Organising theatre list Flashcards
Important things not to miss when handwriting list
-Comorbidities
-Anticoagulants
-Surgical details e.g. laterality
-Sign, date, add time to bottom of list
What preoperative measures can reduce surgical site infection?
-Hair removal at surgical site
-Theatre staff removing hand jewellery
What perioperative measures can reduce surgical site infection rates?
-Tight glycaemic control
-Oxygen supplementation
-Maintain normothermia
-Careful prepping and draping
-Well ventilated theatre
-Antibiotic prophylaxis if indicated
-Sterile gowns for theatre staff
Postoperative mesures to reduce SSI
-Aseptic dressings for wounds
-Wound care advice to pt
-Appropriate ward care by staff with regular review
How would you classify measures to reduce infection?
Preoperative
Perioperative
Post operative
How many doses of antibiotics would you give if indicated prophylactically?
-Clean-contaminated: single dose
-Contaminated: 3 doses
-Dirty: Prolonged
What are high risk patient factors for infection?
-Immunocompromise
-Poorly controlled diabetes
-Malnutrition
-High BMI
What are procedures with high consequence for infection?
-Orthopaedic or vascular implant surgery
-Entry into bone cavities e.g. sternotomy
-Metallic or other prosthetic heart valves
When are prophylactic antibiotics indicated in surgery?
-When risk of infection is high (>4%)
-Patients with risk factors
-High risk procedures
What are the current guidelines for perioperative glycaemic control in the diabetic patient?
Patients with diabetes must be prioritised on waiting list
Routine overnight admission is unneccesary
Starvation time should be no more than 1 missed meal
Analgesia and antiemetics should be used to enable early return to diet and usual insulin regime
Insulin infusions should only be used if pt expected to miss more than 1 meal
Hrly BMs with target 6-10
0.45% nacl with 5% glucose and 0.15 or 3% kcl is recommended IV fluid
When should metformin be stopped before an operation?
omit metformin on morning of procedure to reduce lactic acidosis and renal impairment
Why should diabetics go first in list?
-Prevents complications of hypoglycaemia
-Allows early return to normal glycaemic control
-Peri and post op normoglycaemia reduces risk of SSI
How should pt’s with latex allergy be managed?
-1st on list
-requires clean theatre, time must be given for previous latex ‘dust’ to settle
-All latex products should be removed from theatre or clearly labelled
How should children me managed?
Early in list
Minimises distress to child and patients
how should local patients be managed?
1st or last on list as professional courtesy
Small cases can be between cases to allow recovery of previous pt and anaesthetisation of next
How should major procedures and cancers be managed?
-Should not be cancelled due to time constraints
-Should be early on list
How should patients with infections be managed?
-e.g. MRSA + C.dif should go last on list to avoid contamination between patients
-If possible, order list clean, clean-contaminated, dirty
What are factors that affect list decision making?
Diabetics
Latex allergies
Children
Procedure under LA
Major procedures
Patients with infection
Clinical priority: NCEPOD criteria
What are factors that affect list decision making?
Diabetics
Latex allergies
Children
Procedure under LA
Major procedures
Patients with infection
Clinical priority: NCEPOD criteria
How is an operating theatre laid out? How does this help avoid infections?
-Located near relevant facilities: A + E, radiology, ITU
-Away from main entrances/public areas
-Large enough to hold staff/equipment/pt
-Access to th from anaesthetic room, scrub room, prep room, recovery area
-Easy access to control temp/humidity/ventilation/light
What does WHO checklist involve?
Sign in
Time out
Sign out
What does sign in involve?
Before induction anaesthesia
Pt has confirmed:
-Identity
-Site
-Procedure
-Consent
Site marked
Anaesthesia safety check confirmed
Confirm allergies
Airway + bleeding risks highlighted + appropriate precaution taken (e.g. difficult airway trolley, G+ S
Time out (before skin incision)
Introduce all members of team + roles
Confirm pt name, site + procedure
Surgeons highlight anticipated critical events e.g. blood loss
Anaesthetic team highlight specific concerns (glycaemic control, cardiac risks, problems at induction)
Antibiotic prophylaxis given/needed
Thromboprophylaxis given/needed
Essential imaging displayed
Sign out (before pt leaves operating room)
Confirm name + site of procedure
Confirm swab + instrument count correct
Confirm specimens labelled
Equipment problems
Any concerns for recovery
How can lay out of theatre complex affect pt safety>
-ITU nearby and on same level
-Close proximity to emergency/radiology departments
-Away from main entrance + general hospital traffic
-Theatres should be next to each other to reduce staff movement
-Anaesthetic rooms should be adjacent to theatres
-Sterile services in unit
What measures do you know to improve operative safety?
Surgical: appropriate experience/supervision, communication, anticipating events + planning, e.g. ensuring x matched blood available
Environmental: theatre design and layout, appropriate monitoring
Others: regular auditing of results, pre op assessment
How would you prepare skin before surgery?
Hair removal
Operation site cleaned with swab impregnated with detergent
skin prepped with alcohol based chlorhexadine or povidone-iodine. Should be dried completely and not pool
Skin should be prepped cleanest area to dirtiest
What are the criteria for consideration of day surgery?
-ASA 1 or 2
-BMI <35
-Projected operative time < 1hr
-Acceptable to pt
-Home support on discharge + home phone
-Must live close to hospital
