Chap 4 - The Health Care Facility. Flashcards
Accreditation.
Process by which a team of professionals evaluates a health care institutions practices and policies and the outcome of patient care.
The facility itself must…
- Provide a safe environment for patients, staff, and visitors.
- Enable the work of health care personnel in a way that encourages efficiency of time, movement, and space.
The Joint Commission.
The primary accreditation organisation for all health care facilities.
Chain of command.
A hierarchy of personnel positions that est. both vertical and horizontal relationships between positions.
Organisational chart (organigram).
A graphic depiction of an organisations chain of command that shows the lines of vertical (higher/lower) and horizontal (equal) administrative authority.
Principals of OR design.
- Infection control
- Environmental safety
- Efficient use of personnel, time, space, material resources.
Infection control.
______ is a multidisciplinary process and involves many different areas of expertise and practice.
The physical design of the OR is based on two basic principals.
- Physical separation between the surgical environment and any source of contaminations.
- Containment of sources of infection.
The Decontamination Area.
The area where surgical instruments and equipment are disinfected after use.
When complete physical separation is possible, contaminated objects are __________ in a prescribed area or a barrier.
Contained.
The surgical environment contains many potential sources of __________ _________.
Environmental Safety.
Administration.
- Individuals who manage an institution, plan its activities, and provide oversight for day-to-day operations and employees.
- Liaison between the facility and the community
Air exchange.
- The exchange of air between areas separated by a physical boundary.
- Standards are regulated by health and safety organisations.
- Positive air pressure - 10% higher in the OR
- One-way air movement
Back table.
Large stainless steel table on which most of the sterile surgical supplies and instruments are placed for use during surgery.
Biomedical engineering technician.
Professional who specializes in the maintenance, repair and safe operation of devices used in medicine.
Case cart system.
Organisational method of preparing equipment and instruments for a specific surgery.
Central core.
Restricted area of the operating room where sterile supplies and flash sterilizers are located.
Chain of command.
Relationship between management and staff members.
Decontamination area.
Room or dept., in which soiled instruments, equipment are cleaned of gross matter and decontaminated to remove microorganisms.
Efficiency.
Economic use of time and energy to prevent unnecessary expenditure of work, materials and time.
High-efficiency particulate air (HEPA) filtres.
Remove 99.97% of particles equal to or larger than 0.3 micrometers
Integrated operating room.
- Digital and computerised components can be controlled from a central location in the room.
- Components are built into the room structure as well.
Job description.
Specifies duties, responsibilities, location, pay and management structure of a job.
Laminar airflow (LAF) System.
Moves a contained volume of air in layers at a continuous velocity, with 800 to 900 air exchanges per hour.
Personnel policy:
Sets forth health care facility’s job descriptions, role delineations, requirements for employment, and rules of conduct.
Post-anesthesia care unit (PACU).
Critical care area where patients are taken after surgery for monitoring and evaluations as they emerge from anaesthesia.
Restricted area.
Area of the operating room where only personnel wearing surgical attire (masks, eyewear, shoe coverings, head coverings) are allowed.
Risk management.
Tracking, evaluating, and studying accidents and incidents to protect patients and employees.
Role confusion.
Lack of clarity about one’s job duties and requirements.
Semi Restricted area.
Only personnel wearing surgical attire (scrub suit, hair cap that encloses facial hair) may enter.
EX=Pts awaiting surgery, Supply processing area, storage areas, Clean utility
Traffic patterns.
Movement of people into, out of, and within the operating room.
Transitional area.
Area in which surgical personnel or visitors prepare to enter the semi restricted and restricted areas (includes locker rooms and changing rooms).
Unrestricted area.
Where people enter first
Street clothes
EX = Family Waiting rooms, Outer reception areas
What is the Primary Goal of the Central Core Floor Plan?
Create a clear separation between soiled and clean equipment.
Airflow and Circulation.
Air pressure = 10% higher than the air pressure in adjacent semirestricted areas.
What is available thru inline systems in most hospitals in the OR?
Nitrous oxide
Nitrogen
Oxygen
Compressed air
What is the function of suction?
Evacuate fluids, including blood from surgical incision (wound)
Remove any fluids from patient’s airway during anaesthesia.
Always have MINIMUM OF TWO suctions available.
How is the strength of vacuum measured?
Pounds per square inch (PSI) - is adjustable.
What is the flow of traffic from public to OR suites?
- Unrestricted=Located near entrance/isolated from main hospital corridors–dressing rooms-street clothes to scrubs
- Semi-restricted=OR attire: scrub suit/hair cap w/no hair out–Red line on floor–Instrument, Sterile supply/Storage rms, clean utility rms.
- Sterile/Restricted=Open sterile supplies– Complete surgical suits. Location: OR, procedure room sterile corridor, surgical suites, where sterile supplies are kept & opened.
Which areas in the OR suite are Restricted?
Surgical suites, Procedure rooms, Sterile corridor, Substerile rooms btwn surgical suites, Sterile supply closets.
Types of Health Care Financing.
- Government Assistance.
- Private Insurance.
- Payment systems.
OR PERSONNEL
- Surgeon
- Anesthesia provider/MD, DO
- Operating room director/Perioperative RN
- Primary Dr in OR:Resp for guiding surgical procedure.
- CRNAnestetist:Professional in anesthesian/ pain management–resp for monitoring & adjust-ment of pt physiological status.
- CRN/LRN/CNOR/RNFA=Circulating Nurse: Oversees all clinical/professional activites in dept w/evidense-based standards.
OR PERSONNEL (cont).
- Physician assistant
- CST/CSFA
- LPN/LVN
- Practices medicine under Dr’s supervision.
- CST: Prep equip CSFA: assists Dr–retraction, homostasis, suturing, suctioning directed by Dr.
- State approved LPN/LVN, in OR=scrub
OR PERSONNEL (cont).
- Operating room educator.
- Registered nurse.
- Surgical orderly/aid.
- RN/CST: Dev. programs/seminars/info training of new equip. or techniques w/in dept.
- RN=Circulating Nurse in OR.
- Assists w/pt care–prep of surg suit–sterilization–turnover of pt–very important position.
OR PERSONNEL (cont).
- Assistant Surgeon.
- Central Sterile Processing Technician.
- Patient Care Technician.
- MD, perform and assist in surgery as directed by Surgeon.
- Safe mgmt and sterilization of equipment in prep for and after its use in surgery or other care units.
- Multidisciplinary nursing assistant with ADLs.
Related types of organizations/What do they do?
- Governmental.
- Private volunteer.
- Accrediting.
- Professional.
- CDC: Centers for Disease Control & Prevention.
- ESARVHP: Emergency Services Advanced Resistry for Volunteer Health Professionals.
- JACO: Joint Commission on Accreditation of Healthcare Organisation.
- IAHCSMM: International Association of Healthcare Central Service Materiel Management.
PACU.
Post Anesthesia Care Unit—Recovery.
AIA.
American Institute of Architects = set primary standards & for health care facility engineering.
JC.
The Joint Commission = An independent, nonprofit national organization that develops standards and performance criteria for health care organisations.
EPA.
Environmental Protection Agency = sets/enforces regulations related to safety in envirnment, incl. hazartdous chemicals & radiation.
OSHA.
Occupational Safety Health Admin.=Federal organization that is dedicated to protecting the health of workers by establishing standards that address issues related to safety in the workplace.
AHRQ.
Agency for Healthcare Research and Quality.
APIC.
Association for Professionals in Infection Control and Epidemiology = Conducts research & establishes guidelines for infection control measures.
DRG.
List of services or “products” (procedures) that hospitals deliver; Used by Medicare & insurance companies to determine the amount of money the system pays out for its beneficiaries.
DIAGNOSIS-RELATED GROUP.
Cardiovascular Perfusionist.
Provides extra-corporeal (outside the body) oxygenation of the blood during cardiac bypass procedures in which the heart is places in standstill.
Ancillary Technical Staff.
- Radiology.
- EEG Tech.
- Med. Rep.
- Cardio Perfusionist.
- Admin Personnel.
- Facility Management.
- C.O.O.
- Director of Surgical Services/O.R. Supervisor.
- Periop Nurse Manager.
- Unit Clerk/Secretary.
Environmental engineering.
_________ ________ in the O.R., follows national medical engineering standards for electrical circuits, inline gasses, and other utilities.
Proper storage of sterile supplies ______use of space protect the sterility of the items and enable staff members to find what they need quickly and retrieve it safely.
Efficient.
Kick Bucket.
- Constructed of stainless steel and fitted into a wheeled frame.
- Designated for soiled surgical sponges, and other lightweight, nonsharp, items that must be discarded during surgery and accounted for.
The ______ is used to contain one or two stainless steel basins.
Ring Stand.
Special Procedure Room.
- A surgical room that contains the equipment and technology for special use.
- Cystoscopy room is standard to all surgical departments
Utility Work Room.
Examples of central processing and decontamination rooms.
The OR temperature is maintained at……
68-73º F or 20-23º C
There are numerous codes and standards related to ______ equipment used in the OR.
Electrical.
Clean Processing Room.
- Used for assembly & sterilisation.
- Any instruments that are not sent out of the department for decontamination and sterilization are brought here.
Soiled instruments and equipment are decontaminated or washed in the ______ or ______.
Workroom or Central Processing Area.
The OR could not function without
Collaboration from other departments
Materials Management
This department is the purchasing and logistics center for goods and supplies.
The department is separated into three distinct areas__.
Unrestricted, semi-restricted, and restricted
The primary design goal of the floor plan is to create a clear separation between ____ and ____equipment.
Soiled, contaminated.
. ________ in the surgical suite are stored in closed cabinets to keep them clean.
Sterile Supplies.
The operating room table is adjustable for height, degree of tilt in all directions, orientations in the room, articular breaks, and______.
Length.
The back table is a large, stainless steel table on which all instruments, supplies, and equipment needed for surgery are arranged, except for those needed for ______.
Immediate use.
Whats the diff., between PPO & HMO?
PPO = Choose your own Doctor w/o referrals. HMO = Certain Doctors you can go to.
