All posts by Marrianne

Clinical Governance, Healthcare Technology, Perioperative Education, Professional Development, Surgical Best Practice

📚 Why Time and Education Matter in Instilling Best Practice

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Embedding best practices into clinical skills requires deliberate time investment, structured education, and ongoing reinforcement. Research indicates that:

  • 🔍 Deliberate practice over time improves clinical performance.
    Ericsson et al.’s seminal work on skill acquisition demonstrates that expert performance arises from structured, repetitive practice—not merely experience. In surgical settings, this entails building skills through repeated exposure to procedural norms, instrument setup, and workflow protocols.
    (Ericsson KA et al., 1993. Psychological Review)

  • 🕒 Operating rooms are complex environments with high cognitive demands.
    A prospective observational study by GĂśras et al. (2019) found that surgical teams performed an average of 64 tasks per hour, with nearly half involving communication. Multitasking accounted for 48.2% of the time, and interruptions occurred at a rate of 3.0 per hour, predominantly due to equipment issues. These findings highlight the necessity for structured education and time allocation to manage the complexities of the OR effectively.
    (GĂśras C et al., 2019. BMJ Open)

  • 🧠 Simulation and structured education improve retention of best practices.
    A study in the Journal of the American College of Surgeons found that OR team members who engaged in simulation-based education were more likely to adhere to best practice protocols, such as surgical safety checklists and aseptic setup techniques.
    (Barsuk JH et al., 2009. J Am Coll Surg)

  • 📈 Structured learning platforms help consolidate complex clinical knowledge.
    Digital tools that reinforce policy-based workflows (like ACORN, AORN, AFPP) assist learners in absorbing, applying, and reflecting on clinical procedures in real-time. Platforms like ScrubUp bridge the gap between formal education and day-to-day clinical needs.

Final Thought (Updated):

By investing time in education and reinforcing evidence-based standards, we don’t just teach a skill—we nurture clinical judgment, adaptability, and professionalism. Whether it’s the first surgical tray setup or a case pivot under pressure, clinicians trained with time and structure are best equipped to deliver safe, efficient care.

References:

https://psycnet.apa.org/record/1993-40718-001

https://pubmed.ncbi.nlm.nih.gov/31097486/

https://pubmed.ncbi.nlm.nih.gov/19667306/

Operating Room Efficiency, Perioperative Practice

“Operating Room Time Is Precious: Here’s Why Every Minute Counts”

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⏱️ Every Minute Matters: The True Cost of Surgical Time

 

In the operating room, time is more than just a metric — it’s a matter of cost, safety, and care. Every additional minute a patient spends under anesthesia increases the financial burden on healthcare systems and escalates the risk of complications. Whether it’s a delay due to missing instruments or a scheduling backlog, the consequences of lost OR time are profound.

💰 The Financial Toll of Operating Room Time

 

Research estimates that each minute of operating room time costs between $15 and $100. A U.S. hospital survey reported an average OR charge of $62 per minute, with high-complexity surgeries topping $133/minute. That means a 10-minute delay could cost up to $1,000 — money lost on idle staff, extended prep, or inefficient scheduling.

Hospitals absorb these costs in the form of overtime wages, surgical backlogs, and reduced daily throughput. One U.S. health system lost 631 hours of OR time and nearly $390,000 annually due to late starts for the first case of the day.

⚠️ Time and Patient Safety Are Inseparable

 

The longer a patient is on the operating table, the higher their risk of harm. Compelling data supports this:

  • Surgical complication risk increases by 14% for every 30 extra minutes in the OR.

  • Surgical site infections rise by 13% for every additional 15 minutes.

  • When surgeries exceed 2 hours, the risk of adverse events nearly doubles.

Extended surgical duration not only affects clinical outcomes but also contributes to longer recovery stays, increased bed blockages, and greater pressure on postoperative teams.

🚨 The Ripple Effect of Delay

 

Delays in the OR don’t just affect one case — they cascade across the entire surgical schedule. Late starts, case overruns, and equipment errors result in:

  • Cancelled surgeries, extending waitlists and frustrating patients.

  • Overtime labor, straining budgets and causing staff burnout.

  • Reduced surgical throughput, which means fewer patients treated each day.

Hospitals aiming to optimize their workflow must treat OR time as the limited, high-value resource it is.

✅ ScrubUp: Optimizing Every Surgical Minute

 

This is where ScrubUp steps in. ScrubUp is a digital platform built to support surgical teams with real-time preparation, streamlined equipment checklists, and surgeon preference tracking. By ensuring all surgical setup details are documented, shared, and ready ahead of time, ScrubUp eliminates the most common delays.

Because in the OR, the loss of one minute can mean the loss of a life or a limb.

Healthcare Education

Are You an Expert in Your Surgical Specialty? The Power of Tracking and Reflective Practice

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Introduction

In the dynamic environment of the operating room (OR), achieving expertise isn’t solely about time spent—it’s about deliberate practice, consistent reflection, and continuous learning. Roles such as Instrument Nurse, Circulator Nurse, Surgical Technologist, and Operating Department Practitioner (ODP) are pivotal, each requiring a unique blend of technical skill, clinical judgment, and experiential knowledge.

But how does one measure progress and move from competence to mastery?

The Journey to Surgical Expertise

Becoming proficient in surgical roles typically involves formal education and extensive clinical exposure. For instance, surgical technologists and nurses often complete programs combining academic study with hands-on training. However, true expertise is cultivated over years of performing, adapting, and reflecting within diverse surgical settings.

Tracking the number and variety of surgical cases handled provides tangible evidence of experience. This strengthens professional credibility, enhances clinical reasoning, and builds the confidence essential to anticipate complications and respond under pressure.

The Role of Reflective Practice

Reflective practice is a cornerstone of professional development in healthcare. It involves critically analyzing one’s clinical experiences to foster growth and improve outcomes. Evidence from NSW Health and other research institutions shows that reflective practice enhances learning, improves critical thinking, and leads to safer, more patient-centered care.

In the OR, reflective practice helps clinicians—whether they’re acting as the circulator, scrub nurse, ODP, or technologist—understand the rationale behind actions, refine processes, and collaborate more effectively as a team.

ScrubUp: Empowering Surgical Professionals

ScrubUp supports surgical professionals by offering tools to log and reflect on every procedure, by role. With ScrubUp, users can:

  • ✅ Log and categorize cases by role (Instrument Nurse, Circulator Nurse, Surgical Technologist, or ODP), procedure, and complexity

  • ✅ Track growth over time, identifying strengths and skill gaps

  • ✅ Document reflections and key learnings after each procedure

  • ✅ Generate insights and reports to support credentialing or career development

By facilitating case tracking and reflective practice, ScrubUp turns day-to-day work into measurable professional progress.

Are You Tracking Your Surgical Experience?

If you’re not logging your surgical cases or reflecting on your experience, you may be overlooking a critical tool for growth. Ask yourself:

  • 🧐 How many cases have I supported in my role—circulating, scrubbing, or assisting?

  • 📈 What have I learned from those experiences?

  • 🚀 Where could I focus to further build expertise?

Rather than simply expecting surgical staff to “do the job,” healthcare facilities must enable and protect time for reflection, learning, and documentation. These moments are not extras—they are essential components of safe, expert practice and team improvement.

ScrubUp empowers this process, giving perioperative professionals an intuitive way to track progress, reflect on procedures, and build credibility in their surgical specialty.

Conclusion

Expertise in the OR isn’t accidental—it’s built through exposure, repetition, reflection, and a drive to improve. Whether you’re a Circulator Nurse, Instrument Nurse, ODP, or Surgical Technologist, ScrubUp empowers you to track, reflect, and grow.

Start your journey toward surgical mastery today.
🔗 www.scrubupapp.com

Hospital Efficiency, Operating Room Workflow, Perioperative Nursing, Surgical Technology

Meeting Surgical Demands: How ScrubUp Reduces Delays, Waste, and Costs in the OR

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Meeting the Demands of Surgery: The Case for Smarter OR Preparation

 

In the high-stakes environment of the operating room, every minute has a cost—and not just clinical, but financial. Research shows that circulating nurses spend up to 26.3% of surgery time outside the OR, often to retrieve forgotten or missing items.

 https://www.sciencedirect.com/science/article/pii/S1743919118305338

This has a direct impact on:

  • ⏱ Surgical time (increased case duration)

  • 💸 Hospital costs (staff time, anesthesia, wasted resources)

  • 🔁 Workflow disruptions that affect safety and team focus

The Root Problem: Lack of Preoperative Clarity

 

The study found that the most common reason for surgical supply waste is the anticipation of the surgeon’s needs—nurses opening equipment that goes unused. Circulators frequently leave the OR due to:

  • Incomplete case carts

  • Unexpected surgeon requests

  • Equipment shortages or confusion

This reactive approach costs time, money, and morale.

The Solution: ScrubUp Software

 

ScrubUp is a software platform designed by a peri-operative nurse to tackle exactly these issues. It gives surgical teams access to procedure-specific intelligence before they even step into the room.

With ScrubUp, circulating nurses and techs can:
✅ See exactly which instruments and trays are needed
✅ Review special equipment or hardware preferences
✅ Understand the setup and surgical sequence
✅ Reduce the chance of mid-case supply runs

What’s the Impact?

 

  • Less time lost during surgery

  • Fewer retrievals = lower intra-operative stress

  • More accurate supply use = less waste

  • Faster, more predictable turnover = better scheduling

  • Improved confidence = better team performance

And ultimately—lower costs and better outcomes.

Final Word

 

In today’s healthcare climate, hospitals can’t afford inefficiency. Let’s support perio-perative teams with the data they need to succeed—not just for safety, but for time and cost savings.

Because every minute matters.

Clinical Best Practices, Education, Education & Training, Infection Prevention, Operating Room, Operating Room Education, OR Nursing, Perioperative Education, Skin Antisepsis, Surgical Nursing

Reducing SSIs Through Best Practice Skin Preparation: What Every OR Nurse Should Know

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Best Practice for Surgical Skin Preparation: Reducing the Risk of Surgical Site Infections (SSIs)

Surgical skin preparation is one of the most critical steps in preventing Surgical Site Infections (SSIs)—a complication that not only affects patient recovery but places a significant financial burden on healthcare systems worldwide.

🦠 Why Surgical Site Infections Matter

SSIs are among the most common types of healthcare-associated infections and can occur in up to 5% of surgical procedures. Their consequences extend beyond the immediate surgical outcome:

  • In Australia, SSIs add an average $18,814 to the direct cost of treatment per patient.

  • In the United States, SSIs cost the healthcare system $3.3 to $10 billion annually.

  • A single infection following a hip or knee replacement can add $12,689 USD in direct costs.

  • SSIs significantly prolong hospital stays, often requiring readmission, further tests, and additional treatment.

Given the clinical and economic impact, preventing SSIs is not only a patient safety priority—it’s a healthcare imperative.

🧼 What Is Surgical Skin Preparation?

Surgical skin preparation involves cleansing the skin at and around the surgical site to reduce the microbial count to the lowest possible level. The goal is to create a sterile field that minimizes the risk of microbial contamination during the procedure.

Key Principles of Best Practice:

  • Clean to Dirty: Begin at the cleanest area—typically the planned incision site—and work outward in concentric circles or squares.

  • No Double Dipping: Use a fresh swab for each pass. Never return a used applicator to the antiseptic solution.

  • Wide Coverage: Prep a generous area to accommodate any extension of the surgical incision.

  • High-Risk Zones Prepped Last: Areas such as the groin, umbilicus, open wounds, stomas, orifices should be cleaned last and with separate sponges.

  • Reverse Technique for Contaminated Areas: For high-risk zones, start at the cleaner periphery and move inward to the more contaminated center.

The AORN (Association of periOperative Registered Nurses) recommends selecting an alcohol-based prepping agent based on the anatomical location and patient assessment. Alcohol-based preps should not be used near mucosa, eyes, or ears. Iodine-based alternatives are safer in such cases.

📊 Why It’s Done This Way – The Evidence Behind the Method

The technique of prepping from clean to dirty and using separate applicators for contaminated zones is designed to:

  • Prevent cross-contamination within the sterile field.

  • Maintain the lowest possible bacterial load at the incision site.

  • Ensure compliance with infection control standards such as those outlined by AORN, ACORN, and WHO guidelines.

👩‍⚕️ Educating the Next Generation of Perioperative Professionals

Understanding why and how we perform surgical skin preparation is critical for novice operating room staff. Proper technique supports not only patient safety, but also team trust, procedure efficiency, and hospital sustainability.

Visual guides help reinforce learning by showing the correct prepping zones and motion patterns for various surgical sites.

📷 

✅ Final Thoughts

Following best practice in surgical skin preparation isn’t just a procedural checklist item—it’s a frontline defense against infection. When done correctly, it protects patients, reduces complications, and ensures that the operating team upholds the highest standards of care.

Stay vigilant, prep with purpose, and lead with best practice.

Alcohol Based-Prep, Education, Education & Training, OR Nursing, Skin Antisepsis, Surgical Fire Risk, Surgical Prep Tools

Alcohol-Based Surgical Prep Safety: Best Practices for OR Nurses, Techs & ODP’s.

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Introduction

 

Alcohol-based surgical prep safety is critical in modern operating rooms and alcohol-based surgical skin preps are a cornerstone of infection control, offering rapid and reliable antimicrobial action. But with their benefits comes a critical risk: fire hazards. For operating room nurses and surgical technologists, understanding how to safely use these solutions is essential to protect patients and prevent harm.

 

Why Alcohol-Based Preps Are Standard

 

Alcohol is fast-acting, dries quickly, and kills a broad spectrum of pathogens. It’s commonly combined with chlorhexidine or iodine, making it a go-to for preventing surgical site infections (SSIs). The CDC and WHO both support alcohol-based solutions as a best practice for surgical skin antisepsis. However, it’s extremely flammable. Vapors can ignite when exposed to electrocautery devices or lasers, turning a routine prep into a dangerous situation if not properly managed.

 

The Fire Triangle in the OR

 

Most surgical fires involve these three elements:
– Fuel: Alcohol-based prep
– Ignition: Electrosurgical devices or fiber-optic cables
– Oxidizer: Supplemental oxygen
Over 600 surgical fires are reported annually in the U.S., often due to improper skin prep protocols (ECRI Institute).

 

Best Practices for Alcohol-Based Surgical Prep Safety

 

1. Apply Carefully
Avoid excess pooling, especially around skin folds, hair, or under the patient.

2. Use Safer Application Tools
Products like BD Bard’s ChloraPrep with Tint, help standardize application and reduce risks. ChloraPrep with Tint is a single-use, prefilled applicator containing 2% chlorhexidine gluconate and 70% isopropyl alcohol. Its design supports even application and minimizes pooling, helping reduce fire risk while improving efficiency. ChloraPrep’s built-in safety features include controlled delivery and foam-tipped applicators, making it easier to ensure consistent coverage and drying.

3. Let It Dry
Wait at least 3 minutes for full evaporation. Never drape or activate devices until the prep is dry.

4. Avoid Vapor Traps
Ensure drapes do not seal off wet or moist areas. Allow for ventilation around the surgical site.

5. Communicate with the Team
Clearly announce when alcohol prep is used. Pause to confirm the site is dry before any ignition source is used and pooling is minimized.

6. Train and Audit
Conduct regular education sessions and fire risk drills. Ongoing competency supports safety culture in the OR.

 

Final Thoughts

 

Surgical prep is the foundation of a safe procedure. As OR nurses and techs, your diligence during this phase not only reduces infection risk—it can also save lives. With the support of standardized tools like ChloraPrep, you can perform effective antisepsis with added confidence and control.

 

 

References

  1. Association of periOperative Registered Nurses (AORN). Guideline for skin antisepsis. 2023.
    2. ECRI Institute. Top 10 Health Technology Hazards for 2023.
    3. CDC. Guideline for the Prevention of Surgical Site Infection. 2017.
    4. BD. ChloraPrep™ Patient Preoperative Skin Preparation. https://www.bd.com/en-au/products-and-solutions/products/product-page.m.ChloraPrep
Operating Room, Policies, Technology, Workflow

Current Trends Impacting Operating Room Professionals

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Innovation in healthcare has made a significant impact to enhance patient care and healthcare outcomes.

The operating room focuses on improving surgical outcomes, by implementing strategies and technology that optimise patient care.

 

As an experienced operating room nurse, I have observed the positive impact of technology on patient care.

However, successful implementation of intra-operative technology necessitates a strategic plan and continuous monitoring.

 

According to the Australian Government, 2023-2035, The Nursing Supply and Demand Study,’ there will be a shortage of 70,707 nurses by 2035. In acute care the estimated short fall is 26,665 nurses. Supply is not expected to keep pace with demand.’

 

It is essential to consider the wellbeing of healthcare professionals who, according to research, are experiencing burnout, lack experience, face high turnover rates, represent an ageing workforce, feel overworked and undervalued.

 

Data shows recognition and gratitude enhance healthcare professionals’ wellbeing, teamwork, and sense of value, which is crucial for a sustainable healthcare delivery system.

 

Healthcare professionals wellbeing must be prioritised when introducing new technology, requiring a balanced approach to ensure safety, support and compliance. Stable adoption needs time for adjustments, support, education, and ongoing training.

 

Innovative technology that significantly affects patient care can greatly influence clinical workflows and overall workload.

 

Any adjustments to clinical workflow/workload impacts on patient safety and a number of factors should be thought through prior to implementation.

 

Key factors include:

 

  • Current workflow
  • Technology’s impact on clinicians’ responsibilities
  • Time for setup and preparation
  • Feedback and troubleshooting
  • Clinical skill mix, staffing numbers
  • Impact on instrument handling and patient safety
  • Responsibility for equipment management
  • Policies and governance on equipment use
  • Environmental conditions
  • Equipment monitoring and maintenance

 

 

It is crucial to acknowledge that operating room personnel, especially those in the roles of instrument and circulator, already adhere to mandated legal policy directives, for each surgical procedure they are involved with, requiring contemporaneous documentation, even when using hybrid systems.

 

Prioritising tasks and responsibilities is key to a fluent workflow. Patient safety should always be placed at the forefront of any task.

 

 

The adoption of new technology, along with the modification of policies and procedures, has altered the responsibilities and dynamics faced by healthcare professionals.

 

Peri-operative teams, who work across various surgical specialties, are highly skilled, adaptable, and knowledgeable professionals.

 

Their competencies should always be regarded with the utmost respect.

 

Peri-operative professionals recognise the need for change, however, in order to effectively integrate technology, and sustain a critical workforce, we need to identify, prioritise and support the clinical impact of technology.

 

Sustaining and supporting this skilled workforce is vital to our healthcare system.

 

 

https://hwd.health.gov.au/resources/primary/nursing-supply-and-demand-study-2023-2035.pdf

 

https://onlinelibrary.wiley.com/doi/10.1155/2024/2983251

 

https://www.sciencedirect.com/science/article/pii/S2666142X25000505

 

https://onlinelibrary.wiley.com/doi/10.1155/2024/2983251

 

https://pmc.ncbi.nlm.nih.gov/articles/PMC7164898/

 

 

Operating Room, Patient Safety, Surgical Cleaning

Point of Use (POU) Cleaning of Surgical Instruments

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Are your instruments being cleaned intra-operatively?

 

Surgical instruments are a high cost item, which is why maintaining and sustaining their lifespan is important, especially when it is a surgeon’s, ‘favorite’ or there is a minimal supply.

 

The risk of Surgical Site Infections (SSI’s) increases when surgical instruments are not cleaned effectively. During a surgical case organic material can accumulate and build up if blood and debris are left to dry. This is why it is critical for surgical instruments to be wiped over with sterile water during a surgical case. This also expand’s the life of a surgical instrument and reduces rust, pitting and the build up of biofilm.

 

 

How often have you tried to use a hemostat that is hard to open, or a metzenbaum scissor that is stiff to use?

 

 

 

 

As OR professionals are we not responsible for cleaning our instruments intra-operatively?

 

 

Research identifies that blood can be corrosive and cause pitting and staining of surgical instruments. Blood is high in salts and is very corrosive to metal.

 

 

According to research dried blood presents a serious risk to the integrity of an instrument and is capable of causing irreparable damage to a surgical instrument. Once instrument surfaces and channels begin to rust and form pitting, the metal surface is compromised, which makes it difficult to clean.

 

 

Blood proteins are identified as water soluble, however blood contains fibrin which supports blood coagulation. Research shows that coagulated blood on a hard surface sticks making it dificult to remove, this is why pre-cleaning as close as possible after contamination with sterile water can remove the greatest part of contamination.

 

 

 

Rust develops on an instrument due to spotting, staining and pitting and is a result of chlorides within blood.

 

 

 

Bioburden on Surgical Instruments

 

 

Bioburden is the result of hardened microfilm (tissue and blood) left on a surgical instrument and underneath this bioburden harbors biofilm. Biofilm can be protected and shielded when undergoing the contamination & sterilization process. Biofilm enables the growth of bacteria and can be detrimental to a patient.

 

 

The longer bioburden is left to harden on an instrument, the more time consuming it is, to effectivly decontaminate, reprocess  and ‘turn around’ instruments.

 

 

Once biofilm has formed, it can be nearly impossible to remove in a difficult-to-reach spot, like a scope lumen.

 

 

 

Damaged instruments can impact on surgical case delays, prolong surgical times and impact on patient safety.

 

 

 

Keeping a surgical instrument moist helps to prevent hardening of biofilm.

 

 

 

When OR staff fail to facilitate POU cleaning this impacts the Sterilization Department (SPD) which also impacts on OR productivity.

 

 

 

Best practice is to keep instruments moist and wiped clean of organic matter at regular intervals during a surgical case, with sterile water.

 

 

 

 

 

Failure to Adequately Clean Surgical Instruments puts Patients at Risk

 

Failure of the hospital staff at Porter Adventist Hospital to pre-clean surgical instruments contributed to contaminated instruments being used in procedures, putting nearly 5,800 patients at risk for surgical site infections, including exposure to HIV and hepatitis. The hospital reached out to the affected patients, citing pre-cleaning as the cause of inadequate sterilization. The hospital faced several lawsuits, some dating back all the way to 2015.

 

 

 

https://www.microcare.com/en-US/Point-of-Use-Cleaning

 

 

http://chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://patientsafety.pa.gov/ADVISORIES/documents/201706_71.pdf

 

 

https://www.hpnonline.com/surgical-critical-care/article/21146790/instrument-preservation-a-full-time-operation

 

 

https://www.ajicjournal.org/article/S0196-6553(23)00314-0/fulltext

 

 

 

Operating Room, Patient Safety

Communication in the OR

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The operating room is a culturally diverse background with various levels of multidisciplinary professionals working collaboratively to deliver optimized care.

 

 

A study by the British Journal of Anaesthesia, identifies;

 

 

 

  • Failures in peri-operative communication contributed to patient injury in 43% of 910 anaesthesia malpractice claims

 

 

  • The most common root cause of communication failure was insufficient or inaccurate information, occurring in 30% of procedures

 

 

As part of a team that assessed RCA’s and near misses, communication was highlighted as a contributing factor in a majority of cases. Nurses stated they did not feel heard and confident, especially as a novice.

 

 

Surgeons may also feel unsupported by staff they are unfamiliar with or who are unfamiliar with the flow of surgery.

 

 

We need to empower all operating room professionals to work collaboratively, but we also need to empower and provide knowledge and support to our clinicians, in order to support, and deliver enhanced patient care.

 

 

The annual cost of medical errors likely exceeds $17 billion, with 35% being surgery related

 

 

 

A recent publication, Towards the Future of Surgery, 2024 has highlighted the need for surgeons to further develop their soft skills.

 

 

This is something we should all consider. Here’s a little insight.

 

 

 

“It is clear how patient outcomes are becoming less and less dependent on technical skills (however, this is always essential) and increasingly dependent on non-technical skills. Surgeons have the potential to improve patient outcomes, reduce medical errors, and improve patient satisfaction through their leadership on the multidisciplinary team.”

 

 

“Leadership in surgery entails many non-technical skills, including professionalism, technical competence, motivation, innovation, teamwork, communication skills, decision making, business acumen, ethics, emotional competence, resilience and effective teaching.”

 

 

“Surgeons have the potential to improve patient outcomes, reduce medical errors, and improve patient satisfaction through their leadership on the multidisciplinary team.”

 

 

 

I believe we all have the ability to improve patient outcomes.

 

 

Our use of checklists, such as the Surgical Safety Checklist has reduced errors by 30%.

 

 

Research shows we can improve patient outcomes by developing a team culture by easily identifying surgical team members, via scrub or cap identification.

 

 

Team huddle has also improved team collaboration and work flow.

 

 

Effective communication aims to streamline practices and utilizing resources to share information is key when stakes and patient lives are at risk.

 

 

 

Lets all aim to improve communication, empower clinicians and share our clinical expertise.

 

 

 

 

 

 

ttps://www.bjanaesthesia.org.uk/article/S0007-0912(21)00349-4/fulltext

 

 

Towards the Future of Surgery, 2024

 

https://link.springer.com/book/10.1007/978-3-031-47623-5

Operating Room, Patient Safety

Situational Awareness in the OR

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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

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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?

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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

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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/
Patient Safety, Policies

Costs of staff ‘running’ for supplies outside of the OR, could cost up to $1,500.00.

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A hospitals operating room, store room, can be overwhelming, lots of surgical trays, equipment & supplies everywhere, most of the time in an order that make sense to a supply administrator but not to the surgical team..argh and with limited details to find what you actually need, quickly.

 

This impacts on costs, why, because there are many times when a surgeon may need additional supplies, unexpectedly, intra-operatively. When equipment can not be easily found this builds tension in the OR, in addition to prolonging surgical time, which can also impact on patient outcomes.

 

Research suggests that nurses spend 26% of intra-operative time outside of the OR, attending to additional needs of the surgeon, which would involve collecting additional equipment and supplies to support an optimized surgical outcome.

 

If the equipment required is necessary this can bring the entire operating room to a stand still, costing approximately $1,500.00 for the loss of 15minutes, waiting for the nurse to find the equipment.

 

Research also suggests that nurses ‘spend 21minutes per shift looking for lost equipment, taking them away from direct patient care’.

 

Hospitals need to provide the infrastructure for clinicians to optimize patient safety and to support them in their roles which would remove unnecessary stress, that wastes critical time. Improving clinical resources to streamline practices will improve efficiency and productivity, which will impact on staff and patients.

 

https://www.sciencedirect.com/science/article/pii/S1743919118305338

 

 

https://www.himss.org/resources/applying-rtls-technology-improve-nurse-efficiency-and-patient-care#:~:text=Time%20spent%20looking%20for%20equipment%20certainly%20takes%20them%20away%20from,shift%20searching%20for%20lost%20equipment.

Patient Safety, Policies, Technology

Implications of Equipment Failure During Surgery

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Research states that, ‘Implications of equipment failure during surgery’, occurred in 92% of surgical cases.

According to research,’equipment failures occurred in 76.9% of surgical cases. Equipment availability was impacted by 37.3% of surgical cases.

Unfortunately this is not surprising to those in the industry. I have witnessed first hand the lack of operating room checks, due to, time poor staff, who are already overloaded with paperwork and surgical setups.

When I first started working in the operating room as an instrument and circulating nurse, one of the first things I was taught, was to check the OR environment. This involved turning wall switches on and off, increasing/decreasing hardware settings.

Fast forward twenty plus years and there is more equipment to check, that is more technical and complex.

Staff are not given time to check equipment and the environment, which leads to intra-operative delays, stress and tension. Surgical time is impacted, patient safety is impacted, the waitlist is impacted and costs increase.

I hope that as we engage in more specialised practices that time is spent on checking the surgical environment and hard ware prior to the start of a surgical case load, or that specialised technical support is available to take the load off our already time poor health care professionals.

If you are a facility that provides your staff with additional time to setup and check equipment or has a technical support person. I would love to hear from you.

Contact Us

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9685966/

 

https://qualitysafety.bmj.com/content/22/9/710

 

 

Patient Safety, Uncategorized

Intra-Operative Pressure Injuries (PI)

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A patient has surgery to address a disease, illness, or trauma. They are vulnerable and anxious and surgery maybe the final option.

Surgery can be costly and a patient does not need another complication, such as a Pressure Injury (PI).

According to the Agency for Healthcare Research & Quality, pressure ulcers cost $9.1-$11.6 billion per year in the US. Cost of individual patient care ranges from $20,900 to 151,700 per pressure ulcer.

https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu1.html#:~:text=Cost%3A%20Pressure%20ulcers%20cost%20%249.1-%2411.6%20billion%20per%20year,ranges%20from%20%2420%2C900%20to%20151%2C700%20per%20pressure%20ulcer.

As healthcare professionals it is our role and responsibility to provide the best care we can, to our patients.

This is why pressure area care should be assessed and addressed.

There are a number factors that impact on intra-operative pressure care and what equipment should be used to support blood circulation and minimise pressure on vessels and tissue.

A patients own health and comorbidity can also impact on the predisposition for a postoperative PI.

Correct patient positioning, monitoring pressure sites and utilising equipment can aid in reducing PI. Moisture and heat sources such as a warming blankets can also play a role in the likelihood of skin breaking down.

It can be difficult to identify early stages of skin breakdown intra-operatively, which is why assessments and precautions should be undertaken preoperatively and postoperatively.

Research in identifying and educating health care workers is necessary to reduce the risks to patients. A 2019 study detected that 1 in 150 patients developed an intra-operative stage 1 PI. This study highlights the need for education and further research to assess a patients risk and implement strategies to reduce PI.

See more from AORN about how much a PI is costing your facility.

https://www.aorn.org/syntegrity/resources/tools-calculators/pressure-injury-calc#:~:text=Pressure%20ulcers%20costs%20hospitals%20up%20to%20%2426.8%20billion,first%2C%20calculate%20how%20much%20they%E2%80%99re%20costing%20your%20facility.

Patient Safety, Scrub

Communication in the OR & Valuing Senior OR Staff

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The operating room is an environment where the room for error is minimal and time is always critical.
Surgery is becoming more complex, technical & challenging, which is why, communication & experience should be valued, especially when it comes to operating room professionals.

Effective verbal, observation & listening skills are qualities all surgical team members must demonstrate. Rothrock (2011) states that, “ improved communication is imbedded in human factors, culture, and social systems, all of which are more complex than checklists, mnemonics, and acronyms”.

A senior and experienced OR nurse, ST or ODP is able to recognise a change in the environment, they are able to ‘read the room’ & assess where attention should be focused.

They are able to ask concise questions at pivotal moments.

Example, does the laparoscopic or robotic case need to be ‘opened’? If so what trays & equipment do I require? Is there a bleeding vessel, are more fluids required for irrigation, are additional clips, ties, endoloops required?

Senior staff are able to think ahead because of their experience and surgical exposure especially if they are skilled across multiple surgical specialties.

Time can be critical during these intense moments and cohesive teamwork is vital in reducing surgical time. Surgical errors and complications arise when there is tension.

Time and experience matter, and there is usually a higher cost for these skilled clinicians, is the money worth it? Yes indeed!

Experienced OR staff  bring a wealth of experience, they have trouble shooting skills & clinical knowledge, they are able to think quickly and prioritize the needs of the surgical team.

Surgical time can have a direct impact on a patient, leading to longer post-op recovery which can impact on reduced bed availability and increased hospital costs.

Thank you to all the senior operating room professionals who have a wealth of skills and experience. Never forget how valuable you are.

Patient Safety, Policies

Who is responsible for monitoring the Intra-Operative IDC?

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I wanted to get your feedback on this issue as I observe this intermittently across varying OR’s and I wondered who should take ownership or is it a collective level of responsibility?
The IDC (indwelling catheter) may have been placed by the surgical team, nurse or OR professional, once insitu, who is responsible for monitoring the urine output and if needed updating the fluid balance chart?
I have observed catheters not draining as the catheter was kinked after positioning the patient and this was only observed after I had completed a surgical count, connected equipment and opened all supplies, as a circulator there are other priorities which take place.
I have also observed the catheter being full, requiring a jug to empty it intra-operatively, and the other day the catheter had not drained anything after 1.5hrs into the case.
There are a number of reasons why the urine was not draining, this is for another blog, however my main concern is, who should be responsible for observing and monitoring urine output intra-operatively, or is it a collective level of responsibility?
Technology

Supporting All Operating Room Professionals

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So tell me what are your thoughts on the amount of documentation we are asked to complete whilst we are caring for our patient under anaesthetic.

In the hospitals I have worked, we have a scrub nurse, anaesthetic nurse & circulator or scout nurse. The documentation is both paper and electronic. Responsibilities about paper work vary, as a rule this is how it generally plays out, here in Australia.

1) Pre admission checklist usually completed by the anaesthetic nurse

2) Scanning of instrument trays or attaching stickers to patient notes

3) Time Out Checklist/ VTE Assessment- scrub/scout team

4) Intra – Operative nursing care form- scout nurse

5) Count Sheet- scrub/scout team

6) Chargeable Sheet- scout nurse

7) Prosthesis Sheet-scout nurse

Not to forget

8) Pathology documentation

I am sure that I may have missed some, please contact me regarding any other types of documentation your health facility may have.

I know there are a number of hospitals who still do not have computers in their operating rooms, as a result this documentation is completed manually. Then there are some OR’s that do have computers but not all of the documentation can be accessed via a PC, this requires us multi tasking on paper and PC.

What are your thoughts on this, is there an easier and more efficient way of managing this mandatory paper work. I think we are all in the same vote, although I am not sure if this process works any better in other parts of the world. Would appreciate your thoughts on this.

Regards

Marrianne (Allis Technology)