Role, equipment and surgical items - scrub/scout

Question 1

Circulating nurse role

Answer 1

Initiative and good anticipatory skills are essential as the circulating nurse is very much the arms and legs of the instrument nurse and surgical team.

Question 2

Circulating nurse responsibility (EOEAW)

Answer 2

• Establish and monitor the aseptic field
  
  • Open sterile items and equipment
  • Ensure and maintain patient safety and dignity
  • Anticipate the needs of the instrument nurse prior to and during the procedure
• Work directly with the instrument nurse to support the surgical team.

Question 3

Instrument nurse role

Answer 3

Can only touch the items that are sterile, and you can’t move freely around the OR, must stay within the surgical field.

Question 4

Instrument nurse responsibility (PAEMAR)

Answer 4

• Participating in all processes outlined in the SCC, focusing on the stages of the team “time out” and “sign out”
  
  • Anticipate the needs of the surgical team before and during the surgical procedure
  • Establish and monitor the aseptic field
  • Manage the instruments and associated sterile items
  • Assist the surgeon with access to instruments and supplies required to undertake the surgical procedure
• Recognise intra-op complications or changes in the patients condition and respond promptly.

Question 5

Instrument and circulating nurse collaborate to (APMPEEP)

Answer 5

• Advocate for the pt during the surgical procedure
  
  • Prepare the instruments and equipment needed for the procedure
  • Monitor any breaches in aseptic technique and initiate corrective action
  • Perform the surgical count at prescribed stages
  • Ensure correct handling of surgically removed human tissue and explanted items
  • Ensure that documentation of intra-op nursing care ia accurate and complete
• Provide a comprehensive clinical handover to the nurse caring for the patient in the PACU

Question 6

Instruments (SHCGRAS)

Answer 6

1. Sharps/ cutting instruments
2. haemostats forceps (artery forceps)
3. Clamps
4. grasping/holding instruments
5. retractors
6. accessory instruments
7. specialised instruments

Question 7

instrument trays

Answer 7

Named according to their use and surgical speciality. Trays include a set of instruments used for surgeries within the specialty.
- A tray list ensures the instrument nurse can be prepared.

Question 8

Surgical count

Answer 8

Performed in procedures in which an incision is made or a wound is created and surgical items are used.

Question 9

Surgical count - who is involved?

Answer 9

involves two people (one of which must be an RN) whereby they count the items out loud together. Ensures all items are accounted for.

Question 10

Risk factors for AI

Answer 10

• human factors (poor communication, teamwork, leadership, organisational culture, fatigue)
• surgical factors (lengthy procedures, emergencies, uncontrolled bleeding)
  patient factors (high BMI)
• organisational (lack of standardised count process)

Question 11

the IN count

Answer 11

Initial baseline count conducted prior to the case beginning.
- count conducted whenever new items are added into the field.

Question 12

the OUT count - CAVITY count

Answer 12

• performed prior to closure of cavity within a cavity.
• A count performed before placement of mesh to close a space is considered a cavity count.

Question 13

the OUT count - CLOSING count

Answer 13

count performed before wound closure begins

Question 14

the OUT count - RELIEF count

Answer 14

Count performed at the time of permanent relief of either the scrub person or circulating nurse

Question 15

the OUT count - ANYTIME count

Answer 15

performed at the discretion of any member of the OR team

Question 16

the FINAL count

Answer 16

performed after skin closure, when surgical items are no longer in use and ALL instrumentation is passed off the surgical field