1. Refresher Course
Peggy Robinson
1/10/2018

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

3. 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?

4. 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?

5. 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?

6. 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?

7. 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?

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

9. 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.

10. 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?

11. 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…

12. 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?

13. 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

14. 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