1. Perioperative Services 2015-12-31 rev this is now slide 1do not print it to pdf things to do (check off when complete): x add revision date to cover page x remove triangles x create list for pages to print in the handout 2,7,9-13,18-31,33-43,47,52 add captions for photo slides incorporate notes taken during presentation

2. Perioperative Services for HTM Technicians “I’m a stranger in a strange land …” © D McMahon 150106 rev cewood 2015-12-31

7. “Perioperative Services” includes > Pre-Op Clinic patients visit before surgical day to be seen by an anesthesiologist, get an ECG, lab work, etc. > The Operating Room suite rooms where the surgeries are performed - most rooms are set up for a surgical sub-specialty > Post-Anesthesia Care Unit open-format room for where most patients are taken to be monitored immediately post-surgery - patients from open-heart and other major impact procedures are taken to the ICU

8. Pre-Op Clinic -

9. Association of periOperative Registered Nurses ( AORN ) American Society of Anesthesiologists ( ASA ) American Association of Nurse Anesthetists ( AANA ) Standards-Setters in the O.R. :

10. American Society of PeriAnesthesia Nurses ( ASPAN ) Association for the Advancement of Medical Instrumentation ( AAMI ) American Society for Healthcare Engineering ( ASHE ) Standards-Setters in the O.R. :

11. Typical Surgical Personnel - Surgeon - Surgeon’s Assistant - Surgeon’s Assistant - Scrub Person (Nurse or Scrub Tech) - Scrub Person (Nurse or Scrub Tech) - Circulating Nurse - Circulating Nurse - Anesthesia provider (MD or CRNA) - Anesthesia provider (MD or CRNA) - Anesthesia Tech - Anesthesia Tech

12. Anesthesia providers – Anesthesiologist: MD who has training in an Anesthesia residency (3+ years). May also be ASA Board-certified. Anesthetist (Certified RN Anesthetist): a graduate RN with training in a CRNA program (2+ years).

13. Additional Personnel in the O.R. : - Surgical First Assistant(s) (may be Physician’s Assistant or Nurse Practitioner) - Surgical Resident - Radiology Tech - EEG Tech - Perfusionist - Vendor Rep - Pathologist

18. Attire in the surgical setting: Scrubs, or a Jump Suit Head cover Hood (check about beards) Mask Shoe covers, or specific shoes Gloves

19. Etiquette in the surgical setting: > Hair must always be covered in the O.R. > Mask must always be worn if there is a sterile field. > Stay at least 18” from the sterile field. (i.e. back table, Mayo stand, patient draping, scrub staff) > Do not release liquid droplets or aerosols around a sterile field. > When out of the O.R., wear a white coat or gown. > Scrubs are not to be worn outside the building. > Never bring food or drink into the Operating Room suite.

20. http://hms.harvard.libguides.com/content.php?pid=38249&sid=304542 protocol, protocol...

21. Charges for the Surgical Patient > Hospital charges for O.R. > Professional fees for Surgeon(s) > Professional fees for Anesthesia provider > Charges for procedure-specific items e.g. blood, proprietary expendables, and implants (heart valves, joints, pacemakers, etc)

23. O.R. charges, Akron General Hospital 1/15: In addition, there is an anesthesia charge for any operating room procedure:

25. O.R. Schedule Management

26. Measurement: Poor Performance Medium Performance High Performance Excess Staffing Costs>10%5-10%<5% Start-time delays (mean delay)>60 min45-60 min<45 min Case cancellation rate>10%5-10%<5% Post Anesthesia Care Unit admit delays>20%10-20%<10% Contribution Margin (mean) per O.R.hour<$1,000/hr$1–2,000/hr>$2,000/hr Turnover Time>40 min25-40 min<25 min Prediction Bias>15 min5-15 min<5 min Prolonged turnovers (more than 60 min)>25%10-25%<10% O.R. Management Parameters ‘Start time delays’ and ‘turnover times’ tend to be the most costly

27. Facilities Engineering Aspects of the O.R. Heating, Ventilation, and Air Conditioning Medical Gas Supplies Electrical Service O.R. Lighting Sterilizers

28. Heating, Ventilation, and Air Conditioning - Temperature: 13° - 18° C (55° - 65° F) - Humidity: was >30%, now >20% (2014) - Room Air flow: 12 - 15 turnovers / hour - Air flows must be positive to hallway

29. Medical Gas Supplies - Oxygen - Nitrous Oxide - Medical Air - Nitrogen - Specialty Gases - Vacuum - Zone Valves

30. Electrical Service - Room Circuits on Emergency Grid - Standards for ampacity & distribution - Line Isolation - Line Isolation Monitors

31. O.R. Lighting - Ceiling Lighting - w/ backup power - ambient lighting should be 750 to 1500 lux (AIA) - Overhead Surgical Lights - w/ backup lamp system - newer models use LEDs with color control

33. Sterilizers - Steam > usually medium capacity, one for each 2 rooms - Steris System 1 © (peracetic acid) > for flexible endoscopes - Cidex © (glutaraldehyde) > high-level disinfection for rigid scopes, instruments, and surgical cameras

34. Sticky mats at O.R. entries -

35. Safety Issues in O.R. - Infection Control: Standard Precautions (Sterile Technique) - Endoscopic Instrument Burns - Anesthetic Gas Pollution - Smoke from ESUs & Lasers - Surgical Site Fires

36. More Safety Issues - Patient ID verification - Patient ID verification - Patient positioning - Patient positioning - Wrong-site surgery - Wrong-site surgery - Electrical distribution - Electrical distribution - Floor clutter: Cables, wires, tubing - Floor clutter: Cables, wires, tubing

37. Wrong-Side or Wrong Site Surgery

39. Checklists!

40. Fire Safety in the O.R. Fire hazards specific to the surgical setting: > local pockets of enriched oxygen and nitrous oxide > adjacent flammable materials: -- drapes -- dressings -- gowns -- prep solutions > ignition sources: -- electrosurgical pens -- fiberoptic light cables and fiberoptic sources -- laser beams

41. O.R. Fire Prevention > minimize buildup of oxygen or nitrous oxide > precautions with electrosurgical technique > precautions with fiberoptics > prep or remove facial & body hair

42. > Rescue anyone in immediate danger > Activate the alarm > Contain the fire if possible > Evacuate the area, if necessary > remove burning materials, d/c oxygen > smother flames with drapes, towels, etc O.R. Fire Management

43. Fire Extinguishers Type A: Water Types B,C: Dry chemical Types A,B,C: Foam Types A,B,C were Halon (no longer produced, but available)

44. Patient positioning -

47. Post-Anesthesia Care Unit ‘PACU’ (or ‘Recovery Room’) > Basic role is to monitor post-surgical patients and intervene if their status declines. > Intensive nurse staffing. > Typical Equipment : Full-function monitors at each patient station, ECG recorders, Doppler flow meters, warmers, thermometers, SCDs.

52. Biomed Coverage in Perioperative Services > Stay in touch with the Managers - be involved in capital purchasing - be available for inservicing > Make rounds often in the O.R. > Schedule your PM’s around the O.R. schedule > Keep track of demo- & loaner equipment > Interface with Facilities Engineering on facility issues in O.R. > Interface with IT on network and wireless issues