1. Operating Room Orientation For Medical Students Angela L. Lawrence, BSN, RN, MPA, CNOR

2. After today you should be able to: Describe surgical attire Describe surgical attire Discuss “OR etiquette” Discuss “OR etiquette” List principles of aseptic technique List principles of aseptic technique Discuss safety considerations Discuss safety considerations

3. In Separate Groups we will: Find the Locker Rooms Find the Locker Rooms Obtain scrubs from the Pyxis Scrub Station Obtain scrubs from the Pyxis Scrub Station Meet Angela at the Main OR Front Desk Meet Angela at the Main OR Front Desk (Where’s the desk?) Tour the Operating Room (the 10¢ tour) Tour the Operating Room (the 10¢ tour) Observe scrubbing, gowning and gloving procedure (Any volunteers??) Observe scrubbing, gowning and gloving procedure (Any volunteers??)

4. Surgical Attire Green Scrub suit (obtain from Pyxis) Green Scrub suit (obtain from Pyxis) (What about tee shirts? What about jewelry? Nail polish?) Hospital photo ID badge Hospital photo ID badge Hat or hood Hat or hood Shoe covers (Optional PPE) Shoe covers (Optional PPE) Mask ( when sterile setup is present ) Mask ( when sterile setup is present ) Eye protection (Required PPE) Eye protection (Required PPE)

5. OR Etiquette/Customs Introduce yourself to OR nurse Introduce yourself to OR nurse Write your name (legibly) on the white board Write your name (legibly) on the white board (there’s one in each Operating Room) Offer to obtain your gown or gloves, PRN Offer to obtain your gown or gloves, PRN

6. Principles of Aseptic Technique 1. Scrubbed persons function within the sterile field. Scrubbed persons: Scrub, gown and glove Scrub, gown and glove Sterile touches only sterile Sterile touches only sterile Sterile areas of gown: In front from 2” below neck to table level In front from 2” below neck to table level Sleeves from 2” above elbow to stockinette cuff Sleeves from 2” above elbow to stockinette cuff

7. Principles of Aseptic Technique 2. Sterile drapes should be used to establish a sterile field. Drape from incision area to periphery Drape from incision area to periphery The sterile field is the top surface of the draped tables and the patient The sterile field is the top surface of the draped tables and the patient Any point below the sterile level is unsterile Any point below the sterile level is unsterile Anything permeating the sterile field contaminates it, including moisture Anything permeating the sterile field contaminates it, including moisture

8. Principles of Aseptic Technique 3. All items used in a sterile field should be sterile. Anyone opening and dispensing an item is accountable for its sterile integrity Anyone opening and dispensing an item is accountable for its sterile integrity Shelf life of a packaged item is event-related Shelf life of a packaged item is event-related

9. Principles of Aseptic Technique 4. All items introduced onto the sterile field should be opened, dispensed and transferred by methods that maintain sterility and integrity. Check outer wrapper for integrity Check outer wrapper for integrity Inspect indicators on outside Inspect indicators on outside Check dates, if applicable Check dates, if applicable If sterility is in doubt, do not use the item If sterility is in doubt, do not use the item

10. Principles of Aseptic Technique 5. A sterile field should be maintained and monitored constantly. Scrubbed persons will keep the sterile field in direct view at all times and not turn his/her back to the sterile field.

11. Principles of Aseptic Technique 6. All Personnel moving within or around a sterile field should do so in a manner to maintain the integrity of the sterile field. When scrubbed persons move around each other they should keep: Unsterile to unsterile (“back to back”) or Sterile to sterile (“belly to belly”)

12. Principles of Aseptic Technique 7. Policies and procedures for maintaining sterile field should be written, reviewed annually and readily available within the practice setting. Where do you find them?

13. Surgical Conscience Builds on principles of asepsis Builds on principles of asepsis Allows no compromises in aseptic technique Allows no compromises in aseptic technique Requires regulation of ones own practice Requires regulation of ones own practice Demands recognition and correction of breaks in technique including reporting ones own breaks in technique Demands recognition and correction of breaks in technique including reporting ones own breaks in technique Doing the right thing even when no one is watching! Doing the right thing even when no one is watching! Our Ultimate Goal: Pa tient Safety Our Ultimate Goal: Pa tient Safety

14. More Safety Considerations etc. Do Not touch anything on the Mayo Stand Do Not touch anything on the Mayo Stand Do Not Argue if someone says Do Not Argue if someone says “It’s contaminated.” Masks are either tied properly on your face or in the trash. Masks are either tied properly on your face or in the trash. Dual Frame of Reference: Dual Frame of Reference: Anything touching the patient should be sterile, anything that has touched the patient is contaminated.

15. Introduction to the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™ The Universal Protocol applies to all surgical and nonsurgical invasive procedures. Evidence indicates that procedures that place the patient at the most risk include those that involve general anesthesia or deep sedation, although other procedures may also affect patient safety. The Universal Protocol applies to all surgical and nonsurgical invasive procedures. Evidence indicates that procedures that place the patient at the most risk include those that involve general anesthesia or deep sedation, although other procedures may also affect patient safety.

16. Introduction to the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™ Hospitals can enhance safety by correctly identifying the patient, the appropriate procedure, and the correct site of the procedure. Hospitals can enhance safety by correctly identifying the patient, the appropriate procedure, and the correct site of the procedure.

17. Introduction to the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™ The Universal Protocol is based on the following principles: The Universal Protocol is based on the following principles: Wrong-person, wrong-site, and wrong-procedure surgery can and must be prevented. Wrong-person, wrong-site, and wrong-procedure surgery can and must be prevented.

18. Introduction to the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™ A robust approach using multiple, complementary strategies is necessary to achieve the goal of always conducting the correct procedure on the correct person, at the correct site and on the correct side. A robust approach using multiple, complementary strategies is necessary to achieve the goal of always conducting the correct procedure on the correct person, at the correct site and on the correct side.

19. Introduction to the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™ Active involvement and use of effective methods to improve communication among all members of the procedure team are important for success. Active involvement and use of effective methods to improve communication among all members of the procedure team are important for success. To the extent possible, the patient and, as needed, the family are involved in the process. To the extent possible, the patient and, as needed, the family are involved in the process.

20. Time Out: Is performed immediately prior to incision or when a Regional Block is performed. Is performed immediately prior to incision or when a Regional Block is performed. The Attending Physician, Anesthesia care provider, Circulating RN, and Scrub person must be present. The Attending Physician, Anesthesia care provider, Circulating RN, and Scrub person must be present. All members of the team should be actively involved in the time out. If any member is not paying attention during the time out, stop, gain their attention and restart the time out. All members of the team should be actively involved in the time out. If any member is not paying attention during the time out, stop, gain their attention and restart the time out.

21. Time Out: The circulator will document this verification in the electronic medical record The circulator will document this verification in the electronic medical record

22. Time Out: A complete TIME OUT is performed prior to the start of subsequent procedures and includes the NEW attending physician. A complete TIME OUT is performed prior to the start of subsequent procedures and includes the NEW attending physician. Exceptions are not routine. Should an exception exist, in the event of an urgent surgery, the TIME OUT, in its entirety, must be performed as soon as possible Exceptions are not routine. Should an exception exist, in the event of an urgent surgery, the TIME OUT, in its entirety, must be performed as soon as possible

23. Time Out: The following items are to be stated in the time out: The following will be verbalized: The following will be verbalized: Correct procedure Correct side/ site Correct position Antibiotic started, if applicable Prep dried

25. Endoscope Use Scope tracking is now a required element by the Joint Commission. Tracking is imperative and has major implications for both Medicare our reimbursement and accreditation! The resident/medical student must sign the EGD cart out when it leaves the unit and when it is returned. This includes all scopes that are utilized outside the OR.

27. EGD Tower and Instrument Tray Sign Out Sheet DateItem DescriptionNameLocationReturnDateInitial

30. White Bag Contents

31. Each group will Meet at the Main OR Front Desk Meet at the Main OR Front Desk Discuss the OR schedule board Discuss the OR schedule board Tour the Operating Room Suites Tour the Operating Room Suites Observe scrubbing demonstration Observe scrubbing demonstration Observe gowning and gloving demonstration Observe gowning and gloving demonstration

32. Questions?