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Ministry Of Health, General Directorate Of Nursing
nd
2 Edition
OPERATING ROOM
anual of
ursing
olicies and
rocedures
Prepared by:
Nursing Policies and Procedures’ Committee 2011
Supervised by:
Dr. Munira Al Oseimy
General Director of Nursing-MOH
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECI
CIA
ALIZED NU
NURS
RS
RSIING
NG:: OPERATING RO
ROO
OM
TABLE OF CONTENTS
SN
POLICY TITLE
INDEX NUMBER
.1 DUTIES AND RESPONSIBILITIES OF SCRUB NURSE
SNR-OR-001
.2 DUTIES AND RESPONSIBILITIES OF CIRCULATING NURSE
SNR-OR-002
.3 DUTIES AND RESPONSIBILITIES OF RECEPTION NURSE
SNR-OR-003
.4 DUTIES AND RESPONSIBILITIES OF RECOVERY ROOM
NURSE
.5 OPERATING ROOM LIST- SCHEDULE OF OPERATION
.6 ADMISSION PROCEDURE OF DAY SURGERY PATIENT TO
WARD
.7 IDENTIFICATION OF CORRECT PATIENT FOR SURGERY
.8 PATIENT IDENTIFICATION AND SURGICAL SITE
VERIFICATION IN OPERATING ROOM
.9 PRE-OPERATIVE CHECKLIST
SNR-OR-004
SNR-OR-005
SNR-OR-006
SNR-OR-007
SNR-OR-008
SNR-OR-009
.10 TRAFFIC CONTROL-OPERATING THEATRE SUITE
SNR-OR-010
.11 OPERATING ROOM ATTIRE
SNR-OR-011
.12 SURGICAL HAND SCRUB
SNR-OR-012
.13 GOWNING
SNR-OR-013
.14 GLOVING
SNR-OR-014
.15 SURGICAL COUNT
SNR-OR-015
.16 ASSIST PATIENT FOR GENERAL ANESTHESIA
SNR-OR-016
.17 ASSIST PATIENT FOR REGIONAL ANESTHESIA
SNR-OR-017
.18 INTRA-OPERATIVE CARE
SNR-OR-018
.19 POSITIONING OF PATIENT IN OPERTING ROOM
SNR-OR-019
.20 HANDLING ELECTROSURGICAL UNIT (ESU)
SNR-OR-020
.21 APPLICATION AND USE OF PNEUMATIC TOURNIETS.
SNR-OR-021
.22 SAFE PRACTICE IN THE OPERATING THEATER
SNR-OR-022
.23 SKIN PREPARATION BEFORE SURGERY
SNR-OR-023
.24 MAINTAINING STERILE FIELD
SNR-OR-024
.25 HANDLING OF SPECIMEN IN OPERATING ROOM
SNR-OR-025
.26 DRAPING OF PATIENT FOR SURGERY
SNR-OR-026
.27 DISCREPANCY IN SURGICAL COUNTS
SNR-OR-027
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
TABLE OF CONTENTS
SN
POLICY TITLE
INDEX
NUMBER
SNR-OR-028
.34
SUPPLIES AND MAINTENANCE IN RECOVERY ROOM
CARE, PHYSICAL RESTRAINTS AND DISCHARGE OF
PATIENT IN RECOVERY ROOM
PERI-OPERATIVE DOCUMENTATION FOR OPERATING
ROOM
TRANSFERRING PATIENT FROM TROLLEY TO ANOTHER
TROLLEY/ OR TABLE
CARE AND CLEANING OF SURGICAL INSTRUMENTS
AND POWERED EQUIPMENTS
CARE OF SURGICAL MICROSCOPE IN OPERATING
ROOM
DEATH PROTOCOL
.35
VISITORS IN THE OPERATING ROOM
SNR-OR-035
.36
COORDINATION OF A MAJOR INCIDENT
SNR-OR-036
.37
ENVIRONMENTAL CLEANING OF SURGICAL OPERATING
ROOM AND EQUIPMENTS
SNR-OR-037
.28
.29
.30
.31
.32
.33
SNR-OR-029
SNR-OR-030
SNR-OR-031
SNR-OR-032
SNR-OR-033
SNR-OR-034
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
TITLE:
IPP
SNR-OR-001
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF SCRUB NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 10
1.0 DEFINITION
A person who is responsible for maintaining the integrity, safety and efficiency of the sterile field
through out the operation.
2.0 PURPOSE
2.1 To prepare and arrange sterile drapes, instruments and supplies.
2.2 To assist the surgeon and assistants through out the operation by providing the sterile
instruments and supplies required.
2.3 To maintain patient’s safety through out the operation.
3.0 POLICY
3.1 All scrub personnel shall safety practice and apply strict aseptic to
provide optimum care for the surgical patient.
3.2 To confirm surgical procedure as according to written consent
obtained from patient before any surgical procedure preparation.
3.3 To check all surgical instruments, electrical equipment and suction
apparatus are function before use.
3.4 A surgical hand scrub must be performed as per standards of practice before carry out
surgical procedures.
3.5 The Universal Precaution standards of practice must be complied at all times.
3.0 POLICY
3.6 A sterile gown and gloves must be donned according to aseptic technique according to the
requirements of surgical procedures.
3.7 All instruments and surgical procedures supplies are assembled according to surgeon’s
OR-1
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-001
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF SCRUB NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
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preference and the requirements of surgical procedure.
3.8 All scrub personnel shall perform surgical count as per standard of practice.
3.9 Anticipate surgeon’s requirements and keep one step a head of surgeon in passing
instruments, sutures, sponges and receiving specimen through out surgical procedure.
3.10 Plan, organize and maintain neatness and tidiness of instruments in the sterile working
area, mayo tray and trolley.
3.11 Patient’s safety is to be observed at all times by not placing too many instruments or any
heavy instruments on the patient.
3.12 All medication or drugs that are required in the procedures must be checked for correct
drug, dosage and expiry date with the Circulating personnel prior to use.
3.13 All specimens must be handled correctly and confirmed with surgeon as per standard of
practice.
3.14 Aseptic technique must be maintained strictly through out the surgical procedure.
4.0 RESPONSIBILITIES
4.1 Scrub Nurse
5.0 MATERIALS & EQUIPMENT
5.1 Sterile Gown & Glove
5.2 Sterile Set on a trolley
5.3 Sterile Drape & Mayo tray
5.4 Sterile Basin as required
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-001
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF SCRUB NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6.0 PROCEDURES
RATIONALE
6.1 Confirm the type of surgery as according
to O. R List prior to induction of patient.
1. To check for correct booking of
case
6.2 Assess for:
6.2.1 correct patient with written
consent according to type of
surgery.
6.2.2 Patient’s history of any
allergies.
6.2.3 Correct preparation of patient
according to documentation of
patient’s OR check list.
6.2.4 Functioning of Electrical
Surgical Unit, suction machine
and other necessary
machines/equipment that may
required.
6.3 Prepare for the completeness of
materials & equipment according to the
required surgery and surgeon
preference.
6.4 Perform the surgical hand scrub
as per standard of practice.
6.5 Don a sterile gown and gloves
according to aseptic technique.
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-001
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF SCRUB NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
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6.6 Open the inner sterile set and
assemble the sterile instrument and
accessory sterile items on mayo
tray and trolley according to
standards of practice.
6.7 Receive all the remaining
instruments and supplies from the
circulator.
6.8 Perform surgical count with the
circulator personnel, as per
standard of practice.
Check the count board for
correction of count.
6.9 Assemble the surgical blade (scalpel
blade) to the correct scalpel handle using
needle holder.
6.10 Prepare sutures according to surgeon
preference.
6.11 Gown and glove surgeon if necessary.
6.12 Assist in skin cleaning preparation of
patient as per standard of practice.
6.13 Assist in draping procedure aseptically
as per standard of practice.
6.14 Secure drape, suctioning and
electrosurgical code with towel clip and
drape the end part to circulator.
6.15 Bring mayo stand into position over the
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-001
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF SCRUB NURSE
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patient after draping is completed.
6.16 Ensure the mayo tray is not resting
directly on the patient.
6.17 Check and test the Electrosurgical Unit,
suction machine or other electrical
equipment if any is well connected and
functioning.
6.18 Place the Electrosurgical unit pin in the
quiver or its container when not in use.
6.19 Pass instruments to surgeon in a firm,
decisive, proper position and safe
manner.
6.20 Pass and receive the scalpel from the
surgeon in the kidney dish. Do not pass
the scalpel to hand directly.
20. This is to avoid injury to scrub
nurse or surgeon.
6.21 Place the skin knife away from the
sterile working field.
21. The skin knife is considered
contaminated.
6.22 Pass ringed instrument in a working
position.
6.23 Retract tissue gently if required.
6.24 Mount the tape or ligatures using an
appropriate size artery forceps when
required.
6.25 Remove artery tips as directed by
surgeon and gently releasing the artery
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-001
APPLIES TO:
NURSING
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grip when the ligature begins to ligate
the bleeder’s tissue.
6.26 Cut suture with tip of stitch scissors as
directed by surgeon.
6.27 Assist in tissue coagulating by pressing
the Electrosurgical controls according to
surgeon’s preference
6.28 Clean the Electrosurgical tip free from
eschar before handling to surgeon.
6.29 Assist surgeon in suturing.
6.30 Attach each needle 1/3 of the curve from
eye onto a needle holder and close firmly
6.31 Pass the needle holder by holding both
needle holder and the suture material.
6.32 Anticipate surgeon’s requirements
throughout the procedure. Keep one
step ahead of surgeon in passing
instrument sutures, sponges and
handling of specimen.
6.33 Identify all specimens with the surgeon
and handles surgical specimens
according to standard of practice.
6.34 Maintain the neat and orderly sterile field
of operative field mayo tray and
instrument trolley at all times.
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-001
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF SCRUB NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
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6.35 Maintain strict aseptic technique and
watch for any break in the technique
through out the procedure:
6.35.1 Remove all contaminated used
instrument and pass to circulator
as standard of practice e.g. bowel
surgery.
6.35.2 Acknowledge if sterile field
contaminated and reestablished
sterility.
6.35.3 Change glove at once if
contaminated
6.35.4 Discard a piece of suture
material, tubing or sponge if falls
over edge of the sterile field
without touching the contamination
area.
6.35.5 Keep hands at table levels when at
rest.
6.35.6 Keep contact to sterile field to a
minimum and do not lean on the
sterile trolley, mayo stand or on
the patient.
6.35.7 Use forceps to take any contents
from the sterile package.
6.35.8 Leave a wide margin of safety in
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-001
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF SCRUB NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
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moving about the operating room
if necessary and within the sterile
field.
6.35.9 Sterile person face a sterile area
when changing positions.
6.35.10Keep the sterile field as dry as
possible to prevent strike
through.
6.35.11Discard soiled sponges from the
sterile field immediately to avoid
accumulation.
6.35.12Keep talking to a minimum. Turn
face away from sterile field if
coughing or sneezing.
6.35.13Wipe instruments with wet
sponge to keep clean from
blood and debris.
6.36 Clear off the operative field and mayo
tray as time permits.
6.37 Perform 2nd surgical count sponges,
sharps and instruments with circulating
nurse when surgeon begins closure of
any open cavity.
6.38 Perform final count of sponges, sharps
and instruments with circulating nurse
when surgeon starts the wound closure.
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-001
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF SCRUB NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6.39 Connects drainage equipment if used on
completion of surgical procedure
6.40 Apply dressing to the surgical wound by
non-touch technique.
6.41 Assist in removing the drapes from the
patient.
6.42 Dispose of sharps in sharp container
6.43 Tidy used trolley and throw rubbish into
appropriate bags
6.44 Separate sharps and fine instruments
from heavy instruments and place them
neatly on trolley.
6.45 Cover the soiled instrument before
sending to TSSU or CSSD.
6.46 Remove gown and gloves as per
standard of practice.
6.47 Wash hand immediately after removing
Glove.
6.48 Complete and check documentation of
the peri-operative care plan, record and
sign surgical count sheet.
7.0 ATTACHMENTS
N/A
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-001
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NURSING
DUTIES AND RESPONSIBILITIES OF SCRUB NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
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8.0
REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-10
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-002
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
CIRCULATING NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 9
1.0 DEFINITION
A person who is responsible to assist the scrub nurse by providing the sterile supplies
needed for the operation, maintaining the Integrity of the sterile area and safety of the patient
throughout the operation.
2.0 PURPOSE
2.1 To assist scrub nurse by providing sterile items as needed according to surgeon
preference and surgical requirements procedure.
2.2 To anticipate the needs of the sterile team members for the smooth flow of events before,
during and after the operation.
2.3 To observe vigilantly in safeguarding the sterility of the operative field.
2.4 To maintain patient’s safety and comfortable environment through out the operation.
3.0 POLICY
3.1 All circulating personnel shall safety practice and apply strict aseptic to
provide optimum care for the surgical patient.
3.2 To confirm surgical procedure as according to written consent obtained
from patient before any surgical procedure preparation.
3.3 The operating room must be checked and prepared for the cleanliness,
functioning of the electrical machines and other equipments according to
standard of practice before start of surgery.
3.0 POLICY
OR-11
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-002
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
CIRCULATING NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
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3.4 The Universal Precaution standards of practice must be complied at all
times.
3.5 All instruments and surgical procedures supplies are provided in anticipation, to the scrub
nurse according to surgeon’s preference and the requirements of surgical procedure.
3.6 All circulating nurse shall perform surgical count as per standard of practice.
3.7 Plan, organize and maintain neatness and tidiness of the operating room at all times.
3.8 Patient’s safety is to be observed at all times.
3.9 All medication or drugs that are required in the procedures must be
checked for correct drug, dosage and expiry date with the Scrub Nurse prior to use.
3.10 All specimens must be handled correctly and confirmed with Scrub Nurse per standard of
practice.
3.11 Aseptic technique must be maintained strictly through out the surgical procedure.
3.12 Always remain in the operating room and ensure there is always a replacement if have to
leave. Keep the Scrub Nurse inform when leaving.
4.0 RESPONSIBILITIES
4.1 Circulating Nurse
5.0 MATERIALS & EQUIPMENT
5.1
All the necessary surgical requirements that is needed by the Scrub Nurse for the
operation.
OR-12
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-002
TITLE:
NURSING
DUTIES AND RESPONSIBILITIES OF
CIRCULATING NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6.0 PROCEDURES
6.1
Confirm the type of surgery as according
to O. R List prior to induction of patient.
6.2
Assess for:
RATIONALE
6.2.1 correct patient with written
consent according to type of
surgery.
6.2.2 patient’s history of any allergies.
6.2.3 correct preparation of patient
according to documentation of
patient’s OR check list.
6.2.4 Functioning of Electrical Surgical
Unit, suction machine, operating
table and other necessary
machines and equipment that
may required.
6.3
APPLIES TO:
Prepare for the completeness of
operating room, materials & equipment
according to the required surgery,
surgeon reference and standard of
practice.
6.3.1 Prepare the correct position of
operating table and always check
that operating table is always
locked. Gather all the necessary
operating table’s accessories as
needed in the patient’s
positioning.
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Ministry of Health, General Nursing Administration
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INTERNAL POLICY AND PROCEDURE
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IPP
SNR-OR-002
TITLE:
APPLIES TO:
DUTIES AND RESPONSIBILITIES OF
CIRCULATING NURSE
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EFFECTIVE DATE:
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6.3.2 Ensure operating light for focus,
intensity and movement.
6.3.3 Ensure functioning of suctioning
apparatus, Electrical Surgical Unit
and other electrical equipment.
6.3.4 Arrange machines and
equipments to maintain the
integrity of sterile field.
6.4
Fasten the Scrub Nurse, surgeon and
other sterile team member's gown.
6.5
Check the sterile equipment for its expiry
date, sterility and integrity of package
before opening to the Scrub Nurse.
6.0 PROCEDURES
6.6
Assist the Scrub Nurse in the
preparation of sterile field by providing
sterile supplies and opening of sterile
package as required.
6.7
Provide the required solutions or
medication as required and check with
NURSING
RATIONALE
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Ministry of Health, General Nursing Administration
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SPECIALIZED NURSING: OPERATING ROOM
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POLICY NUMBER:
IPP
SNR-OR-002
TITLE:
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
CIRCULATING NURSE
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scrub nurse or surgeon to confirm the
correct drug, dosage and expiry date.
6.8
Perform 1st surgical count with Scrub
Nurse as per standard of practice.
Check the count board for correction of
count.
6.9
Perform surgical count with the
circulator personnel, as per standard of
practice.
6.10 Collect the right patient when the
operating room is prepared.
6.11 Assist in the safe transfer of patient on
to the operating table.
6.12 Remain with patient during induction
and intubation.
6.12 To anticipate for any emergency that
may arise.
6.13 Assist in the positioning of patient as
accordance to the type of surgical
procedure and standard of practice.
Position the patient upon the
anesthetist‘s approval.
6.13 The anesthetist is in charge of patient’s
airway management. Change of
position may dislodge the ETT.
6.14 Place the Electrical Surgical Unit
conductive pad on the patient as
according to standard of practice.
6.15 Assist in the application of the
tourniquet to the patient if required and
as standard of practice.
OR-15
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-002
TITLE:
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
CIRCULATING NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
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6.16 Expose the operative site.
6.17 Turn on the operating light and assist in
the focusing on the operative site.
6.18 Connect suction and Electro Surgical
Unit cord to the machine as required.
6.19 Place stools and kick bucket in the
suitable place.
6.20 Be alert and anticipate the needs of
sterile surgical team.
6.21 Collect and separate discarded
sponges by using forceps or glove.
Place on moisture proof surface and
where visible to scrub nurse.
6.22 Wear gloves to handle any blood
stained equipment/items or body fluids
according to universal precautions.
6.23 Stay in the operating room all the time
and ensure there is always a
replacement when have to leave.
Inform Scrub Nurse upon leaving.
6.23 Monitor the operating room traffic flow
and observe any unauthorized
personnel in and out of the operating
room. Limit the number of personnel
inside the operating room.
6.24 Check that operating room doors are
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IPP
SNR-OR-002
TITLE:
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
CIRCULATING NURSE
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kept closed at all times. Keep noise
and conversation to a minimum
6.25 Observe the sterile field for any break in
aseptic technique. Report immediately
if detected.
6.26 Anticipate the requirements of Scrub
Nurse and Surgeon throughout the
procedure.
6.27 Perform 2nd surgical count sponges,
sharps and instruments with scrub
nurse when surgeon begins closure of
any open cavity.
6.0 PROCEDURES
RATIONALE
6.28 Attend to the surgical specimen
according to the standard of practice.
6.29 Perform final count of sponges, sharps
and instruments with circulating nurse
when surgeon starts the wound closure.
6.30 Assist in the connection of drainage
equipment if used on completion of
surgical procedure.
6.31 Check that patient’s dressing and
drainage tube are well secured if any.
6.32 Assist in removing the drapes from the
patient.
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Ministry of Health, General Nursing Administration
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SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-002
TITLE:
APPLIES TO:
DUTIES AND RESPONSIBILITIES OF
CIRCULATING NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6.33 Put on the patient’s gown and cover
with blanket.
6.34 Remove the Electrosurgical conductive
plate and tourniquet if used. Check for
skin integrity.
6.35 Open neck and back closure of sterile
gown of surgeons and scrub nurse.
6.36 Check and complete the recording of all
necessary documents.
6.37 Supervise and assists with safe transfer
of patient to recovery room or intensive
care unit
6.38 Pass over complete information to the
recovery room nurse or intensive care
unit nurse regarding the patient’s intra –
operative care. Check that all charts, Xray folders and other records are
completely endorsed.
6.39 Send specimen to laboratory as per
standard of practice.
6.0 PROCEDURES
NURSING
RATIONALE
6.40 Check operating room is clean and
ready for the next procedure.
7.0 ATTACHMENTS
N/A
OR-18
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-002
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
CIRCULATING NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
9 of 9
8.0
REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition: McGraw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-19
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
TITLE:
IPP
SNR-OR-003
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
RECEPTION NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 4
1.0 DEFINITION
A person responsible to receive patient from surgical ward, and determine patient is well
prepared and safe for operation.
2.0 PURPOSE
2.1 To check and confirm consent is taken for operation.
2.2 To check patient for complete preparation to undergo operation.
2.3 To check and confirm correct patient, correct site for operation according to consent and
operating room list scheduled.
2.4 To act as a liaison officer coordinate communication between personnel in Operating room
and outside operating room.
2.5 To maintain patient's safety and comfortable environment.
3.0 POLICY
3.1 Reception Nurse should confirm surgical procedure as according to written consent
obtained from patient.
3.2 The reception area must be checked and prepared for cleanliness, functioning of the
electrical machines and other equipments according to standard of practice.
3.0 POLICY
3.3 Patient safety and privacy must be observed at all times and all patients must not be left
unguarded.
3.4 Create, maintain and control an optimum therapeutic environment in the reception area for
maximum patient's relaxation and effect of sedation are not counteracted.
OR-20
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-003
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
RECEPTION NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
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3.5 Reception Nurse is to coordinate and maintain communication with Anesthetist, Surgeons,
Operating Room team members, with ward nurses and other departments in relation to
patient's management in operating room.
4.0 RESPONSIBILITIES
4.1 Reception Nurse
5.0 MATERIALS & EQUIPMENT
5.1
All the necessary materials and equipment that is needed by the Reception
Nurse to receive patient.
6.0 PROCEDURES
RATIONALE
6.1
Prepare for the completeness of
reception are, materials and equipment
according to the standard of practice.
6.1 To be organized and easy access to
materials and equipment as needed.
6.2
Damp dust all reception area and
Equipment.
6.2 To reduce risk of contamination to
irreducible minimum.
6.3 Check the operation list of the day
6.4 Call patient from the ward as according
to the list schedule ahead of operation
time.
6.4 To assist in efficiency of time
management.
6.5 Coordinate with circulating nurses,
surgeons and anesthetist for plan of care
in a particular patient.
6.5 To anticipate and organize in patient
management of care.
6.6 Receive patient from the ward.
OR-21
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-003
TITLE:
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
RECEPTION NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6.0 PROCEDURES
3 of 4
RATIONALE
6.7
Receive blood, medication or any
requested items. Counter check for
accuracy and inform anesthetist and
circulating nurse or any operating room
team members.
6.8
Confirm the correct patient and surgery
according to written consent and
operating room list scheduled.
6.9 Check patient's surgical preparation for
operation according to operating room
check list.
6.9 To ensure correct operation is done on
the correct patient.
6.10 Provide comfort and safety to patient
while waiting for patient to be sent into
operating room.
6.10 Operating Room check list act as a
guideline to ensure patient is well
prepared for surgery.
6.11 Keep noise to a minimum in the waiting
area.
6.12 Administer medication as per anesthetist
orders and record accordingly.
6.12 To promote relaxation and allay patient's
anxiety.
6.13 Check and confirm status of the next
case in each operating room to call for
the next case.
6.14 Answers calls, relay messages and
coordinate with all operating room team
members.
OR-22
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-003
TITLE:
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
RECEPTION NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
4 of 4
6.15 Inform and seek advice from operating
room head nurse or supervisor for any
immediate problem and difficulties that
may arise.
6.16 Inform anesthetist, surgeon, circulating
nurse and operating room staff of any
changes made in a particular patient.
6.17 Make rounds to all rooms in operating
room, check for tidiness and keep in
contact with operating room personnel.
6.17 To be well inform of operating room
status and to assist in the smooth
management of operating room list and
operating room team members.
7.0 ATTACHMENTS
N/A
8.0
REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-23
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
TITLE:
IPP
SNR-OR-004
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
RECOVERY ROOM NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 5
1.0 DEFINITION
A person who is responsible to provide immediate post operative care to patient in the recovery
room/area.
2.0 PURPOSE
2.1 To provide immediate post operative care during the critical recovery period.
2.2 To observe patient vigilantly in and continuously.
2.3 To maintain patient’s safety and comfortable environment in the recovery room.
3.0 POLICY
3.1 The recovery room must always made safe, good lighting for visual observation of patient,
quiet and comfortable for patient.
3.2 The recovery room must be prepared with complete resuscitation drugs, equipments and
suction machines in readiness to receive postoperative patients.
3.3 All patients must be assessed immediately upon receiving for level of consciousness,
airway and circulation where applicable.
3.4 All Recovery Room nurse must receive a complete handing over report about patient’s
operation verbally from the respective OR personnel.
3.5 Patient’s identification must be confirmed with OR personnel and patient’s identification
band.
3.0 POLICY
3.6 All patient’s documents must be checked for completion upon receiving patient from OR.
OR-24
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-004
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
RECOVERY ROOM NURSE
APPROVAL DATE:
EFFECTIVE DATE:
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NUMBER OF PAGES
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3.7 Recovery room nurse must remain with patient at all times and maintain a clear view of
patient.
3.8 Patient’s oxygen saturation and hAemodynamic status must be monitored at all times.
3.9 Monitor and record vital signs and other observations as indicated every 5 minutes.
3.10 Patient’s comfort and safety must be maintained and commence reorientation
process once patient is conscious.
3.11 Oxygen is to be administered to all patient who has undergo anesthesia unless ordered by
Anesthetist until not to give. Patient is to receive oxygen until discharge from the Recovery
room.
3.12 Medications, Pain relief management, IV therapy and all other treatment ordered should be
given as prescribed.
3.13 Any significant changes identified on patient’s condition must immediately informed the
anesthetist.
3.14 Determine patient readiness for discharge example stable vital signs, present of gag reflex,
able to swallow or cough and as per discharge criteria and inform anesthetist for approval
of discharge from recovery room .
4.0 RESPONSIBILITIES
4.1
Recovery Room Nurse
5.0 MATERIALS & EQUIPMENT
5.1
All the necessary machines and equipment that is needed by the Recovery Nurse for the
operation.
OR-25
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-004
TITLE:
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
RECOVERY ROOM NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
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6.0 PROCEDURES
RATIONALE
6.1
Prepare for the completeness of
recovery room, materials and
equipment according to the standard of
practice.
Check for functioning of suction
machines, lighting and other equipments
are in a working condition.
6.1
To be organized and easy access to
materials and equipment needed.
6.2
Facilitates immediate intervention.
6.3
Damp dust all recovery room surfaces
and equipment.
6.3 To reduce risk of contamination to a
irreducible minimum
6.4
Note the time of arrival on receiving the
patient.
6.4 Time is important data to note the
occurrence of incident.
6.5
Assess air exchange status, color of
the patient and attach pulse oximeter.
6.5 To identify signs of hypoxia and oxygen
saturation level.
6.6
Administer oxygen therapy via mask
until discharge from recovery room
unless contraindicated by the
Anesthetist:
Adult : 5 liter per minute
Children up to 12 years : 2 LPM
6.7
Connect patient to all necessary
hemodynamic monitoring equipment.
6.8
Receive a verbal complete handing
over report about patient’s operation
from the respective OR personnel.
6.9
Confirmed patient’s identification with
OR personnel and patient’s
identification band.
6.2
6.7 To assist in closely monitoring the
patient’s hemodynamic status.
OR-26
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Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-004
TITLE:
APPLIES TO:
NURSING
DUTIES AND RESPONSIBILITIES OF
RECOVERY ROOM NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6.10 Check all patient's documents for
completion upon receiving patient
from OR.
6.11 Assess the level of patient's
consciousness.
6.12 Assess for any complain of pain from
patient.
6.13 Monitor the patient’s vital signs every
5 minutes.
6.14 Observe any signs of bleeding from
wound sites and drainage tube.
6.15
Administer medication as per
Anesthetist orders and record
accordingly.
6.16
Ensure patient is in comfortable
position and as according to
anesthetist and surgeon's order:
Supine position for patient with
epidural catheters.
6.17
Carry out post operative orders such
as IV fluids or blood transfusion as
ordered and provide the necessary
care for IV therapy.
6.18
Notify Anesthetist or surgeon concern
of any significant changes in patient’s
condition.
OR-27
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INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-004
TITLE:
APPLIES TO:
DUTIES AND RESPONSIBILITIES OF
RECOVERY ROOM NURSE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6.19
Determine patient readiness for
discharge as per standard of practice
and inform Anesthetist.
6.20
Inform respective ward to fetch
patient after Anesthetist’s approval.
6.21
Check availability of patient’s
documents with patient’s operation
notes written up.
6.22
Give complete verbal report to the
ward nurse including procedure done
and the condition of the patient at
time of transfer.
NURSING
5 of 5
7.0 ATTACHMENTS
N/A
8.0
REFERENCES
8.1
8.2
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12th Edition:
Mosby.
Seymour Schwat'z (2008) Principles of Surgery. 8 th Edition: McGraw-Hill Professional.
8.3
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-28
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
APPLIES TO:
SNR-O.R.-005
NURSING
OPERATING ROOM LIST- SCHEDULE OF
OPERATION
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 7
1.0 DEFINITION
The collection of daily Operating Room notifications for elective cases posted a day before scheduled
date.
2.0 PURPOSE
2.1 To provide proper coordination among ward staff, surgeons, and operating room staff.
2.2 To allow the nurse to have the time to prepare needed instruments and
equipments.
3.0 POLICY
3.1 The list should be made and submitted to Operating Room department at 4pm a day
before and must be accepted by head nurse to arrange surgical instrument needed.
3.2 The list must be signed by the head of surgical department.
3.3 The notification must be fulfilled completely.
3.4 The list should indicate the name of surgeon who will be fully responsible
for the patient.
3.5
The priorities are given to major risky patients (DM, HPN, Bronchial Asthma).
3.6
There will be no elective list on Thursday which is cleaning day of the theatre.
OR-29
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Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
SNR-O.R.-005
TITLE:
IPP
APPLIES TO:
NURSING
OPERATING ROOM LIST- SCHEDULE OF
OPERATION
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
2 of 7
3.0 POLICY
3.7
Operating Room notification should be made of two copies and filled by treating surgeon
himself and signed by him.
4.0 RESPONSIBILITIES
4.1
OR Secretary
5.0 MATERIALS & EQUIPMENT
5.1
OR Daily Schedule List
5.2 OR Notification
6.0 PROCEDURES
6.1
RATIONALE
POSTING-should be done by surgical
resident:
6.1.1 Deadline for surgery posting is
1500H except Thursdays and
Fridays.
6.1.2
Operating Room notifications
should be submitted to and received
by the outside reception secretary
(extension number 1265).
6.1.3
A complete Operating Room
notification consist of the following:
6.1.3.1 Patient’s full name
OR-30
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-O.R.-005
TITLE:
APPLIES TO:
OPERATING ROOM LIST- SCHEDULE OF
OPERATION
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6.1.3.2 Nationality
6.1.3.3 Age
6.1.3.4 Sex
6.1.3.5 Medical record number
6.1.3.6 Hospital unit where the
patient is admitted
6.1.3.7
6.1.3.8 Pre- Operative
Diagnosis
6.1.3.9 Operative procedure(s)
6.1.3.9
NURSING
Type of anesthesia
requested
6.1.3.10 Estimated length of
surgery (patient to
patient out)
6.1.3.11
Need for frozen
sections, x-ray and other
special procedures
6.1.3.12
If operating on a
specific side (left or
right)
6.1.3.13
Any special
preferences of surgeon
that requires preparation
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The surgeons name
and his assistant(s)
If a notification fails to reach the
1500H deadline theatre manager
will receive the notification and
mark "late received" and make
necessary coordination with
anesthesia.
6.1.5
In the interest of the patient,
necessary arrangement and
adjustment will be made
complete all listed cases.
6.1.6
Aged, diabetic patients and
children should be the priority to
avoid long time of fasting.
NURSING
OPERATING ROOM LIST- SCHEDULE OF
OPERATION
APPROVAL DATE:
6.1.3.14
6.1.4
SNR-O.R.-005
6.2
After a final list has been made, signed and
approved by chief of surgery it will be
posted in operating room at 1600H.
6.3
The head nurse begins to make daily staffing
assignments based on knowledge and skills
and experience of the staff members.
6.4
Residents and anesthetist notify operating
room for any cancellation in patients who
are expected to be admitted at 2100H for
further investigations and preparations.
6.5
Emergencies will be on a first come, first
serve basis or according to the urgency
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SNR-O.R.-005
TITLE:
IPP
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6.6
Urgent cases- cases which are urgent,
but not true emergencies the case will
be placed on the first room that
completes its listed cases.
6.7
Day Surgery- day surgery patients are
posted the same manner as in patients.
The patient’s must have with him the
duplicate copy of his operating room
notification and must have the following
in his file:
Original copy of operating room
notification
6.7 .2
Valid consent
6.7.3
History and physical
assessment form
6.7.4
Result of all latest blood
investigation required to him or
her
6.8 The Morning Surgery
6.8.1
First cases of each theatre will
be in the pre-operative cubicles
at 0800H with the other comes
on a "to follow" (TF) basis.
6.8.1.1
NURSING
OPERATING ROOM LIST- SCHEDULE OF
OPERATION
required by the patient’s condition, it will be
arranged between surgeon and anesthesia.
6.7.1
APPLIES TO:
If a case is to start at an
earlier time; coordination
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POLICY NUMBER:
IPP
SNR-O.R.-005
TITLE:
APPLIES TO:
NURSING
OPERATING ROOM LIST- SCHEDULE OF
OPERATION
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
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will be made between
surgeon and anesthetist
and patient will be called
on a requested time that
they have agreed upon.
6.8.1.2
If a case is to be delayed
or cancelled; the head
nurse must be notified as
room as possible in order
that the room may be
utilized for other cases.
6.8.1.3
Completion Time- the
majority of cases should be
completed by 1700H, if a
big case is still on progress
after 1600H, it is not
possible to start another
case in another theatre
because second team is
stand by for real
emergency case (e.g.
Caesarean Section and
RTA patient’s).
7.0 ATTACHMENTS
N/A
8.0
8.1
REFERENCES
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Seymour Schwat'z (2008) Principles of Surgery. 8 th Edition: McGraw-Hill Professional.
OR-34
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
APPLIES TO:
SNR-O.R.-005
NURSING
OPERATING ROOM LIST- SCHEDULE OF
OPERATION
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
NAME:
7 of 7
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-35
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-006
TITLE:
APPLIES TO:
NURSING
ADMISSION PROCEDURE OF DAY SURGERY
PATIENT TO WARD
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1.0 DEFINITION
A guide on how to admit out patient's that needs further care.
2.0 PURPOSE
2.1 To provide continuous care to patient after day surgery.
3.0 POLICY
3.1
Admission is only applicable to day surgery patients, who had difficulty to recover if
anesthesia or there is any surgical complication.
3.2
It should be properly explain to the patient by surgeon or the physician concern.
4.0 RESPONSIBILITIES
4.1 OR Staff Nurse
5.0 MATERIALS & EQUIPMENT
5.1 Recovery report form
5.2 Admission category form
5.3 Patient's file
6.0 PROCEDURES
RATIONALE
6.1
Assess patient’s condition, if it is
requires admission inform the surgeon to
evaluate the patient.
6.2
The surgeon should explain to patient the need
for admission, as it may cause fear to the patient.
6.3
If no relative is around, find a way to
inform the relative of admission.
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TITLE:
IPP
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
Ensure that admission is accepted in the ward,
take a bed number and inform the ward head
nurse of admission.
6.5
Provide all necessary documents for
Admission:
6.5.1 Admission category.
Admission order written in the
order sheet and post operation
order.
6.6
Send relative or porter to admission office
(hospital lobby) to secure approved
admission paper.
6.7
Inform ward staff to pick-up newly admitted
patient from day surgery unit and give
following information:
6.7.1 Admitting surgeon.
6.7.2 Procedure done to the patient.
6.7.3
Patients initial data.
6.8 Gather all the personal belongings of patient
and clearly endorsed to ward staff.
7.0 ATTACHMENTS
7.1
NURSING
ADMISSION PROCEDURE OF DAY SURGERY
PATIENT TO WARD
6.4
6.5.2
APPLIES TO:
Patient's file
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POLICY NUMBER:
IPP
TITLE:
SNR-OR-006
APPLIES TO:
NURSING
ADMISSION PROCEDURE OF DAY SURGERY
PATIENT TO WARD
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
3 of 3
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-38
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
TITLE:
IPP
SNR-OR-007
APPLIES TO:
NURSING
IDENTIFICATION OF CORRECT PATIENT FOR
SURGERY
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 4
1.0 DEFINITION
Patient is identified correctly for correct operation, correct site, correct side and adequate
physical preparation with correct written consent from patient.
2.0 PURPOSE
2.1 To provide accuracy in identification of patient for surgery.
2.2 To ensure safety for patient undergoing surgery.
2.3 To prevent error and mistakes by OR personnel in identification of patient before surgery.
3.0 POLICY
3.1 All patients scheduled for surgery regardless under Local anesthesia or General
anesthesia must have a valid written consent.
3.2 Reception Nurse must identified patient correctly before accepting the patient for
surgery.
3.3 Confirm with patient by asking him/her verbally if conscious for correct
identification. For unconscious, fully sedated, senile or handicapped patient confirm with
relatives for correct identification. For children confirm correct identification with parents or
guardian.
OR-39
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-007
APPLIES TO:
NURSING
IDENTIFICATION OF CORRECT PATIENT FOR
SURGERY
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
2 of 4
3.0 POLICY
3.4 All patients entering OR must wear identification band at all times and must not be
removed.
3.5 Patient’s identification band must correlate with the operating list as scheduled and
correlate with all patients document that is accompanied with patient.
3.6 All patients preoperative documents must be completed with relevant, updated laboratory
investigation results (within 7 days), X rays film available, Checklist Form and all
necessary charts are completely recorded.
3.7 The ward Head Nurse must be notified immediately for any discrepancies or mistakes
found in the identification of patient or patient’s document.
4.0 RESPONSIBILITIES
4.1
Surgeon
4.2
Scrub Nurse
4.3
Circulating Nurse
4.4
Recovery Room Nurse
4.5
Anesthesiologist
5.0 MATERIALS & EQUIPMENT
5.1
Pre-operative checklist
5.2
Patient’s identification band
5.3
Patient’s file with complete document
OR-40
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-007
TITLE:
APPLIES TO:
NURSING
IDENTIFICATION OF CORRECT PATIENT FOR
SURGERY
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
3 of 4
6.0 PROCEDURES
RATIONALE
6.1
Greet and receive patient from the ward
nurse at the Operating Room entrance
6.1
Nurse politeness will create a warmth
comfortable environment and reduces
anxiety.
6.2
Introduce self to patient and explain
purpose of checking patient’s
identification
6.2
Proper explanation will increase
cooperation , avoid confusion or
misunderstanding from patient.
6.3
Patient and parents/relatives are
important people in confirmation of
correct patient.
6.3
Ask patient’s name and check with
identification band for name, age, sex,
MRN number and Consultant in charge.
6.3.1 Ask parents, guardian/relatives
for confirmation of correct
patient.
6.4
Check and verify patient’s consent for
validity, correctly filled and witnessed.
6.4
A written consent is a legal valid
document to protect patient from
unsatisfied and unwanted procedures.
6.5
Check patient using Preoperative
Check List.
6.5
To protect hospital and surgeon from
claims of an unauthorized operation.
7.0 ATTACHMENTS
7.1
Pre-operative Checklist
7.2
Time-out Procedure Form
OR-41
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-007
APPLIES TO:
NURSING
IDENTIFICATION OF CORRECT PATIENT FOR
SURGERY
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
4 of 4
8.0
REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Preparation. 2nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12th Edition.
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8 th Edition: McGraw-Hill. Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-42
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
TITLE:
IPP
SNR-OR-008
APPLIES TO:
NURSING
PATIENT IDENTIFICATION AND SURGICAL SITE
VERIFICATION IN OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 9
1.0 DEFINITION
Proper patient identification and verification of surgical site done before any surgery or procedure. The
Surgical Team is defined as Surgeons, Anesthetists, Recovery Room, Holding Bay, O.R., Ward Nurses
and Anesthesia Technicians.
2.0 PURPOSE
2.1 To provide in detail the implementation, requirements, exemption and adaptation of special
situations, to prevent wrong procedure, wrong site and wrong person surgery.
2.2 To ensure safety for patient undergoing surgery.
2.3 To provide accuracy in identification of patient for surgery.
2.4 To prevent performing procedure to a wrong patient.
3.0 POLICY
3.1 The Head nurse shall not accept any scheduled postings without indicating appropriate
site or side to be valid.
3.2
At the receiving area, patient identification, procedure and correct site shall be verified
with:
3.2.1 the patient or family
3.2.2
identification band
3.2.3
operating room notification form
3.2.4
medical record
3.3 This policy and procedure which is safeguard against wrong procedure, wrong site and
wrong person surgery will be enforced and must be shared responsibility between all the
surgical team who are involved in patient care and in performing the surgical procedure.
OR-43
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-008
APPLIES TO:
NURSING
PATIENT IDENTIFICATION AND SURGICAL SITE
VERIFICATION IN OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
4.0 RESPONSIBILITIES
4.1 Surgeon's
4.2 Anesthetist
4.3 Scrub Nurse
4.4 Circulating Nurse
4.5 Recovery Room Nurse
4.6 Ward Nurse
5.0 MATERIALS & EQUIPMENT
5.1 Patient's ID wrist band
5.2 Patient's file with clearly written hospital number
5.3 Signed consent paper with O.R. notification
6.0 PROCEDURES
RATIONALE
6.1
Upon receiving patient from recovery
staff, the circulating checks the file and
calls patient by name, in case patient is
unable to hear and respond, check the
identification band.
6.2
Check the file for the procedure, side
and site of operation.
6.3
The surgeon in charge shall check the patient
finally before administration of anesthesia.
OR-44
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-008
EFFECTIVE DATE:
DUE FOR REVIEW:
6.0 PROCEDURES
6.4
Intra-operatively, the circulating nurse
and anesthesia provider shall review the
patient’s medical record, results of
diagnostic tests and verbally confirm to
each other.
6.5
Intra-operatively, the circulating nurse
shall document in the intra-operative
record the site or side of operation.
6.6
Pre-Operative verification process:
6.6.2
NURSING
PATIENT IDENTIFICATION AND SURGICAL SITE
VERIFICATION IN OPERATING ROOM
APPROVAL DATE:
6.6.1 Schedule will occur at the time
the surgery or processes.
APPLIES TO:
NUMBER OF PAGES
3 of 9
RATIONALE
6.6.1 To ensure that the correct surgical
procedure will be performed on the
right site and to the right person prior
to the surgery.
Will occur at the time of the
admission to or on entering the
hospital facility.
6.7 Care of the patient is transferred to
another caregiver, verification of the
correct person, procedure and site
should occur.
6.8 Informed patient day before surgery for
the admitted patient about the surgical
procedure when he/she is awake and
aware if it is possible, or a member of
the family as applicable.
6.8
6.9
6.9 To ensure that there are no unnecessary
delays.
Documentation of all relevant
documents as listed in the anesthetic
OR-45
To ensure that the patient will be
informed and proactively involved in
his/her surgery.
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-008
APPLIES TO:
NURSING
PATIENT IDENTIFICATION AND SURGICAL SITE
VERIFICATION IN OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
4 of 9
record checklist must be complete.
6.10 Requested all required implant and
special equipment by the surgeons to
the O.R. Booking Office at least 48
hours prior to the surgery.
6.10 To ensure that the implant and any
special equipment needed may be
ordered and is available in the kingdom.
6.11 Will occur before the patient leaves the
pre-operative area (holding Bay) or
enters the procedures/surgical room.
6.12 Marking the Operative Site:
6.12.1 Do not mark any nonoperative site(s) unless
necessary for some other
aspect of care. Mark at or
near the incision site.
6.12.1 This is to prevent wrong site surgery.
6.12.2 The mark must be
unambiguous (clearly visible)
6.12.3
Mark must be positioned so
as to be visible after the
patient is prepped and
draped for surgery.
6.12.4
Mark must be made with
indelible skin marker to
remain visible. These are
"Snowman" Waterproof pens
G-12T purchased through
stationary supplies.
6.12.5 Marking the site (Marking the
site should not be used as the
OR-46
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-008
NURSING
PATIENT IDENTIFICATION AND SURGICAL SITE
VERIFICATION IN OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
sole means).
6.12.6
APPLIES TO:
Mark all cases involving
laterality (right or left), multiple
structures (fingers, toes,
lesions), or (when required)
multiple levels (spine).
6.12.7 Note: In addition to preoperative skin marking of the
general spinal region, special
intra-operative radiographic
techniques are used for
marking the exact vertebral
level.
6.12.8 Performing the procedure, the
surgeon or his designee as
applicable (with the exception
of interns), should do the site
marking. The Nurses must
not mark the patient.
6.12.9 Marking must take place with
the patient involved, awake
and aware, if possible.
6.12.10 Marked the site of the operative
procedure before the patient
arrives in theatre. (Day surgical
patients will be marked in the
Recovery Holding Bay).
6.12.11 Verification of the site mark must
take place during the "time out".
OR-47
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-008
APPLIES TO:
NURSING
PATIENT IDENTIFICATION AND SURGICAL SITE
VERIFICATION IN OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6 of 9
6.12.12 If patient refuses to be marked
for a procedure, the refusal must
be documented in the patient's
progress notes, and the
remainder of the surgical team
etc. notified.
6.13 Exception:
6.13.1 Single organ cases (e.g.
caesarian section, cardiac
surgery).
6.13.2 Interventional cases for which
the catheter / instrument
insertion site is not predetermined (e.g. cardiac
catheterization).
6.13.3 Teeth- but, indicate operative
tooth name(s) on documentation
or mark the operative tooth (teeth)
on the dental radiographs or dental
diagram.
6.13.4 Premature infants, for whom the
mark may cause a permanent tattoo.
6.13.5 Trauma cases with obvious
wounds needing attention or a
skin disease where marking the
skin will be harmful for the
patient.
6.14 "Time-out" immediately before starting
6.14 "Time-Out" means the period just prior
OR-48
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-008
NURSING
PATIENT IDENTIFICATION AND SURGICAL SITE
VERIFICATION IN OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
the procedure:
7 of 9
to the beginning of the procedure,
involves confirmation of details by
members of the staff directly involved
i.e. the surgical team.
6.14.1 Conducted must be in the
location where the procedure
will be performed & just
before starting the procedure.
6.14.2
APPLIES TO:
6.14.1 The entire surgical team will take
responsibility for confirming all details
of the patient's surgery, prior to the
anesthetic being administered.
Documentation on the "TimeOut Checklist", which includes:
6.14.2.1 Correct patient
identity.
6.14.2.2
Correct side and site.
6.14.2.3
Agreement
on
the
procedure
to
be
performed, confirmed
by the consent form and
the OR list.
6.14.2.4 Correct patient
position.
6.14.2.5 All the implants are
correct.
6.14.2.6 Special equipment is
available prior to the
surgery.
6.14.3
In the event that there are
6.14.3 To formulate a consistent pattern
OR-49
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-008
APPLIES TO:
NURSING
PATIENT IDENTIFICATION AND SURGICAL SITE
VERIFICATION IN OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
reconciling differences in staff
responses during the "timeout", the surgery, or
procedure will be delayed
until the differences are
rectified.
8 of 9
for confirmation of details
throughout the hospital setting, and
to increase patient safety.
6.15 Procedure for non OR settings including
bedside procedures:
6.15.1 Marking of the site must be
done for any procedure that
involves laterality (left & right),
multiple structures or levels
(even if the procedure takes
place outside of an OR).
6.15.2 Verification, site marking and
"time-out", procedure should be
consistent as possible throughout the
hospital where invasive procedure
could be performed.
6.15.3 Exception:
6.15.3.1 Case in which the
individual doing the
procedure is in
continuous
attendance with the
patient, i.e. form the
initial decision to
perform the
procedure. In this
situation there may
OR-50
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-008
APPLIES TO:
NURSING
PATIENT IDENTIFICATION AND SURGICAL SITE
VERIFICATION IN OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
9 of 9
be exemption from
the site-marking
requirement. The
need for a “time-out”
final verification still
applies.
6.15.4 Clinical Audits will be done by
the Quality Management
Department as required, to
ensure compliance for correct
completion of the preoperative patient checklist
7.0 ATTACHMENTS
7.1
Time out procedure form
8.0 REFERENCES
8.1
8.2
8.3
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2nd Edition.
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-51
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-009
APPLIES TO:
NURSING
PRE-OPERATIVE CHECKLIST
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 7
1.0 DEFINITION
A collection of data that serves as a written proof that the patient had been endorsed by ward staff and
received by operating room staff.
2.0 PURPOSE
2.1 To serve as a baseline data.
2.2 To systematically evaluate patients readiness for surgery.
3.0 POLICY
3.1 All patients for surgery must have a filled-up pre operation checklist in the file.
3.2 Operating room staff receives patient at the holding bay.
3.3 Operating room staff receives patients file, old file and X-ray jacket if available.
4.0 RESPONSIBILITIES
4.1 Recovery Room Staff
4.2 Ward Staff
5.0 MATERIALS & EQUIPMENT
5.1
Pre-operative checklist
5.2 Pen
OR-52
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-009
TITLE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
RATIONALE
Check patients ID band for its MR
number, patients complete name and
match with the patients file.
6.2
Call patients name; if conscious.
6.3
Check surgical consent if properly filled
up by surgeon.
NURSING
PRE-OPERATIVE CHECKLIST
APPROVAL DATE:
6.0 PROCEDURES
6.1
APPLIES TO:
6.3.1 Complete surgical procedure
with site/side if applicable.
6.3.2 Signature of surgeon who
explained the procedure to the
patient.
6.3.3 Signature of patient or qualified
guardian.
6.4 Ask the endorsing nurse if patient had
any required consultation (Ex: Cardiac
Consultation Medical).
6.5 Check for patient's written history and
physical assessment chart.
OR-53
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-009
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
as needed by Anesthesiologist to
determine amount of anesthesia to be
given.
6.7 Ask patients or relatives if there is any
known allergy.
Check if surgical preparation such as shaving
is done.
6.9
NURSING
PRE-OPERATIVE CHECKLIST
TITLE:
6.6 Patient's weight should be written clearly
6.8
APPLIES TO:
Check X-ray jacket, note how many films
you have received. Check X-ray films for its
date x-ray was taken (x-ray a normal findings
is valid for 6 months unless the
anesthesiologist and surgeon requires for
another x-ray.
6.10 Check the written MR number, if any simple
number is mistakenly written, another x-ray
must be taken for safety purposes.
6.11 Check report if results deviate from normal
values.
6.12 All blood investigation results must be
checked if available and note any deviation
OR-54
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
SNR-OR-009
TITLE:
IPP
APPLIES TO:
NURSING
PRE-OPERATIVE CHECKLIST
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
from normal values.
6.13 Serology report and sickle cell trait
results are checked for safety precaution
purposes.
6.14 ECG, Electrocardiogram is required for
patients whose age is above 40 unless
required by anesthetist and surgeon
there are cardiac conditions
contraindicated to surgery and
anesthesia.
6.15 Vital signs which includes Temperature,
pulse, respiratory shed be obtained,
note if there is any irregularity and its
quality.
6.15.1 BP must be taken on several
occasions before surgery to
establish an accurate baseline
an anxious patient provides
inaccurate result.
6.16 Check to see if fresh and clean gown,
cap and bath blanket is worn by patient.
OR-55
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Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-009
NURSING
PRE-OPERATIVE CHECKLIST
TITLE:
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6.17 Pre-approved medications given should be
properly signed at the medication card, time
indicated.
6.18 Do not accept unlabelled medication and
diluted medication in syringe.
6.19 Side racks must be raised up at all
times to protect medicated patient from
falling.
6.20 Pre-op teaching must be enforced to
patient from midnight before day of
surgery.
6.20 NPO midnight.
6.21 Morning shower on the day of surgery,
if possible and not contraindicated.
6.22 Blood reservation must be checked.
All patients for surgery must have
intravenous cannula, properly labeled
in date of insertion.
6.23
APPLIES TO:
Pre-up checklist must be both signed
by the endorsing nurse and receiving
OR-56
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-009
APPLIES TO:
NURSING
PRE-OPERATIVE CHECKLIST
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6 of 7
nurse in time and date indicating that
they both conformed in all the data
written on it.
6.24
Check pre-operative checklist for its
complete address graph to see if the
checklist belongs to the right patient.
7.0 ATTACHMENTS
7.1
OR Notification
7.2 Surgical Consent
8.0 REFERENCES
8.1
8.2
8.2
Brunner & Suddarth's (2006). Textbook of Medical Surgical Nursing. (11 th Ed.).
Lippincott William & Wilkins, Philadelphia.
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
William & Wilkins (2006). Manual of Nursing Practice. (8 th Ed.) Lippincott, Philadelphia.
New York.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-57
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-009
APPLIES TO:
NURSING
PRE-OPERATIVE CHECKLIST
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
OR-58
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-010
APPLIES TO:
NURSING
TRAFFIC CONTROL-OPERATING THEATRE
SUITE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 6
1.0 DEFINITION
It is the movement of patients, personnel and equipment, into, through and out defined areas within the
Theatre Suite.
2.0 PURPOSE
2.1 To decrease the potential for contamination.
2.2 To reduced to a minimum the number of people in operating room and its movement.
3.0 POLICY
3.1 Only essential personnel should be allowed inside operating room.
3.2 The amount of activity increases as the number of people increases present.
4.0 RESPONSIBILITIES
4.1 OR Staff
4.2 Surgeon
4.3 Visitors
5.0 MATERIALS & EQUIPMENT
N/A
OR-59
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6.0 PROCEDURES
2 of 6
RATIONALE
Three designated areas:
6.1 UN-RESTRICTED- street clothes are
permitted in this area, and the area
provides access to communication with
personnel within the suite. This area
includes dressing rooms, office, and
receiving area.
6.1.1 Monitor the entrance of personnel
and materials.
6.2 SEMI-RESTRICTED- proper operating
room attire must be worn in this area
and the area provides access to the
procedure rooms within the surgical
suite. Traffic control must be imposed to
prevent violation in this area by
unauthorized personnel. This area
includes storage area for clean and
sterile supplies, corridors leading to
procedure rooms, reception, conference
room, staff lounge.
6.1.1 Street clothes are permitted.
6.2
6.2.1 Peripheral support areas, storage
areas for clean and sterile
supplies, work areas for the
processing and storage of
instruments.
6.2.2 Report to the Reception window
and receive authorization for their
visit.
OR-60
Peri-operative attire is required (scrub
suit, hair and beard covering,
designated theatre shoes or shoe
covers).
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6.2.3
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Kept the doors to the theatre
closed.
6.2.4 Movement of personnel, talking
and the number of people
present are kept to a minimum
level.
6.2.5 Clean and sterile supplies are
transported on covered carts.
6.2.6 Removed all supplies from their
shipping containers/boxes,
before entering the unrestricted
areas of the theatre suite.
6.2.7 Separate clean, non-sterile
supplies to avoid contamination.
6.2.8 Covered in plastic bags the
soiled items and garbage bags
from the individual theaters.
6.2.9 Placed the carts containing soiled
linen or garbage in the hallway
adjacent to the utility room.
6.2.10 Placed all contaminated items
and Instruments in double yellow
plastic bags.
6.2.11 Damp dusted with an appropriate
cleaning agent, all equipments
from outside the theatre suite.
OR-61
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6.3 RESTRICTED- proper attire including
mask must be worn in this area since
this area requires maximum protection
from possible contamination. This area
includes operating theatre, and sub
sterile area where scrub sinks and
storage for immediate use can be found
(Induction Room).
6.3.1 Report to the reception window
and receive authorization for
their visit.
6.3.1
To ensure that there is no breach or
confusion with regards to Aseptic policy.
6.3.3
Limited space in these areas, plus it is
encroaching upon another patient's
privacy.
6.3.2 Patients are to be transported to
the operating theatre suite on
trolleys or beds that have been
cleaned prior to transport.
6.3.3 When required, one parent only,
is allowed to accompany their
child to the Holding Bay and/or
Anesthetic induction area.
6.3.4 Kept the doors to the theatre
closed, except during movement
of patients, personnel, supplies
and equipment.
6.3.5 During a procedure, talking and
the number of people present
are kept to a minimum.
6.3.5 To comply with Infection
Control Guidelines.
6.3.6
6.3.6
Clean and sterile supplies are
transported on covered carts, here
they are deposited.
OR-62
To ensure safe conveyance and
protection of sterile items from
damage.
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6.3.7
Removed all supplies from their
shipping containers/boxes, before
entering the unrestricted areas of the
Theatre Suite.
6.3.8
Separate clean, non-sterile supplies to
avoid contamination covered in
plastic bags the soiled items and
garbage nags from the individual
theatres.
6.3.9
Placed the carts containing soiled
linen or garbage in the hallway
adjacent to the utility room.
6.3.10 All contaminated items and
instruments should be placed in
double yellow plastic bags.
6.3.7
5 of 6
Vermin may be present in these
containers.
6.3.10 Placed all contaminated items and
instruments in double yellow plastic
bags.
6.3.11 Equipment from outside the Theatre
Suite, such as new furniture, must be
damp dusted with and appropriate
cleaning agent in the unrestricted area
prior to being brought into the
Operating Room.
6.3.12 Damp with an appropriate cleaning
agents, all equipments from outside
the theatre suite.
7.0 ATTACHMENTS
N/A
OR-63
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
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NURSING
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SUITE
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8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8 th Edition: McGraw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-64
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______________________________________________
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APPLIES TO:
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OPERATING ROOM ATTIRE
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1.0 DEFINITION
An approved uniform used in operating room.
2.0 PURPOSE
2.1 To provide effective barriers that prevents the dissemination of microorganisms to patient
or environment.
2.2 To protect personnel or patients against exposure to communicable disease and
hazardous materials.
3.0 POLICY
3.1 The approved operating room attire consists of head covers, shirt, trousers and shoe
cover.
3.2
The sterile scrub suite for sterile personnel consists of sterile gown, sterile glove and face
mask, added to the basic operating room attire.
3.3
All personnel or visitors are required to change into operating room attire from outside
clothes at all times upon entering operating room. Clean OR attire is donned upon
reentrance into OR.
3.4 All operating room personnel must wear freshly laundered clean operating room attire at all
times. OR attire should be discarded for laundry and not hung in the locker/cupboard with
outside cloths.
3.0 POLICY
3.5
It is required to change into new operating room attire if wet/blood stained.
3.6 Operating room attire must be worn correctly at all times.
3.7 Operating room attire should not be worn outside operating room complex.
3.8 Face mask should be worn in restricted area of operating room.
OR-65
Ministry of Health, General Nursing Administration
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3.8.1
Face mask must be worn over both nose and mouth and conform to facial contour.
3.8.2
Mask string must be tied tightly and never cross over head as it can distort contour
of mask along cheeks.
3.8.3
No hanging of mask around neck.
3.8.4
Mask should be kept clean and must be changed when ever necessary.
3.8.5
Talking should be kept to a minimum.
3.9 Jewelry should be removed, pierced – ear studs must be confined within head cover.
3.10 Fingernails should be kept short, without nail polish and artificial nails.
3.11 Outside clothes are only allowed in unrestricted area.
3.12 Shoe inside operating room should not be worn outside the operating room.
3.12.1 Shoe cover should be removed when outside the operating room.
3.12.2
Change shoe cover whenever it became wet or torn.
3.13 All personnel to do initial hand wash for five minutes upon entering
operating room.
3.14 Eye glasses should be wiped with a tissue wet with antiseptic solution
before each operation to prevent cross contamination.
3.15 Comfortable supportive shoes should be worn to relieve fatigue.
3.16 Staff with acute infection, such as a cold or sore throat, or skin lesion, such as furuncle or
any contagious condition, should not be permitted within the OR suite.
3.17 Only head covers that is provided by the hospital are allowed.
OR-66
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4.0 RESPONSIBILITIES
4.1
OR Staff
4.2
Surgeon
4.3
Visitors
5.0 MATERIALS & EQUIPMENT
N/A
6.0 PROCEDURES
6.1
Wash hands.
6.2
Remove outside cloths and shoes.
6.3
Put on head cover first:
RATIONALE
6.3 To protect the OR garment or body
covers from contamination by hair.
6.3.1 Confine all hairs in the head
cover.
6.3.1 Head cover should fit well to
cover hair completely to prevent
any escape of hair and confine
microorganisms. Hair is highest
source of contamination and a
source of electrostatic spark.
6.3.2 Confine earrings or ear studs
in the head cover.
6.4
Don OR garment or body covers.
6.5
Wear approved OR shoe.
6.5
OR-67
Outside shoes are a source of gross
contamination and of cross infection
from one area of the hospital to another
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6.6
Wash hands upon entering OR.
6.6
To prevent transmission of
Microorganism.
6.7
Wear mask in restricted area.
6.7
To protect the restricted environment
from droplets containing microorganism
expelled from oro- and nasopharynx.
6.7.1 Hold mask by the strings.
6.7.1 To minimize touching and
prevent contamination.
6.7.2
Cover both mouth and nose
with mask completely.
6.7.2 To effectively catch all of
person’s exhalation.
6.7.3
Tie upper strings at back of
head first followed by lower
strings behind neck. Secure the
mask well and comfortably.
6.7.3 Strings are never crossed over
head because this distorts
contour of mask along cheeks.
Well secured mask prevent
venting at side of face contour.
6.7.4
Press the exterior pliable strip or
nose band to contour mask over
the bridge of the nose.
6.7.4 To conform to facial contour
and to fit mask snugly.
6.7.5
Check mask cover nose and
mouth at all times. Check mask
is not hang around neck or
tucked into pocket for future use.
6.7.5 To prevent disseminating
microorganism.
6.7.6
Remove mask by:
6.7.6.1 Untie upper string
6.7.6.2 Untie lower string
6.7.6.3 Discard mask in a
proper receptacle.
OR-68
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SPECIALIZED NURSING: OPERATING ROOM
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POLICY NUMBER:
IPP
TITLE:
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7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8 th Edition: McGraw-Hill. Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-69
Ministry of Health, General Nursing Administration
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1.0 DEFINITION
The process of scrubbing using mechanical friction and chemical antisepsis to remove transient and
resident microorganisms from the hands and arms before participating in an operation.
2.0 PURPOSE
1. To decrease the number of microorganisms on skin to an irreducible minimum.
2.To keep the population of microorganisms at a minimum during the operative procedure by
suppression of growth.
3.To reduce the hazard of microbial contamination of the operative wound by skin flora.
3.0 POLICY
3.1 All scrub personnel shall safety practice and apply strict aseptic to
provide optimum care for the surgical patient.
3.2 To confirm surgical procedure as according to written consent
obtained from patient before any surgical procedure preparation.
3.3 To check all surgical instruments, electrical equipment and suction
apparatus are function before use.
3.4 A surgical hand scrub must be performed as per standards of practice before carry out
surgical procedures.
3.5 The Universal Precaution standards of practice must be complied at all times.
OR-70
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3.0 POLICY
3.6 A sterile gown and gloves must be donned according to aseptic technique according to the
requirements of surgical procedures.
3.7 All instruments and surgical procedures supplies are assembled according to surgeon’s
preference and the requirements of surgical procedure.
3.8 All scrub personnel shall perform surgical count as per standard of practice.
3.9 Anticipate surgeon’s requirements and keep one step a head of surgeon in passing
instruments, sutures, sponges and receiving specimen through out surgical procedure.
3.10 Plan, organize and maintain neatness and tidiness of instruments in the sterile working
area, mayo tray and trolley.
3.11 Patient’s safety is to be observed at all times by not placing too many instruments or any
heavy instruments on the patient.
3.12 All medication or drugs that are required in the procedures must be checked for correct
drug, dosage and expiry date with the Circulating personnel prior to use.
3.13 All specimens must be handled correctly and confirmed with surgeon as per standard of
practice.
3.14 Aseptic technique must be maintained strictly through out the surgical procedure.
4.0 RESPONSIBILITIES
4.1 Scrub Nurse
OR-71
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5.0 MATERIALS & EQUIPMENT
5.1 Sterile Gown & Glove
5.2 Sterile Set on a trolley
5.3 Sterile Drape & Mayo tray
5.4 Sterile Basin as required
6.0 PROCEDURES
RATIONALE
6.1 Confirm the type of surgery as according
to O. R List prior to induction of patient.
1. To check for correct booking of
case
6.2 Assess for:
6.2.1 correct patient with written
consent according to type of
surgery.
6.2.2 Patient’s history of any
allergies.
6.2.3 Correct preparation of patient
according to documentation of
patient’s OR check list.
6.2.4 Functioning of Electrical
Surgical Unit, suction machine
and other necessary
machines/equipment that may
required.
6.3 Prepare for the completeness of
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materials & equipment according to the
required surgery and surgeon
preference.
6.4 Perform the surgical hand scrub
as per standard of practice.
6.5 Don a sterile gown and gloves
according to aseptic technique.
6.6 Open the inner sterile set and
assemble the sterile instrument and
accessory sterile items on mayo
tray and trolley according to
standards of practice.
6.7 Receive all the remaining
instruments and supplies from the
circulator.
6.8 Perform surgical count with the
circulator personnel, as per
standard of practice.
Check the count board for
correction of count.
6.9 Assemble the surgical blade (scalpel
blade) to the correct scalpel handle using
needle holder.
6.10 Prepare sutures according to surgeon
preference.
6.11 Gown and glove surgeon if necessary.
6.12 Assist in skin cleaning preparation of
patient as per standard of practice.
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6.13 Assist in draping procedure aseptically
as per standard of practice.
6.14 Secure drape, suctioning and
electrosurgical code with towel clip and
drape the end part to circulator.
6.15 Bring mayo stand into position over the
patient after draping is completed.
6.16 Ensure the mayo tray is not resting
directly on the patient.
6.17 Check and test the Electrosurgical Unit,
suction machine or other electrical
equipment if any is well connected and
functioning.
6.18 Place the Electrosurgical unit pin in the
quiver or its container when not in use.
6.19 Pass instruments to surgeon in a firm,
decisive, proper position and safe
manner.
6.20 Pass and receive the scalpel from the
surgeon in the kidney dish. Do not pass
the scalpel to hand directly.
20. This is to avoid injury to scrub
nurse or surgeon.
6.21 Place the skin knife away from the
sterile working field.
21. The skin knife is considered
contaminated.
6.22 Pass ringed instrument in a working
position.
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6.23 Retract tissue gently if required.
6.24 Mount the tape or ligatures using an
appropriate size artery forceps when
required.
6.25 Remove artery tips as directed by
surgeon and gently releasing the artery
grip when the ligature begins to ligate
the bleeder’s tissue.
6.26 Cut suture with tip of stitch scissors as
directed by surgeon.
6.27 Assist in tissue coagulating by pressing
the Electrosurgical controls according to
surgeon’s preference
6.28 Clean the Electrosurgical tip free from
eschar before handling to surgeon.
6.29 Assist surgeon in suturing.
6.30 Attach each needle 1/3 of the curve from
eye onto a needle holder and close firmly
6.31 Pass the needle holder by holding both
needle holder and the suture material.
6.32 Anticipate surgeon’s requirements
throughout the procedure. Keep one
step ahead of surgeon in passing
instrument sutures, sponges and
handling of specimen.
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6.33 Identify all specimens with the surgeon
and handles surgical specimens
according to standard of practice.
6.34 Maintain the neat and orderly sterile field
of operative field mayo tray and
instrument trolley at all times.
6.35 Maintain strict aseptic technique and
watch for any break in the technique
through out the procedure:
6.35.1 Remove all contaminated used
instrument and pass to circulator
as standard of practice e.g. bowel
surgery.
6.35.2 Acknowledge if sterile field
contaminated and reestablished
sterility.
6.35.3 Change glove at once if
contaminated
6.35.4 Discard a piece of suture
material, tubing or sponge if falls over
edge of the sterile field
without touching the contamination
area.
6.35.5 Keep hands at table levels when at
rest.
6.35.6 Keep contact to sterile field to a
minimum and do not lean on the
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sterile trolley, mayo stand or on
the patient.
6.35.7 Use forceps to take any contents
from the sterile package.
6.35.8 Leave a wide margin of safety in
moving about the operating room
if necessary and within the sterile
field.
6.35.9 Sterile person face a sterile area
when changing positions.
6.35.10Keep the sterile field as dry as
possible to prevent strike
through.
6.35.11Discard soiled sponges from the
sterile field immediately to avoid
accumulation.
6.35.12Keep talking to a minimum. Turn
face away from sterile field if
coughing or sneezing.
6.35.13Wipe instruments with wet
sponge to keep clean from
blood and debris.
6.36 Clear off the operative field and mayo
tray as time permits.
6.37 Perform 2nd surgical count sponges,
sharps and instruments with circulating
nurse when surgeon begins closure of
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any open cavity.
6.38 Perform final count of sponges, sharps
and instruments with circulating nurse
when surgeon starts the wound closure.
6.39 Connects drainage equipment if used on
completion of surgical procedure
6.40 Apply dressing to the surgical wound by
non-touch technique.
6.41 Assist in removing the drapes from the
patient.
6.42 Dispose of sharps in sharp container
6.43 Tidy used trolley and throw rubbish into
appropriate bags
6.44 Separate sharps and fine instruments
from heavy instruments and place them
neatly on trolley.
6.45 Cover the soiled instrument before
sending to TSSU or CSSD.
6.46 Remove gown and gloves as per
standard of practice.
6.47 Wash hand immediately after removing
Glove.
6.48 Complete and check documentation of
the peri-operative care plan, record and
sign surgical count sheet.
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TITLE:
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APPLIES TO:
NURSING
SURGICAL HAND SCRUB
APPROVAL DATE:
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10 of 10
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-79
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
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1.0 DEFINITION
Sterile surgical gown is an important component of sterile operating room attire. It completes the attire
for scrubbed team members.
2.0 PURPOSE
2.1 To allow the wearer to handle sterile supplies or tissues of the operative
wound.
2.2 To create a barrier between sterile and un-sterile area.
2.3 To prevent contamination of wounds, equipment, supplies and site of
invasive procedures.
2.4 To maintain sterility and asepsis throughout operative procedures.
3.0 POLICY
3.1 Sterile gowns are mandatory for all procedures that require surgical
technique.
3.2
Sterile gowns are donned after hands have been thoroughly clean and
surgically scrubbed.
4.0 RESPONSIBILITIES
4.1
Scrub Nurse
4.2
Surgeon
4.3
Assistant Surgeon
OR-80
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5.0 MATERIALS & EQUIPMENT
5.1
Sterile Gown
6.0 PROCEDURES
6.1
RATIONALE
Prerequisite:
6.1.1 Open sterile gown and glove
package on designated flat
surface.
6.1.2 Surgical hand scrub
6.1.3 Dry hand aseptic technique
6.2
DON STERILE GOWN: UNASSISTED
GOWNING:
6.2.1 Grasp the folded gown at the
neckline and step back from the
sterile field, allowing the gown to
unfold completely, with the
inside toward the wearer.
6.2.2
NURSING
GOWNING
TITLE:
IPP
APPLIES TO:
Holding the arms at shoulder level,
slide both arms simultaneously into
the armholes.
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6.0 PROCEDURES
6.2.3
APPLIES TO:
RATIONALE
The circulator assists by reaching
inside and pulling the gown up over
the shoulders for proper sleeve
adjustment. The cuffs are left
extended over the hands for the
closed glove technique, and the
cuffs are pulled up to expose the
hands for the assisted glove
technique.
6.2.4 The circulator ties the inside ties
at the waist and secures the
gown at the neckline. The final
tie on a wraparound gown is
completed after the sterile
gloves have been donned.
6.2.5 Complete closure on a sterile
back gown in one of three ways:
6.2.5.1 Grasp the belt tie
and handover the
long end of the tie to
circulator with sterile
instruments.
6.2.5.2 Grasp the belt tie
and hand it to other
sterile team
member.
6.2.5.3 For a disposable
gown, hand the
prepackaged card
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securing the belt tie
to the circulator.
6.2.6
The circulator holds the
prepackaged card or sterile
instrument while team member
pivots to the left, thereby
completing the back closure of
the gown. The sterile team
member pulls the belt tie free
and ties it while the circulator
retains the cardboard or
instrument.
6.2.7
The arms should be flexed at
the elbows and held in front
with both hands in sight at all
times. Sterile hands should
never be dropped below table
or waist level. If using a cloth
gown, the long end of the tie is
handed to sterile team member.
NURSING
6.2.8 Gowns are considered sterile in
front from shoulder to table level;
sleeves are sterile from 2 inches
above the elbow to the wrist,
excluding the stockinet cuff. The
back of a wraparound, sterile
back gown is not considered
sterile because it cannot be
observed by the scrubbed
person.
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6.3.1
Open the hand towel and lay it
on the surgeon’s hand, being
careful not to touch the hand.
6.3.2
Unfold the gown carefully,
holding it at the neckband.
6.3.4
APPLIES TO:
Keep hands on the outside of
the gown under a protective
cuff of the neck and shoulder
area, offer the inside of the
gown to the surgeon. Surgeon
slips the arms into sleeves.
Release the gown. The surgeon
holds arms outstretched while
circulating nurse pulls the gown
onto the shoulders and adjusts
the sleeves so the cuffs are
properly placed.
6.3.5
Secure it at the neck and at the
waist with the inside tie.
6.3.6
Grasp the belt tie and hand it to
other sterile team member.
NURSING
GOWNING
TITLE:
ASSISTED GOWNING:
6.3.3
6.4
SNR-OR-013
CHANGING CONTAMINATED GOWN
DURING OPERATION /SURGERY:
6.4.1 Circulator unfasten neck and
waist tie.
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6.4.2 Grasp the gown at shoulder, the
gown is pulled off inside out.
6.4.3 Gown is always removed first
then glove.
6.5
REMOVE CONTAMINATED GOWN
AFTER OPERATION /SURGERY:
6.5.1 Gown is always removed first
then glove.
6.5.2 Circulator unfasten the gown.
6.5.3 Pull gown downward from
shoulders, turning sleeves inside
out. Remove gown.
6.5.4 Remove glove using skin to skin
and glove to glove technique.
7.0 ATTACHMENTS
Non
8.0 REFERENCES
8.1
8.2
8.3
Arthur D. Smith (2007) Operating Room Set UP and Patient Preparation. 2 nd Edition.
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition: McGraw-Hill Professional.
OR-85
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DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-86
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
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APPLIES TO:
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1.0 DEFINITION
Sterile surgical glove is an important component of sterile operating room attire. It completes the attire
for scrubbed team members.
2.0 PURPOSE
2.1 To allow the wearer to handle sterile supplies or tissues of the operative wound.
2.2 To prevent contamination of wounds, equipment, supplies and site of invasive procedures.
2.3 To prevent transmission of microbial flora from owns hands to patient.
2.4 To maintain sterility and asepsis throughout operative procedures
3.0 POLICY
3.1 Sterile gloves are mandatory for all procedures that require surgical technique.
3.2 Sterile gloves are donned after hands have been thoroughly clean and surgically
scrubbed.
3.3 Close method technique is preferred when sterile gown is used for sterile procedure.
3.4 Open method technique is used for re-gloving. The closed glove technique cannot be
used for re-gloving because the stockinet cuff is considered contaminated.
3.5 Double-gloving is indicated during activities when gloves may tear or puncture and as a
protective barrier for operative cases for standard precaution.
4.0 RESPONSIBILITIES
4.1 Scrub Nurse
4.2 Surgeon
4.3 Assistant Surgeon
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5.0 MATERIALS & EQUIPMENT
5.1
Sterile Glove with appropriate size
5.2 Sterile hand Towel
6.0 PROCEDURES
6.1
RATIONALE
Prerequisite:
6.1.1 Open sterile gown and glove
package on designated flat
surface.
6.1.2
Surgical hand scrub
6.1.3
Dry hand aseptic technique
6.1.4
Don sterile gown
NURSING
GLOVING
TITLE:
IPP
APPLIES TO:
6.2 GLOVING
6.2.1 Don a sterile gown, slide the
fingers into the sleeves until the
cuff is reached. Open the inner
glove wrapper on a sterile field.
The gloves should be palm side
up, with the glove labeled L on
the left and R on to the right.
6.2.2 Don the left glove first, turn the
left hand palm side up and flip
the left glove onto the left palm.
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6.0 PROCEDURES
RATIONALE
Place the folded glove cuff even
with the gown cuff. Seam; the
thumb of the glove is on the
thumb side of hand and the
finger tips pointing toward the
elbow.
6.2.3 Grasp the lower edge of the
glove cuff with the left thumb and
index finger.
6.2.4
Secure the upper edge of the
glove cuff with the right thumb
and index finger and stretch the
entire glove cuff over the
stockinet opening, being careful
not to touch the edge of the
stockinet cuff.
6.2.5
Work the fingers into the glove, then
grasp the left glove and gown at the
seam with the right hand and pull
over the wrist.
6.2.6
Turn the right hand palm side up.
Flip the right glove on the right palm.
Place the folded glove cuff even with
the gown cuff seam; the thumb of the
glove is on the thumb side of the hand
and the fingers on the ulnar side of the
wrist, with the glove finger tips
pointing toward the elbow.
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6.2.8 Work the fingers into the glove,
then grasp the right glove and
gown at the seam with the left
hand and pull up over wrist.
6.2.9 Adjust both gloves for comfort
and fit.
6.2.10 Inspect gloves for integrity.
ASSISTED GLOVING:
6.3.1
Grasp the right glove under the
inverted cuff (the right hand is
usually gloved first in assisted
gloving).
6.3.2
Stretch the cuff while protecting
the sterile thumbs and fingers by
placing them under the cuff on
the exterior side of the glove.
6.3.3
Hold the stretched glove open,
palm side toward the team
member being gloved. Assist the
team member's hand into the
glove by gently pulling the glove
upward as the team member
NURSING
GLOVING
TITLE:
6.2.7 Grasp the lower edge of the glove
cuff with the right thumb and index
finger. Secure the upper edge of
the glove cuff with the left thumb
and index stockinet opening, being
careful not to touch the edge of
the stockinet cuff.
6.3
APPLIES TO:
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pushes his or hand into the
glove.
6.3.4 Cover the gown stockinet cuff
completely with the sterile glove.
6.3.5 Repeat the process for the
other hand.
6.3.6
6.4
Inspect gloves for integrity.
OPEN METHOD TECHNIQUE:
6.4.1 Apply skin to skin technique and
glove technique.
6.4.1 To maintain the principle of sterile
person touch sterile items only.
6.4.2 Grasp the inside edge of glove
with thumb and first two fingers
of your dominant
hand.
6.4.3 Pick up the glove and step back
from sterile field.
6.4.3
6.4.4 Holding both hands above waist
level, insert thumbs and fingers
of non dominant hand into
glove and pull it on.
6.4.5 Slip gloved hand underneath
second gloved cuff still in
package. Pick up the glove and
step back.
6.4.6 Insert thumbs and fingers of
OR-91
Any items below waist level is
considered not sterile.
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dominant and into glove and
pull it on, leaving the cuff
turned well down over the
stockinet and hand.
6.4.7 Adjust the glove fit, touching
only sterile areas of glove
and cover the gown
stockinet cuff completely.
Keep hands above waist
level at all times.
6.5
6.4.7
CHANGING CONTAMINATED
GLOVE, DURING
SURGERY/OPERATION. STERILE
GOWN STILL IN PLACED:
6.5.1
Turn away from sterile field.
6.5.2
Extend the glove out of the
sterile field. The circulator,
wearing protective gloves, pulls
off the contaminated glove,
leaving the stockinet cuff in
place.
6.5.3 Wear glove by assisted gloving
or open glove method.
OR-92
Area around the tip of stockinet is
not sterile as in contact with the skin
hand.
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6.0 PROCEDURES
6.6
APPLIES TO:
7 of 8
RATIONALE
REMOVE CONTAMINATED GLOVE
AFTER SURGERY/ OPERATION:
6.6.1 Apply skin to skin technique and
glove to glove technique.
6.6.2 Insert thumb of dominant hand
into the inner aspect of glove.
Invert the glove exposing the
inner aspect of glove outside
with the contaminated glove
inside.
6.6.3 Pull off the contaminated glove
with the glove of non dominant
hand using glove to glove
technique.
6.6.3 After use, the outer surface of gloves
is contaminated and could transfer
micro organisms to the nurses wrist.
6.6.4 Discard into appropriate
receptacle.
7.0 ATTACHMENTS
Non
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition: McGraw-Hill Professional.
8.3
OR-93
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DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-94
Ministry of Health, General Nursing Administration
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______________________________________________
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1.0 DEFINITION
A method of a counting procedure for items put on sterile table for use during an
operation. Sponge, sharps and instrument counts are taken on every procedure performed in Operating
Room.
2.0 PURPOSE
2.1 To systematically and accurately account for sponges and sharps used
during a surgical procedure.
2.2 To prevent any retain of foreign body in any part of patient’s body cavity
that may cause physical injury, wound infection or disruption of wound
healing.
3.0 POLICY
3.1 Sponges including cottonoids, peanuts, dissectors, 4x4 radiopaque gauze sponges and
laparotomy sponges will be counted on all procedures in which the likelihood exists that a sponge
could be retained.
3.2 Sharps including suture needles, injection needles and scalpel blades will be counted on
all procedures.
3.3 Instruments are counted for all procedures.
3.4 The surgical count procedure must be counted audibly and viewed concurrently by the
circulating nurse and the scrub nurse.
3.5 Surgical count must be completed before the commenced of surgery, at the closure of any
cavity and prior to skin closure.
3.6
The counting of surgical count during surgery will begin from the operative site, followed
by mayor tray, scrub nurse trolley and lastly the area that has been passed off the sterile
field. (kick bucket).
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3.7
Counted items removed from the sterile field must remain in the room and are retained for
visibility for the count procedure and avoid any discreparency.
3.8
All linen hampers and waste receptacles and their contents remain in the operating room
until the final count is completed.
3.9
If a package of sponges, blades, or needles is found to have an incorrect number of the
item, they will be handed off the field, marked as incorrect and isolated. Do not use them
during the case.
3.10 Surgical count sheet should be documented for all cases requiring surgical procedure.
3.11 A separate count is required to be carried out for surgical cases of more than one
procedure performed in the same patient at the same time. Documentation is required in
a separate count sheet .
3.12 A complete surgical count must be carried out when a change over by other personnel
takes place and documented in Surgical Count Sheet.
3.13 A separate bucket for swabs and another receptacle for waste are required.
Swabs and waste materials cannot be mixed in the same container.
3.14 The surgical count must be audible and visible and concurrently viewed during the count
procedure.
3.15 The names of all personnel involved in the surgery to be documented in the Surgical
Count Sheet.
3.16 The Scrub Nurse will inform surgeon on all surgical count and surgeon must
acknowledge that he heard and understood of the count.
3.17 Surgical Counts shall be performed according to the following:
3.17.1
First Count – before incision is made.
3.17.2 Second count – when a cavity is being closed (e.g. peritoneal,
pleural).
OR-96
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3.0 POLICY
3.17.3
Final count – as skin closure is begun.
3.17.4
Additional counts:
3.17.4.1
Whenever
a hollow
organ (e.g.,
uterus)
additional count is completed as the organ is closed.
an
is
opened,
3.17.4.2
When the retroperitoneum, is opened,
completed as the retroperitoneum is closed.
additional
3.17.4.3
When bilateral procedure is performed, a separate count is taken for
each side.
3.17.4.4
When either the scrub person or the circulating nurse is relieved, a
count is taken by the relieving person (s). when sponge are packed
in the wound at the time of the relief count, that fact should be
indicated on the record (ex: 12 lap sponges counted, 3 packed in the
wound).
3.17.4.5
When a patient is brought back to the operating room with retained
sponges in a non-emergent situation, an-x-ray will be done at the
closing count to ensure all retained sponges have been removed.
3.17.4.6
When a member of the surgical team requests an interim count.
3.17.4.7 When sponges and/or sharps are added to the field, the additional
items will be counted and recorded as additions.
3.18 If a sponge must be cut for use, all pieces must be retained for the final
count.
3.19 Sponges may be weighed for estimated blood loss:
3.19.1 Accurate dry weight of one sponge multiplied by the number of sponges being
OR-97
count
an
is
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weighed, i.e. 4x4 gm. Dry x 10 sponges = 40gm dry weight.
3.19.2
Bagged sponges to be weighed on scale which has been reset to zero.
3.19.3 Count dry weight from the total weight to get estimated blood loss. Keep a
running total as a worksheet.
3.19.4 The weight of a group of sponges exceed the scale, these sponges may be
weighed separately following the same procedure.
3.20
Count must
procedures.
be
repeated
if
any
interruption
3.21
Gauze is issued only upon completeness of final count.
occurs
4.0 RESPONSIBILITIES
4.1
Scrub Nurse
4.2 Circulating Nurse
5.0 MATERIALS & EQUIPMENT
5.1
All swabs, sharps and surgical instrument that is required in the operation.
OR-98
during
the
counting
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6.0 PROCEDURES
6.1
Perform count with circulator,
concurrently view during the count
procedure.
6.2
Count in unison, aloud and document
immediately in Surgical Count Sheet.
6.3
PERFORM SPONGE / SWAB COUNT :
NURSING
5 of 9
RATIONALE
6.3.1 Lay gauze singly with radioopaque thread facing upward in
row of five or 10 depending on
how they are packaged.
6.3.1
6.3.2 Open and count abdominal
pack making sure the radio
opaque thread with tape intact.
6.3.2 To ensure the abdominal pack is
intact.
6.3.3 Count Lahey swab /cherries
singly ensuring radio-opaque
thread visible. When use, lahey
swab should be loaded on a
forceps.
6.3.3
OR-99
Laying count singly is to keep swab
count for easier visibility.
Loaded on a forceps is for easier
handling and to keep track easily.
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6.3.4
Lay open tonsil strip, square
tonsil singly and count
separately.
6.3.5
Count patties singly
ensuring the radio-opaque
thread intact.
6.3.6
Count tapes vessels loops
singly.
6.3.7
Cottonoids will be collected by
the scrub person in groups of
10 and handed off to the
circulating nurse to count and
bag.
6.3.8
If a sponge must be cut for
use, all pieces must be
retained for the final count.
NURSING
SURGICAL COUNT
TITLE:
6.0 PROCEDURES
6.4
APPLIES TO:
6 of 9
RATIONALE
6.3.4
Lay open is to check for
completeness.
6.3.8
To keep control of every part is
secured and no sponge
discrepancies.
PERFORM SHARPS COUNT:
6.4.1
Use sharps counting devices
to assist in the counting
procedure.
6.4.1
Easy to count as needles and
sharps are small and tiny.
6.4.2
Count a traumatic needle
singly with needle facing
upward and intact.
6.4.2
To confirm needle is intact.
6.4.3
Count surgical needle,
injection needle and scalpel
blade singly.
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6.4.4
Keep needles secure to
suture, material in inner fold or
needle packet until surgeon is
ready to use, Suture packet's
can remain sealed until scrub
nurse anticipate their use.
6.4.4
To keep needles in placed and
prevent from losing.
6.4.5
Hand sharps to surgeon on an
exchange basis.
6.4.5
To keep close in track of needle.
6.4.6
Hand needles and needle
holder as a unit. No needle
without a needle holder.
6.4.7
Account for all pieces of
broken sharps, verify with
surgeon that the pieces are
broken.
6.4.8
Secure all used needles and
sharps on scrub nurse trolley.
6.5.1
To keep count easier and to have
good visibility.
6.5.3
To be organized and systematic in
counting.
6.4.9
6.5
SNR-OR-015
Retain suture foil for checking.
PERFORM INSTRUMENT COUNT:
6.5.1
Expose instrument by
arranging on scrub nurse
trolley.
6.5.2
Point to instrument using
forceps when counting for
easier visibility.
6.5.3
Keep instrument on mayo tray
and scrub nurse trolley in even
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numbers.
6.5.4
Remove the instrument when
re-draping.
6.5.5
Count all detachable and
dissembled parts.
6.5.6
Recover and retain pieces of
instrument that breaks during
use.
6.5.7
Lay contaminated instrument
on the floor in front of scrub
nurse.
6.6
Verify to surgeon count is correct
during closure of any cavity by saying”
Sponge, needle and instrument count
are correct.
6.7
Perform final count during subcuticular
or closure of skin.
6.8
Document and signs operative record
from circulating nurse and scrub nurse.
6.5.4
To prevent instrument from being
Hidden.
6.5.7
For visibility of scrub nurse and
circulator and prevent missing of any
instrument.
6.6
To keep surgeon inform and
acknowledgement from surgeon on
correct count is important verification
that he is informed.
6.8
To keep record and a legal document of
correct count.
7.0 ATTACHMENTS
7.1
Intra-operative Report
7.2
Operation Report
7.3
Anesthesia Report
7.4
Recovery Room Report
OR-102
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8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition: McGraw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-103
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NURSING
ASSIST PATIENT FOR GENERAL ANESTHESIA
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1.0 DEFINITION
The care given to a patient during administration of anesthesia until procedure has been completed.
2.0 PURPOSE
2.1 To relieve patient's apprehension.
2.2 To ensure a comfortable and safe environment for the patient.
2.3 To help protect patient against possible injury during intubations.
3.0 POLICY
3.1 The nurse should be familiar with methods used by anesthesiologist.
3.2 A nurse does not administer any anesthetic drug unless he/she has had special education
in anesthesia.
3.3 It is the nurse responsible to keep the room quiet, talking should kept to a minimum.
3.4 Any source of excitement to the patient should be eliminated.
4.0 RESPONSIBILITIES
4.1 Anesthesia Technician
5.0 MATERIALS & EQUIPMENT
N/A
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6.1 Stay at the patient's side during
induction of anesthesia.
6.2 Put aside other duties to assist
anesthesiologist until patient has
been successfully anesthetized.
6.3
In case, the patient vomit and aspirate or
any complication fatal to patient's life, be
prepared to assist the anesthesiologist
until situation is controlled:
6.3.1
Suction should be ready at all
times.
6.3.2
Emesis basin should be within
your reach.
6.3.3
Know the mechanism of
operating room tables,
positioning will be helpful as
well.
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition: McGraw-Hill Professional.
OR-105
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NAME:
3 of 3
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-106
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NURSING
ASSIST PATIENT FOR REGIONAL ANESTHESIA
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1.0 DEFINITION
The care given to a patient during administration of regional anesthesia.
2.0 PURPOSE
2.1 To relieve patient's apprehensions before and during administration of anesthesia.
2.2 To protect patient's against injury.
3.0 POLICY
3.1 The nurse must remain alert and cooperate fully with the anesthesiologist.
3.2 A nurse must refuse to administer anesthetic drugs.
3.3 Limit conversation to a minimum.
4.0 RESPONSIBILITIES
4.1 Anesthesia Technician
5.0 MATERIALS & EQUIPMENT
N/A
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NURSING
ASSIST PATIENT FOR REGIONAL ANESTHESIA
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6.0 PROCEDURES
6.1
APPLIES TO:
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RATIONALE
Prepare all the necessary equipment.
6.2 Clean the area with betadine.
6.3 Drape the area.
6.4 Help the patient maintain a good
posture.
6.5 Explain to patient what to expect to gain
cooperation.
6.6
Prepare for possible vomiting with
suction and emesis basin.
6.7 Monitor the patient throughout the
procedure for toxic reactions.
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
8.2
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-108
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1.0 DEFINITION
Interventions based on professional judgment aimed at maintaining the goals of patient safety.
2.0 PURPOSE
2.1 To protect patient from injury.
2.2 To maintain an aseptic environment.
3.0 POLICY
3.1 All staff working in the theatre must develop a surgical conscience.
4.0 RESPONSIBILITIES
4.1 Surgeons
4.2 Anesthesia
4.3 Scrub Nurse
4.4 Circulating Nurse
4.5 Anesthesia Technicians
5.0 MATERIALS & EQUIPMENT
N/A
OR-109
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6.0 PROCEDURES
6.1
Assist and prepare the operating room
using aseptic techniques.
6.2
Receive endorsement from recovery
staff, files, x-ray jacket.
6.3
Check to see that table and stretcher
are locked before moving patient to
table.
6.4
Secure all tubing's and other
connections.
6.5
Assist patient to move to operating
room table, explain to the patient if
conscious to gain cooperation
6.6
If patient is unconscious, obtain enough
help and move the patient safely and
smoothly.
6.7
If pediatric patient, never at all leave
patient until anesthesia process has
been completed. Assist with anesthesia
as requested during induction.
6.8
When moving patient for positioning:
6.8.1
Prepare all necessary
equipments for positioning.
6.8.2
Ask permission from the
anesthesiologist.
NURSING
RATIONALE
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Obtain enough help to move
patient to desired position.
6.8.4
Be gentle, support all joints and
extremities because it is
vulnerable to injury. Respect
patient's dignity, avoid
unnecessary exposure during
surgery.
6.8.5
Maintain proper body
alignment regardless of the
position required for the
procedure.
6.8.5
Once in position, secure
patient with a safety strap,
avoid pressure over an area.
Strap should be placed on
top of the blanket covering
the patient.
NURSING
INTRA-OPERATIVE CARE
APPROVAL DATE:
6.8.3
Place the diathermy pad on proper
position. Don't apply over scar
tissue/implanted prosthesis.
6.9.1 Less hairy areas
6.9.2
APPLIES TO:
Avoid bony areas
6.10 POINTS TO REMEMBER:
6.10.1 Shave (if needed) clean and
dry the site before applying the
patient plate.
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Follow manufacturer
instructions.
6.10.3 Apply the plate in complete
contact with well muscular
tissue.
6.11
Apply gel if needed.
6.12
Don’t allow fluids to pool at patient
plate site.
6.13 Don’t cut patient plate, smaller to fit
patient.
6.14 Dispense supplies to the surgical field
aseptically.
6.15 Conduct and accurate counting and
record accurately.
6.16 Maintain a surgical environment by:
6.16.1
Limiting the number of
persons in operating room.
6.16.2
Keep the operating room
door closed.
NURSING
6.16.3 Adhere to proper operating
room attire.
6.17 Accurate documentation of
Intra-operative process.
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7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition: McGraw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-113
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1.0 DEFINITION
It is a procedure of positioning patient appropriately according to the desired operation to be performed.
2.0 PURPOSE
2.1 To provide adequate exposure and accessibility of the operative field for the surgical scrub
team to perform the necessary surgery.
2.2 To provide and maintain patient safety and comfort through out the surgery.
2.3 To provide adequate pre-operative preparation and safe anesthesia.
3.0 POLICY
3.1 The choice of position for operation is made by the surgeon in consultation with the
anesthesiologist and adjustment made as necessary for anesthesia.
3.2 The position of the patient on the operating room bed is determined by the surgery to be
performed.
3.2.1
The patient's position should provide optimum exposure for the procedure,
providing access to the patient's airway, IV lines, and monitoring devices.
3.2.2
The position should not compromise circulatory, respiratory, musculoskeletal or
neurological structures.
3.3 The surgeon, anesthetist and circulator are responsible for placing the patient in the
desired position.
3.4
Patient safety must be observed in positioning patient in operating room:
3.4.1
The patient must be properly identified when transferred to the operating table
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site affirmed.
3.4.2
The table must be securely locked in position with brake applied, when the patient
is on it and during transfer to and from the table.
3.4.3
The anesthetist guards the patient’s head at all times and supports it during
movement.
3.4.4
There must be adequate assistance, minimum of four people in lifting the patient
is necessary to prevent further injury.
3.4.5
Approval must be given by Anesthetist before any commencement of positioning
procedure.
3.4.6
An arm board must be guarded to avoid hyper-extending arm or dislodging
infusion needle.
3.4.7
Anesthetized patients and the aged patient must be moved slowly and gently to
allow the circulatory system to adjust.
3.4.8
If a patient is on his or her back, the ankles and legs must not be crossed, which
would create occlusive pressure on blood vessels and nerves.
3.4.9
If a patient is on his or her side, a pillow must be placed lengthwise between the
legs to prevent pressure on blood vessels.
3.4.10 If patient on prone position, the thorax must be relieved of pressure to facilitate of
pressure.
3.4.11 The position should not obstruct tubing's (catheter, intravenous, etc.) and
monitors.
3.4.12 Body support and restraining straps must not be fastened too tightly.
3.4.13 All positioning devices should be tested before positioning.
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Surgeon must be consulted if there is any doubt on which position to be used.
3.6 Patient shall be positioned “after” administration of general or spinal anesthesia. In local
anesthesia patient shall be positioned “before” the administration of local anesthetic agent.
3.7 Patient’s privacy must be maintained at all time during positioning.
3.8 Proper body alignment must be maintained and criteria must be met for physiological
positioning.
3.9 Assemble all necessary equipment so as to expedite the procedure.
3.10 Anesthetic screen is necessary for all cases to keep drape from patient’s face and provide
access to patient’s airway.
4.0 RESPONSIBILITIES
4.1
4.2
4.3
4.4
Surgeons
Anesthesia
Scrub Nurse
Circulating Nurse
5.0 MATERIALS & EQUIPMENT
5.1 Operating table accessories
5.2 Special equipment and table attachment
5.3 Safety belt
5.4 Anesthesia Screen
5.5 Wrist or arm strap
5.6 Arm Band
5.7 Arm Board
5.8 Double Arm Board
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5.9 Elbow pads
5.10 Shoulder bridge
5.11 Shoulder Braces or support
5.12 Shoulder Roll
5.13 Elevating Pads
5.14 Body Rests or Braces
5.0 MATERIALS & EQUIPMENT
5.15 Kidney Rests
5.16 Body-Restraint Strap
5.17 Stirrups
5.18 Special padded Head rests and attachment
5.19 Pillows and sandbags
6.0 PROCEDURES
6.1
NURSING
RATIONALE
Asses the patient for the following:
6.1.1
Preoperative neuropathies,
preexisting conditions and/or
disease; physical limitations;
age; height and weight; skin
condition; nutritional status; and
procedure type and position
required for surgery.
6.1.2
Specific positioning and
securing devices that is
required.
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6.2
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Special operative beds.
Place patient on his back with arms
secured at the sides, palms down.
Place hand with cannula on arm
board.
6.2.2
Place the patients’ head on
head ring or pillow as the
anesthetic preference.
6.2.3
Patients’ leg should be straight
and parallel, in line with head
and spine.
6.2.3.1 Patients’ leg should not
be crossed.
6.2.3.2 Feet must not be in
prolonged plantar flex
on.
6.2.4
Place safety belt over patients’
thigh approximately 2 inches
above the knee. Fasten strap
securely.
6.2.5
Place urinary catheter with a
continuous bladder drainage in
between patients’ leg without
tension and hang it securely at
the foot of the operating table.
NURSING
POSITIONING OF PATIENT IN OPERTING ROOM
Supine (Dorsal) Position
6.2.1
APPLIES TO:
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Attach anesthesia screen.
Arm Extension
6.3.1.1 Place arm on an arm
board at right angle to
the body.
6.3.1.2 Affected side of the
body must be closed to
table edge for access
to operative area.
6.3.2
NURSING
POSITIONING OF PATIENT IN OPERTING ROOM
Modification of Supine Position
6.3.1
APPLIES TO:
Face and Neck
6.3.2.1 Place head on a
headrest or head ring.
6.3.2.2 Close eye with eye
pad.
6.3.2.3 Place a small shoulder
roll under shoulder to
hyperextend the neck
or lower head part of
the table.
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Shoulder
6.3.3.1
Place a small sand
bag or pad under
affected side to
elevate the shoulder.
6.3.3.2
Stabilize the body to
prevent rolling or
twisting of spine.
Dorsal Recumbent
6.3.4.1
Place patient in
supine with knees
flexed and thighs
externally rotated.
6.3.4.2
Rest the soles of the
feet on the table.
6.3.4.3
Place pillows under
knees for support.
6.3.5 Modified Recumbent
6.3.5.1
Flex knee slightly.
6.3.5.2
Place pillow under
flexed knee.
6.3.5.3
Rotate thigh
externally.
NURSING
POSITIONING OF PATIENT IN OPERTING ROOM
6.0 PROCEDURES
6.3.3
APPLIES TO:
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6.4
6.5
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Trendelenburg- Head is lower then feet
6.4.1
Position the patient supine with
knee over break off table.
6.4.1
To prevent pressure on peritoneal
nerves and veins in the legs.
6.4.2
Place arm on the arm board at
any angle not greater than 90º
or as anesthetist preference.
6.4.2
Hyperextension of arm will cause
neural or vascular injury such as
brachial plexus injury.
6.4.3
Tilt table with head down not
more than 45º.
6.4.4
Use padded shoulder rests if
required by surgeon or an
anesthetist.
6.4.5
In returning to horizontal
position, leg should be raised
first slowly while reversing
venous status in legs.
Reverse Trendelenburg - Head is
higher then feet
6.5.1 Position the patient supine.
6.5.2 Tilt the table so that the head is
higher than the feet.
6.5.3 Place a small pillow under the
knee and the lumbar curvature.
Optional
6.5.4 Return slowly to supine position
once finished.
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6.6
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Lateral Position
6.6.1 Gather minimum of 4 persons
to turn the patient.
6.6.1
6.6.2 Place patient on right or left
side with back at the edge of
the table. Waist over center
break.
6.6.3 Place lower knee of lower leg
Flex and upper leg straight with
Pillows in between the legs.
6.6.4 Place upper arm on a padded
arm rest or flexed slightly at
elbow and raised above head.
6.6.5 Flex lower arm ensuring no
restriction of blood flow or nerve
damage.
6.6.6 Place safety strap at hip level.
6.6.7
6.7
APPLIES TO:
Position the patient according to
surgeon request if a modified
lateral position is required.
Lithotomy Position
6.7.1 Place patient in supine position
with buttock rest along break
between body and leg sections
of the table.
OR-122
Adequate assistance is important to
maintain body stability.
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6.7.2 Place and adjust stirrups at
equal height on both sides and
at appropriate height for length
of the patient’s leg. Stirrup must
not be hyper -abducted.
6.7.3
Test stirrups or pole for stability.
6.7.4
Obtain permission from
anesthetist.
6.7.5
Place arms and hands resting
on chest.
6.7.6
Elevate both leg simultaneously
and place in stirrups.
10 of 13
6.7.2 To maintain symmetry when patient is
position.
6.7.5 To prevent injury to hand when putting
the leg in lithotomy.
6.7.7 Check that leg do not touch any
metal parts.
6.7.8 Lower foot section of the table.
6.7.9 Check patient’s buttock is even
with the table edge.
6.7.10 Place arms on arm board or
loosely cradled over lower
abdomen and secured by end of
the sheet.
6.7.11 After Surgery
6.7.11.1
NURSING
Raise leg section of
table and replace
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6.7.11.2
NURSING
POSITIONING OF PATIENT IN OPERTING ROOM
lower section of
materials.
6.8
APPLIES TO:
Legs must be
removed
simultaneously and
lowered slowly from
stirrups to prevent
hypertension.
Prone Position
6.8.1 Place patient in supine
6.8.2 Gather sufficient assistance in
positioning patient minimum of 4
people.
6.8.3 Obtain approval from anesthetist.
6.8.4 Synchronizes the team turning
the patient onto abdomen.
6.8.5 Turn patient slowly and
cautiously onto abdomen on
operating table.
Body is rotated like rolling a log.
Anesthetist must hold the head
and stabilize endo-tracheal tube
while positioning the patient.
6.8.6 Place chest rolls under axilla and
rolls under iliac crest to raise
body weight from abdomen and
thorax to facilitate respiration.
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6.8.7 Female breast should be moved
laterally to reduce pressure.
6.8.8 Male genitals must be free from
pressure.
6.8.9 Place arms on arm boards and
rotating them upward in mutual
range of motion. Flex elbow and
palm down.
6.8.10 Turn head to one side, resting on
A padded head ring to prevent
pressure on ear, eye and face.
6.8.11 Place patient feet and ankles on
a pillow to prevent pressure on
toes.
6.8.12 Place safety belt across mid
thigh.
6.9
Kidney Position
6.9.1 Turn patient onto unaffected
side, flank region must be over
kidney elevator on table.
6.9.2 Table is flexed slightly so kidney
elevator can be raised as
desired.
6.9.2
To increase space between lower ribs
and iliac crest.
6.9.3 Strap body over the hip.
6.9.3
To stabilize patient.
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6.9.4 Place chest and back rest to
stabilize patient.
6.9.5 Elevate the head and upper part
of body in a straight line with the
hip.
6.9.6 Before closure, table is
straightened for better
approximation of tissue.
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
8.2
8.3
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition: McGraw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-126
Ministry of Health, General Nursing Administration
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______________________________________________
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APPLIES TO:
NURSING
HANDLING ELECTROSURGICAL UNIT (ESU)
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1.0 DEFINITION
It is a passage of high frequency oscillating electric currents through tissue between two electrodes to
coagulate or cut tissues.
2.0 PURPOSE
2.1 To coagulate tissue in order to prevent or control bleeding.
2.2 To cut across tissue and coagulate tissues simultaneously.
3.0 POLICY
3.1 All electrical surgical unit machine should have the manufacturer operational instruction
attached to each machine.
3.2 For the safety of the patient and personnel, follow instructions for use and care on machine
or in the manual provided by the manufacture that accompanies each electrosurgical unit.
3.3 All the regular service and maintenance should be recorded. Any default should be
reported to the Nursing Supervisor and Head Nurse of Operating Room.
3.4 Any ESU machine which is found default or unused should be labeled “Do not used. Out
of order ”.
3.5 The inactive grounding pad/plate must be properly placed and connected to avoid
electrical burn to the patient.
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3.0 POLICY
3.6 The diathermy pad or plate should be applied on muscular, dry, clean site where no
pooling of solution will take place. Diathermy pad/plate cannot be applied on the following
sites:
3.6.1
Excessive adipose tissue, scar tissue
3.6.2
Excessive hairy areas
3.6.3
Sites to be x-rayed
3.6.4
Sites of implanted prosthesis example hip prosthesis
3.7 All patients for surgery should not have any metal items such as jewelry example rings
earning, watch etc.
3.8 All patients must be checked for any electrosurgical burns on completion of surgery.
3.9 Unless disposable, reusable cords should be inspected by the biomedical engineering
department periodically for electrical integrity.
3.10 The ESU pad/plate must only be applied after patient has been positioned.
3.11 The Scrub Nurse must take care of electrode tip clean, dry and visible all the time and
safely kept in a container in the sterile field when not in use.
3.12 The surgeon and scrub nurse must be informed of the amount of power used in ESU
machine. The circulator must announce loud once the power is set and at any time
when there is change increase or decrease of power as requested by surgeon.
3.13 If there is any injury related to ESU, to write an incident report and to report immediately to
surgeon and Nursing Supervisor , Head Nurse of Operating room.
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4.0 RESPONSIBILITIES
4.1 Scrub Nurse
4.2 Circulating Nurse
5.0 MATERIALS & EQUIPMENT
5.1 Electrical Surgical Unit machine
5.2 ESU cord
5.3 ESU pen
5.0 MATERIALS & EQUIPMENT
5.4 ESU pad/ plate
5.5 ESU electrode tip: blade, loop, ball needle. This will be determined by type of
operation and current to be used.
6.0 PROCEDURES
6.1
RATIONALE
Check the machine for good working
order.
6.1.1
NURSING
Inspect the electrical cables
for cracks, fraying or damaged
Insulation.
6.1.2 Check that all connection are
secure with no loose screws.
6.1.3 Check the power point to ensure
no visible damage is present
OR-129
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prior to use.
6.2
Alert the anesthetist of the use of ESU.
6.2
To anticipate use of ESU where high
concentration of oxygen or any
inflammable anesthetics are used.
6.3
Select a suitable site for application
of ESU plate close to the operative site
if possible.
6.3
To minimize electric current through
Body
6.4
Check the skin area for hair , scar
tissue, excessive adipose tissue, bony
prominences.
6.4
Hair or scar tissue tends to act as
insulation. The surface area affects
heat buildup and dissipation. Bony
prominences result in pressure points
and in turn can cause current
concentration.
6.5
Place ESU pad on muscular and dry
area.
6.6
Ensure that application of the ESU
pad is smooth, wrinkle free and in full
contact with the patient skin.
6.7
Place the ESU machine opposite
Scrub nurse but not close enough to
contaminate the sterile field.
6.7
6.8
Scrub nurse will hands end of
conductor cord off sterile field to the
circulating nurse who attaches it to the
ESU machine.
Ensure the cord is long and flexible
enough to reach between the sterile
field and ESU machine It must be free
of kinks and bend.
This is to allow the surgeon and scrub
nurse to have a good view of the
electrical frequency and power. To
minimize current through the body.
6.9
To prevent any possible breakage or
strain to the cord. The kinks and bends
can deviate the current flow.
6.9
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6.10
Select cutting , coagulation or
bipolar according to surgeon’s
preference.
6.11
Scrub nurse will test the active
diathermy pencil is functioning.
6.12
Place the foot switch conveniently by
the surgeon’s foot if it is required.
Cover the foot switch if procedure
involves irrigation.
6.13
Check the patient for electrosurgical
burns on completion of surgery.
6.14
Document in the nurses notes on the
skin integrity of the pad/plate site
before operation and after operation.
NURSING
5 of 6
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8 th Edition: McGraw-Hill Professional.
OR-131
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NAME:
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DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-132
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NURSING
APPLICATION AND USE OF PNEUMATIC
TOURNIETS.
TITLE:
IPP
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EFFECTIVE DATE:
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NUMBER OF PAGES
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1.0 DEFINITION
An inflated cuff with applied pressure to the extremity proximal to the site of surgery to provide
homeostasis by constricting the flow of blood in an extremity to make dissection easier and less
tissue trauma.
2.0 PURPOSE
2.1 To provide information for testing, applying, cleaning and documenting the use of
pneumatic tourniquet equipment.
2.2 Through the used of mechanical means to minimized bleeding.
3.0 POLICY
3.1
Application of tourniquets
3.1.1
All types of tourniquets used should be clean, check and ready for use.
3.1.1.1
Check Pneumatic Tourniquets for the following:
3.1.1.1.1
Intact, free of wrinkles, strings attached and closure device.
3.1.1.1.2
Ensure rubber tubing's are intact and function able.
3.1.1.1.3
Clean and of correct size.
3.1.2
Keep the tourniquets equipment according to manufacturer's instructions.
3.1.3
Report for malfunctioning.
3.1.4
Assist surgeon in the application of tourniquet, at the correct site and side with
the permission of the anesthetist.
OR-133
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APPLICATION AND USE OF PNEUMATIC
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3.1.5
Tourniquet is only applied on the instruction and under supervision of operating
surgeon.
3.1.6
Choose the correct and appropriate cuff size for the limb. It should be wider to
occlude blood flow at a lower pressure.
3.1.7
Check the integrity of skin before application.
3.1.8
Apply wrinkle-free padding adequately around the affected extremity.
3.1.9
Position the tourniquet cuff at the point of maximum circumference of the limb.
3.1.10
Check the tourniquet cuff for firmness and secure the connecting tubing's.
3.1.11
Do not apply tourniquet on:
3.1.11.1
3.1.12
Distal part of extremity if impaired
3.1.11.2
Arterio-venous fistula for dialysis is present
3.1.11.3
Infection of tumor
3.1.11.4
Vulnerable neurovascular structures
Elevate the limb when applying the cuff.
3.1.13 Apply the cuff starting from the distal end of the extremity spirally and firmly
towards the cuff.
3.1.14 Inflate the pneumatic cuff to required pressure upon request of surgeon.
3.1.15 Remove the cuff bandage.
3.1.16 Document the inflation time on the count board, on the peri-operative care plan
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and anesthetic record form.
3.1.17 Place the pressure gauge at visible level.
3.1.18 Check the pressure gauge periodically for accuracy and detect for any fault.
3.1.19
Inform the surgeon on the time of tourniquet every hourly for 1st hour and half
hourly subsequently.
3.1.20
Release the pressure gauge of the tourniquet upon request by the surgeon.
3.1.21
Examine the patient's skin integrity and circulation after removal of the cuff.
3.1.22
Record if any injuries sustained relating to tourniquet in the peri-operative care
plan and complete an incident report. Inform the personnel in charge of the
operating department and the surgeon.
3.1.23
In case of 2 limbs to be operated, inflate one cuff at a time.
4.0 RESPONSIBILITIES
4.1 Scrub Nurse
4.2 Circulating Nurse
4.3 Surgeon's
5.0 MATERIALS & EQUIPMENT
5.1 Pneumatic Tourniquets
5.2 Reusable cuffs
5.3
Padding (Velband/ Webril)
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6.0 PROCEDURES
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RATIONALE
6.1 Tourniquets should be apply for
then purpose of obtaining a dry
surgical field, and should be
applied safely to prevent nerve
damage and to restrict blood flow.
6.2 Patient's notes should be consulted
before use of the tourniquet to
exclude clinical indications for
tourniquet use, e.g. Sickle cell
anemia, and to ascertain correct
operative site by reference to
consent from.
6.3 Instructions for using the tourniquet
should be attached to the
apparatus.
6.4 The pressure gauge should be
checked prior to use, and should
be monitored periodically
throughout the procedure.
6.3 Accuracy of calibration of pressure
gauges is critical. Excessive pressure
can result in nerve injury or palsy.
6.4 Correct sizing allows for even pressure
and skin/nerve/muscle protection.
6.5 Cuff size should be determined
based on patient's age, anatomy
and medical condition to comply
with producer or manufacturers
recommendations. The integrity of
the cuff will be visually ensured
and the inner tubing should be
totally encased and connectors
intact.
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6.6 Tourniquet cuff should be applied
under the supervision of a
physician.
6.6.1
Padding (Velband/Webril),
of greater width than that
of the tourniquet cuff
should be applied wrinkle
free to the area of
maximum circumference
of the limb to protect the
skin from mechanical
injury.
6.6.2 The cuff should then be
secured over the padding
with the connector easily
accessible. Cuff should
not be rotated after
application.
6.6.1
Vascular and nerve damage may
result from improper tourniquet use.
Wrinkles may cause post-operative
discomfort.
6.6.2
Rotation may cause micro-vascular
damage.
6.6.3 The cuff may be further
secured by elastoplasts
tape, but this should not
be in direct contact with
the skin.
6.7 The surgeon should be notified of
tourniquet time at one hour
intervals. Generally, the tourniquet
time should not exceed 1 hour on
the arm or 1.5 hours on the leg;
however, the surgeon may
request additional time.
6.7
OR-137
Pooling of prepping solutions may
cause skin irritations.
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6.7.1 After deflation of tourniquet,
the cuff should not be reinflation for a minimum of
five (5) minutes.
6.7.2 Prior to re-inflation, the
surgeon should be notified
of the precise downtime.
6.8 Exsanguinations should take
place after the administration of
pre-operative antibiotics (if
prescribed).
6.9 In cases where bilateral
tourniquets are applied, the
respective side of the tourniquets
should be indicated, on the table
side, tourniquets machine or the
connecting hoses.
6.10 Use of the tourniquet is
documented in the patient's
operation notes, and the count
sheet. This should include limb,
the side, the times of inflation
and deflation, cuff pressure, and
the skin and tissue integrity
under the cuff before and after
use.
6.10 Accurate documentation of tourniquet
application is a medico-legal
requirement.
6.11 After, surgical procedures,
tourniquet cuffs should be wiped
down with antimicrobial solution,
with these exceptions:
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6.11.1 Reusable cuffs soiled by
bloody/body
decontamination and
cleaning with return
instructions.
6.12 Pneumatic tourniquets should be
regularly checked and
maintained to ensure safety for
the patient.
7.0 ATTACHMENTS
7.1
Intra-operative Report
8.0
REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition: McGraw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-139
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
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IPP
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1.0 DEFINITION
Written policies and procedure provide a reference base for orientation, in-service, continuing education,
quality improvement and safety programs. Operating suites and surgical areas are potentially high-risk
locations.
2.0 PURPOSE
2.1 To minimize presentable physical injury.
2.2 To minimize risk of harm to patients.
2.3 To minimize human error and environmental deficiencies.
3.0 POLICY
3.1
It is essential to provide a safe and protected environment for the patient’s, staff and
visitors to the theatres.
3.2
Safe practice within the operating theatre should be used in conjunction with the safety
programs outlined in the policies of the hospital.
4.0 RESPONSIBILITIES
4.1 Surgeon
4.2 Anesthesiologist
4.3 Scrub Nurse
4.4 Circulating Nurse
4.5 Anesthesia Technician
OR-140
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5.0 MATERIALS & EQUIPMENT
N/A
6.0 PROCEDURES
6.1
RATIONALE
Burns-Chemical:
6.1.1
Applied properly skin preparation
solution.
6.1.1 Burns to the patient may be
prevented if pooling of prep
solution is avoided.
6.1.2
Prep solutions or degreasing
agents shall be applied to the skin
without contacting any placed
electrodes.
6.1.2 Solution on electrodes may
cause burn to skin.
6.1.3
Disinfectant solutions should be
used in the appropriate dilutions.
6.1.4
Mattresses or hypo/hyperthermia
blankets should be wiped with
alcohol after routine disinfection.
6.1.4 Removal of residual phenol
reduces the incidence of chemical
skin burns.
6.1.5 A layer of fabric/sheet should
always be placed between the
patient and the mattress material.
6.2
6.1.5 Direct skin contact with residual
chemical solutions, or plastic/
rubber materials, may cause
skin irritation, rashes or burns.
Burns-Thermal:
6.2.1
Attached to each
hypo/hyperthermia unit the
complete operating instruction
and temperature ranges.
6.2.1
OR-141
By following instructions, injuries to
patients and staff, and equipment
problems will be avoided.
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6.2.2
6.2.3
6.2.4
6.3
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Used always a temperature
probe locator as per manufacturer’s
instructions. The temperature setting
should be properly monitored and
documented.
Shut-off switch at the maximum
safety.
6.2.3 Maximum temperature should
not exceed 40 degrees C.
Inspected the hypo/hyperthermia
blankets for damaged prior to
each use and if damaged,
discarded.
6.2.4 Patients may be burned by
electrical current leakage
from the electro-surgical unit
following through water which
may have pooled due to a
leak in the blanket.
6.2.5 Turned-off the endoscopic
equipment when not in use.
6.2.5 ‘cold’ fiber-optic light leads can
ignite materials or burn the
patient’s skin.
6.2.6 Used ice packs to call patients,
should always be wrapped in
fabric.
6.2.6 Fabric between the skin and
the ice help to prevent potential
freezing of the tissues.
Mechanical Injuries:
6.3.1
6.3.2
Prevent pressure areas; the
operating table mattress should
be thick enough.
Cover the height of arm board
level with the operating table
mattresses to prevent undue strain on
the patient’s nerves and joints etc.
OR-142
6.3.2 Hyperextension of the arm
may cause brachial plexus
damage.
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6.3.3
6.3.4
6.4
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Protect pressure points by adding
padding.
Checks should be made to
ensure that the skin has not been
damaged due to repositioning of the
operating table or due to lengthy
procedures.
4 of 12
6.3.3
Pressure areas, nerve, vessel
and muscular damage may
result in temporary or serious
long-term complications and
discomfort.
6.3.4
Checks must be made to
prevent skin tears and pressure
ulcers.
6.3.5 Aware all members of the
surgical team about the patient
at all times. They must not lean
against them or place heavy
instruments on them that may
cause undue pressure.
6.3.5 Injury to soft tissue, muscles,
joints and nerves may result.
6.3.6 Attachment of the table must be
securely applied.
6.3.6 So as not to cause accidental
dislodgement or movement
resulting in injury to the patient.
Personnel Safety:
6.4.1
6.4.2
Aware personnel working within
the Operating theatre suite must
be made through continuing
education, of specific health
hazards within their working
environment.
6.4.1
Operating room personnel will
be equipped with the resources to
protect themselves from undue
injury.
Immunization for e.g. Hepatitis B
is available for all Operating
Theatre personnel through the
6.4.2
Operating room health care
teams are exposed to blood and
body fluids and should be well
OR-143
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Staff Health service.
6.4.3
5 of 12
protected in the event of exposure.
Report incident must be completed
whenever an injury occurs. It is
compulsory that injured staff attend
Staff Health as soon as possible
after the incident.
6.4.4 Treated all body substances as
potentially infectious. Protective
attire is provided.
6.4.5 Reported all blood/body fluid
splashes in the eye and /or to
mucous membrane. The patient
involved should be serologically
screened for Hepatitis B and HIV
viruses.
6.4.3
Incident reports are the
required types of documentation
needed to process insurance
compensation for staff.
6.4.4
Standard Precautions must
be followed to prevent
transmission of disease and
occupational exposure to infection.
6.4.5 Hepatitis B and HIV are examples
of diseases that may enter the
body through mucous membranes.
6.4.6 Recapped of used/contaminated
needles should be avoided.
6.4.6 A high rate of needle stick
injuries occur when recapping
needles.
6.4.7 A high rate of needle stick
injuries occur when recapping
needles.
6.4.7 Disposed the sharps in an
appropriate receptacle that is
ideally puncture-proof.
6.5
NURSING
Fire Explosion and Safety:
6.5.1
Provided Operating room
personnel with adequate
orientation and on-going
education on fire management
and evacuation techniques.
6.5.1 To function effectively in a
disaster situation it is the
responsibility of all health care
personnel to be aware.
OR-144
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6.5.2 Operating Room personnel must
be able to state:
6.5.2.1
Location of fire alarms.
6.5.2.2
Location of fire exits.
6.5.2.3
Location of fire-fighting
equipment.
6.5.2.4
Location of the
appropriate
extinguisher for
potential operating
room electrical
fires, combustible.
6.5.2.5
Evacuation routes.
6.5.2.6
Steps in reporting a
Fire.
6.5.2.7
6 of 12
6.5.2 Should a disaster such as a fire
occur, the staff must be ready to
perform the required duties
expeditiously and efficiently to
ensure safety for the patients and
staff.
The initial steps in
dealing with a fire:
6.5.2.7.1 Personnel should
identify potential fire
hazards such as
methacrylate (bone
cement), electrosurgical devices
(diathermy), draping
materials, lasers,
toxic smoke from
6.5.2.7.1
OR-145
Knowledge of
potential fire
hazards enables the
staff to introduce
preventive safety
measures.
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petroleum based
foam padding, and
endoscopic light
cables.
6.5.2.7.2
Evacuation routes
should be
Unobstructed.
6.5.2.7.2 Evacuation of
patients and
health care team
members is a
complex task and
critical in the
operating room,
therefore, this
requires an
Unobstructed
evacuation route.
6.5.2.7.3 Fire extinguishers
should be clearly
marked with the
most recent date.
6.5.2.7.4 The Head Nurse or
designee, should
ensure that all fire
extinguishers have
been checked.
6.5.2.7.5
6.5.2.7.4 Outdated
Extinguishers
present an
additional hazard.
All anesthetic machines
should be
connected to a
scavenging system
to remove waste
gases. A preventive
Maintenance
OR-146
6.5.2.7.5 Uncontaminated air
will improve the
environment for
the health and
safety of the
operating theatre
personnel.
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program should be in
place.
6.5.2.7.6 A closed system
disposable suction
apparatus and tubing
should be used.
6.5.2.7.6
Dispersal of
aerosols
contaminants into
the environment will
be prevented. Every
chemical should be
considered
potentiality harmful
until proven
otherwise.
6.5.2.7.7 Vacuum outlets and
devices should
Be of adequate
amounts, and be
complete and
operational with
sufficient pressure.
6.5.2.7.7
Insufficient outlets
and quality
of vacuum system
and equipment
compromise patient
safety.
6.5.2.7.8
6.5.2.7.8 Reduction of
anesthetic
pollution into the
environment is
critical for the
protection of
personnel.
Closed liquid
dispensing units
should be used to
transfer anesthetic
agents into
vaporizers with a
minimum of leakage.
6.5.2.7.9 Doors to operating
theatres must be
kept closed to
maintain positive
pressure and
6.5.2.7.9 This reduces the
amount of bio-burden
in the room.
OR-147
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prevent air
turbulence.
6.5.2.7.10 Leaks in medical gas
connectors should be
repaired
immediately.
6.6
6.5.2.7.10 Gas leaking into the
environment are
pollutants and
extremely
expensive.
Radiation Safety:
6.6.1
6.6.2
6.6.3
6.6.4
6.6.5
Radiological protective devices
and apparel, e.g. lead aprons,
thyroid protective collars should
be provided for all of the health
care team members and
patients are required.
6.6.1
This is to prevent undue
exposure of personnel to X-ray
radiation.
Thyroid protective collars should
be provided for surgeon performing
procedures where they are working
directly near fluoroscopic fields, e.g.
closed urological or pacemaker
procedure.
Lead aprons should cover the
sternum, chest and abdomen.
Surgeons injecting contrast
media should be able to step behind
a lead screen or other radiological
protection for filming.
All personnel working on a
regular basis in the operating
theatre suite be issued with a
6.6.5 This is to determine the amount of
OR-148
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radiation detector (film badge)
that will be screened and
upgraded every 3 months.
6.6.6
6.6.7
NURSING
10 of 12
radiation exposure.
Only radiology personnel should
operate radiological equipment
in the operating room.
6.6.6
Radiology technicians should
receive instruction in aseptic
technique and operating room
practices to prevent potential
contamination of the sterile field.
Professionally qualified
personnel will reduce the
radiation risks of the health
care team and patients.
6.6.8 The theatre staff should assist
the radiology technician in
maintaining a sterile field./all of
the surgical team should remain
vigilant.
6.6.9
Appropriate warnings signs
should be posted where radiation
danger.
6.6.10 When X-rays are anticipated,
nursing staff should ascertain
whether their patient is pregnant
and provide the necessary
precautions.
6.6.10 Precaution will protect the
fetus and the patient.
6.6.11 Pregnant personnel in the first
trimester should avoid areas of
radiation.
6.6.11 Rotation of personnel
decreases the accumulative
radiation exposure.
OR-149
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6.6.12 Appropriate hangers should be
provided for the lead aprons.
aprons should be maintained in
good condition, they should be
x-rayed annually to detect
cracks, and defective aprons
should be replaced.
6.7
APPLIES TO:
11 of 12
6.6.12 Bending or folding of aprons
results in cracks through
which radiation may penetrate.
Electrical Safety:
6.7.1 Each electrical device shall bear
a sticker identifying it as safe to
use in the operating theatre.
6.7.2
Each electrical device should
have an up to date record of
preventive maintenance and
repairs.
6.7.3
All new equipment should be
inspected by the Biomedical
Engineering Department, prior to
its use within the operating
theatre suite.
6.7.1
Injury to personnel and
patients is prevented by using
safe electrical equipment.
6.7.4 Questionable and faulty
equipment should be removed
and repaired as soon as
possible.
6.7.5 Electrical extension cord
should be avoided. Proper
electrical cords should be
attached to equipment when the
cords are too short.
6.7.5 Current leakage is proportionate
to the length of cord, and it is
recommended that no extension
cords are to be used in the
operating theatre suite.
OR-150
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6.7.6 All equipment must be tested,
prior to use by the theatre
personnel.
6.7.6
12 of 12
Checking for frayed cords, torn
insulation or any other defect
may prevent electrical hazard.
6.7.7 The electrical Biomedical
department should be consulted
in the decision to replace or
repair electrical equipment.
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8 th Edition: McGraw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-151
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1.0 DEFINITION
Thorough mechanical cleaning with an antiseptic agent.
2.0 PURPOSE
2.1 To render the operative site as free as possible from transient and resident
microorganisms, dirt, and skin oil.
2.2 To prevent wound infection
3.0 POLICY
3.1 Skin cleansing and disinfecting is the responsibility of the surgeon before surgical intervention.
3.2 All patients shall have shower or bath the evening before and morning of operation using
chloroxhedine.
3.3 The ward staff shall be responsible for pre-operative bathing and shaving.
3.4 Skin around operative site shall be free of gross dirt and debris.
3.5 History of allergy to a disinfectant shall be obtained by the ward staff and duly endorsed to
OR staff.
3.6 Observe patients general skin condition for any abnormal skin irritation, infection and
abrasion and inform the surgeon.
3.0 POLICY
3.7 Mechanical cleansing of the operative site shall be done with the use of povidone iodine
10% followed with alcohol 70%.
3.8 Skin preparation is done post anesthesia induction.
OR-152
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4.0 RESPONSIBILITIES
4.1 Surgeon
5.0 MATERIALS & EQUIPMENT
5.1 Chlorhexidine
5.2 Povidone iodine 10%
5.3 Alcohol 70%
5.4 Towel
6.0 PROCEDURES
6.1
RATIONALE
Special considerations in specific
Anatomic areas- Eye :
6.1.1 Never shaved or removed
eyebrows unless the surgeon
deems this essential.
6.1.1 Eyebrows do not grow back
completely.
6.1.2 Trimmed eyelashes, if ordered by
the surgeon, with fine scissors
coated with sterile petrolatum to
catch the lashes.
6.2
6.1.3
Cleansed eyelids and peri-orbital
areas with non irritating agent.
6.1.4
Flushed conjunctival sac with a
non toxic agent, such as sterile
normal saline, using a bulb
syringe.
NURSING
Ears, Face or Nose:
OR-153
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6.2.1 Usually it is not possible to
define the area with towels.
6.3
6.2.2
Protect eyes with a piece of
sterile plastic sheeting. If
patient is awake, ask that eyes
be kept closed during the
preparation.
6.2.3
As much of surrounding area is
included as is feasible and consistent
with aseptic technique.
6.2.4
Clean the nostrils and external ear
canals with cotton applicators.
6.2.3
Neck :
6.3.1 One sterile towel is folded under
the edge of the blanket and
gown, which are turned down
almost to the nipple line.
6.3.2 The area includes the neck
laterally to the table line and up
to the mandible, tops of the
shoulders and chest almost to
the nipple line.
6.3.3
For combined head and neck
operation, include face to the eyes,
shaved areas of the head, ears,
posterior neck and area over the
shoulders.
OR-154
Skin surfaces should be cleansed at
least to the hair line.
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6.4 Lateral Thoracoabdominal :
6.4.1 Removed gown.
6.4.2 Arm is held up during preparation.
6.4.1 Blanket is turned down well below
lower limit of area to be prepared.
A towel is folded under edge of
blanket.
6.4.3 Beginning at the site of incision,
area may include axilla, chest
and abdomen from the neck to
crest of the ilium. For operations
to axilla and down to pubis. The
area also extended beyond the
midlines, anteriorly and
posteriorly.
6.5 Chest and Breast :
6.5.1 Anesthesiologist turns patient's
face toward unaffected side.
6.5.2
One towel is folded under blanket
edge, just above pubis. Another is
placed on table under shoulder and
side.
6.5.3
Arm on the affected side is held up
by grasping hand and raising
shoulder and axilla slightly from the
table.
6.5.4
Area includes shoulder, upper arm
down to the elbow, axilla and chest
wall to the table line and beyond
sternum pposite shoulder.
6.6 Shoulder :
OR-155
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6.6.1 Anesthesiologist turns patient face
toward opposite side.
6.7
6.6.2
Towel is placed under shoulder and
axilla.
6.6.3
Arm is held up by grasping hand and
elevating shoulder slightly from the
table.
6.6.4
Rectoperieneal area is prepped first,
with patiottin lithotomy position,
followed by abdominal prep. With
patient in supine position, for a
combined abdominoperineal
operation. Two separate prep trays
are used.
Vagina :
6.7.1
NURSING
SKIN PREPARATION BEFORE SURGERY
TITLE:
IPP
APPLIES TO:
A sponge forceps must be
included on the preparation
table for a vaginal prep because
a portion of prep is done
internally. A disposable vaginal
prep tray, with sponge sticks
included, is available.
6.7.2
A moisture proof pad is placed
under the buttock extends to kick
bucket that receives solutions and
discarded sponges.
6.7.3
Towel is folded under edge of
OR-156
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Area includes pubis, vulva labia,
perineum. And adjacent area,
including inner aspects of the upper
third of thighs. The vagina is
prepped last.
6.7.5
Begin over pubic area,
scrubbing downward over vulva
and perineum. Discard sponge
after going over anus.
6.7.6
Inner aspect of the thighs are
scrubbed with separate sponges
from labia majora outward.
6.7.7
Vagina and cervix are cleansed
with sponges on sponge
forceps after external
surrounding areas are
scrubbed.
NURSING
SKIN PREPARATION BEFORE SURGERY
blanket above pubis.
6.7.4
APPLIES TO:
6.7.8
The cleansing agent should be
applied generously in the
vagina because vaginal
mucosa has many folds and
crevices that are not easily
cleansed.
6.7.9 After thoroughly cleansing vagina,
wipe it out with a dry sponged to
prevent possibility of fluid
entering peritoneal cavity during
operation on pelvic organs.
6.7.10 Catheterized, if indicated.
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6.8
SNR-OR-023
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Hip :
6.8.1 One towel is placed under thigh
on the table. Another towel is
placed on abdomen and folded
under edge of gown, just above
umbilicus.
6.8.2
Leg on affected side is healed up by
supporting it just below knee.
6.8.3
Area includes abdomen on the
affected side, thigh to the knee,
buttocks to table line, groin, and
pubis.
6.9 Thigh :
6.9.1
One towel is placed under thigh
on the table. Another towel is
placed on abdomen and folded
under edge of gown, just below
umbilicus.
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
OR-158
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DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-159
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NURSING
MAINTAINING STERILE FIELD
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1.0 DEFINITION
Measures taken to create and maintain an aseptic environment.
2.0 PURPOSE
2.1 To effectively apply the principles of asepsis and sterile technique.
2.2 To prevent the transmission of microorganisms that can cause infection.
2.3 To create and to work in sterile field.
3.0 POLICY
3.1 A disposable item should not be washed and reused for another patient.
3.2 Reusable items must be terminally sterilized or high level disinfected before reuse.
3.3 All item to be used are sterile without exception.
3.4 If there is any doubt about the sterility of any item or it should be considered not sterile.
3.5 If the integrity of a packaging material is not intact; consider it un-sterile.
3.6 If a package becomes damp or wet, discard it.
3.7 Every person working in sterile area must develop a “sterile consumer” alert to
contamination, no matter how slight.
3.0 POLICY
3.8 All items used within a sterile field must be sterile.
3.9 Persons who are sterile touch only sterile items or areas, persons who are
not sterile touch only un-sterile areas or items.
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4.0 RESPONSIBILITIES
4.1 Surgeon
4.2 Scrub Nurse
4.3 Circulating Nurse
5.0 MATERIALS & EQUIPMENT
N/A
6.0 PROCEDURES
RATIONALE
6.1 Surgical hand scrub
6.1.1 Wear surgical attire before
beginning the surgical hand scrub.
6.1.2
Perform surgical hand scrub
according to acceptable technique.
6.1.3
Use an approved scrub agent.
NURSING
6.2 Gowning
6.2.1 Remember that gown is
considered sterile in front from
chest to the level of the sterile
field.
6.2.2 The gown cuff must be covered at
all times by sterile gloves.
6.3 Gloving
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6.3.1 Preserve the sterility of the gloved
hands, it should be kept within
sterile bounding.
6.3.2 Change gloves and gown if there
is any break in the technique, do
not conserve.
6.4 Draping
6.4.1
Drape an un-sterile surface first
toward themselves.
6.4.2
Change drape or cover drape if it
becomes fermented or moist.
NURSING
MAINTAINING STERILE FIELD
TITLE:
IPP
APPLIES TO:
6.5 THE STERILE ITEMS
6.5.1 Check the outer wrapper or
package to make sure there are
no leans or holes.
6.5.2
Inspect to see that items are
properly sterilized evidence by
indicators.
6.5.3
Discard any instrument you are in
doubt of sterility.
6.5.4
Transfer and dispense items on to
sterile field by methods that maintain
sterility and integrity.
6.6 Constantly monitor and maintain sterile
field.
6.7 Keep un-sterile person a safe distance
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from sterile field.
6.8 Keep Operating Room doors shut during
a procedure.
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-163
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1.0 DEFINITION
It is the collection of specimen by the use of surgical technique.
2.0 PURPOSE
2.1 To provide guidance in the proper labeling and safe, effective handling of surgical
specimens.
2.2
Careful handling and accurate labeling of tissue biopsies and surgical specimen is
essential.
2.2.1 The patient's diagnosis and future treatment may depend entirely upon the
results of the laboratory examination of specimens obtained during surgery.
2.2.2 The loss of Biopsy or specimen is particularly hazardous for the patient. It could mean the
possibility of a second surgical procedure in order to obtain another sample. If diagnosis
cannot be made because of a lost specimen, the patient may not received the correct
treatment.
2.3 Improperly labeled specimen could result in the wrong diagnosis and the possibility of
critical involvement for two patients.
3.0 POLICY
3.1 Wear gloves when handling specimen.
3.2 Scrub personnel must ensure that specimen is properly received to maintain the nature of
specimen by:
3.2.1 Prepare a suitable bowl to receive the specimen.
3.2.2 Do not place specimen on sponge or gauze.
3.2.3 Ensure all specimens are collected before handling over the circulator.
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3.2.4 Careful handling of specimen ensuring the tissue is not damage or tear.
3.2.5 Do not clamp specimen, especially small specimen as this many crush cell and
making identification difficult.
3.2.6 Pass the specimen immediately to the circulator to put into the fixative.
This is to prevent dryness of specimen.
3.3
Check the preference of laboratory examining the specimen for accuracy of collection of
specimen.
3.4
Clarify with surgeon immediately if there are any doubts about the specimen's
identification.
3.5
Ensure the specimen container has an adequate size and no leakage for the specimen.
3.6
Careful label of specimens into the correct jar with the correct patients name and
registered number and nature of specimen for the specific examination is done by the
circulator.
3.7
The scrub personnel must counter check that the above, No.6 is being done correctly.
3.8
Both scrub and circulator are responsible for the collection of specimen.
3.9
Any specimen removed must not be thrown away unless with permission of surgeon and
document in the peri-operative care plan.
3.10 Specimen is only shown to patient upon request with surgeon's permission.
3.11 All specimens must be labeled around the jar and not on the cap of specimen container.
3.12 All specimens dispatched to the laboratory must be entered into the dispatch book and
signed by the laboratory staffs.
3.13 Foreign body can be given to patient upon request and document in the peri-operative
care plan.
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3.13.1 For medico legal cases foreign body is given to the police.
3.14 Amputated limbs are dispatch to the ward personnel and document in the Peri-operative
care plan.
3.15 For frozen section specimen, arrangement must be made by the surgeon with the
Pathologist.
3.15.1 O.R. in charge must re confirmed with surgeon that arranged for
Frozen section has been done to ensure necessary step has been
carried out.
4.0 RESPONSIBILITIES
4.1 Scrub Nurse
4.2 Circulating Nurse
5.0 MATERIALS & EQUIPMENT
5.1 Sterile bottle or un-sterile bottle.
5.2 Specimen.
5.3
Formalin
5.4
Specimen form
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6.0 PROCEDURES
6.1
Prepared a request for specimen
analysis throughout the procedure is the
responsibility of the circulating nurse.
6.2
Preserve all specimens in the state
received and ensure that sterility of the
specimen is maintained, is the
responsibility of the scrub nurse.
6.3
Remove all the accountable items
(instruments, sponge) from the
specimen whenever possible, before
handling the specimen of the sterile
field. It is the responsibility of the scrub
nurse.
6.4
The scrub nurse should be responsible
for the correct labeling of the specimen.
4 of 7
RATIONALE
6.4
It is the surgeon's responsibility to give
the correct anatomical identification of
the specimen. Wrongful labeling can
lead to misdiagnosis or consequent
injury to the patient.
6.5 The scrub nurse will ascertain from the
surgeon the type of medium required to
preserve the specimen.
6.6 Formalin 10% is the standard
preservative used for histopathology
specimens.
6.6 Kept in closed cabinet in utility room
(50:44) and must be used with extreme
care.
6.7 Exceptions:
6.7.1
Testicular Biopsy for fertility-use
(Bouins Solution).
OR-167
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6.7.2
Frozen Sections- sent fresh to
the laboratory (No solution used).
6.7.3
Remove all of the accountable
items is the responsibility of scrub
nurse.
6.7.2
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Frozen sections are sent with the OR
porter to the laboratory as soon as
possible. Special register is kept at the
theatre reception desk. Theatre
coordinator will organize this in
collaboration with the operating team.
6.8 The circulating Nurse should:
6.8.1
Prepare container by correctly
labeling with patient name, date,
time and attending surgeon's
name. Labels must never be
placed on the lid.
6.8.1 Where the specimen is contaminated,
the circulating nurse, wearing
protective equipment (goggles, apron,
gloves, etc) will remove the
accountable items from the specimen.
6.8.2
Provide a separate container for
each specimen. Ensure that it is
of adequate size.
6.8.2 This is to avoid the possibility of an
incorrect count later in the procedure.
6.8.3
Sequentially number the specimens.
6.8.3
All staff handling the specimens will
ensure that standard precautions
followed. Careful preparations of the
specimen will prevent contamination
and ensure preservation.
6.8.4
Append the name and site of the
specimen as described by the
scrub nurse.
6.8.4
Compliance with laboratory protocol is
essential for proper care and handling
of all specimens.
6.8.5
Cover the specimen fully with the
nominated medium e.g. Formalin,
as soon as possible.
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6.8.6
Place specimen in a clear plastic
bag for transport. (Ensure that the
request form is placed in the
separate pocket).
6.8.6 Special care should be taken with
small specimens. Beside easily lost,
they tend to dry out quickly, causing a
change in their gross appearance and
causing artifacts which may prelude
the ability to make microscopic
diagnosis.
6.8.7
Arranged frozen section
specimen to laboratory as soon
as possible.
6.8.7
Recording the fact that the specimen
have been sent to the laboratory assist
in control and may prevent loss.
6.8.8
Responsible for ensuring that the
specimen is correctly labeled
should be the scrub nurse and
the circulating nurse.
6.8.9
Record all types and number of
specimen at the operative record.
6.8.9
To ensure that all details have been
filed out correctly, that there is formalin
in the specimen containers awaiting
collection, and that all lids are secured.
6.8.10 Note: It is the responsibility of the
theatre staff, to check the utility room
specimens prior to their completion
of shift.
6.8.11 Refrigeration of specimen is
necessary if after hours, on
weekends or holidays.
6.8.11 Presents a contamination risks.
6.8.12 Completed all OVA (incident) report
must be completed for any
mismanaged specimen.
6.8.13 No tissue removed surgically or
calculi are given to the patients.
6.8.13 Forensic testing must be performed;
therefore minimal handling of the
object should occur.
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6.9
TITLE:
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Foreign Bodies:
6.9.1 Discarded all screws, pins and
plates.
6.9.1
Administrative Services are
responsible for guiding the
proceedings.
6.9.2 Handled bullets/projectiles with
forceps or sponge only.
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition: McGraw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-170
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1.0 DEFINITION
It is the procedure of covering patient and surrounding areas with a sterile barrier to create and maintain
an adequate sterile field during operation.
2.0 PURPOSE
2.1 To provide effective barrier between the surgical wound and the surrounding un-sterile
environment.
2.2 To eliminate and minimize passage of microorganisms between sterile and un-sterile area.
2.3 To create and maintain an adequate sterile field during operation
3.0 POLICY
3.1 Patients must be draped according to the surgical procedure in preparation for surgery.
3.2 During draping procedure, the circulating nurse should stand by to direct scrub nurse as
necessary and to watch carefully for breaks in aseptic technique.
3.3 All surgical scrub team and circulating nurse must be familiar with the types of drapes
used in surgery and the draping procedure must be done correctly to maintain sterility.
3.4 Disposable drapes should be used for all infectious cases.
3.5
Reusable drapes must be checked for integrity and laundered before sterilization.
3.6
There must be sufficient space and time for draping to permit correct application.
3.7
The drapes must be handled as little as possible. Avoid shaking drapes at all times.
3.8
Discard drapes if sterility is in doubt or when contaminated. Do not handle a contaminated drape
further, discard it without contaminating gloves or other items.
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3.9 The skin preparation solution must be dried before commencement of draping.
3.10 Commence the drape by first creating the sterile area for the surgical team. Drape from
the operative site to peripheral, cover the near side of un-sterile surface with drape to
protect the sterility of gown and personnel. Never reach across the operating table to
drape the opposite side.
3.11 During draping protect gloved hands by cuffing end of sheet over them. Do not let
gloved hands touch skin of patient.
3.12 In unfolding a sheet from the operative site toward foot or head of table, protect gloved
hand by enclosing it in turned-back cuff of sheet provided for this purpose. Keeps hands
at table level.
3.13 The drape must hold high until it is directly over proper area, then lay it down where it is
to remain. Once a sheet is placed, do not adjust it. Be careful not to slide sheet out of
place when opening folds. If a drape is incorrectly placed, discard it. The circulating
nurse will remove the drape from the table without contaminating other drapes or
operative site.
3.14 Do not repositioned once a towel clip has been through a drape. The tip of towel clip is
considered un-sterile. The towel clip is only remove if absolutely necessary, discard it
from sterile setups without touching points.
3.15 If a hole is found in a drape after it is laid down, the hole must be covered with another
piece of draping material or the entire drape discarded.
3.16 Drapes must always have adequate coverage to create a sterile field. It must cover
entire patient, operating table, the foot of patient and anesthesia shield . Only the
incision site is not covered.
3.17 If a tear or hole is found on drape material after it is been laid down, the hole must be
covered with another piece of sterile drape or entire drape discarded and re-drape.
3.18 If hair is found on the drape, remove the entire drape. Hair can cause foreign body
tissue reaction in patient if it gets to the wound.
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3.19 The top of draped table is considered sterile. Any part of drape falls below the table
surface is considered un-sterile. The drape sheet must not touch the floor.
3.20 Equipment that is brought into sterile field but cannot be sterilized must be draped before
it is handled by sterile team members.
4.0 RESPONSIBILITIES
4.1 Surgeon's
4.2 Assistant Surgeon
4.3 Scrub Nurse
4.4 Circulating Nurse
5.0 MATERIALS & EQUIPMENT
5.1 Basic linen pack.
5.2 Supplementary linen packs such as op- site membrane, legging, gauze bandage and etc.
5.3
Laparotomy sheet if required
6.0 PROCEDURES
6.1
RATIONALE
Abdominal Surgery:
6.1.1 Pass one end of the fan
folded drape to the surgeon,
supporting the folds, keeping
it high and holding it taut until
it is opened; then lay it down
as near as possible to the
incision site.
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6.1.2 Ensure glove hand is cuffed.
6.1.2 To prevent contamination of
sterile glove.
6.1.3 Drape the upper and the
lower position in the same
manner.
6.1.4 Place folded sheet at both
side of the incision area.
6.1.5 Secure each side of the
drape with two towel clips
ensuring the sharp end of
towel clip do not injure patient.
6.1.6
Reinforce the initial drape area
at the upper end and lower
portion with another drape to add
to the thickness of the drape.
6.1.7
Place an adhesive plastic
drape over the incision site
before and after formal
draping if required.
6.1.6
6.1.7.1 Assist in applying
adhesive drapes as
surgeon’s preference.
6.1.7.2 Hold the sterile drape
taut with the assistant
or surgeon.
6.1.7.3 Peel off the paper
backing towards the
OR-174
The thickness of drape is to
minimize strike-through.
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person who is
pulling and hand it off
to the circulating
personnel.
6.1.7.4
Lower the drape to
Operative site area and
position with the
adhesive side down.
6.1.7.5 Smooth the adhesive
drape if necessary.
6.1.7.6
6.2
Avoid contamination of
gloves at all times.
Head Surgery:
6.2.1 Place four or two towels
under the head.
6.2.1 Number of towel depend on surgeon's
preference. The towel is to have
adequate thickness to prevent strike
through and good coverage of sterile
area.
6.2.2 Wrap one or two sheet
around the head and secure.
Towel clips are not used if Xrays will be taken during
operation.
6.2.3 Hand one end of a fan folded
large sheet to assistant.
Holding it taut , unfold and
secure it over the head end of
operating table below
operative area at skin edge of
the draping towel.
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6.2.4 Place a fenestrated sheet
according to surgeon
preference.
6.2.5
6.3
If a split sheet is used, the
tails are placed toward head
end of operating table, draped
around patient’s head, and
secured with towel clips.
Face Surgery:
6.3.1 The exposure of entire face
will depend on surgeon’s
preference. Even if operation
is unilateral, surgeon may
want the entire face exposed
for comparison of skin lines.
6.3.2 The circulating nurse holdup
the patient’s head.
6.3.3 Surgeon place a drape under
head and the towel is drawn
up on each side of face, over
forehead or at hairline, and
fastened with a clip.
6.3.3
6.3.4 Place a medium sheet just
below site. This sheet must
overlap the one under the
head.
6.3.5 A fenestrated drape may be
placed to complete draping.
OR-176
This leaves the desired amount of face
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6.3.6 Cover remainder of foot of
table , as necessary with a
single sheet.
6.3.7 If patient is receiving inhalation
anesthesia, use a minor sheet
instead of a towel on a medium
sheet for first drape under head.
A minor sheet is large enough to
draw up on each side of face and
to enclose tubes from
contaminating the sterile field.
6.3.8 If operation on face is unilateral,
the anesthetist may sit at
unaffected side, near patient’s
head, with anesthesia screen
placed on this side of table.
6.4
APPLIES TO:
Eye Surgery:
6.4.1 Protect eye with sterile eye
pad before draping patient.
6.4.2 Circulating nurse holdup the
patient’s head.
6.4.3 Scrub Nurse hand over to
surgeon two or three towels
according to surgeon
preference.
6.4.4 Surgeon drape patient:
One towel is drawn up
around head, exposing only
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6.4.5 Hand over to surgeon four
towels and towels clips to
isolate operative site or give
self adhering aperture drape
according to surgeon
preference.
6.4.6 Cover patient and remainder
of table below operative site
with a single sheet.
6.4.7 If local anesthesia is used:
raise drapes off patient’s nose
and mouth to permit free
breathing.
Ear Surgery:
6.5.1 Drape patient as same
procedure as face or eye
operation, except that only
ear is exposed.
6.5.2 Turn head toward unaffected
side.
6.6
NURSING
DRAPING OF PATIENT FOR SURGERY
the eyebrow and operative
eye, Fastened with a clip
without applying pressure on
eye.
6.5
APPLIES TO:
Chest and Breast Surgery:
6.6.1 Arm is held up following
skin preparation.
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6.6.2 Place a minor sheet on
arm board, under patient’s
arm, extending sheet under
side of chest and shoulder.
the person who has been
holding arm lays it on
arm board and fastens it with
a wrist strap.
6.6.3 Hand up towels clips 5 or 6 as
required.
6.6.4 Apply breast sheet so axilla is
exposed for anticipated
axillary dissection or drape to
expose breast only if no
axillary dissection.
6.7
APPLIES TO:
Shoulder Surgery:
6.7.1 Arm is held up following skin
preparation.
6.7.2 Place towel under arm and
shoulder.
6.7.3 Place towel over the chest
covering the neck.
6.7.4 Surgeon’s outline operation
with towels and secure with
towel clips.
6.7.5 Surgeon’s wrap the arm
securing it with a sterile
bandage. Sterile member of
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the team relieves person who
has been holding arm.
6.7.6 Cover the rest of the patient
including anesthesia screen
with a large sheet.
6.8
APPLIES TO:
Elbow Surgery:
6.8.1 Arm is held up following skin
preparation.
6.8.2 Place towel over arm board
6.8.3 Surgeon places a towel
around lower arm, to limit
area of site of operation, and
secure it with a towel clip.
6.8.4 Pull stockinet over hand or
surgeon wrap towel hand with
a towel securing it sterile
bandage. The circulating
nurse is relieved of holding
arm. The arm is laid on
arm board.
6.8.5 Place large sheet on top of
the arm covering, the chest
including the anesthesia
screen.
6.8.6 Cover the rest of patient’s
body with another large
sheet.
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Hand Surgery:
6.9.2 Place towel under arm board.
6.9.3 Pull stockinet/sterile gloves
over hand the arm is laid on
arm board.
6.9.4 Place large sheet to cover
patient including anesthesia
screen.
6.10 Perineum : In Lithotomy position:
6.10.1 Place one towel under the
buttocks.
6.10.2 Cover each leg and stirrup
with one legging sheet.
6.10.3 Place one large sheet over
pubic area towards the
abdomen.
Hip Surgery:
6.11.1
Leg is held up following skin
preparation.
6.11.2 Place large sheet under the
leg up to the buttocks.
6.11.3
NURSING
DRAPING OF PATIENT FOR SURGERY
6.9.1 Arm is held up following skin
preparation.
6.11
APPLIES TO:
Surgeon wrapped foot and
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leg and secure with sterile
bandage.
6.11.4 Surgeon outlines the
incision area with towels
securing it with towel clip or
sew it.
6.11.5 Place large sheet above
operative area and over
anesthesia screen.
6.11.6 Place sterile adhesive drape
over incision area and towels
according to surgeon’s
preference.
6.12 Knee Surgery:
6.12.1
APPLIES TO:
Leg is held up following skin
preparation.
6.12.2 Place large towel under the leg
up to buttock.
6.12.3 Surgeon limits sterile field
above knee by placing towel
around the leg and secure with
towel clip.
6.12.4 Surgeon wrap the leg with towel
securing it with sterile bandage.
6.12.5 Place large sheet above the
operative area and cover the
patient towards the head.
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6.13 Lower Leg and ankle:
6.13.1
APPLIES TO:
Leg is held up following skin
preparation.
6.13.2 Place large sheet under leg.
6.13.3 Surgeon wrapped the leg
above area of intended incision
and secure with towel clip.
6.13.4 Surgeon wrapped the lower
part of foot with towel or sterile
gloves. Sterile team relieves
the person holding the leg.
6.13.5 Place large sheet over the
patient toward the head of the
patient.
6.14 Foot Surgery:
6.14.1 Foot is held up following skin
preparation.
6.14.2 Place large sheet on table,
under foot.
6.14.3 Enclose foot stockinet/gloves
sterile team relieves person
holding the leg.
6.14.4 Place large sheet over the foot
toward the head of the patient.
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TITLE:
SNR-OR-026
APPLIES TO:
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7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-184
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-027
APPLIES TO:
NURSING
DISCREPANCY IN SURGICAL COUNTS
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
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1.0 DEFINITION
Lacking of instruments, sponges and sharps item during procedure.
2.0 PURPOSE
2.1 To systematically and thoroughly search for the items sponge and sharps or instrument in
an operation.
2.2 To prevent any retain of foreign body in any part of patient's body cavity that may cause
physical injury, wound infection or disruption of wound healing.
3.0 POLICY
3.1 All surgical Scrub Team should abide to surgical count policy strictly. Scrub Nurse and
Circulating Nurse will inform surgeon immediately for any discrepancy in surgical count.
Surgeon must acknowledge Circulating Nurse for surgical count. Hospital administration
personnel must be informed and incident report must be written for any discrepancy in
surgical counts.
4.0 RESPONSIBILITIES
4.1 Scrub Nurse
4.2 Circulating Nurse
5.0 MATERIALS & EQUIPMENT
5.1 All swabs, sharps, and surgical instrument that is required in the operation.
5.2 Intra-operative report form.
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APPLIES TO:
DISCREPANCY IN SURGICAL COUNTS
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6.0 PROCEDURES
6.1
Inform surgeon immediately once a
surgical count is incorrect.
6.2
Repeat entire count immediately.
6.3
Search for the missing items.
6.3.1
Circulating nurse look into the
kick bucket, trash receptacles,
floor, linen hamper, underneath
all operating personnel shoe and
entire operating room.
6.3.2
Scrub nurse look on mayo tray,
scrub nurse trolley/ instrument
trolley and over the drapes.
6.3.3
Surgeon looks into the operative
field and in the wound.
6.4
Notify operating room Head Nurse
immediately.
6.5
Order for X-ray to be taken if missing
item is not found.
6.6
Write incident report regardless of items
found or not found. If found, write
where the item is located and how has it
been found.
6.7
Document in the surgical count sheet of
the incorrect count.
NURSING
RATIONALE
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TITLE:
SNR-OR-027
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NURSING
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7.0 ATTACHMENTS
7.1
Intra-operative Form
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-187
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-028
APPLIES TO:
NURSING
SUPPLIES AND MAINTENANCE IN RECOVERY
ROOM
APPROVAL DATE:
EFFECTIVE DATE:
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1 of 4
1.0 DEFINITION
Making the recovery room unit prepared and ready to received post anesthesia patient to deliver optimum
care to patient.
2.0 PURPOSE
2.1 To ensure proper supplies and equipments are available at all times on a 24hour basis.
2.2 To ensure that all recovery room equipment are always functioning properly.
3.0 POLICY
3.1 Supplies are to be ordered when needed on requisition provided.
3.2 Replace supplies daily as needed.
3.3 Every Monday, a through check of supplies is made and reordering is done.
3.4 A logbook is provided to check all equipments and supply daily, for endorsement and
inventory purposes.
3.5
Discard drapes if sterility is in doubt or when contaminated. Do not handle a contaminated
drape further, discard it without contaminating gloves or other items.
4.0 RESPONSIBILITIES
4.1 Recovery Room Nurse
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5.0 MATERIALS & EQUIPMENT
5.1 Oxygen flow meter
5.2 Oxygen mask, prongs and tubing
5.3 Blood pressure cuff
5.4 Stethoscope
5.5
Various size syringes
5.6
Various size needles
5.7
5.8
Dressings (sterile gauge)
Various tapes and adhesives
5.9
Tissues
NURSING
5.10 Cardiac monitor and electrodes
5.11 Towel and wash clothes
5.12 Tongue depressor
5.13 Alcohol prep
5.14 Emesis basins
5.15 Oral airway, various sizes
5.16 Suction catheter, various sizes
5.17 Sterile gloves
5.18 Sterile water for injection
5.19 Kelly clamps
5.20 Intravenous infusion
5.21 Urinals and bedpans
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APPLIES TO:
SUPPLIES AND MAINTENANCE IN RECOVERY
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6.0 PROCEDURES
RATIONALE
6.1
At the beginning of every 12hours shift,
the senior in charge nurse in recovery
room checks all supplies and equipment
guided by a logbook to be signed.
6.2
Receive special endorsement from outgoing
shift staff.
6.3
Crash cart has to be checked for
completeness of emergency drugs and
function of defibrillator and suction machine.
6.4
Check to see that all machines are
functioning well and all accessories are
present.
6.5
Put on draw sheet on all trolleys, ready
to receive patient at any time.
6.6
Check the following:
6.6.1 wall mounted suction
6.6.2 warmer
6.6.3 centralized oxygen supply
6.6.4 blood pressure, saturation,
ECG monitoring machines
6.7
Check all forms and other supplies if
available and replace if needed.
6.8
Be quick to answer phone calls if
possible as nobody will call without
purpose.
NURSING
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6.9
TITLE:
SNR-OR-028
APPLIES TO:
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SUPPLIES AND MAINTENANCE IN RECOVERY
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Report to head nurse any supply
needed but not available.
6.10 Report to head nurse any equipment or
machine not in function to coordinate
with technicians as quick as possible.
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8 th Edition: McGraw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-191
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-029
APPLIES TO:
NURSING
CARE, PHYSICAL RESTRAINTS AND DISCHARGE
OF PATIENT IN RECOVERY ROOM
APPROVAL DATE:
EFFECTIVE DATE:
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1.0 DEFINITION
A care rendered to a patient for safe recovery and arousal from anesthesia, it begins after surgical
procedure is completed and the patient is admitted to post operative recovery area, application of
protective restraints for non-cooperative restless post anesthesia patient's and discharge process for
patient's discharged from post anesthesia care unit.
2.0 PURPOSE
2.1 To assist patient to return to its safe physiological level after anesthesia.
2.2 To allow the nurse to observe a present complication as well as providing
emergency actions.
2.3 To protect patient from injury and operative site from trauma.
2.4 To ensure that the patient to be discharged is stable and ready to return to pre-operative
area.
3.0 POLICY
3.1 Regardless of the surgical procedure performed the patient must be observed, well
recovered before transfer to the nursing unit.
3.2
Restraints should be used only as necessary to prevent injury.
3.3
Restraints shall be used only per physicians advice/ or after considerations had made.
3.4
Patient and family should be informed that the restraint is temporary and protection.
3.0 POLICY
3.5 Use only soft restraints for wrist or ankle for confused or semi-conscious patient.
3.6 Attach restraints stumps to bed frame not with the side rails.
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TITLE:
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3.7 Check the circulation and skin integrity of the restrained wrist or ankle every now and
then.
3.8
Document in the nurses notes patient's behavior support your protective measures.
4.0 RESPONSIBILITIES
4.1 Anesthesiologist
4.2 Recovery Room nurse
5.0 MATERIALS & EQUIPMENT
5.1
Cardiac monitors and electrodes
5.2
Oxygen apparatus/ flow meter
5.3
Oxygen mask, prongs and tubing's
5.4
Saturation probe
5.5
BP cuffs
5.6
Thermometer
5.7
Stethoscope
5.8
Suction apparatus
5.9
Different sizes of suction catheter
5.10 Emesis basin
5.11 Sterile/ disposable gloves
5.12 Intravenous infusion fluids
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TITLE:
SNR-OR-029
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5.13 Urinals and bedpans
5.14 Urine bags
5.15 Kelly clamp
5.16 Different sizes of oral airway
5.17 Various size syringes
5.18 Various size needles
5.17 Sterile water for injection
5.18 Alcohol prep
5.19 Tissue
5.22 Warmer apparatus
5.23 Patient's file-with post-operative record, post-operative order, intra-operative record
5.24 Anesthesia record
5.25 X-ray film with x-ray jacket
5.26 Medication card
5.27 Recovery report
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SNR-OR-029
NURSING
CARE, PHYSICAL RESTRAINTS AND DISCHARGE
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6.0 PROCEDURES
6.1
APPLIES TO:
RATIONALE
Upon receiving the patient, the recovery
room nurse should receive a verbal
hand over from the anesthetist and the
theatre nurse to ensure continuity of
care.
6.2 The recovery room nurse immediately
checks the potency of the patient’s
airway and administer oxygen via an
oxygen mask.
6.3 Oxygen should be delivered at 5 liters
per minute via the flow meter or as
directed by the anesthetist. The amount
of oxygen delivered to pediatric patients
will be determined by the anesthetist.
6.4
Suction should be ready at all times.
Oxygen is continued until the patient is
awake and oriented with oxygen
saturation of greater than 90% or
hemodynamically stable, disorientation
and restlessness, area and skin
condition where restraint is to be placed.
6.5
Vital signs are taken on admission to
establish a baseline data and every 5
minutes interval.
6.5.1 Vital signs consist
6.5.1.1 Blood pressure
6.5.1.2 Pulse rate
6.5.1.3 Circulation
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TITLE:
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NURSING
CARE, PHYSICAL RESTRAINTS AND DISCHARGE
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6.5.1.4 Movement
6.5.1.5 Temperature
6.5.2 Measure the level of
consciousness, check from
potency of catheters and drains,
wound dressings, blood loss.
6.6 Vital signs must be cross referenced
with pre-operative and intra-operative
observations to determine deviations.
6.7 The patients comfort should be
considered at all times, provide
privacy and adjust bed to proper height.
6.8
Warm blankets should be applied, pad
skin and bony prominences that will be
under restraints. And evaluate skin
under restraints for abrasion and patient
response to restraints.
6.9
Ensure that the correct intravenous fluid
is infusing according to the physicians
order and that the cannula is patent and
secure (all cannula should be signed
and dated).
6.10 Analgesic and anti-emetics should be
given as ordered by the physician.
6.11 Arterial lines and central venous lines
should be monitored (if present).
6.12 In case a blood transfusion is infusing
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INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-029
APPLIES TO:
NURSING
CARE, PHYSICAL RESTRAINTS AND DISCHARGE
OF PATIENT IN RECOVERY ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
at the time patient is endorsed to
recovery room staff, proper
endorsement must be taken from
anesthesia team.
6.13 Patient’s having local anesthesia will
remain in recovery room for:
6.13.1 Complete assessment of
patient’s condition.
6.13.2
Documents; should be properly
accomplished and notify doctor for
any changes.
6.13.3
Post-operative evaluation is
signed by the anesthetist that the
patient is fit for safety transfer
from operating room department to
another unit.
6.13.4
Proper endorsement must be
given to the ward staff, all
important information's.
6.13.5
Recovery Room staff gives
verbal report of the patient's
status to the ward nurse
responsible for the continuity of
post operative management.
7.0 ATTACHMENTS
N/A
OR-197
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POLICY NUMBER:
IPP
TITLE:
SNR-OR-029
APPLIES TO:
NURSING
CARE, PHYSICAL RESTRAINTS AND DISCHARGE
OF PATIENT IN RECOVERY ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
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8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient preparation. 2nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8 th Edition: McGraw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-198
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
SNR-OR-030
TITLE:
IPP
APPLIES TO:
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
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1.0 DEFINITION
To collect data about the surgical patient through interviews, physical assessment and evaluation of
records to facilitate an individualized patient care plan and continuity of care.
2.0 PURPOSE
2.1
To collect data about the surgical patient before surgical operation.
3.0 POLICY
3.1
DOCUMENTATION:
3.1.1 The patient's identification must be present on all documents caring the correct details.
3.1.2
All documents must be completed with current and relevant data.
3.1.3
Writes all data if an addressograph label is not available.
3.1.4
Writes the date and time of each entry.
3.1.5
Writes all information in ink.
3.1.6
Writes factual information only.
3.1.7
Uses approved abbreviations only.
3.1.8
Avoids using vague terms.
3.1.9
Writes reports objectively.
3.1.10 Do not write over mistakes or between written lines.
3.1.11 Do not use ink or adhesive paper on any medical records.
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SPECIALIZED NURSING: OPERATING ROOM
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POLICY NUMBER:
IPP
TITLE:
SNR-OR-030
APPLIES TO:
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
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3.1.12 Crosses errors with a single line and adds initials.
3.1.13 All observations must be recorded accurately.
3.1.14 Record all documents and chart in accordance with legal requirements and hospital
policy.
3.1.15
Accurately completes all charts prior to the patients return to the ward.
3.1.16
All incident report is complete and accurate in case of unusual occurrences.
3.1.16.1 Inaccuracies in the surgical count.
3.1.16.2 Patient injury.
3.1.16.3 Medication errors.
3.1.16.4 Staff Injury.
3.1.16.5 Unsafe condition.
3.1.16.6 Loss or hefty.
3.2
WRITING INCIDENT REPORT:
3.2.1
Write the incident report in accordance with legal requirements and hospital
standards.
3.2.2
Give details of person involved in the incident.
3.2.3
Records any facts, observations and actions.
3.2.4
Make a comprehensive description in case of lost property:
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IPP
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TITLE:
APPLIES TO:
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
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EFFECTIVE DATE:
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3.2.4.1 Approximate cost
3.2.4.2 Color
3.2.4.3 Size
3.2.4.4 Where and when it was last seen
3.2.5
Case of involving the patient.
3.2.5.1 Record the time the doctor visited patient.
3.3
3.2.6
Hands the completed incident report to the Head Nurse in charge Operating
Room.
3.2.7
Enter the details of the incident on the peri-operative care plan and record if
required.
PROCEDURE OF INCIDENT REPORT:
3.3.1
Guidelines to write a statement:
3.3.1.1 The statement should be written as soon as possible after the occurrence
of the event.
3.3.1.2 The statement should state only what the writer has personally witnessed.
3.3.1.3 Sentences must be short, clear, using simple language describing
accurately the occurrence under discussion.
3.3.1.4
Opinion should not be given.
3.3.1.5 The statements must indicate the time and date of the occurrence.
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POLICY NUMBER:
TITLE:
IPP
SNR-OR-030
APPLIES TO:
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
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3.3.1.6 The document is to be signed and dated.
3.3.1.7 If a witness is present, he/She should complete a statement.
3.3.1.8 Statements should be carefully checked to ensure the validity and
accuracy.
3.3.1.9 Statement must be handed to the O.R. in charge who will submit it to the
Nurse Manager.
3.4 COMMENTS:
3.4.1
The Nursing care given to a patient during the peri-operative phase of their surgical
experience should be documented and retained as an integral part of the patient's
medical record.
4.0 RESPONSIBILITIES
4.1 Ward Staff
4.0 RESPONSIBILITIES
4.2 Recovery Room Staff
5.0 MATERIALS & EQUIPMENT
5.1
Patient chart-Medical records-Laboratory results and X-Ray reports.
6.0 PROCEDURES
6.1
RATIONALE
Admission to the Operating Theatre:
6.1.1 The Receiving Nurse6.1.1.1
Will perform patient
interview to identify
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6.1.1.2
6.1.1.3
6.1.1.4
6.1.1.5
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
psychosocial and
cultural needs of the
patient.
Perform a visual physical
assessment of the patient to
identify physical limitations
considerations of the patient.
Will document
assessment findings on
the nursing record.
Will communicate
assessment findings to the
Health Care team for
continuity of care.
SN's in the operating
room & (PACU)
Recovery will asses the
patient intra operatively
and post operatively to
evaluate the effect the
peri-operative nursing
care on the patient.
6.2 Documentations:
6.2.1 Pre-Operative identification and
peri-operative admission
procedures.
6.2.2
APPLIES TO:
Intra-operative Nursing Care.
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6.3
SNR-OR-030
TITLE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
Anesthesia Care
6.2.4
Surgical count record.
6.2.5
Post-operative Nursing Care
and Observations.
6.2.6
Incidence Reporting.
6.2.7
Entries into the drug register.
6.2.8
Record of specimens.
6.2.9
Implant tracking, and provide
accurate documentation that
details the planning,
implementation and evaluation
of all of the Nursing care
delivered.
Legal Requirements:
The Peri-operative Nurse must:
6.3.1.1 Comply with all
statutory requirements
for documentation.
6.3.1.2 Comply with the Health
care facility's policy on
documentation.
6.3.1.3
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
APPROVAL DATE:
6.2.3
6.3.1
APPLIES TO:
Documents events and care
chronologically and
contemporaneously.
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6.3.2
SNR-OR-030
TITLE:
APPLIES TO:
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6.3.1.4
Ensure that all of the
documentation is accurate,
objective and concise.
6.3.1.5
Ensure that all of the
documentation is legible,
signed and dated.
Intra-operative Documentation
must:
6.3.2.1 Document personnel
providing the
peri- operative care
(Name, Title & MRN).
6.3.2.2
Identify surgery and
wound classification.
6.3.2.3
Document date and time
of surgery, arrival in the
operating Room and
anesthesia times.
6.3.2.4
Identify type of
anesthesia.
6.3.2.5
Document pre-operative,
post-operative and
operative procedure.
6.3.2.6
Use of Intra-Operative
x-rays:
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TITLE:
APPROVAL DATE:
EFFECTIVE DATE:
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6.3.2.6.2 X-Ray
Technicians
name
6.3.2.7 Monitoring equipment
used (ECG, NIBP, and
SaO2 etc.)
6.3.2.8 Patient' specimens and
cultures taken during
the surgical procedure.
Document the patients overall skin
condition on arrival and discharge from
the peri-operative suite:
6.4.1 Skin Integrity and condition.
6.4.2 Location of the skin prep. And
Shave site.
6.4.3
Type of skin prep solution used.
6.4.4
Location and type of drains and
wound packing.
6.4.5
Type of Foley catheter used and
personnel inserting.
6.4.6
Dressing type and site.
6.4.7
Additional Nursing notes-any
significant or unusual occurrences
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
6.3.2.6.1 X-Ray site
6.4
APPLIES TO:
OR-206
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POLICY NUMBER:
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SNR-OR-030
TITLE:
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
Implant Record:
6.5.1 Placement and location of
implants (e.g. prosthetic devices,
grafts, tissue and bone).
6.6
6.5.2
Name of Manufacturer / Distributor.
6.5.3
Lot and Serial number.
6.5.4
Expiration Date
6.5.5
Patient's name MRN, Telephone
number (if applicable) & address.
6.5.6
Physician implanting.
Patient Positioning:
6.6.1
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
pertinent to peri-operative patient
outcomes.
6.5
APPLIES TO:
Use of pat-slide or slide sheet
when indicated for use.
6.6.2
Position on the table.
6.6.3
Position of the arms.
6.6.4
Use of leg or body straps.
6.6.5
Positional devices (e.g. stirrups,
clowards frame, chest roll and etc.)
6.6.6
Use of padding or protective
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devices.
6.7
Equipment:
6.7.1 Tourniquet- a) site b) pressure
c) time on and off.
6.8
6.7.2
Insufflators- time on and off.
6.7.3
Electrosurgical Unit- a) serial
number b) settings
c) dispersive pad site
6.7.3
Warming Device- (Bair hugger or
Mallinkrodt)-serial number and
setting Laser- a) serial number b)
operator c) setting d) laser safety
protocols implemented.
Sponge and instrument counts (see IPP
Surgical Count)
6.8.1 The surgical count must be
accurately documented in the
patient's medical record.
6.8.2
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
TITLE:
IPP
APPLIES TO:
The peri-operative nurses must
comply with the health care facility's
policy in relation to the surgical
Count.
6.8.3 The peri-operative nurse must
comply with the AORN Standard
"Recommended Practices for
Counts-Sponge, Sharp and
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TITLE:
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
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Instrument".
6.8.4 The peri-operative nurses must
ensure that the count sheet is
retained in the patients medical
record.
6.9
APPLIES TO:
Sponge and instrument counts (see IPP
Surgical Count)
6.9.1 The peri-operative nurses must
ensure that the count sheet is
signed by the nurses
responsible for the counts.
6.9.2
Sponge, needle and sharps X3
6.9.3
Instrument Count x 2
6.9.4
Initial / signatures of person
counting
6.9.5
Instrument Intact
6.9.6
Document person reporting counts,
surgeon and person response.
6.10 Intra-operative Fluid Balance
6.10.1 Type, amount and total infused.
6.10.2 Blood Products-listed unit number
of each product used.
6.10.3 Estimated Blood Loss.
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TITLE:
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6.11 Medications:
6.11.1
Irrigation (Normal Saline,
Glycine, H2O)
6.11.2
Narcotics used / wasted.
6.11.3
Antibiotics
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
6.10.4 Total urine output.
6.12 Planning and providing care
6.12.1
APPLIES TO:
Unit (PACU/Recovery, ICU,
NICU, PICU etc.)
6.12.2
Name of the staff member handed
over to.
6.12.3
Patients transfer via stretcher or
bed
6.12.4
Patient transfer Status- a)
spontaneous respirations b)
intubated c) oral airway d)
assisted respirations e) ambu- bag
f) Jackson Rees circuit (paediatric)
etc
6.13 Planning and Providing Care
6.13.1 Initial vital signs from PACU /
Recovery.
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6.14.1 The patients record should
reflect a continuous evaluation
of the peri-operative Nursing
care and the patient's response
to applied nursing interventions.
Ensure that any information
documented on nursing care
plans is made in a timely
manner and only by the nursing
staff directly involved with the
patients care.
6.15 Confidentiality
6.15.1
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
6.14 Circulating Nurses signature and date.
6.14.2
APPLIES TO:
The peri-operative nurse must
ensure that the patients rights
to confidentiality are preserved.
6.15.2
Store records in areas to which
only authorized staff are permitted.
6.15.3
Comply with the Health Care
facility's policy for the use of
patient medical records in research
activities.
OR-211
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______________________________________________
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INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-030
APPLIES TO:
NURSING
PERI-OPERATIVE DOCUMENTATION FOR
OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
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7.0 ATTACHMENTS
7.1 Peri-operative checklist
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-212
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-031
APPLIES TO:
TRANSFERRING PATIENT FROM TROLLEY TO
ANOTHER TROLLEY/ OR TABLE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1.0 DEFINITION
Assisting patient from trolley to another trolley without creating injury to the patient.
2.0 PURPOSE
2.1 To prevent musculo-skeletal injury.
2.2 To provide good body alignment.
3.0 POLICY
3.1 Adequate assistance is required when transferring patient.
3.2 The care of intravenous line, drainage tubes or traction must be maintained to ensure
safety throughout the procedure.
3.3
Patient's safety and comfort must be observed throughout the procedure.
3.4
Watcher can be included to assist in transferring.
3.5
Encourage patient to participate.
3.6
Use a safe and effective transfer technique.
4.0 RESPONSIBILITIES
4.1
NURSING
OR Staff Nurse
4.2 Ward Staff Nurse
OR-213
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POLICY NUMBER:
SNR-OR-031
TITLE:
IPP
APPLIES TO:
TRANSFERRING PATIENT FROM TROLLEY TO
ANOTHER TROLLEY/ OR TABLE
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
5.0 MATERIALS & EQUIPMENT
5.1 Lifting sheet
5.2 Trolley
6.0 PROCEDURES
6.1
RATIONALE
Assess patient for:
6.1.1 Body alignment
6.1.2
Risk factors that can contribute
to complication brought about
by improper shifting.
6.1.3
Level of consciousness.
6.1.4 Physical ability to help with
moving and shifting.
6.2
6.1.5
Presence of drains, incisions.
6.1.6
Number of assistance required
to transfer patient.
Prepare for complete equipment.
6.3 Obtain adequate assistance.
6.4
Explain the procedure to the patient/
relative.
6.5
Provide privacy.
6.6
Raise or lower level of bed to
NURSING
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Remove all devices or pillows used in
previous position.
6.8 Place the bed flat and position patient to
supine.
6.9
NURSING
TRANSFERRING PATIENT FROM TROLLEY TO
ANOTHER TROLLEY/ OR TABLE
comfortable working height.
6.7
APPLIES TO:
Place both trolleys side by side and
same height lock the wheels of both
trolleys.
6.10 Place patient's both arms across the
chest or abdomen.
6.11 Check all necessary actions has been
carried out.
6.12 Take appropriate position:
6.12.1 Nurse A position at center of
bed.
6.12.2
Nurse B position at head of
bed.
6.12.3
Nurse C position at foot of bed.
6.13 Grasp the lifting sheet.
6.14 Inform patient that you will start to
transfer from operating room trolley to
ward trolley.
6.15 Count three and simultaneously lift the
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POLICY NUMBER:
IPP
SNR-OR-031
TITLE:
APPLIES TO:
NURSING
TRANSFERRING PATIENT FROM TROLLEY TO
ANOTHER TROLLEY/ OR TABLE
APPROVAL DATE:
EFFECTIVE DATE:
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bed-sheet to the center of ward trolley.
6.16 Place patient in a comfortable position/
check all tubing's.
6.17 Raise up the side rails.
6.18 Evaluate patient and document in the
nurses notes patient is safely shifted to
another trolley.
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-216
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-032
APPLIES TO:
NURSING
CARE AND CLEANING OF SURGICAL
INSTRUMENTS AND POWERED EQUIPMENTS
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
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1.0 DEFINITION
These recommended practices provide guidelines to assist peri-operative staff in the decontamination,
cleaning, maintenance, handling, storage, and/ or sterilization of surgical instruments and powered
equipment.
2.0 PURPOSE
2.1 To avoid using instruments in poor working condition.
2.2 To avoid creating serious hazard to the patient.
3.0 POLICY
3.1 Each instrument must be actually inspected after each cleaning.
3.2 Instruments with movable parts should be inspected and tested.
3.3 Instruments should be repaired at the first sign of damage or malfunction.
3.4 If an instrument breaks during a procedure all nurses should be accounted for.
4.0 RESPONSIBILITIES
4.1
OR Staff Nurse
5.0 MATERIALS & EQUIPMENT
5.1 Used instruments
5.2 Scrub soap
5.3 Medical air
OR-217
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-032
TITLE:
NURSING
CARE AND CLEANING OF SURGICAL
INSTRUMENTS AND POWERED EQUIPMENTS
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6.0 PROCEDURES
6.1
APPLIES TO:
2 of 9
RATIONALE
Cleaning instruments during
procedure:
6.1.1 Wiping the instruments with
sponges moistened with sterile
water, gross contaminants may
be removed.
6.1.1
6.1.2
Cleaning of blood and secretions
on instruments may result in
retained organisms.
6.1.3
Corrosion, rusting, and pitting
Occur when blood and debris
are allowed to dry in or on
surgical instruments.
6.1.4
Cannulated or lumened
instruments may become obstructed
from organic material.
6.1.5
Irrigating instruments with sterile
Water removes residues and prevents
tissue damage.
6.1.6 Saline causes deterioration of
instrument surfaces.
6.1.7 Decontamination of instruments
initially begins immediately after
Careful cleaning lengthens the life of
the instruments, reduces replacement
costs, and may reduce the risk of exposure
of personnel to bio-hazardous material.
6.1.6 Pitting of the instruments occurs from
prolonged contact with saline and
blood. Saline deposits in box locks
cause rusting.
6.1.7 The cleaning process, and protection
of instruments, is facilitated by
organized sorting, and wiping of soil
OR-218
Ministry of Health, General Nursing Administration
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______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-032
TITLE:
APPLIES TO:
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CARE AND CLEANING OF SURGICAL
INSTRUMENTS AND POWERED EQUIPMENTS
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the completion of any invasive
procedure.
3 of 9
from instruments, before sending to
the central cleaning area (CSSD).
6.1.8 Disassemble the set-up by
separating delicate/ sharp
instruments, and by soaking
soiled and bloody instruments.
6.2
6.1.9 Hand washing of instruments
should be used whenever
possible, brushing should be
avoided.
6.1.9
6.1.10 Dropping of instruments into
basins, or sinks should be
avoided.
6.1.10 Instrument tips may be damaged and
joints may be sprung from the abuse.
6.1.11 Care should especially be taken
not to drop instruments on the
floor.
6.1.11 Instruments are very costly to replace,
and not always readily available from
distributors.
6.1.12 Dried instruments should store
either sterile or un-sterile.
6.1.12
Care and proper use of instruments:
6.2.1 Handled gently the instruments
in small groups or individually if
OR-219
Brushing of instruments causes
aerosol droplets that may contaminate
personnel resulting in infection.
Later spotting and rusting results
when instruments are stored wet.
Sterile sets may become
contaminated by moisture droplets or
by strike through.
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-032
APPLIES TO:
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CARE AND CLEANING OF SURGICAL
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4 of 9
delicate.
6.2.2
6.2.3
Used only the instruments for their
intended purpose.
Protected delicate tips and sharp
edges from damage and possible
protrusion through mesh-bottomed
trays.
6.2.2 Abuse causes strain, breakage and
dulling of sharp edges.
6.2.3 Wrapping instruments in towels, plastic
mats or foam wraps, or using protective
tips (snuggers) or special foam padded
boxes, prevent damage to instruments
and injury to personnel.
6.2.4 Placed the heavy instruments at
the bottom of trays.
6.2.4 Damage to fine instruments will occur
otherwise.
6.2.5 Ratchet styled instruments should
only be closed to the first notch
when being passed to the
surgeon or assistant.
6.2.5 Excessive pressure on ratchets causes
spreading of the instrument tips and
causes strain on the box joints.
6.2.6 Keep box locks, ratchets and
hinges free from debris.
6.2.6 If substances are allowed to build up,
the instrument will become stiff and
become subject to misalignment and
cracking.
OR-220
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Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-032
TITLE:
NURSING
CARE AND CLEANING OF SURGICAL
INSTRUMENTS AND POWERED EQUIPMENTS
APPROVAL DATE:
EFFECTIVE DATE:
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6.2.7 Passed to, and received from
the surgeon the sharp
instruments in the yellow plastic
dish provided.
6.3
APPLIES TO:
5 of 9
6.2.7 The yellow dish is to highlight the fact
that sharp is in transit.
Damaged Instruments:
6.3.1
Inspect instruments when
initially opening trays for proper
alignment of tips, ease in
opening and closing hinges,
ratchets etc.
6.3.2 Found defects, the item/s must
be isolated, clearly marked for
repair or replacement, and
documented on the instrument
checklist as damaged.
6.3.3
If an item is damaged during an
invasive procedure, the same
process should be followed.
Ensure always that all parts of
6.3.2 Enable CSSD to resolve the problem
as soon as possible.
6.4.3
OR-221
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______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
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POLICY NUMBER:
IPP
SNR-OR-032
TITLE:
APPLIES TO:
NURSING
CARE AND CLEANING OF SURGICAL
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the instrument are located, and
not inadvertently left in the
patient. Surgeon must be
aware.
6.4
Powered Equipment:
6.4.1 Care and sterilization of power
equipment should be followed at
all times.
6.4.2 Tested all equipments before
being handed to the surgeon.
All team members should wear
eye protection.
6.4.2 Advance testing of power
equipment ensures proper working
conditions, safety for the operator, and
avoids delays after the surgery has
begun.
6.4.3 Air-powered equipment: should
not be immersed in any liquid.
6.4.4
6.4.4
Decontamination and
sterilization, the equipment
should be disassembled
according to the Manufacturer's
specifications, prior to cleaning.
If power equipment is immersed, fluid will
enter the interior and cause rusting and
damage.
6.4.4 Proper cleaning and sterilizing
will prolong the life and use of the
equipments.
6.4.5 Operate Air-Powered
equipments with Medical-grade
compressed air and
compressed dry nitrogen
(99.97% pressure).
6.4.5 Excessive pressure can damaged
equipment and exert great stress on
air hoses.
6.4.6 Set operating powered
equipment and the correct
6.4.6
OR-222
Electrically powered equipment may
be a potential explosion hazard in the
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-032
TITLE:
NURSING
CARE AND CLEANING OF SURGICAL
INSTRUMENTS AND POWERED EQUIPMENTS
APPROVAL DATE:
EFFECTIVE DATE:
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pressure as the manufacturer's
recommendation.
6.4.7
APPLIES TO:
7 of 9
operating room.
Motors should be explosion
proof. All electrical equipment
should have spark proof
connections. Power switches
should be off when plugging
electrical cords into outlets. All
motors should be tested on a
regular basis, for leakage by
Biomedical Engineer's.
6.4.8 The motor should not be
immersed in any liquid.
6.4.9 Checked all power cords and
plugs for any cracks or breaks
prior to each use.
6.4.9 Faulty cords may result in loss
of power during surgery, electrical
shorts and fires
6.4.10 Checked all electrical
equipments routinely by
Biomedical Department before
being put into service, and
thereafter should be included
in a preventive maintenance
program.
6.4.10 Preventive maintenance provides
control to ensure the safety of patients,
staff and equipments.
6.4.11 Maintained a record of and on
the equipment, unless the
record impedes sterilization or
use.
6.4.11 Maintenance records serve as a guide
for replacement or repair, and form
part of the Quality Improvement
Program.
OR-223
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
6.5
SNR-OR-032
TITLE:
APPLIES TO:
NURSING
CARE AND CLEANING OF SURGICAL
INSTRUMENTS AND POWERED EQUIPMENTS
APPROVAL DATE:
EFFECTIVE DATE:
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8 of 9
Staff Education:
6.5.1 Provided all operating room staff
with in service education on
equipment utilized in the
operating room complex.
6.5.2 Provide education with Medical
representatives and their
companies and backup service
for all new equipment.
6.5.3
It is policy of the hospital that
surgeons must be accredited by
the Privilege Committee and
signed off and approved by the
Medical Director, prior to
Utilizing new equipment (e.g.
Holmium Laser, Sterotactics,
etc).
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
OR-224
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-032
APPLIES TO:
NURSING
CARE AND CLEANING OF SURGICAL
INSTRUMENTS AND POWERED EQUIPMENTS
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
NAME:
9 of 9
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-225
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-BC-033
APPLIES TO:
NURSING
CARE OF SURGICAL MICROSCOPE IN OPERATING
ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 3
1.0 DEFINITION
A magnifying glass that can assists the surgeon in obtaining a sharp, non-distorted image of the surgical
site.
2.0 PURPOSE
2.1 To constantly maintain the microscope in an optimal state.
2.2 To educate the nurse working with the microscope about its features and
component to facilitate a successful surgery.
3.0 POLICY
3.1 Check to see that all knobs are secured after the microscope has been placed in final
position.
3.2 Assist the surgeon with attachments of accessory items.
3.3 Take special care of power cables to prevent accidental breakage, be sure they are properly coiled
for storage.
3.4 Take special care of special items to avoid breaking, scratching or leaving fingerprints.
3.5 Tighten the lens to fingertips tightness only, being careful not to cross thread during attachment.
3.6 When attaching the lens, perform the task over a paddle surface to prevent accidental breakage if
dropped.
OR-226
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
SNR-BC-033
POLICY NUMBER:
IPP
TITLE:
APPLIES TO:
NURSING
CARE OF SURGICAL MICROSCOPE IN OPERATING
ROOM
APPROVAL DATE:
EFFECTIVE DATE:
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2 of 3
3.0 POLICY
3.7 Cleaning process should follow manufacturer’s guidelines.
3.8 Keep extra lamp bulbs and fuses available.
3.9 When moving microscope, position the viewing portion over the base to add stability.
3.10 When storing microscope, avoid using plastic bag or cover instead, use a cloth pillowcase.
3.11 Cover the foot pedal with a clear bag to keep it clean and dry.
4.0 RESPONSIBILITIES
4.1 Scrub Nurse
4.2 Circulating Nurse
5.0 MATERIALS & EQUIPMENT
5.1
Microscope and accessories
5.2
Foot pedal
5.3
Cloth pillow case
6.0 PROCEDURES
6.1
Verify with the circulator the lens for a
specific surgeon and procedure.
6.2
Check the lens and oculars are clean.
6.3
Put the drape properly to accommodate
microscope accessory items with
maintaining sterile T-square.
RATIONALE
OR-227
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-BC-033
APPLIES TO:
NURSING
CARE OF SURGICAL MICROSCOPE IN OPERATING
ROOM
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6.4
Place mayo tray and instrument table in
convenient location so your eyes do not have
to leave the field.
6.5
Maintain a calm atmosphere, fine and slow
direction is going on.
3 of 3
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-228
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-034
APPLIES TO:
NURSING
DEATH PROTOCOL
TITLE:
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 5
1.0 DEFINITION
Rendered Care for the deceased Patient with respect to religious and cultural beliefs.
2.0 PURPOSE
2.1 To safeguard the dignity and rights of a dead patient's.
2.2 To prepare the body for family to take home.
2.3 To compile and check for completion of documents in patient's file.
3.0 POLICY
3.1
Death protocol is to be carried out after Death Declaration of the patient and certification.
3.2 Privacy and respect of the Deceased and Family must be observed throughout the
procedure.
3.3 Attending Surgeons/ Mortuary Personnel is responsible in informing the relatives of the
patient's Demise.
3.4
Security Supervisor must be informed for Medico-Legal Cases.
3.5 Detailed documentation of patient's death is written in nurses notes by nurse-in charge of
patient.
4.0 RESPONSIBILITIES
4.1 OR Nurse
OR-229
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-034
APPLIES TO:
NURSING
DEATH PROTOCOL
TITLE:
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EFFECTIVE DATE:
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2 of 5
5.0 MATERIALS & EQUIPMENT
5.1 Trolley
5.2 Basin, sponge cloth, plastic apron, gloves
5.3 Scissor bandage and tape
5.4 Cotton wool, antiseptic solution
5.5 Three name tags: one for wrist, one for big toes, on the shroud
5.6 Shroud
5.7 Death declaration form
5.8 Receipt of the Death Body Form
6.0 PROCEDURES
6.1
RATIONALE
If death should occur intra operatively
continue with the closure of the
operative site in the usual manner.
6.2 Removed accountable items from the
patient, and the final count shall be
performed as per (IPP Surgical
Count).
6.3 The attending Surgeon/Anesthetist
and the Nursing Staff should
complete all of the relevant
documentation.
6.3 Careful documentation is required
particularly if the death is subject to an
inquiry. Complete all of the relevant
Documentation.
6.4 The time of death should be recorded
in:
OR-230
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______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
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IPP
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DEATH PROTOCOL
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6.4.1 Medial Chart/ Patients Notes
6.4.2 Anesthetic Record
6.4.3 Operative Record
6.5 Notify the AED Nursing during working
Hours.
6.6 Obtained a preliminary death certificate.
6.6
Information of the Nursing and
executive office in order to process the
preliminary death documentation.
6.7 Contacted the Nursing Coordinator
during out of hours and weekends.
6.8 Organize the preliminary death
certificate for the patient's relatives.
6.9 Sent medical chart once all of the
documentation has been completed
to the medical records department.
6.10 Ensure that the attending surgeon
speaks to the patient's relatives.
6.11 Care of the patient:
6.11.1 Cleaned the patient of all
obvious blood.
6.11.1
6.11.2 Covered all wounds with a
suitable dressing, all tubes
should be removed.
6.11.3
Wrapping and securing the
patient will be found in the
shroud kit.
OR-231
Appropriate care of the patient
at death.
Ministry of Health, General Nursing Administration
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______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
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APPLIES TO:
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DEATH PROTOCOL
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6.11.4 The two identification labels will
be secured to the patient, one
on the arm and the other on the
leg or toe.
6.11.4
4 of 5
Clear identification of the
patient is important.
6.11.5 Wrapped the patient in a clean
white sheet.
6.11.6 Transported the patient to the
mortuary, in the mortuary
trolleys.
6.11.6 Two (2) porters are required to
help lift the patient into
mortuary refrigerator.
6.11.7
6.11.7
The attending nurse or the
Nursing Coordinator signs the
patient in to the mortuary, by
filling out the register.
6.11.8 Two patient identification
stickers are required, one for
the mortuary register/ log, and
one for the refrigerator door.
Identification of the patient is
vital for the disposal of/ or the
hand-over of bodies to the
relatives.
6.11.8 Logging in the patient's details
provides a consistent and
permanent record/ tracking
system.
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.2
P & P GN: Kafan Al-Mayet.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
OR-232
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-034
APPLIES TO:
NURSING
DEATH PROTOCOL
TITLE:
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
NAME:
5 of 5
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-233
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
TITLE:
IPP
SNR-OR-035
APPLIES TO:
NURSING
VISITORS IN THE OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 6
1.0 DEFINITION
Prohibition of the entry of non-surgical team in operating room to maintain privacy and confidentiality.
2.0 PURPOSE
2.1 To control the presence of people in patient care areas of the Operating Room.
2.2 To ensure that the standards of a patient's right to privacy, confidentiality, safety and
infection control protocols are upheld.
3.0 POLICY
3.1 All Surgical procedures have potential risks involved. An optimal outcome is desired for all
surgical candidates. The Surgical team desires to provide efficient and safe care for all
surgical candidates.
3.1.1 Family Members are not allowed to observe surgical procedures in order to:
3.1.1.1 Eliminates stress upon the surgical team.
3.1.1.2 Eliminates stress upon the family member in the event of an unusual
occurrence affecting patient outcome.
3.1.2
Medical/Sales Representatives- the patient must be informed and give express
consent for the representative to be in attendance while a procedure is being
performed.
3.0 POLICY
3.1.3
Non-Theatre Personnel- visiting medical students, interns, residents, graduate
nurses and other multi-disciplines must gain permission from the theatre services
manager or designee, before access to the Operating Room Suite is granted.
OR-234
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-035
TITLE:
APPLIES TO:
VISITORS IN THE OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
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4.0 RESPONSIBILITIES
4.1 OR Staff Nurse's
5.0 MATERIALS & EQUIPMENT
N/A
6.0 PROCEDURES
6.1
RATIONALE
Family Members:
6.1.1 One family member may
accompany a patient/child to the
Recovery Holding Bay prior to
their surgical procedure.
6.1.2 They should not be present
during actual surgical procedures.
6.1.3
NURSING
Allow the parent of a pediatric
patient, to escort them into the
operating room anesthetic bay.
6.1.4 Allow family member into the
anesthetic bay, should be
escorted from the theatre suite,
after the induction of anesthesia,
and before intubations.
6.1.5 Family members should not
return to the operating theatre
suite during the procedure or
when the patient is walking up.
6.1.6 Family members may however
enter the Recovery/PACU during
OR-235
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Ministry of Health, General Nursing Administration
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______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
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POLICY NUMBER:
IPP
SNR-OR-035
TITLE:
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NURSING
VISITORS IN THE OPERATING ROOM
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3 of 6
the recovery period to allay their
anxieties.
6.1.7 To remain knowledge in their
field, members of the
peri-operative team must acquire
instruction on new procedures,
techniques, technology and
equipment, for this reason it is
essential to invite medical
representatives and biomedical
engineers into the operating
room.
6.2
6.1.7
Medical Sales Representatives:
6.2.1 Arrangement must be made with
the theatre Manager or designee
and the relevant surgeon, before
a representative is allowed to
enter the facility.
6.2.2 Ensure that the theatre Manager
to had appropriate instruction to
the representative about the
principle of asepsis. Infection
Control practices, blood-borne
pathogens, safety issues, dress
code, patient privacy and
confidentiality prior to entering
the theatre suite.
6.2.3 Observe the policies, procedures
at all times.
OR-236
It is the responsibility of the Medical
Representatives to provide adequate
training to the staff prior to the use of
the device or product.
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-035
TITLE:
NURSING
VISITORS IN THE OPERATING ROOM
APPROVAL DATE:
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6.2.4 Operation of equipments the
medical representatives has
nothing to do or priorities.
6.2.5 Agrees shall be at his or her own
risk to release the institution from
claims and liability to their
presence.
6.2.6 Provide the company
represented by the Medical
representative the materials
Manager or designee.
6.2.7 Agree that the medical
representative must confine his
or her presence to the area
approved.
6.2.8 The signature of the Medical
Representative is important in the
confidentiality release of liability.
6.3
APPLIES TO:
New Product, device or equipments:
6.3.1 Ensure that the materials
management will have
approval for the use intent.
6.3.2 Check the equipment for
electrical integrity and
compatibility features
prior to its acceptance in the
operating room suite by the
bio-medical engineering
OR-237
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-035
TITLE:
NURSING
VISITORS IN THE OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
department.
6.3.3 Check the utilities and
management as required, the
capability of the existing
circuitry to ensure adequate
capacity.
6.3.4 Check and certify the
responsibility of the medical
representative.
6.4
APPLIES TO:
Non-Theatre Personnel- this category
covers: Medical students, interns,
residents, graduate nurses and other
multi disciplines.
6.4.1 Prior arrangements must be
made with the theatre manager
or designee, before access to
the operating theatre is granted.
6.4.2 Non-theatre personnel must be
given adequate instruction on
dress code, asepsis, safety
issues, patient privacy and
confidentiality before entering the
unit.
6.4.3
All must abide the operating theatre
policies and procedures while in the
unit.
6.4.4
All guest, courtesy and respect
for the theatre staff members
working within the unit are
expected.
OR-238
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-035
APPLIES TO:
NURSING
VISITORS IN THE OPERATING ROOM
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
6 of 6
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-239
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-036
APPLIES TO:
NURSING
COORDINATION OF A MAJOR INCIDENT
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 5
1.0 DEFINITION
A catastrophic event which requires unusual and immediate response of hospital resources. It is
therefore imperative to have a method devised to co-ordinate and delegate duties to the appropriate staff
involve.
2.0 PURPOSE
2.1
To facilitate quick response and action, avoid confusion and waste of time.
2.2
To give direction to each member of surgical team.
3.0 POLICY
3.1 Major incidents are likely to occur at any time, because of the geographical location of the
hospital. Therefore staff should familiarize themselves with Action Cards and the Major
Incident Plan in preparation for these times.
4.0 RESPONSIBILITIES
4.1 OR Head Nurse
4.2 OR Staff Nurse
5.0 MATERIALS & EQUIPMENT
5.1 Action Cards
OR-240
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-036
TITLE:
APPLIES TO:
NURSING
COORDINATION OF A MAJOR INCIDENT
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
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6.0 PROCEDURES
2 of 5
RATIONALE
6.1 The HEAD NURSE or designee should
co-ordinate the operating Suites
response, to a Major Incident call during
working hours.
6.2 Upon receiving the Major Incident call,
The head nurse should:
6.2.1
6.2 Good communication avoids
confusion.
Instruct all theatres to complete
procedures as soon as possible.
6.2.2 Postpone all listed procedures
and return patients to the wards
as soon as possible.
6.2.3 Hand out Action Cards to the
head nurse.
6.2.4 Contact the Control Room.
6.3 The head nurse will keep the staff
apprised of the situation as information
is relayed from the Control Room and
the (ER) Emergency Room.
6.3 Preparation for any type of surgery will
lessen confusion and enable staff to
respond quickly to each event.
6.4
6.4 Resuscitation equipment must be readily
available.
Head Nurse will set up their rooms
according to the Action Cards.
6.5 The Senior Anesthetic Technician will
co-ordinate the provision of emergency
anesthetic equipment in each room.
6.6
6.5
The Recovery Room (PACU) Team
Service Leader will designate a
OR-241
Dependent on the number of casualties,
drugs may need reordering as
necessary.
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-036
TITLE:
APPLIES TO:
NURSING
COORDINATION OF A MAJOR INCIDENT
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
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member of staff to:
6.6.1 Check the supply of drugs etc. in
the pharmacy and to order more
if necessary.
6.6.2
Check the defibrillator.
6.6.3Ascertain the availability of emergency
drugs.
6.7
Out of hours protocol:
6.7.1 The HEAD NURSE of the On
Call Team shall act as
coordinator until relieved by the
head nurse or designee. In the
event the head nurse will
investigate the cascade call out
by:
6.7.1
6.7.1.1 Telephoning the
Theatre Manager.
6.7.1.2 Contacting the Senior
Anesthetic Technician.
6.7.1.3 If there is no response
from the head nurse,
contact the Charge
Nurses who live at the
hospital.
6.7.1.4 The cascade call will then
be conducted at the
OR-242
Conducting a cascade callout through
Medical City avoids congestion of
hospital switchboard lines. Cascade
call-outs ensure contacting the most
number of staff in the shortest possible
time.
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-036
TITLE:
APPLIES TO:
NURSING
COORDINATION OF A MAJOR INCIDENT
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
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hospital according to the
cascade list.
6.8 The HEAD NURSE will have the Call
Team commence the preparation of
each theatre.
6.9
When the Staff arrived in the unit, the
team Leader will allocate them to the
teams.
6.10 The head nurse will contact the Control
Room to advise on the state of
readiness, stating the number of staff
available, the number of theatres that is
possible to open, and the number and
type of staff needed to assist, to cover
the shortfall in staff.
6.11 Following the stand-down call, the
Coordinator will advise the Control
Room of any continuing procedures,
which will necessitate the retention of
staff.
6.12 The Coordinator will organize:
6.11 Keeping the Control Room appraised of
the situation allows for proper triage coordination.
6.12.1 Sufficient staff to continue with
any emergency cases.
6.12.2
Return of extra equipment.
6.12.3
Resumption of the list if time
permits.
6.12.4 A record of all staff that
attended, if Overtime hours
are warranted.
OR-243
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-036
APPLIES TO:
NURSING
COORDINATION OF A MAJOR INCIDENT
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
5 of 5
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2 nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
NAME:
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-244
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-037
APPLIES TO:
NURSING
ENVIRONMENTAL CLEANING OF SURGICAL
OPERATING ROOM AND EQUIPMENTS
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
1 of 6
1.0 DEFINITION
Guidelines intended to give direction and information for the prevention of proliferation and spread of
microorganism. And maintaining the cleanliness of operating room and equipments.
2.0 PURPOSE
2.1 To maintain cleanliness of the environment so that microorganisms are kept to a minimum.
2.2 To prevent cross infection.
2.3 To protect patient from sources of contamination.
2.4 To ensure that cleanliness of operating room are maintained as per standard of practices.
3.0 POLICY
3.1
Prior to opening supplies for the first scheduled procedure of the day, horizontal surfaces,
including theatre lamps, will be damp-dusted with disinfectant solution.
3.2
During operative procedures, efforts will be directed at confining contamination.
3.3
All items that have come in contact with the patient and/or sterile field should be considered
contaminated, and their disposition will reflect appropriate contamination control measures.
3.4
At the completion of the day’s schedule, each operating room and scrub/utility area, and corridors
will be comprehensively cleaned.
3.5
The theatre suite will be cleaned according to an established routine as outlined in the
Environmental Health Manual policies and procedures for the operating theatres.
3.6
Clean linen is transported to the department in a clean covered trolley daily at designated
times by the laundry department.
OR-245
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-037
TITLE:
APPLIES TO:
ENVIRONMENTAL CLEANING OF SURGICAL
OPERATING ROOM AND EQUIPMENTS
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
4.0 RESPONSIBILITIES
4.1 All OR Staff Nurses
5.0 MATERIALS & EQUIPMENT
5.1
Dettol
5.2
Basin
5.3
Dry and wet sponge
5.4
Dump duster
5.5
Moistened clean/ germicidal cloth
5.6
Leak proof, tear resistant containers
5.7
Approved chemical disinfectant (10% Clorox)
5.8
Plastic linen container
5.9
Protective barriers, e.g. disposable gloves, disposable gown and plastic apron
5.10 Yellow and black waste bags
6.0 PROCEDURES
6.1
NURSING
RATIONALE
Prior to opening supplies for the first
scheduled procedure of the day:
6.1.1 Damp-dusted with a clean cloth
the flat surfaces of tables,
equipment and overhead lamps
with a facility approved detergent
germicide or disinfectant.
OR-246
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
6.2
SNR-OR-037
TITLE:
APPLIES TO:
NURSING
ENVIRONMENTAL CLEANING OF SURGICAL
OPERATING ROOM AND EQUIPMENTS
APPROVAL DATE:
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During operative procedures:
6.2.1 Cleaned spills of contaminated
debris in areas outside the
surgical field with a facility
approved agent.
6.2.2
Placed contaminated
disposable items used in the
container.
6.2.3
Discarded count sponges from the
sterile field and confined in a plastic
linen receptacle.
6.2.4
Handled contaminated items using
protective barriers.
6.2.5
Placed all blood, tissues and bodyfluid specimens at the leak-proof
containers.
6.2.6
Placed wet linen at the center of
the laundry bundle unless plastic
bags are used.
6.2.7
Placed used or soiled disposable
fabric in the black plastic bags for
disposal.
6.2.8
Placed used surgical instruments
by the gloved, scrub person
directly into trays for
reprocessing.
6.2.5
To prevent contaminations.
6.2.7 To prevent soaking through to
the outside of the bag.
OR-247
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
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POLICY NUMBER:
IPP
6.3
SNR-OR-037
TITLE:
APPROVAL DATE:
EFFECTIVE DATE:
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6.3.1
After the procedure, all items
that have come into contact with
the patient should be considered
contaminated. Disposal of the
garbage and fluids from the O.R.
is done under the guidelines
from the Environmental Health &
Safety Department.
6.3.2
Items used during the prep
may be placed in white or black
garbage bags if they have not
been in contact with blood or
body fluids. Once the surgery
has commenced, only red bags
should be used.
6.3.3
Placed used gown and gloves at
the proper receptacles.
6.3.5
Placed all soiled linens inside the
linen hampers.
Placed wet linen at the center of
the laundry bundle unless
plastic bags.
6.3.6 Placed used or soiled
disposable fabric in the red
plastic bags for disposable.
6.3.7
NURSING
ENVIRONMENTAL CLEANING OF SURGICAL
OPERATING ROOM AND EQUIPMENTS
Conclusion of operative procedures:
6.3.4
APPLIES TO:
Placed used surgical instruments:
OR-248
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Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
SNR-OR-037
TITLE:
APPLIES TO:
NURSING
ENVIRONMENTAL CLEANING OF SURGICAL
OPERATING ROOM AND EQUIPMENTS
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
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5 of 6
6.3.7.1 For transfer to the
decontamination
area/utility room.
6.3.7.2
All hinged instruments
should be in the open
position for processing for
reprocessing.
6.3.8 Suction units should be
disconnect by circulating
personnel and capped for
disposal. Disposable suction
tubing will be discarded after
used.
6.3.9 Cleaned the horizontal surfaces
of furniture and equipment that
have been involved in the
surgical procedure with the used
of detergent-germicide using
mechanical friction.
7.0 ATTACHMENTS
N/A
8.0 REFERENCES
8.1
Arthur D. Smith (2007) Operating Room Set Up and Patient Preparation. 2nd Edition.
8.2
Nancymarie Phillips (2007) Berry and Kohn's: Operating Room Technique. 12 th Edition:
Mosby.
8.3
Seymour Schwat'z (2008) Principles of Surgery. 8th Edition, Mc Graw-Hill Professional.
OR-249
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
______________________________________________
SPECIALIZED NURSING: OPERATING ROOM
INTERNAL POLICY AND PROCEDURE
POLICY NUMBER:
IPP
TITLE:
SNR-OR-037
APPLIES TO:
NURSING
ENVIRONMENTAL CLEANING OF SURGICAL
OPERATING ROOM AND EQUIPMENTS
APPROVAL DATE:
EFFECTIVE DATE:
DUE FOR REVIEW:
NUMBER OF PAGES
NAME:
6 of 6
DATE
PREPARED BY:
Jocel Facto Panagsagan-RN-BSN
2010
REVIEWED BY:
Mr. Nasser Al-Zayedi
Nursing Supervisor, Quality Improvement
2010
APPROVED BY:
Central Committee Of NPP 2010 - General Directorate
Of Nursing- MOH.KSA
2010
OR-250