1. PATIENT SAFETY Protecting Patient’s Right Protecting Patient’s Right General Patient Safety Measures General Patient Safety Measures Admission of the Patient to the Admission of the Patient to the Operating Room Operating Room PRPD/DN/DM/2010 PRPD/DN/DM/2010

2. PRPD/DN/DM/102 Protecting patient’s rights protection of patients’ personal moral and legal rights begins at the time of admission. protection of patients’ personal moral and legal rights begins at the time of admission. The course of action involves correctly identifying patients, safeguarding their right to privacy and their right to make choices regarding their care and keeping confidential all records and reports. The course of action involves correctly identifying patients, safeguarding their right to privacy and their right to make choices regarding their care and keeping confidential all records and reports. Personnel who obtain consents or witness them should be aware of the conditions that ensure validity of the consent. Personnel who obtain consents or witness them should be aware of the conditions that ensure validity of the consent.

3. PRPD/DN/DM/103 Cont.. A signed consent must also be an informed consent, which implies adequate communication with the patient regarding the procedure or procedures for which the consent is being signed. A signed consent must also be an informed consent, which implies adequate communication with the patient regarding the procedure or procedures for which the consent is being signed. No surgical procedure should be performed without a signed and witnessed informed consent. No surgical procedure should be performed without a signed and witnessed informed consent. The surgeon is ultimately responsible for informing the patient about the proposed operation or other invasive procedure, its inherent risks and complications, and for obtaining consent. The surgeon is ultimately responsible for informing the patient about the proposed operation or other invasive procedure, its inherent risks and complications, and for obtaining consent. On the patient’s arrival in the operating room, the circulating nurse and anaesthesia provider are responsible for verifying that the consent is on the chart and is correct, properly signed and witnessed before the administration of anaesthesia. On the patient’s arrival in the operating room, the circulating nurse and anaesthesia provider are responsible for verifying that the consent is on the chart and is correct, properly signed and witnessed before the administration of anaesthesia.

4. PRPD/DN/DM/104 General patient safety measures Minimizes human error helps eliminate hazardous conditions for the patient undergoing operative or other invasive procedures. Minimizes human error helps eliminate hazardous conditions for the patient undergoing operative or other invasive procedures. In all perioperative settings, where the patient is unable to protect himself or herself, nursing personnel must provide protection for the patient. In all perioperative settings, where the patient is unable to protect himself or herself, nursing personnel must provide protection for the patient. Communication of vital medical information to surgical team members is essential to safe patient care. Communication of vital medical information to surgical team members is essential to safe patient care. An allergy identification band is used to communicate a patient’s allergy to a given medication or substance. Patients should be queried regarding allergies to medication or food products. An allergy identification band is used to communicate a patient’s allergy to a given medication or substance. Patients should be queried regarding allergies to medication or food products.

5. PRPD/DN/DM/105 Cont… All medication must be checked three times before administration: All medication must be checked three times before administration: (1) When removed from the drug cabinet (2) Before being drawn up in the syringe (3) Before being given to the patient Patients’ hearing tends to become more acute after administration of the perioperative medication and in the induction stage of anaesthesia. Patients’ hearing tends to become more acute after administration of the perioperative medication and in the induction stage of anaesthesia. A quiet environment is essential for all patients awaiting surgery. Noise in the OR should be controlled and conversation kept to a minimum.

6. PRPD/DN/DM/106 Cont… Stretchers and operating room beds must be stabilized with the wheels locked when a patient is moving from one to another. Stretchers and operating room beds must be stabilized with the wheels locked when a patient is moving from one to another. All safety devices on stretchers and operating room beds must be in proper working order. All safety devices on stretchers and operating room beds must be in proper working order. Locking mechanisms, side rails, restraint straps, intravenous standards, hydraulic controls, armboards and other protective devices should be used whenever necessary. Locking mechanisms, side rails, restraint straps, intravenous standards, hydraulic controls, armboards and other protective devices should be used whenever necessary.

7. Admission of the Patient to the Operating room Is a critical time for the perioperative nurse to gather data and help plan for the patient’s care and safety. Is a critical time for the perioperative nurse to gather data and help plan for the patient’s care and safety. It is the opportunity to collaborate with the patient by identifying and verifying his or her needs and then planning care to meet those needs. It is the opportunity to collaborate with the patient by identifying and verifying his or her needs and then planning care to meet those needs. Empathic communication, good listening skills, being alert to nonverbal communication, offering gentle reassurance, providing explanations and utilizing comforting behaviours are essential attributes of perioperative nurses. Empathic communication, good listening skills, being alert to nonverbal communication, offering gentle reassurance, providing explanations and utilizing comforting behaviours are essential attributes of perioperative nurses. 7PRPD/DN/DM/10

8. Institutional policy and procedure for patient admission Should include the following steps: The perioperative nurse verifies the patient’s identification orally with the patient (if feasible) and compares the name on the surgical schedule with the name on the patient‘s armband and medical record. The perioperative nurse verifies the patient’s identification orally with the patient (if feasible) and compares the name on the surgical schedule with the name on the patient‘s armband and medical record. The procedure to be performed (including the operative site, side, and surgical approach) is verified by the patient and matched with the surgical posting, medical record, and consent form. The procedure to be performed (including the operative site, side, and surgical approach) is verified by the patient and matched with the surgical posting, medical record, and consent form. The operative consent form, history and physical examination record, laboratory results, and other examination or diagnostic results should be complete before surgery and reviewed by the perioperative nurse as part of patient assessment The operative consent form, history and physical examination record, laboratory results, and other examination or diagnostic results should be complete before surgery and reviewed by the perioperative nurse as part of patient assessment 8PRPD/DN/DM/10

9. Cont…. Allergies; previous unfavourable reactions to anaesthesia or blood transfusion; previous reaction to latex; religious; cultural, spiritual, or ethnic preferences; and any advanced directive must be carefully noted. Allergies; previous unfavourable reactions to anaesthesia or blood transfusion; previous reaction to latex; religious; cultural, spiritual, or ethnic preferences; and any advanced directive must be carefully noted. The patient should be queried about personal effects, including clothing, money, jewelry, wigs, religious symbols, and prosthesis such as dentures, lenses, glass eyes and hearing aids. The nurse is responsible for ensuring the safe handling and proper disposition of patient property and valuables. The patient should be queried about personal effects, including clothing, money, jewelry, wigs, religious symbols, and prosthesis such as dentures, lenses, glass eyes and hearing aids. The nurse is responsible for ensuring the safe handling and proper disposition of patient property and valuables. 9PRPD/DN/DM/10

10. Cont…. The perioperative nurse should review the orders and results concerning pre-operative skin preparation, medication administration, and elimination, such as enema results and the amount of urine voided or collected through a catheter. The perioperative nurse should review the orders and results concerning pre-operative skin preparation, medication administration, and elimination, such as enema results and the amount of urine voided or collected through a catheter. It is important to determine whether preoperative dietary and fluid restrictions (NPO status) have been maintained, this is crucial in preventing the aspiration of gastric contents during anaesthesia induction. It is important to determine whether preoperative dietary and fluid restrictions (NPO status) have been maintained, this is crucial in preventing the aspiration of gastric contents during anaesthesia induction. 10PRPD/DN/DM/10

11. Cont …. The nurse should meticulously document any medications, fluids, blood, or blood products administered as ordered during the immediate preoperative period. The nurse should meticulously document any medications, fluids, blood, or blood products administered as ordered during the immediate preoperative period. The nursing staff should apply side rails, locking devices, and safety straps on stretchers and operating room beds to prevent falls and injury to the patient during transport, transfer and positioning. The nursing staff should apply side rails, locking devices, and safety straps on stretchers and operating room beds to prevent falls and injury to the patient during transport, transfer and positioning. 11PRPD/DN/DM/10

12. A Preoperative Checklist It is frequently used to prevent oversights, omissions, and sentinel events, displays critical items to be checked preoperatively. It is frequently used to prevent oversights, omissions, and sentinel events, displays critical items to be checked preoperatively. Sentinel events defined as an “unexpected occurrence involving death or serious physical or psychological injury, or risk thereof.” Sentinel events defined as an “unexpected occurrence involving death or serious physical or psychological injury, or risk thereof.” (JCAHO, 1997) 12PRPD/DN/DM/10

13. Clinical Documentation A record should be kept of each operation, including: A record should be kept of each operation, including: - the preoperative diagnosis - the preoperative diagnosis - the surgery performed - the surgery performed - a description of findings - a description of findings - the specimens removed - the specimens removed - the postoperative diagnosis - the postoperative diagnosis - the names of all persons participating in - the names of all persons participating in intraoperative care intraoperative care This operative record is a permanent part of the patient’s chart. This operative record is a permanent part of the patient’s chart. 13PRPD/DN/DM/10

14. Intraoperative Patient Care Record Should include: Evidence of a patient assessment upon arrival in the operating room which includes an assessment of patient’s skin condition immediately before and after the procedure. Evidence of a patient assessment upon arrival in the operating room which includes an assessment of patient’s skin condition immediately before and after the procedure. Evidence of a plan of care individualized for the patient. Evidence of a plan of care individualized for the patient. Any sensory aids or prosthetic devices worn by the patient on admission to the operating room and their subsequent disposition. Any sensory aids or prosthetic devices worn by the patient on admission to the operating room and their subsequent disposition. Patient position, including supports or restraints used. Patient position, including supports or restraints used. Location of dispersive electrode pad placement and identification of ESU and settings used. Location of dispersive electrode pad placement and identification of ESU and settings used. 14PRPD/DN/DM/10

15. Cont…. Location of temperature-control device placement, with identification of unit used and recording of time and temperature. Location of temperature-control device placement, with identification of unit used and recording of time and temperature. Placement of monitoring electrodes. Placement of monitoring electrodes. Medication administered or dispensed by the perioperative nurse. Medication administered or dispensed by the perioperative nurse. Presence of catheters, drains, packing and dressings. Presence of catheters, drains, packing and dressings. Location of tourniquet cuff placement, identification of unit, pressure setting and inflation and deflation times. Location of tourniquet cuff placement, identification of unit, pressure setting and inflation and deflation times. 15PRPD/DN/DM/10

16. Cont…. Fluid output, including blood loss estimates, as appropriate. Fluid output, including blood loss estimates, as appropriate. Type, size and appropriate identifying information (such as serial number) of implants. Type, size and appropriate identifying information (such as serial number) of implants. Skin-preparation solutions used, areas prepped, and any reactions to prep. Skin-preparation solutions used, areas prepped, and any reactions to prep. 16PRPD/DN/DM/10

17. Cont …. Known allergies to medications, prep solutions, tape, latex, etc. Known allergies to medications, prep solutions, tape, latex, etc. Sponge, sharp, and instrument counts taken and results obtained. Sponge, sharp, and instrument counts taken and results obtained. Wound classification. Wound classification. Time of discharge and disposition of patient from operating room, including mode of transfer and patient status. Time of discharge and disposition of patient from operating room, including mode of transfer and patient status. 17PRPD/DN/DM/10

18. In Conclusion Perioperative nursing document needs to describe the assessment, planning and implementation of perioperative care that reflects individualization of care, as well as Perioperative nursing document needs to describe the assessment, planning and implementation of perioperative care that reflects individualization of care, as well as the evaluation of patient outcomes. the evaluation of patient outcomes. The design format such as “Checklists” will minimizes time needed for the documentation process. The design format such as “Checklists” will minimizes time needed for the documentation process. The End 18PRPD/DN/DM/10