Management of Intraoperative Activities; Part 2 Flashcards
What 4 things does management need to make sure everyone understands?
- philosophies
- objectives
- policies
- procedures
define philosophies
beliefs related to patient care and perioperative nursing responsibilities to achieve the expected outcomes
define objectives
specific goals, purposes, and performance aims
define policies
authoritative statements to guid decision-making and actions within the context of the organizational philosophy and objectives
define procedures
policy implementation actions related to a task or skill
What is the most important role for managers with management techniques?
the allocation of staff and ensuring work completion by competent persons
What is an important concept in any health care environment?
chain of command
How does the chain of command progress?
staff person, to team leader, charge nurse, manager, director, and chief nursing officer
Who also must take accountability in representing the organizational philosophy, objectives, policies, and procedures?
the RN
What are 2 things managers must take into consideration when it comes to staffing?
- patients present with comorbidities that OR managers must take into consideration
- Or managers must take into consideration the technical requirements of the procedure - robotic, minimally invasive, laser - and the competency level of personnel
what is evidence based practice?
the performance of nursing practice based on the most recent research available on a particular topic
What does EBP result in?
positive patient outcomes by implementing best practices
Finish the statement: Research shows that health care providers who use EBP demonstrate a (blank) level of satisfaction in their work because they know that they are providing the very best care, and this in turn (blank) retention
higher; increases
How can RN’s serve as a mentor in the perioperative environement? 3 things
they can create a respectful environment, build interprofessional relationships, and ensure peer support
Preceptors fulfill what kind of relationship with a new team member?
short-term relationship
Why do preceptors have a short-term relationship with a new team member?
to develop competency in the perioperative environment
Are team members with the most experience the best option for either preceptor or mentor?
no
What should be considered when choosing the individual who will be responsible for promoting the next generation of perioperative nurseS?
skill, attitude, and commitment to national standards
Is it essential for all RNs to be aware of their state’s what?
state Nurse Practice Act
Why should nurses be aware of the NPA?
to determine the specific scope of practice standards
Who is responsible for the safety of all those who work in the OR?
the nursing leadership
When applying the nursing process, the RN implements what?
nursing interventions that address the physical, psychological, and spiritual responses of the patient undergoing surgery or other invasive procedure
What are 2 key roles of the perioperative RN?
delegation and supervision
what is delegation?
the act of transferring a task to another person who has demonstrated competency while adhering to the 5 rights of delegation
the RN’s role encompasses supervision of who?
unlicensed personnel who scrub in surgery, such as scrub techs
What is the primary responsibility of the scrub tech?
to prepare and maintain the sterile surgical field during surgical and other invasive procedures
A scrub tech, whether an RN or ST, works under who?
direction and supervision of an RN
How can someone prepare to be an ST?
through a certificate program or a college degree program
What is what AORN is to an RN, to a ST?
Association for surgical technologists (AST)
What kind of a degree can an AST have?
associate degree
What are central service personnel responsible for?
for cleaning, decontaminating, sterilizing, and distributing medical and surgical instrumentation
true or false; central service personnel are some of the most vital contributors to the delivery of safe, high quality patient care
true
What is the role of CS personnel?
providing sterile, functioning, and clean instruments for the for the procedure in a timely mannger
What is the organization for CS professionals?
International Association of Healthcare Central, Service Material management
What are the 2 different certification exams for CS professionals
- Certified registered central service technician
- certified instrument specialist
do some states require CS professionals to be certified?
yes
What do larger perioperative settins have a team of to clean rooms and expedite room turnover?
ES personnel
What should ES personnel be educated on?
the importance of their work in decreasing health care associated infections and on effective cleaning for high-touch areas
How can RN’s help ES personnel?
they should be familiar with the processes of cleaning in order to assist in the ES area, provide oversight, and serve as a resource for environment infection prevention practices
who is ultimately responsible for a clean, safe environment for the perioperative patient?
the RN
The presence of who is essential to providing care with the most current equipment and techniques available?
vendors or health care industry representatives (HCIRs)
Who is not a member of the perioperative team and who may be present in the perioperative environment?
patient’s family member
When can a family member be present?
for the birth of a child or for support with highly anxious padiatric patients
why is it important for HCIR’s to be in the perioperative environment?
because they fulfill the vital roles of subject-matter experts for both surgeons and perioperative personnel related to instruments, equipment, and implants
Event though HCIRs are very needed, what do they increase the risk of?
increased risk to patient safety
What 3 things do HCIRs pose a risk to?
- a risk to legal exposure
- lack of compliance with regulatory standards
- infection secondary to people in the patient’s OR or procedure room
Perioperative managers must ensure what with HCIR’s?
must ensure that facility-specific policies are in place to address the presence and supervision of HCIR’s in the perioperative environment
What does credentialing of HCIR’s ensure?
that they are compliant with regulatory standards and risk prevention, including vaccinations
AORN and ACS have 5 important safeguards for HCIRs?
HCIR should
1. not participate in decision-making related to medical or nursing practice
2. not be involved with the performance of surgery
3. not have any direct patient contact
4. never be scrubbed in on any procedure
5. be monitored and supervised by the surgeon and RN circulator
RN’s should surpervise the presence of all students (medical, RN) to maintain what?
the sterile field, patient safety, and patient privacy
Allowing family members to present in the OR is based on what?
facility-specific policy
A common practice is for a single member of a patient’s family to be present during what?
c-sections
Some facilities allow a parent to be present during the induction of who?
pediatric patients
true or false; a parent may also be present in the PACU unit to comfort pediatric patients post op?
true
Who determines family presence in unusual situations?
anesthesia professional and surgeon
Although the primary commitment and focus are on the patient, the RN must be cognizant of the family member who is present? the RN circulator must monitor the family member for what?
for adherence to surgical attire and sure that the family member does not interfere with the care of the patient
If a family member becomes ill during the procedure, what should the RN do?
seek assistance in caring for the family member while maintaining the progress of the procedure and ensuring safety of the surgical patient
What does the health care facility rely on to help remain fiscally solvent?
nurses’ judicious use of supplies and equipment
What is the role in patient advocate for HCIRs in the OR?
maintain patient privacy and dignity
What 2 actions does the RN take for HCIR’s in the OR to be patient advocate?
- ensure that the HCIR is not present in the room during prepping and draping
- verify that the patient has given written consent to the presence of the HCIR
What is the role in competency for HCIRs in the OR?
verify that the team has had adequate training and education
What actions does the RN take for HCIR’s in the OR for competency?
verify with the OR manager or educator that each team member has completed competency verification related to equipment use, necessary techniques, and new technology
What is the role in materials management for HCIRs in the OR?
verify facility approval for the HCIRs presence and equipment use
What 3 actions does the RN take for HCIR’s in the OR for materials management?
- verify with the OR manager that each HCIR has current credentialing according to facility policy
- ensure that each HCIR wears a name badge
- Verify with the OR, sterile processing, and biomedical department managers that all equipment has been checked by biomedical engineering personnel for safe use
What is the role in infection prevention for HCIRs in the OR?
verify that equipment, personnel, and traffic patterns support patient safety related to the risk of infection
What 5 actions does the RN take for HCIR’s in the OR for infection prevention?
- verify with the OR or sterile processing manager that loaner instruments have been sterilized in the facility before use
- Limit traffic in the room to decrease airborne contaminants
- verify that each HCIR is earing facility-approved clothing in the perioperative environment
- monitor the HCIR’s movement around the sterile field
- Ensure that the HCIR uses appropriate personal protective equipment correctly
What is the role in collaboration for HCIRs in the OR?
Assist the HCIR and perioperative team to work cooperatively to achieve the best patient outcomes according to facility policy
What 2 actions does the RN take for HCIR’s in the OR for collaboration?
- monitor the HCIR’s activiites
- Facilitate interactions between the HCIR and perioperative team
What are the 5 key roles for RN’s and perioperative staff in supplies and equipment?
- multidisciplinary product evaluation and selection processes
- ensuring and monitoring preventive equipment maintenance
- ensuring the availability and sterility of supplies
- implementing cost-containment measures
- implementing practical environmental sustainable practices (reprocess vs. recycle)
What does product evaluation provide for?
an excellent opportunity for nurses to use their unique knowledge of the perioperative setting in the selection of equipment and supplies that the surgical team needs to provide safe, cost-effective, high quality patient care
Being part of a multidisciplinary product selection committee carries with it the responsibility to objectively and knowledgeably evaluate products and supplies based on?
- safety factors
- financial effect
- environmental effect
- reliability factors
- quality patient care factors
- regulatory and standard-setting agency compliance factors
- HCIR support and quality of training factors
What are examples of safety factors for product evaluation?
latex free, compliance with governmental and regulatory requirements, ergonomically correct, fire resistant
What are examples of financial effect for product evaluation?
cost effectiveness, direct and indirect costs, reimbursement potential, contract pricing, duplication of current products, compatibility with existing products
What are examples of environmental effect for product evaluation?
compatibility with existing disposal and processing methods, disposable versus reusable, reprocessing capabilities
What are examples of reliability factors for product evaluation?
clinical performance, estimated useful life of the product, outdates, repair history
What are examples of quality patient care factors for product evaluation?
ease of use, patient-and end user-related requirements
How do HCIRs serve as an important resource to end users for negotiating contracts related to purchase price?
they provide just-in-time education and training for their equipment and supplies
What do HCIRs provide for product evaluation and evaluation? 3 things:
- information on current research related to the product
- processing and reprocessing requirements
- individualized finanacial considerations - consignment, partial purchase orders, shared inventory, just-in-time purchase agreements
What is an important step in prolonging the useful life of equipment and should be taken into account during product evaluation and selection?
preventative maintenance
Aside from patient safety considerations, what is another issue when it comes to preventative maintenance?
warranties may expire prematurely or be voided if a piece of equipment has been abused or used for purposes other than intended
What should nurses do in order to ensure safe patient care when it comes to preventative maintanence?
checking equipment before it is used to ensure that it has met routine scheduled maintenance requirements conducted by qualified personnel according to manufacturer’s recommendations
Ensuring the availabiliy and sterility of supplies makes efficient use of what?
operative time
What does efficient use of operative time have implications for?
- cost
- surgical and anesthesia related complications
- patient safety
- and surgeon, personnel, and patient satisfaction
What is one way to reduce the incidence of immediate-use steam sterilization?
planning ahead to ensure that instruments will be available
In terms of cost, what should be taken into consideration during the product eval phase?
direct and indirect costs
What is an example of a cost-containment measure?
purchasing disposable products for items that are used infrequently or that have a short useful life and requires frequent updates
conversely, what is the benefit of purchasing reusable items?
may be better choice if shelf space is limited
A lot of the waste in the OR is inappropriately treated as what?
medical waste
How can we be an advocate when it comes to waste?
- recycling when possibel
- opening supplies
- separating biohazardous from medical waste for proper disposal
Review of what can decrease the waste associated with opened and unused supplies?
procedural packs
What can help decrease waste while helping to promote global health?
donating unused or no-longer-needed medical supplies and equipment to developing countries or for disaster relief purposes
How can standardization of physician preferences help cost-contaiment measures?
- reduce costs
- enhance inventory control
- decrease storage requirements
- reduce end-user training time and errors related to the need to be competent on numerous items with the same function
What are 3 direct costs associated with product purchase?
- purchase price
- replacement plan
- associated equipment
What are 7 indirect costs associated with product purchase?
- utilities
- waste processing
- storage
- training
- depreciation
- cleaning/packaging/sterilization
What is one way to engage in environmental sustainability but also another way to control costs and reduct medical waste?
reprocessing single-use devices that previously were considered one-time use or disposable
Reprocessing is possible within the guidelines and procedures established by the who?
US food and drug administration under the 510k approval process
Because the FDA carefully monitors the types of products that can be reprocessed facilities may decide what?
that using a third-party processor rather than in-house reprocessor is better
Who is responsible for ensuring that the correct implants are available before the beginning of the procedure?
TJC’s universal protocol
How are implants used for ortho procedures often delivered?
on consignment by manufacturer HCIRs
Are reusable implants delivered to facilities processed in the same manner as in-house instruments?
yes
Are implants processed or transported under unknown conditions considered sterile?
no
If it is determined that there is no other alternative and IUSS must be used for sterilizing implants what must be run in the load as well?
biological and class V indicators
results of positive biological indicators must be reported to who?
surgeon and infection preventionist as soon as the results are known
What does the implant registry include?
- patient identifiers
- the surgeon’s name
- the date of the procedure
- the name of the manufacturer of the implant
- the implant’s lot, batch, model, and serial numbers
- the type and size of the implant
- the site where the implant was placed
- the sterilizer load
- any other info that would help the manufacturer and facility identify a patient with a specific implant
Biological implants include both what?
autograf tnad allograft
what are 2 common allografts
organs (hearts, kidneys, eyes) and other body tissues (corneas, heart valves, tendons)
bone is typically kept where before use?
freezer
What is an additional responsibility of an RN when it comes to biologics?
that the freezer is monitored and kept at the appropriate temperature
donor and recipient identification information must be logged how?
in the same manner as other implants
how must autologous tissue be saved for autotransplantation at a later date?
must be stored in a manner that maintains the structural integrity and sterility of the tissue
Does autologous tissue that is preserved and replanted within the same facility need to be registered with the FDA as an implant?
no
If an autograft is transferred to another facility, what needs to be done in terms of documentation?
documentation similar to that used for allografts must be provided so that the autograft can be traced to its final disposition
What is recommended storage medium for avulsed tooth?
- hanks’ balanced salt solution
- milk
- water (only if this is the only option ot keep the tooth moist)
What is special consideration for avulsed tooth?
the tooth should be replanted as soon as possibleWhat
is recommended storage medium cranial bone flap?
- freeze
- cryopreserve
What are special considerations for cranial bone flap?
- autologous bone should be stored at about 4 degrees fahrenheight or colder for 6 months or less
- bone flaps can also be stored in a SQ pocket within the patient in an anatomical location determined by the physician
What is recommended storage medium for parathyroid tissue?
cryopreserve
What is special consideration for parathyroid tissue?
the optimal storage temperature has not been determined
What is recommended storage for skin?
- normal saline
- cryopreserve
What is special consideration for skin?
autologous skin should be stored between 32 degrees F (0 C) and 50 degrees F (10C) for no longer than 14 days
What is recommended storage medium for veins?
normal saline or lactated ringer solution and then refigerated
What are 2 considerations for vein?
- autologous veins should be stored between 32 degress F (0 C) and 50 degrees F (10C)
- cryopreservation is not recommended
If a cranial bone flap is dropped and the decision is made to replant, what should the next action be?
rinse the graft with sterile normal saline using low pressure pulsatile lavage on a separate sterile field.
What should the wound classification be changed to if a cranial bone flap is dropped?
Class III
What should be filled out or occur with the team if a cranial bone flap is dropped?
should be debriefed and a variance report completed
