealthnews.org/news/tossing-unused-surgical-supplies-wastes-millions-of-dollars-study-finds/

Electro Surgical Unit, Patient Safety

Patient Safety using an Electro-Surgical Unit

Leave a comment

Patients rely on healthcare facilities & health professionals to look after them during their surgical journey. The aim is to leave a healthcare facility in a more optimal state than when they were admitted.

In the OR an electro surgical unit is used in 80% of surgical cases, this involves an electrical current that can be localised- Bipolar (cautery), or is an electrical circuit- Monopolar. Incidences of electro surgical injuries according to research are under reported.

 

Monopolar is an electrical current that flows through the patient and requires a patient return electrode which connects to the electro surgical unit.

Thermal injury is a result of a burn from the use of electro surgery. This is why jewellery, piercings and any metal implants should be flagged with the peri-operative team, prior to surgery.

Laparoscopic cases have been show to increase the incidence of a surgical burn injury.

 

Research suggests that 3.6 per 1,000 laparoscopic procedures may result in a burn injury.

 

Electro surgical units are also a fire source, they are commonly referred to as a fire stick.

 

“It is currently estimated that around 500 to 600 surgical fires occur annually in the United States”, this impacts on patient safety but also impacts on healthcare facilities, costing them ‘millions of dollars annually”.

 

In order to reduce surgical burns the surgical team are responsible for assessing equipment & instruments prior to all surgical cases.

 

It is important that all surgical instruments are checked prior to use, to prevent thermal injuries, particularly in laparoscopic/robotic cases, where the insulation of laparoscopic instruments can become worn and compromised.

Leads & connections should also be checked.

 

Patient positioning is also extremely important so that no body part is touching any metal, especially in lithotomy and prone cases.

 

There are other safety precautions healthcare workers need to be mindful of, including prep solutions- pooling, alcohol and the use of oxygen, especially in the airway.

 

Pacemakers and any metal implants should also be flagged with the peri-operative team, in order for them to prepare the right equipment in advance of the surgery.

 

Depending on the type of surgery, bipolar may be a safer option.

 

Lets educate & support our healthcare workers

 

Educating and supporting clinicians is vital to empowering and informing best and safe practice.

Training & education requires time by employees and employers.

 

The value in supporting electrosurgery education benefits the facility by empowering and encouraging safe practice in addition to increasing a clinicians level of competence and understanding, all of which impacts, on safe surgical care & outcomes.

 

 

References
https://pubmed.ncbi.nlm.nih.gov/30472721/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456630/
https://www.jscimedcentral.com/jounal-article-info/Journal-of%C2%A0Dermatology%C2%A0and-Clinical-Research/Peri-Operative-Management-of-the–Patient-with-Body-Piercings-8253
https://www.infectioncontroltoday.com/view/managing-new-class-electrosurgical-risk
https://jackson-medical.com/prevent-electrosurgical-fires/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599256/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407433/
https://www.sciencedirect.com/science/article/abs/pii/S0002961016310285
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456630/