Refresher Course Peggy Robinson 1/10/2018

Prioritizing Exercises Have you encountered an event that appeared chaotic or unsafe? What was done well? What could have been done better?

Prioritizing Scenario Your patient is on the OR table, awaiting induction. She is very cold and anxious. There is a lot of noise in the room. The phone is ringing and your surgical technologist is asking for a closing suture they forgot to ‘pull’ before scrubbing in. What do you do?

Prioritizing Scenarios You are in a TKR and the surgical tech is getting ready to mix the cement and needs you to turn on (activate) the vacuum for the cement system. You also notice that the irrigation system bag is empty and the surgeon is currently using the irrigation to clean the site before cementing. What do you do?

Prioritizing Scenarios You are performing the final count as the surgical team is closing the patient’s incision. A sponge is missing. The surgeon needs more closing suture and anesthesia needs to hang another IV bag but is out of the solution needed. What do you do?

Prioritizing Scenarios It is 15 minutes until the end of your case. You must perform counts, place dressings on the field, complete Intraoperative Documentation, and call recovery to let them know to expect your patient. In what order do you do these tasks?

Prioritizing Scenarios A male patient is having a Abdominal Aortic Aneurysm Repair. You are the circulator and during insertion of the foley, you notice ‘resistance’. What do you do?

Status Change: What do you do if your case needs to convert from a Laparoscopic Procedure to an Open Procedure?

Conversion Continued: #10 blade More lap sponges Open Major Instrument Set – Count according to hospital specific policy Open surgeon’s preferences for self- retaining retractors/ other needs If not controlled, request assistance.

Prioritizing Scenarios Your patient is loosing an unanticipated large volume of blood. Your surgeon has the Bovie machine, stick and free ties, and Floseal on the field. Anesthesia is now requesting blood STAT, and your surgeon wants additional suture on the field to control bleeding. During these requests, you notice that the patient’s arm has fallen off the arm board and is hanging. What do you do?

Prioritizing Cases Continued What do you do if your patient starts to bleed out….. Request Assistance (Anesthesia/ Circulating Help/ Charge Nurse or Supervisor Order/ obtain blood Open supplies to control bleeding as requested (Instruments/ suture/ Hemostatic agents If patient’s condition deteriorates during procedure, start planning for the worst…

Prioritizing Scenarios You are in a room when a resident comes in, dries his hands, gowns and gloves and is waiting to be tied up. At the same time, your surgeon has started the case and needs the electrocautery machine and suction hooked up. Lastly, the telephone starts to ring. What do you do?

Interview Scenarios #1 78 yr old man having a (VAT) Thoracoscopy Inpatient with slight dementia Alert and oriented x 3 during interview Valid DPA signed consent (son) Allergies to tape, Vancomycin & latex Bedsore on Lt Buttock, bruises on hands, arms and legs preoperatively Feet slightly mottled/ cooler to touch Tube of blood on ‘hold’ NPO since 7pm last evening Hx of MH (maternal Uncle) Lt Total Hip implant

Interview Scenario #2 41 yr old single mother having Rt Breast Lumpectomy Anxious (re: procedure & outcome) Sister in the Family Waiting Room Allergies to PCN, 2 grams of Ancef ordered NPO since 9pm last evening Ambulates independently No jewelry or metal implants Signed consent