Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
OPERATING/PROCEDURE ROOM OBSERVATION TOOL Date of observation: ______ Operating/Procedure Room # ________ Procedure(s): ______________________ Time: From ________ To ________ Observer: ____________________ Patient Identifiers: ______________________________ Any answer that is in a RED box requires an action plan Compliant YES STANDARDS Compliant NO N/A DESCRIPTION/COMMENTS I. Operating/Procedure Room Environment 1. 2. 3. 4. 5. Operating/procedure room appears clean, dust free, uncluttered Operating/procedure room facility in good repair (e.g., no holes in walls, floors or ceiling) Solid ceiling; no tiles Are non-essential items stored uncovered in operating/procedure rooms? Interim (between cases) environmental cleaning performed directionally, from top to bottom YES NO YES NO YES NO YES NO YES NO Dust located: _______________________________ II. Room Procedure Observation 1. 2. 3. 4. Was floor mopped in between cases? Doors closed, doors not propped open; traffic in and out of room kept to minimum during case Number of personnel in room kept to a minimum Were there personnel in operating/procedure room not directly involved in case? YES NO YES NO YES NO YES NO # door openings/per hour: _______________ Might choose to list reasons for opening and/or collect specific data: Door openings from hall prior to incision Door openings from sterile core before incision Door openings from hall after incision Door openings from sterile core after incision] # personnel in room during case: ________ 1.02 OPERATING/PROCEDURE ROOM OBSERVATION TOOL 1 III. Perioperative Patient Care 1. 2. 3. 4. Pre-op antibiotic given by anesthesia personnel within 60 minutes prior to incision (Note: 120 minutes for Vancomycin /Fluoquinolines) IV injection ports swabbed prior to access Hair removal performed before entering operating/procedure room (planned hair removal only; occasionally additional hair must be clipped or done in the operating/procedure room) Pre-op skin prep: a. Was op-site cleaned prior to scrub? b. Dual agent prep used (i.e., Chloraprep or Duraprep) Product used for skin prep at operative site: __________________________ c. Is application technique appropriate for product used? Side to side (Chloraprep) In concentric circles, beginning in the middle and then out to periphery (Betadine) d. Perineal area prepped and covered with impervious drape? e. Is operative site allowed to air dry prior to incision? How long did site dry prior to incision?_________________ f. Is operative site dried with a towel or 4x4s prior to incision? g. Is adhesive incise drape used? YES NO YES NO YES NO YES NO YES NO AORN guidelines recommend clipping occur in non-OR site; consider action plan Describe application method: YES NO YES NO YES NO YES YES NO NO IV. Attire (for anyone entering semi-restricted and restricted surgical site areas) 1. 2. 3. 4. 5. Surgical caps/hood cover all head hair a. Nursing b. Anesthesia c. Surgeons Chest and beard hair fully covered Do any operating/procedure room staff members appear to have long fingernails? Do any operating/procedure room staff members appear to have artificial fingernails? Dress code followed: a. No rings; other jewelry (e.g. watches, earrings, bracelets, necklaces, piercing) should be removed or totally confined within scrub attire b. No fanny packs c. Wearing long sleeves (approved cover jacket) d. No turtlenecks e. Clean (not visibly wet or soiled) operating/procedure room scrub suit f. Shirts of scrub suit tucked in or close fitting YES YES YES YES YES NO NO NO NO NO YES NO YES NO YES NO YES NO YES YES YES NO NO NO YES NO YES NO Natural nails short 1.02 OPERATING/PROCEDURE ROOM OBSERVATION TOOL 2 g. h. i. All non-scrubbed personnel wearing long sleeved jackets that are buttoned or snapped Undergarments completely covered by scrub suit No fleece YES NO YES YES NO NO V. Sterile Field 1. 2. Mask covers nose and mouth and is tied securely Mask in place when entering operating/procedure room and sterile packs open and when in sterile core 3. Sterile items left open no more than 60 minutes prior to patient entering room and should be constantly monitored during that time period 4. Scrubbed persons maintain sterility of sterile gown, gloves, supplies (e.g., while waiting for procedures to be done such as X-Rays?) 5. Chemical indicators must be checked when instruments are opened, before they are placed on the sterile field 6. Items introduced into sterile field are opened, dispensed, and transferred by methods to maintain sterility/integrity 7. Items/devices dropped below level of the operating/procedure room table are considered contaminated 8. Is the drape between anesthesia and patient above the level of anesthesiologist’s nose and mouth? 9. Do anesthesia personnel lean over drape during procedure? 10. Surgical equipment (e.g. cables, tubing) should be secured to sterile field with non-perforating devices 11. Nonsterile equipment (e.g., mayo stands, C arms) should be covered with sterile barrier materials; only sterile items should touch sterile surfaces; sterile barrier material should be applied to any equipment adjacent to the sterile field 12. All personnel moving in/around sterile field do so in manner to maintain sterility, for example: a. Staff do not turn back to sterile field b. Scrubbed personnel pass front to front or back to back c. Hands remain above waist d. Separation of sterile team from non-sterile team maintained e. Unscrubbed personnel do not pass between two sterile fields YES NO YES NO YES NO YES NO Yes NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO VI. Anesthesiology 1. 2. 3. Drainage bags (e.g., foley) kept off the floor Aseptic practice used for IV tubing, fluids, medications – injection ports swabbed prior to access Sterile equipment including IV solution/tubing is assembled immediately prior to use YES NO YES NO YES NO 1.02 OPERATING/PROCEDURE ROOM OBSERVATION TOOL 3 4. 5. 6. 7. 8. Aseptic practice used for all invasive procedures (e.g., epidurals, blocks, IV insertion) Was antibiotic infusion mentioned/checked prior to incision? Was antibiotic infusion repeated if surgery is longer than 4 hours? Anesthesia cart appears clean; handsanitizer readily available Re-usable personal equipment (e.g., stethoscope) cleaned between cases YES NO YES YES YES YES NO NO NO NO Note: type of ATB may require repeat dose VII. Medications/Solutions 1. Are medications and solutions: (circle one) a. Single-dose b. Multi-dose What solutions/medications are multi-dose?___________________________ 2. Are solutions supplied in large containers? 3. Are any medications or solutions expired? 4. Is the wound irrigated? If yes, list solution used for irrigations: ___________________________ 5. List any topical medications used: __________________________________ 6. What is used to close the wound? (circle one) a. Sutures b. Staples c. Derma-bond 7. What dressing is placed on the wound?_______________________________ 8. Are any solutions mixed in the operating/procedure room? If yes, list:__________________________ 9. Are any containers refilled? If yes, list:________________________________ 10. Are any solutions supplied or used as a spray? YES YES NO NO YES NO If YES, observing technique should be part of action plan YES NO YES NO VIII. OSHA/Bloodborne Pathogen Standard 1. 2. 3. 4. Appropriate eye protection used Sharps containers not overfull Sharps are passed in a basin or by using neutral zone rather than by hand Sharps safety devices utilized where available YES YES YES YES NO NO NO NO Devices used: ________________________________ IX. General Infection Prevention and Control 1. 2. 3. 4. Do members of the surgical team appear to have upper respiratory infection (e.g., cough, sneezing)? Do any operating/procedure room staff appear to have hand/forearms/skin/fingernail open lesions or infections? Was conversation in sterile field limited to only necessary conversation? Sterile team removes gloves and washes hands at end of case YES NO YES NO YES YES NO NO 1.02 OPERATING/PROCEDURE ROOM OBSERVATION TOOL 4 5. 6. 7. 8. 9. Were gloves changed between dirty and clean procedures? Was hand hygiene performed when gloves changed? Is a hand antisepsis product available? Clean, sterile, and soiled items are kept separate Used sterile instruments/equipment transported to CSP for decontamination and sterilization YES YES YES YES NO NO NO NO YES NO X. Sterilization 1. 2. 3. 4. 5. 6. 7. 8. Are instrument trays checked by nurse for breaks prior to placing on sterile field? Are biologicals performed and within normal limits for sterilizers? Do processes appear efficient in SPD with items/areas tidy and well labeled? Are instruments pre-cleaned or soaked soon after use? Were items sterilized using immediate-use steam sterilization (ISS)? If yes, list reason for using ISS: __________________________________________ Were instruments sterilized using ISS delivered to sterile field without contamination? Was water splashed on the sterile field when instruments sterilized using ISS were delivered? Was the item that was sterilized using ISS contaminated by circulating nurse? YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO XII. HVAC Systems (If not optimal, action plan required) 1. 2. 3. Room humidity: ____________ (Between 30-60% is optimal) YES NO Temperature: ___________________ (Between 68-73 degrees is optimal) YES NO Air exchanges/hour: ___________ (Min. 15/hour required, 20-25 is optimal) YES NO XIII. Hand Scrub (Observe one individual scrubbing) 1. Physician___Nurse_____Tech_____SA__________ (Select one) 2. Product used: ______________________________ 3. Scrub brush used with product YES NO 4. Does the healthcare worker clean under his/her fingernails? YES NO 5. Is scrub accomplished from hands to forearm to elbow? YES NO 6. Does the surgical scrub last 3-5 minutes? YES NO 7. When the scrub is finished, are fingers held up so water runs down YES NO toward elbows? 8. If waterless product is used as the first scrub of the day, is it a water YES NO aided scrub? 9. If waterless product is used, does the staff member apply product to hand YES NO and then up arms to elbow? 10. Are hand scrub products “topped off?” YES NO 1.02 OPERATING/PROCEDURE ROOM OBSERVATION TOOL 5 RESOURCE Developed by the Oregon Patient Safety Commission; adapted from tools by BJC Healthcare, Kaiser Permanente, Duke University, University Hospital North Carolina, and Oregon Health and Sciences University. DISCLAIMER: All data and information provided by the Oregon Patient Safety Commission is for informational purposes only. The Oregon Patient Safety Commission makes no representations that the patient safety recommendations will protect you from litigation or regulatory action if the recommendations are followed. The Oregon Patient Safety Commission is not liable for any errors, omissions, losses, injuries, or damages arising from the use of these recommendations. 1.02 OPERATING/PROCEDURE ROOM OBSERVATION TOOL 6