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Snyder, Rhonda P. "Operating Room Nursing: Perioperative Practice." AORN Journal 53, no. 5 (May 1991): 1274. http://dx.doi.org/10.1016/s0001-2092(07)69269-2.
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Liang, Weijing. "Application of Standardized Nursing in the Perioperative Period of Patients with Idiopathic Scoliosis." Advanced Journal of Nursing 2, no. 3 (November 29, 2021): 47. http://dx.doi.org/10.32629/ajn.v2i3.527.
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Objective — To explore the standardized nursing program for idiopathic scoliosis deformity correction under general anesthesia during perioperative period. Methods — Retrospective analysis 28 patients with adolescent idiopathic scoliosis (AIS) as the research object admitted from 2020 July to August 2021. The nursing plan formulated in the operating room of our hospital was strictly implemented, patients and surgical risks were comprehensively evaluated before surgery, the operating room, surgical instruments and intraoperative drugs were carefully prepared, the operation was performed with strict aseptic techniques, the surgical medical team cooperated skillfully, and the changes of the condition were closely observed after surgery. Results — Operations were smoothly conducted for all the 28 patients with full recovery. The patients were proved without presence of symptoms of skin pressure injury, nervous system injury, serious timeout, postoperative paralysis, hemorrhagic shock and other serious adverse events. Conclusions — Posterior orthopaedic surgery for scoliosis is proved to be difficult for operation with long duration and high risks. There are many risk factors in perioperative nursing. According to standardized and specialized nursing programs, strict intervention throughout the perioperative period can improve the quality of nursing in the operating room, which can improve the efficiency of surgery, reduce the risk of surgery, ensure the safety of patients, and promote the rapid recovery of patients.
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Radford, Mark. "The Recovery Room." British Journal of Anaesthetic and Recovery Nursing 1, no. 4 (November 2000): 3. http://dx.doi.org/10.1017/s1742645600000310.
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The speciality of anaesthetic and recovery nursing has grown from a foundation of hard evidence that the majority of anaesthetic complications occur in the post operative period, and there is a need for a highly trained and experienced nurse with skills and expertise in caring for patients during this critical period. This development during the late 60's and early 70's was shaped by anaesthetists and has over the years been continually developed and enhanced by nursing. Post Anaesthetic nursing practice is now an integral part of the perioperative process, with some suggesting that recovery nursing is largely distinct from the other perioperative skills and should be treated as such in terms of education and planning.
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Egan, Patricia, Anthony Pierce, Audrey Flynn, Sean Paul Teeling, Marie Ward, and Martin McNamara. "Releasing Operating Room Nursing Time to Care through the Reduction of Surgical Case Preparation Time: A Lean Six Sigma Pilot Study." International Journal of Environmental Research and Public Health 18, no. 22 (November 18, 2021): 12098. http://dx.doi.org/10.3390/ijerph182212098.
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Healthcare systems internationally are working under increasing demand to use finite resources with greater efficiency. The drive for efficiency utilises process improvement methodologies such as Lean Six Sigma. This study outlines a pilot Lean Six Sigma intervention designed to release nursing time to care within a peri-operative environment; this was achieved by collaborating with stakeholders to redesign the process for laparoscopic hernia surgical case preparation (set up) material. Across 128 laparoscopic hernia surgical cases, the pilot resulted in a 55% decrease in overall nursing time spent in gathering and preparing materials for laparoscopic hernia surgical cases, with a corresponding reduction in packaging waste. The major impact of releasing nursing time to care within busy Operating Room environments enabled nurses to focus on continuing to deliver high-quality care to their patients and reduce pressure expressed by the Operating Room nurses. The results have led to an ongoing review of other surgical procedures preparation to further release nursing time and will be of interest to perioperative teams internationally.
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Sandberg, Warren S., Bethany Daily, Marie Egan, James E. Stahl, Julian M. Goldman, Richard A. Wiklund, and David Rattner. "Deliberate Perioperative Systems Design Improves Operating Room Throughput." Anesthesiology 103, no. 2 (August 1, 2005): 406–18. http://dx.doi.org/10.1097/00000542-200508000-00025.
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Background New operating room (OR) design focuses more on the surgical environment than on the process of care. The authors sought to improve OR throughput and reduce time per case by goal-directed design of a demonstration OR and the perioperative processes occurring within and around it. Methods The authors constructed a three-room suite including an OR, an induction room, and an early recovery area. Traditionally sequential activities were run in parallel, and nonsurgical activities were moved from the OR to the supporting spaces. The new workflow was supported by additional anesthesia and nursing personnel. The authors used a retrospective, case- and surgeon-matched design to compare the throughput, cost, and revenue performance of the new OR to traditional ORs. Results For surgeons performing the same case mix in both environments, the new OR processed more cases per day than traditional ORs and used less time per case. Throughput improvement came from superior nonoperative performance. Nonoperative Time was reduced from 67 min (95% confidence interval, 64-70 min) to 38 min (95% confidence interval, 35-40 min) in the new OR. All components of Nonoperative Time were meaningfully reduced. Operative Time decreased by approximately 5%. Hospital and anesthesia costs per case increased, but the increased throughput offset costs and the global net margin was unchanged. Conclusions Deliberate OR and perioperative process redesign improved throughput. Performance improvement derived from relocating and reorganizing nonoperative activities. Better OR throughput entailed additional costs but allowed additional patients to be accommodated in the OR while generating revenue that balanced these additional costs.
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Henry, Nader, Romelyn Icot, and Steve Jeffery. "The benefits of latex-free gloves in the operating room environment." British Journal of Nursing 29, no. 10 (May 28, 2020): 570–76. http://dx.doi.org/10.12968/bjon.2020.29.10.570.
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Sterile protective gloves are used to reduce the risk of infection for patients and clinicians in all healthcare settings. This is particularly important in operating theatres, where surgical site infection is a common and serious complication for perioperative patients. These gloves have traditionally been made from natural rubber latex and dusted with cornstarch powder. However, frequent use of latex gloves can lead to a hypersensitivity or allergy to latex. A latex allergy causes discomfort and inconvenience, and it may reduce productivity, impose significant financial burdens and even be life threatening. There has not been sufficient evidence to ban the clinical use of latex; however, in cases of suspected latex allergy, guidelines recommend the use of either latex-free gloves or powder-free, low-protein latex gloves. The use of these alternative gloves has typically been limited to cases of allergy, because they have previously been associated with reduced dexterity and durability compared with latex gloves. This article presents four case studies, in which health professionals in a perioperative setting compare the advantages and disadvantages of using traditional latex surgical gloves with those of latex-free gloves manufactured by Cardinal Health. The findings of these case studies suggest that these latex-free gloves are equal to latex gloves in terms of establishing asepsis and providing comfort and dexterity to the wearer, without presenting the risk of developing latex sensitivity and/or allergy.
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Hegarty, J. "Perioperative Temperature Regulation." British Journal of Anaesthetic and Recovery Nursing 5, no. 2 (May 2004): 27–30. http://dx.doi.org/10.1017/s1742645600001947.
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The regulation of body temperature is one of a variety of mechanisms, which play a part in maintaining a stable internal environment in the body thus enabling the body to function optimally. It is crucial that the core body temperature is maintained within a narrow (36–37.5°C) range [Luckmann, 1997]. Thermoregulation in the operating theatre and post anaesthetic care unit is often an underemphasized concern for surgical patients. Anaesthesia and surgery commonly cause substantial alterations in the temperature of surgical patients.Unnecessary heat loss, hypothermia, the typical variation, results from a combination of anaesthetic-induced impairment of thermoregulatory control, a cool, operating room environment and other factors exclusive to surgery and anaesthesia. Estimates of the incidence of inadvertent perioperative hypothermia range from 60% to 90% of all surgical cases [Bernthal, 1999, Litwack, 1995], when this condition is defined as a body temperature below 36°C (degrees Celsius) 96.8°F (degrees Fahrenheit) (Arndt, 1999). Hypothermia apart from causing a very unpleasant sensation of cold, places the patient at risk of developing life-threatening events, which include altered cardiac performance, delayed emergence from anaesthesia and increased rates of morbidity and mortality. Although the aim of temperature management by intraoperative medical and nursing staff is prevention of heat loss, the objective of post anaesthetic recovery room staff is usually the restoration of normothermia. Thus, perioperative nurses need to be aware of the need to monitor patient's temperature, be familiar with different patient warming/rewarming methods and be alert for potential problems that can arise from hypothermia.
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Park, Boo Hyo, and Sung Ok Chang. "The Process of Situational Awareness Embodiment of Perioperative Scrub Nurses: An Analytic Induction Approach." Journal of Korean Academy of Fundamentals of Nursing 29, no. 1 (February 28, 2022): 94–104. http://dx.doi.org/10.7739/jkafn.2022.29.1.94.
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Purpose: This study aimed to identify and explore how perioperative scrub nurses embody their situational awareness to elucidate the association between research and application.Methods: This qualitative study employed an analytical induction approach. The analytical method reconstructed by Bloor (1978) and modified by Johnson (2004) was used to investigate and analyze the phenomenon in clinical practice. The study was conducted from January 12 to May 20, 2019. Data were collected using semi-structured interviews; the study subjects included 12 perioperative scrub nurses working at three university hospitals.Results: Perioperative scrub nurses embodied situational awareness by comparing and identifying general and abnormal situations throughout surgical procedures, setting priorities in their tasks, responding to situations according to the degree of emergency in the operating room, and developing an integrated view. Perioperative scrub nurses embodied situational awareness through typical patterns involving empirical cases based on experiences, apprenticeship-oriented training, information exchange among surgical team members, and self-directed simulation. Professional responsibility and the level of surgical emergency played an essential role in embodying these patterns.Conclusion: These findings will provide practical categories that will contribute to the development of strategies for practical education of novice perioperative scrub nurses and nursing students.
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Mattia, Ana Lúcia De, Maria Helena Barbosa, João Paulo Aché de Freitas Filho, Adelaide De Mattia Rocha, and Nathália Haib Costa Pereira. "Warmed intravenous infusion for controlling intraoperative hypothermia." Revista Latino-Americana de Enfermagem 21, no. 3 (June 2013): 803–10. http://dx.doi.org/10.1590/s0104-11692013000300021.
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OBJECTIVE: to verify the effectiveness of warmed intravenous infusion for hypothermia prevention in patients during the intraoperative period. METHOD: experimental, comparative, field, prospective and quantitative study undertaken at a federal public hospital. The sample was composed of 60 adults, included based on the criteria of axillary temperature between 36ºC and 37.1ºC and surgical abdominal access, divided into control and experimental groups, using the systematic probability sampling technique. RESULTS: 22 patients (73.4%) from both groups left the operating room with hypothermia, that is, with temperatures below 36ºC (p=1.0000). The operating room temperature when patients arrived and patients' temperature when they arrived at the operating room were statistically significant to affect the occurrence of hypothermia. CONCLUSION: the planning and implementation of nursing interventions carried out by baccalaureate nurses are essential for preventing hypothermia and maintaining perioperative normothermia.
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Brown, LaSandra, Debbie Belgard, Nakeisha Washington, and Sparkle Grueso. "Operating room nurse residency and specialty educators: Paramount in the success of novice nurse retention." Journal of Nursing Education and Practice 8, no. 5 (December 18, 2017): 20. http://dx.doi.org/10.5430/jnep.v8n5p20.
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Perioperative service is one of the specialties of nursing in which a team approach is vital for optimal patient care. The registered nurse is responsible for coordinating and delivering safe patient care. Operating room (OR) nurses are responsible for applying fundamental applications of the nursing process while formulating plans of care unique to surgical patients. The growing shortage of nurses worldwide especially impacts highly complex areas such as the OR, where skills specialized are needed to care for patients. One of the largest challenges of a graduate nurse (GN) is becoming enculturated to new environments. Traditionally, OR nursing is a paradigm foreign in nursing curricula; this creates challenges in the GN population in applying their practical nursing skills to surgical patients. In an effort to combat ongoing knowledge deficits unique to OR nursing, Houston Methodist Hospital (HMH) created an OR nurse residency program. The literature suggests that specialty-specific nursing residency programs offer GNs essential tools for becoming successful in their transition. Additionally, research suggests reductions in nurse burnout and turnover rate among GNs with adequate training and preparation. The purpose of this article was to provide insight on the importance of introduction to the OR prior to graduating from nursing school and the importance of OR nursing specialty residency programs and specialty educators as they pertain to the ideal nursing transition, sustainability, retention, and favorable patient outcomes. A questionnaire was created to capture successful applicable practices; the questionnaire also provided an opportunity for GNs to suggest opportunities for program improvements. The questionnaire was used to explore feedback from the summer 2014 Operating Room (OR) residency program graduate nurses in an effort to capture improvements needed for future program success.
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Dai, Jiao, and Yanan Li. "Effect of Nursing in Operating Room Combined with Intraoperative Heat Preservation Intervention on Prevention of Incision Infection and Improvement of Hemodynamics in Patients with Anterior Cruciate Ligament Injury and Reconstruction under Knee Arthroscopy." Computational and Mathematical Methods in Medicine 2022 (April 15, 2022): 1–8. http://dx.doi.org/10.1155/2022/2915157.
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Objective. To explore the effect of nursing in operating room combined with intraoperative heat preservation intervention on preventing incision infection and improving hemodynamics in patients with anterior cruciate ligament (ACL) injury and reconstruction under knee arthroscopy. Methods. About 200 patients with knee arthroscopic ACL reconstruction in our hospital from January 2019 to July 2021 were enrolled. The patients were randomly assigned into two groups: the control group and the study group. The former group received nursing care in the operating room operating room and the latter group received nursing care in operating room combined with intraoperative heat preservation intervention. Nursing satisfaction, incidence of incision infection, knee joint VAS score, knee joint range of motion, knee joint Lysholm score, and hemodynamic indexes were compared. Results. First of all, we compared the nursing satisfaction, the study group was very satisfied in 78 cases, satisfactory in 20 cases, and general in 2 cases, and the satisfaction rate was 100.00%, while in the control group, 445 cases were very satisfied, 20 cases were satisfied, 15 cases were general, and 8 cases were dissatisfied. The satisfaction rate was 82.00%. The nursing satisfaction of the study group was higher compared to the control group ( P < 0.05 ). Secondly, we compared the incidence of incision infection. The incidence of incision infection in the study group was lower compared to the control group ( P < 0.05 ). With regard to the knee joint VAS score, the knee joint VAS score of the study group was lower compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation ( P < 0.05 ). In terms of the range of motion of the knee joint, the range of motion of the knee joint in the study group was higher compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation ( P < 0.05 ). Regarding the knee joint Lysholm score, the knee joint Lysholm score of the study group was higher compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation ( P < 0.05 ). Finally, we compared the hemodynamic indexes. Before nursing, there exhibited no significant difference ( P > 0.05 ). During and after nursing, the indexes of HR and MAP in the study group fluctuated little ( P < 0.05 ). Conclusion. During the perioperative period of patients with ACL injury and reconstruction under knee arthroscopy, standardized and necessary operating room combined with intraoperative thermal insulation intervention measures should be given, attention should be paid to the management of operating room, and intraoperative thermal insulation intervention should be strengthened. It includes preoperative visit, psychological nursing of patients, strict application of antibiotics before operation, monitoring of air quality in operating room, disinfection and sterilization of surgical instruments, shortening operation time, maintaining body temperature during operation, and paying attention to hand hygiene of medical staff. It plays a supervisory role in promoting the attention of medical staff to the prevention of wound infection, which is beneficial to the healing of surgical wounds of patients. It plays a positive role in enhancing hemodynamic indexes. Comprehensive nursing intervention on the risk factors of each link can effectively prevent postoperative wound infection and strengthen the prognosis and quality of life of patients.
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Sebert, Michael E., Mary Lou Manning, Karin L. McGowan, Elizabeth R. Alpern, and Louis M. Bell. "An Outbreak ofSerratia marcescensBacteremia After General Anesthesia." Infection Control & Hospital Epidemiology 23, no. 12 (December 2002): 733–39. http://dx.doi.org/10.1086/502003.
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Objective:To investigate an outbreak ofSerratia marcescensbacteremia among patients after general anesthesia.Design:A case-control study.Setting:A 304-bed, pediatric teaching hospital.Patients:Twenty-three pediatric patients who developedS. marcescensbacteremia within 2 weeks after general anesthesia between June 15 and September 22, 1999, were compared with 46 age-matched control-patients who had undergone procedures on the same clinical services of the hospital during the same period.Results:Cases were distributed over a wide range of surgical services and were not correlated with exposure to any of the surgical, anesthesia, or nursing staff. Case-patients were significantly more likely than control-patients to have received cefazolin (odds ratio [OR], 11.1; 90% confidence interval [CI90], 1.9 to 24.3) or to have had perioperative placement of a central vascular catheter (OR, 4.2; CI90, 1.2 to 18.8). The timing of the procedures of patients who subsequently developedS. marcescensbacteremia was significantly associated with the shifts of one or more of five operating room technicians (OR, 2.9 to 6.8) who were responsible for preparing intravenous fluids used both to reconstitute perioperatively administered antibiotics and to prime central vascular catheter assemblies.Conclusions:Our findings are consistent with a pattern of intermittent contamination due to periodic breaches in sterile technique, rather than a point-source of contamination. The unique challenges that such a procedural breakdown presents to an epidemiologic investigation are discussed. This outbreak stresses the importance of providing comprehensive training in antisepsis when multifunctional personnel are incorporated into an operating room work environment.
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Demissie, Wondu Reta, Bilisuma Mulatu, Ahmed Siraj, Abdulmenan Hajikassim, Edosa Kejela, Zemenu Muluken, Gezahegn Tesfaye Mekonin, et al. "Pattern of Perioperative Surgical Patient Care, Equipment Handling and Operating Room Management During COVID-19 Pandemic at Jimma Medical Center." Journal of Multidisciplinary Healthcare Volume 15 (November 2022): 2527–37. http://dx.doi.org/10.2147/jmdh.s372428.
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Vaziri, Sasha, Joseph M. Abbatematteo, Max S. Fleisher, Alexander B. Dru, Dennis T. Lockney, Paul S. Kubilis, and Daniel J. Hoh. "Correlation of perioperative risk scores with hospital costs in neurosurgical patients." Journal of Neurosurgery 132, no. 3 (March 2020): 818–24. http://dx.doi.org/10.3171/2018.10.jns182041.
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OBJECTIVEThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online surgical risk calculator uses inherent patient characteristics to provide predictive risk scores for adverse postoperative events. The purpose of this study was to determine if predicted perioperative risk scores correlate with actual hospital costs.METHODSA single-center retrospective review of 1005 neurosurgical patients treated between September 1, 2011, and December 31, 2014, was performed. Individual patient characteristics were entered into the NSQIP calculator. Predicted risk scores were compared with actual in-hospital costs obtained from a billing database. Correlational statistics were used to determine if patients with higher risk scores were associated with increased in-hospital costs.RESULTSThe Pearson correlation coefficient (R) was used to assess the correlation between 11 types of predicted complication risk scores and 5 types of encounter costs from 1005 health encounters involving neurosurgical procedures. Risk scores in categories such as any complication, serious complication, pneumonia, cardiac complication, surgical site infection, urinary tract infection, venous thromboembolism, renal failure, return to operating room, death, and discharge to nursing home or rehabilitation facility were obtained. Patients with higher predicted risk scores in all measures except surgical site infection were found to have a statistically significant association with increased actual in-hospital costs (p < 0.0005).CONCLUSIONSPrevious work has demonstrated that the ACS NSQIP surgical risk calculator can accurately predict mortality after neurosurgery but is poorly predictive of other potential adverse events and clinical outcomes. However, this study demonstrates that predicted high-risk patients identified by the ACS NSQIP surgical risk calculator have a statistically significant moderate correlation to increased actual in-hospital costs. The NSQIP calculator may not accurately predict the occurrence of surgical complications (as demonstrated previously), but future iterations of the ACS universal risk calculator may be effective in predicting actual in-hospital costs, which could be advantageous in the current value-based healthcare environment.
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Turrentine, Florence E., Sarah B. Giballa, Puja M. Shah, David R. Jones, Traci L. Hedrick, and Charles M. Friel. "Solutions to Intraoperative Wound Classification Miscoding in a Subset of American College of Surgeons National Surgical Quality Improvement Program Patients." American Surgeon 81, no. 2 (February 2015): 193–97. http://dx.doi.org/10.1177/000313481508100234.
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Intraoperative wound classification is a predictor of postoperative infection. Therefore, accurately assigning the correct classification to a surgical wound is of particular importance. Our institution participates in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), a national outcomes database that collects wound classification for all qualifying operative procedures, and we noted discrepancies when comparing ACS NSQIP wound classification coding with perioperative coding in our electronic medical record. We tested the effectiveness of an intervention that included staff educational sessions, informational posters, and postoperative debriefings on improving the accuracy of documented intraoperative wound classification. The χ2 test was used to compare proportions of wound classification miscodings before and after educational sessions and debriefings commenced. Baseline data revealed misclassification of wounds occurred 21 per cent (30 of 141) of the time in predominately colorectal procedures performed by two surgeons from April through August 2012. Errors decreased to 9 per cent (13 of 147) from August to December 2012, after our intervention of education sessions with operating room staff and the surgeons incorporating a statement confirming the wound classification at the end of the case debriefing. The χ2 statistic was 8.7589. The P value was significant at 0.003. Ensuring concordance of classification between the surgeon and nurse during a post-procedure debriefing as well as education of perioperative nursing staff through posters and seminars significantly improved the accuracy of intraoperative wound classification coding.
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Klein, Aline Staub, Julia Valeria Oliveira Vargas Bitencourt, Daiane Dal Pai, and Wiliam Wegner. "Nursing records in the perioperative period." Revista de Enfermagem UFPE on line 5, no. 5 (June 24, 2011): 1096. http://dx.doi.org/10.5205/reuol.1302-9310-2-le.0505201103.
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ABSTRACT Objective: to evaluate the records of nursing in the perioperative period from a hospital in Porto Alegre, Rio Grande do Sul. Method: a quantitative approach, with a descriptive, conducted with 110 records from January and February 2010, through a form with closed questions. Approved by the Ethics Committee of the Methodist University IPA (346/2009) and the Institution search (357/CEM/09). Results: 65,4% of records had no nursing records. Only 7,3% of the medical records were analyzed on the history of the patient's health and on their physical assessment. At surgery, the patient's position was the most frequent item of complete records (13,6%), whereas postoperatively were vital signs (57,3%). Conclusion: there is a shortage of perioperative nursing records, which compromises the nursing process. It is suggested that the institutionalization of a single instrument that enables systematic records of perioperative, thereby stimulating a flow of information about the surgical procedure - an event vital to human life. Descriptors: perioperative care; operating room nursing; nursing records; postoperatively. RESUMO Objetivo: avaliar os registros de enfermagem no período perioperatório de um Hospital de Porto Alegre, Rio Grande do Sul. Método: trata-se de estudo quantitativo, com abordagem descritiva, realizado com 110 prontuários no período de Janeiro e Fevereiro de 2010, por meio de um formulário com questões fechadas. Aprovado pelo Comitê de Ética do Centro Universitário Metodista IPA (346/2009) e da Instituição pesquisada (357/CEM/09). Resultados: 65,4% dos prontuários não apresentaram registros de enfermagem. Apenas 7,3% dos prontuários analisados apresentaram registros sobre a história de saúde do paciente e sobre a sua avaliação física. No transoperatório, o posicionamento do paciente foi o item com maior frequência de registros completos (13,6%), enquanto que no pós-operatório foram os sinais vitais (57,3%). Conclusão: há escassez de registros de enfermagem no perioperatório, o que compromete o processo de enfermagem. Sugere-se a institucionalização de um instrumento único e sistematizado para os registros do perioperatório, estimulando assim um fluxo de informações sobre o procedimento cirúrgico – evento vital para a vida humana. Descritores: assistência perioperatória; enfermagem centro cirúrgico; registros de enfermagem; pós-operatório. RESUMEN Objetivo: evaluar los registros de enfermería en el perioperatorio de un hospital de Porto Alegre, Rio Grande do Suly. Métodos: un enfoque cuantitativo, con un estudio descriptivo, realizado con 110 registros de enero y febrero de 2010, a través de un formulario con preguntas cerradas. Aprobado por el Comité de Ética de la API de la Universidad Metodista (346/2009) y la búsqueda de la Institución (357/CEM/09). Resultados: el 65,4% de los registros no tenían registros de enfermería. Sólo el 7,3% de las historias clínicas fueron analizadas en la historia de la salud del paciente y de su evaluación física. En la cirugía, la posición del paciente fue el tema más frecuente de registros completos (13,6%), mientras que después de la operación fueron los signos vitales (57,3%). Conclusión: hay una escasez de registros de enfermería perioperatoria, lo que compromete el proceso de enfermería. Se sugiere que la institucionalización de un solo instrumento que permite un registro sistemático de perioperatorio, estimulando así un flujo de información sobre el procedimiento quirúrgico - un acontecimiento vital para la vida humana. Descriptores: cuidados perioperatorios; la enfermería de quirófano; enfermería registros; después de la operación.
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Sandhu, Simrenjeet, Aleena Virani, Hilary Salmonson, Karim Damji, Pamela Mathura, and Rany Al-Agha. "Implementing a Diabetic Algorithm for Ophthalmology Surgery Patients: A Quality Improvement Initiative." Global Journal on Quality and Safety in Healthcare 5, no. 4 (November 1, 2022): 93–99. http://dx.doi.org/10.36401/jqsh-21-18.
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ABSTRACT Introduction The objective of this quality improvement, interventional study regarding patients with diabetes undergoing diabetic ophthalmology outpatient surgery aimed to develop, implement, and evaluate a new diabetic algorithm to improve safety, operating room efficiency, and decrease supply cost. Methods A multidisciplinary study team was assembled, including ophthalmologists, endocrinologists, anesthesiologists, management, and nurses to review the current diabetic protocol. From August 2016 to July 2017, 13 patient safety concerns or incident reports were reviewed that identified two serious cases of hypoglycemia. Using the concerns data, frontline perspectives, and reviewing best practice guidelines, a new diabetic algorithm was developed and trialed for 24 months. The new algorithm limited the use of an existing preoperative insulin protocol and reduced the number of nurses required. The number of adverse events, nursing setup process steps, setup time, and preoperative insulin infusion protocols used were collected. An evaluation of the supply costs was performed. Results After implementing the new diabetic algorithm, zero safety incidents were reported, and a 97.5% reduction in the use of preoperative insulin protocol resulted. Nursing staff perceived that the new diabetic algorithm was easier to configure, 23 minutes faster to set up, and required one nursing staff member. Supply cost was reduced by $30.63 (Canadian Dollars, CAD) per patient. Conclusion Perioperative glucose irregularities may threaten patient safety and surgical outcomes. Healthcare professionals must improve patient safety, decrease healthcare expenditure, and prevent unnecessary delays. Multidisciplinary frontline staff experiential knowledge aided in the recognition of potential problems and comprehensive solutions to optimize patient care.
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Clarke, Sean P., Maria Schubert, and Thorsten Körner. "Sharp-Device Injuries to Hospital Staff Nurses in 4 Countries." Infection Control & Hospital Epidemiology 28, no. 4 (April 2007): 473–78. http://dx.doi.org/10.1086/513445.
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Objective.To compare sharp-device injury rates among hospital staff nurses in 4 Western countries.Design.Cross-sectional survey.Setting.Acute-care hospital nurses in the United States (Pennsylvania), Canada (Alberta, British Columbia, and Ontario), the United Kingdom (England and Scotland), and Germany.Participants.A total of 34,318 acute-care hospital staff nurses in 1998-1999.Results.Survey-based rates of retrospectively-reported needlestick injuries in the previous year for medical-surgical unit nurses ranged from 146 injuries per 1,000 full-time equivalent positions (FTEs) in the US sample to 488 injuries per 1,000 FTEs in Germany. In the United States and Canada, very high rates of sharp-device injury among nurses working in the operating room and/or perioperative care were observed (255 and 569 injuries per 1,000 FTEs per year, respectively). Reported use of safety-engineered sharp devices was considerably lower in Germany and Canada than it was in the United States. Some variation in injury rates was seen across nursing specialties among North American nurses, mostly in line with the frequency of risky procedures in the nurses' work.Conclusions.Studies conducted in the United States over the past 15 years suggest that the rates of sharp-device injuries to front-line nurses have fallen over the past decade, probably at least in part because of increased awareness and adoption of safer technologies, suggesting that regulatory strategies have improved nurse safety. The much higher injury rate in Germany may be due to slow adoption of safety devices. Wider diffusion of safer technologies, as well as introduction and stronger enforcement of occupational safety and health regulations, are likely to decrease sharp-device injury rates in various countries even further.
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Teixeira, Nathália Ferreira, Ricardo De Oliveira Meneses, Cíntia Silva Fassarella, Débora De Oliveira Nunes da Silva Dos Reis, Cecília Maria Izidoro Pinto, and Maria Virgínia Godoy Da Silva. "Planejamento do principal recurso material utilizado em sala operatória." Revista de Enfermagem UFPE on line 13, no. 5 (May 30, 2019): 1223. http://dx.doi.org/10.5205/1981-8963-v13i5a239011p1223-1230-2019.
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RESUMOObjetivo: analisar o fluxo do principal recurso material utilizado em sala operatória de um hospital universitário. Método: trata-se de um estudo qualitativo, descritivo, documental e observacional realizado em um hospital universitário. Executaram-se duas etapas: análise documental dos recursos materiais utilizados em sala operatória; e construção e análise descritiva do fluxograma do material elencado. Catalogaram-se, posteriormente, esses recursos, armazenando-os em um banco de dados no Microsoft® Excel, versão 2016, para a realização da análise descritiva. Resultados: revelou-se que os materiais mais utilizados foram gaze e compressa com 3.415 e 3.325 unidades, respectivamente. Evidenciaram-se, pelo fluxograma, 44 etapas, 10 departamentos envolvidos e 15 processos documentais mapeados. Conclusão: observou-se que a falta de compressa resultou em compras emergenciais para garantir o funcionamento do setor e o fluxo institucional. A aquisição de materiais é complexa, burocrática e morosa. Pode-se minimizar a falta dos recursos materiais com uma inserção mais evidente do enfermeiro no planejamento em sala operatória. Descritores: Administração e Planejamento em Saúde; Assistência Perioperatória; Fluxo de Trabalho; Enfermagem de Centro Cirúrgico; Administração de Materiais no Hospital; Enfermagem. ABSTRACTObjective: to analyze the flow of the main material resource used in an operating room of a university hospital. Method: this is a qualitative, descriptive, documentary and observational study carried out in a university hospital. The two initial phases were: documentary analysis of the material resources used in the operating room; and construction and descriptive analysis of the flowchart with the material listed. These resources were subsequently cataloged and stored in a database using Microsoft® Excel, version 2016, in order to perform the descriptive analysis. Results: it was found that the most used materials were gauzes and compresses, with 3,415 and 3,325 units, respectively. The flowchart indicated 44 phases, 10 departments involved, and 15 mapped processes. Conclusion: it was observed that the lack of compresses resulted in emergency purchases aimed at maintaining the operation of the sector and the institutional flow. The acquisition of materials is complex, bureaucratic, and time-consuming. The lack of material resources can be minimized with a more evident insertion of nurses in operating room planning. Descriptors: Health Administration and Planning; Perioperative Care; Workflow; Nursing in the Surgical Center; Hospital Materials Management; Nursing.RESUMENObjetivo: analizar el flujo del principal recurso material utilizado en el quirófano de un hospital universitario. Método: se trata de un estudio cualitativo, descriptivo, documental y observacional realizado en un hospital universitario. Se llevaron a cabo dos etapas: análisis documental de los recursos materiales utilizados en el quirófano; y la construcción y el análisis descriptivo del diagrama de flujo del material enumerado. Esos recursos fueron posteriormente catalogados y almacenados en una base de datos usando Microsoft® Excel, versión 2016, para la realización del análisis descriptivo. Resultados: se encontró que los materiales más utilizados fueron gasa y compresa con 3.415 y 3.325 unidades, respectivamente. El diagrama de flujo mostró 44 etapas, 10 departamentos involucrados y 15 procesos documentales mapeados. Conclusión: se observó que la falta de compresas resultó en compras de emergencia para asegurar el funcionamiento del sector y el flujo institucional. La adquisición de materiales es compleja, burocrática y morosa. Se puede minimizar la falta de recursos materiales con una inserción más evidente del enfermero en la planificación en el quirófano. Descriptores: Administración y Planificación en Salud; Atención Perioperatoria; Flujo de trabajo; Enfermería de Centro Quirúrgico; Administración de Materiales en el Hospital; Enfermería.
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Almeida, Cristiane Leite de, Mayra Gonçalves Menegueti, Natassia Carmo Lopes Queiroz Ferreira, Thamiris Ricci de Araújo, and Ana Maria Laus. "Avaliação de intervenções educativas e conhecimento da equipe de enfermagem no uso de eletrocirurgia." Enfermería Global 20, no. 4 (October 8, 2021): 456–505. http://dx.doi.org/10.6018/eglobal.480031.
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Objetivo: Evaluar el efecto de las intervenciones educativas en el conocimiento y la aplicabilidad de la electrocirugía del equipo de enfermería.Material y método: Cuasiexperimento, con evaluaciones antes y después en un solo grupo, llevado a cabo en el centro quirúrgico de un hospital universitario terciario brasileño. Se realizó en siete etapas, se aplicó un cuestionario semiestructurado para evaluar los conocimientos de los participantes. Los participantes fueron expuestos a dos intervenciones educativas (clase expositiva, dialogada y video clase) y después de cada intervención se evaluó la retención de conocimientos. También se evaluaron indicadores de la aplicación de la unidad de electrocirugía durante los procedimientos quirúrgicos.Resultados: Participaron del estudio 4 enfermeros y 28 técnicos en enfermería. Los enfermeros tenían conocimientos previos sobre el tema de la mayor parte de los tópicos. Los técnicos en enfermería, mejoraron en los ítems verificación del equipamiento y colocación de la placa. Conclusiones: Los profesionales presentaron un buen desempeño teórico pero el mismo no se refleja en la práctica porque los profesionales son reacios a realizar prácticas que no coincidan con la teoría. La realización de este tipo de investigaciones es conveniente porque les permite a los gestores la posibilidad de proponer proyectos para una mejora continua de la asistencia perioperatoria. Objective: To evaluate the effect of educational interventions on the Nursing team's knowledge and applicability of electrosurgery.Material and Method: A quasi-experiment, with pre- and post-tests in a single group developed in the operating room of a Brazilian tertiary-level university hospital. It was developed in seven stages, with the application of a semi-structured questionnaire to assess the participants' knowledge. The participants were exposed to two educational interventions (lecture, dialogue and video-lesson) and, after each intervention, they were evaluated for knowledge retention. Indicators of the application of the electrosurgery unit during surgical procedures were also evaluated.Results: Four nurses and 28 nursing technicians participated in the study. The nurses had prior knowledge of the theme on most of the topics. Among the nursing technicians, there was an improvement in the “equipment check” and “electrodispersive plate positioning” items. Conclusions: The professionals presented good theoretical performance but the same is not evidenced in the practice because they are reluctant to having a practice different from the theory. Research of this nature is timely because it provides managers with a possibility to propose projects for continuous improvement of perioperative assistance. Objetivo: Avaliar o efeito de intervenções educativas no conhecimento e aplicabilidade de eletrocirurgia da equipe de enfermagem. Material e Método: Quase-experimento, com pré e pós-testes em um único grupo desenvolvido no centro cirúrgico de um hospital universitário terciário brasileiro. Foi desenvolvido em sete etapas, com aplicação de questionário semi-estruturado para avaliação do conhecimento dos participantes. Os participantes foram expostos a duas intervenções educativas (aula expositiva, dialogada e vídeo aula) e após cada uma das intervenções, foram avaliados quanto a retenção do conhecimento. Também foram avaliados indicadores da aplicação da unidade de eletrocirurgia durante os procedimentos cirúrgicos. Resultados: Participaram do estudo quatro enfermeiros e 28 técnicos de enfermagem. Os enfermeiros apresentaram conhecimento prévio do tema na maioria dos tópicos. Entre os técnicos de enfermagem, observou-se melhora nos itens checagem do equipamento e posicionamento da placa eletrodispersiva. Conclusões: Os profissionais apresentaram um bom rendimento teórico, porém o mesmo não fica evidente na prática pois os profissionais relutam em ter uma prática diferente da teoria. Pesquisas dessa natureza são oportunas pois proporcionam aos gestores uma possibilidade de propor projetos de melhoria contínua da assistência perioperatória.
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Owen, Charlotte. "Logic of Operating Room Nursing." AORN Journal 42, no. 5 (November 1985): 787. http://dx.doi.org/10.1016/s0001-2092(07)64397-x.
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Kenawy, Dahlia, and Daniel Schwartz. "An evaluation of perioperative communication in the operating room." Journal of Perioperative Practice 28, no. 10 (June 14, 2018): 267–72. http://dx.doi.org/10.1177/1750458918780154.
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Communication failures can lead to sentinel events in the operating room. Knowledge of basic surgical steps is important for all team members to ensure work flow efficiency. Surgeons and non-surgeons were surveyed to determine perceived and actual quality of communication between team members, using knowledge of surgical steps as a marker of communication quality. Participants agreed that communication was important, but non-surgeons were unable to name the four key steps of a laparoscopic cholecystectomy (p = 5.0E-07), indicating poor communication between surgeons and non-surgeons.
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Osborne-Smith, Lisa, and R. Kyle Hodgen. "Communication in the Operating Room Setting." Annual Review of Nursing Research 35, no. 1 (January 2017): 55–69. http://dx.doi.org/10.1891/0739-6686.35.55.
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Ideal and effective communication consists of a clear, audible, and focused message from a transmitter that is delivered to an attentive, undistracted receiver, and consists of both verbal and nonverbal types. Communication in the health care setting is highly complex and dynamic, involving multiple settings, participants, and unique challenges. Effective communication in the perioperative environment is a requirement for safe patient care delivery and an important element of teamwork. A message must be accurately delivered in a uniquely high-risk and time-sensitive location, beset with numerous distractions, barriers, and challenges. Surgical checklists and time-out procedures have promoted a standardized, "all-hands" approach to addressing some of the challenges to effective communication in the perioperative environment. Postoperative debriefing sessions have demonstrated effectiveness in improving team functioning in the simulated learning environment and hold promise as another strategy to address these challenges, but require further research and development. Other promising strategies to improve effective perioperative communication are focused on team building activities and minimizing distractions at critical time points within patient care delivery, but to date are not substantiated by evidence. Future research is necessary to examine these novel approaches to improving communication in the perioperative environment to influence the safety of patient care delivery in this highly challenging health care setting.
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Hanssen, Ingrid, Inger Lise Smith Jacobsen, and Sisilie Havnås Skråmm. "Non-technical skills in operating room nursing: Ethical aspects." Nursing Ethics 27, no. 5 (April 29, 2020): 1364–72. http://dx.doi.org/10.1177/0969733020914376.
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Background Non-technical skills are cognitive and interpersonal skills underpinning technical proficiency. Ethical values and respect for human dignity make operating room nurses responsible for nursing decisions that are clinically and technically sound and morally appropriate. Aim To learn what ethical issues operating room nurses perceive as important regarding non-technical skills. Research design Qualitative individual in-depth interviews were conducted. The interviews were analysed using Braun and Clarke’s six phases for thematic analysis. Participants and research context Eleven experienced perioperative/operating room nurses working in an operating unit at a Norwegian university hospital. Ethical considerations Approval was given by The Norwegian Social Science Data Service in care of the hospital’s Data Protection Officer. Findings Three main themes were found: respect and care for the patient, making the patient feel safe, and respect within the perioperative team. These features or themes, which incorporate collaboration and communication, are closely connected to patient safety. Discussion Defending the patient’s dignity is part of caring for and respecting the patient. The manner in which the operating room team collaborates is important for the patient to feel safe and secure. Poor teamwork may have dire consequences. Reciprocal respect within the team includes respect for each other’s tasks and responsibilities and to talk to one another in a friendly manner. Conclusion Being respectful and contributing to a caring atmosphere are central ethical skills in the operating room. To patients, harmonious teamwork translates into a feeling of safety and being cared for. The nurses see respect and patient safety, and respect and reciprocal politeness among the members of the perioperative team as central ethical non-technical skills. Lack of respect influences the team negatively and is detrimental for patient safety. Good communication is an important safety measure during surgery and creates a feeling of good ‘flow’ within the operating room team.
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Shelley, Sandra R. "Is professional nursing in the operating room?" AORN Journal 51, no. 1 (January 1990): 287–89. http://dx.doi.org/10.1016/s0001-2092(07)67264-0.
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Andersen, Karen. "Safe Use of Lasers in the Operating Room-What Perioperative Nurses Should Know Safe Use of Lasers in the Operating Room What Perioperative Nurses Should Know." AORN Journal 79, no. 1 (January 2004): 171–88. http://dx.doi.org/10.1016/s0001-2092(06)61151-4.
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Hasan, Aysha, Remy Zimmerman, Kelly Gillock, and Richard H. Parrish. "The Perioperative Surgical Home in Pediatrics: Improve Patient Outcomes, Decrease Cancellations, Improve HealthCare Spending and Allocation of Resources during the COVID-19 Pandemic." Healthcare 8, no. 3 (August 7, 2020): 258. http://dx.doi.org/10.3390/healthcare8030258.
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Cancellations or delays in surgical care for pediatric patients that present to the operating room create a great obstacle for both the physician and the patient. Perioperative outpatient management begins prior to the patient entering the hospital for the day of surgery, and many organizations practice using the perioperative surgical home (PSH), incorporating enhanced recovery concepts. This paper describes changes in standard operating procedures caused by the COVID-19 pandemic, and proposes the expansion of PSH, as a means of improving perioperative quality of care in pediatric populations.
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Sadeghi, Mahsa, Jerome A. Leis, Claude Laflamme, Darrel Sparkes, Wendy Ditrani, Aaron Watamaniuk, Ru Taggar, et al. "Standardisation of perioperative urinary catheter use to reduce postsurgical urinary tract infection: an interrupted time series study." BMJ Quality & Safety 28, no. 1 (May 29, 2018): 32–38. http://dx.doi.org/10.1136/bmjqs-2017-007458.
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BackgroundPrevention of healthcare-associated urinary tract infection (UTI) has been the focus of a national effort, yet appropriate indications for insertion and removal of urinary catheters (UC) among surgical patients remain poorly defined.MethodsWe developed and implemented a standardised approach to perioperative UC use to reduce postsurgical UTI including standard criteria for catheter insertion, training of staff to insert UC using sterile technique and standardised removal in the operating room and surgical unit using a nurse-initiated medical directive. We performed an interrupted time series analysis up to 2 years following intervention. The primary outcome was the proportion of patients who developed postsurgical UTI within 30 days as measured by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Process measures included monthly UC insertions, removals in the operating room and UC days per patient-days on surgical units.ResultsAt baseline, 22.5% of patients were catheterised for surgery, none were removed in the operating room and catheter-days per patient-days were 17.4% on surgical units. Following implementation of intervention, monthly catheter removal in the operating room immediately increased (range 12.2%–30.0%) while monthly UC insertion decreased more slowly before being sustained below baseline for 12 months (range 8.4%–15.6%). Monthly catheter-days per patient-days decreased to 8.3% immediately following intervention with a sustained shift below the mean in the final 8 months. Postsurgical UTI decreased from 2.5% (95% CI 2.0-3.1%) to 1.4% (95% CI 1.1-1.9; p=0.002) during the intervention period.ConclusionsStandardised perioperative UC practices resulted in measurable improvement in postsurgical UTI. These appropriateness criteria for perioperative UC use among a broad range of surgical services could inform best practices for hospitals participating in ACS NSQIP.
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Behar-Spicer, Cina. "Attempting to Rationalise the Perioperative Nursing Role." British Journal of Anaesthetic and Recovery Nursing 2, no. 3-4 (August 2001): 9–13. http://dx.doi.org/10.1017/s1742645600000644.
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Nursing and the role of the nurse have always been difficult to define (Nightingale 1986). This is especially true in operating theatres where task focused care often takes precedence over holistic patient care (Conway 1995). There is no shortage of literature suggesting that theatre nurses are preoccupied in preparation of instrumentation (Conway 1995, Holmes 1994) and if a non-nurse were to observe staff in some operating theatres it may be difficult to see where the nursing exists.
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Sørensen, Erik Elgaard, Kathrine Hoffmann Kusk, and Mette Grønkjaer. "Operating room nurses’ positioning of anesthetized surgical patients." Journal of Clinical Nursing 25, no. 5-6 (October 23, 2015): 690–98. http://dx.doi.org/10.1111/jocn.13000.
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Clark-Burg, Karen. "Future Perioperative Registered Nurses: An Insight into a Perioperative Programme for Undergraduate Nursing Students." Journal of Perioperative Practice 18, no. 10 (October 2008): 432–35. http://dx.doi.org/10.1177/175045890801801001.
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An Australian College of Operating Room Nurses (ACORN) submission (ACORN 2002–2008) recently stated that the specialities that suffered significantly from the transition of hospital-based nursing training to university training were the perioperative specialty, critical care and emergency. The main reason for this was that perioperative nursing was not included in the undergraduate nursing curriculum. Less than a handful of universities in Australia offer the subject as a compulsory unit. The University of Notre Dame Australia (UNDA) is one of these universities. This paper will provide an insight into the perioperative nursing care unit embedded within the Bachelor of Nursing (BN) undergraduate curriculum.
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Gill, Amanda, David Read, Jodie Williams, and Annette Holian. "Transformative Surgical Team Training." Prehospital and Disaster Medicine 34, s1 (May 2019): s173. http://dx.doi.org/10.1017/s1049023x19003960.
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Introduction:Sudden onset disasters exceed the capabilities of local health services. Emergency Medical Teams (EMTs), including the Australian Medical Assistance Team (AUSMAT), are a vital element of the Australian Governments capacity to respond to regional and international sudden-onset disasters. AUSMAT has the capacity to deploy an EMT Type 2 surgical field hospital and has been successfully verified by the World Health Organisation (WHO). All AUSMAT members must complete AUSMAT Team Member training. The National Critical Care and Trauma Response Centre, Darwin, Australia is responsible for all AUSMAT training.Aim:To educate and train the Surgical Team (perioperative nurses, surgeons, and anesthetists) in preparation for AUSMAT deployments in the austere environment.Methods:Prior to 2015, the surgical AUSMAT training was conducted via two courses: one for perioperative nurses and a separate course for surgeons and anesthetists. In 2015, the course was redesigned with the aim of collaborative training with all the Surgical Team Members. The new Surgical Team Course (STC) engages all three professions to learn alongside each other and discuss potential difficulties in techniques, the daily running of the operating room, and ethical discussions.Results:Since the rejuvenation of the STC, 15 surgeons, 17 anesthetists, and 18 perioperative nurses have completed the course. The attendees are familiarized with operational and clinical guidelines, the surgical field hospital, and operating room equipment including CSSD. A pivotal component of the course focuses on the essentials of medical records and Minimum Data Set reporting for EMTs as defined by WHO.Discussion:Since 2015, the NCCTRC has successfully run two courses. The revised collaborative model for AUSMAT STC has enhanced the quality of the program and subsequent learning experiences for participants.
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Bhalerao, Chetana V., Tuhin Mistry, Stephan Jebaraj, and Jagannathan Balavenkatasubramanian. "Modified Clavipectoral Fascial Plane Block to The Rescue: Polytrauma Patient with Brachial Plexus Injury Undergoing Awake Clavicle Surgery." International Journal of Regional Anaesthesia 3, no. 2 (2022): 107–9. http://dx.doi.org/10.13107/ijra.2022.v03i02.065.
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Dear Editor, Clavipectoral fascial plane block (CFPB) is an attractive alternative to traditional regional anaesthesia (RA) techniques for clavicle surgery. It was reported to provide motor-sparing, diaphragm-sparing stand-alone surgical anaesthesia, or perioperative analgesia [1]. We want to highlight the application of CFPB as the sole RA technique in a polytrauma patient with brachial plexus injury for surgical management of clavicle fracture. Consent was obtained for the publication of this letter. A 30-year-old American Society of Anesthesiologist physical grade I male (weight 75 kg, height 170 cm) patient was admitted with an alleged history of a fall from a two-wheeler. He had displaced comminuted right clavicle fracture (Allman type I) (Figure 1a), displaced fracture of right transverse processes of C6-T1, and right brachial plexus injury. He had undergone emergency left fronto-temporo-parietal craniotomy and evacuation of an acute subdural hematoma under general anaesthesia. The patient was transferred to the intensive care unit following surgery and weaned off from ventilatory support after three days. A Follow-up computed tomography (CT) scan revealed a significant reduction of cerebral edema and a thin rim of residual left frontal, bilateral tentorial, and interhemispheric subdural hematoma. Magnetic resonance imaging of the right brachial plexus revealed C5-C8 complete nerve root avulsion with hematoma and soft tissue edema in the adjacent area. After ten days of craniotomy, the patient was scheduled for right clavicle open reduction and internal fixation with plating (Figure 1b). The plan was to provide motor-sparing, phrenic nerve-sparing surgical anaesthesia without brachial plexus block (BPB). The anaesthesia plan was explained to the patient and relatives, and informed written high-risk consent was obtained. Standard monitors were attached inside the operating room, and an infusion of ringer lactate was started. Oxygen supplementation using a Hudson mask at 5 L/min flow was provided. The patient was placed supine with the head turned towards the contralateral side. Ultrasound-guided modified right CFPB was performed as described by Sonawane et al.[2] A high-frequency linear probe (Sonosite HFL 38xp/13–6 MHz; Fujifilm SonoSite Inc., Bothell, WA, USA) was placed on the skin over the anterior surface of the clavicle. The local anesthetic (LA) was deposited on the medial (10 ml) and lateral (10 ml) third of the clavicle between the clavipectoral fascia and periosteal collar using an in-plane technique (Figure 1c,d). In addition, the probe was kept over the fracture site, and LA (5 ml) was deposited around it under vision. Also, the skin over the incision site was covered by an additional subcutaneous infiltration (5 ml). The total volume of the LA was 30 ml (1:1 of 0.25% Bupivacaine and 1% Lignocaine-adrenaline, 8 mg Dexamethasone). The patient’s vitals remained stable, and the procedure was completed without complications. Clavicle innervation is complex and controversial. The pain-generating elements in clavicle surgeries include the skin and the richly innervated periosteum. The brachial plexus roots involved in complete innervation (dermatome, myotome, and osteotome) of the clavicle are C3-C7. Proximal BPB has been a standard practice for anaesthesia or analgesia for clavicle fracture surgeries. Hemidiaphragmatic paresis due to blockade of the phrenic nerve can be detrimental in polytrauma patients with lung injury or pneumothorax. Recently, the C5 ventral ramus block and selective supraclavicular nerve and upper trunk (SCUT block) with a low volume of LA have been described as site-specific and phrenic-sparing RA techniques for clavicle surgeries [3, 4]. However, BPB is contraindicated in patients with ipsilateral brachial plexus injury. Bhat et al. reported an incident of apnoea and cardiac arrest following paraesthesia-guided subclavian perivascular BPB in a polytrauma patient with undiagnosed brachial plexus injury [5]. The spread of injected LA to the subarachnoid space through the dural tear around the ruptured nerve roots resulted in total spinal anaesthesia and cardio-respiratory arrest. A CT myelogram after the resuscitation revealed a traumatic meningocele of the C8 nerve root. We avoided BPB in our patient, considering such dreaded consequences. In 2017, Dr. Luis Valdes described CFPB as an RA technique for clavicle surgeries targeting the sensory nerves that traverse the clavipectoral fascia [1]. CFPB creates a field block by depositing the LA at the medial and lateral third of the clavicle between the clavipectoral fascia and the periosteum of the clavicle involving all the nerves piercing the fascia to enter the clavicle. Rosale et al. managed a case where CFPB with intravenous Dexmedetomidine sedation provided intraoperative surgical anaesthesia and postoperative analgesia up to 16 hours after the block [6]. However, the skin incision may not be covered with the CFPB alone. So, an additional supraclavicular nerve block, cervical plexus block, or skin infiltration is required. The spread of LA in CFPB depends on the integrity of the clavipectoral fascia, which is lost in displaced or comminuted fractures due to a breach in the continuity of the fascia around the fractured site. Hence, an additional injection or hematoma block at the fracture site may improve the quality of the RA. We opted for the modified CFPB, which covered all the innervations and provided optimal surgical anaesthesia or analgesia. To conclude, the modified CFPB can be a better alternative to general anaesthesia or other available RA techniques in providing incision congruent surgical anaesthesia or postoperative analgesia for awake clavicle fracture surgery, especially in polytrauma patients with brachial plexus injury. However, randomized controlled trials are warranted for further validation.
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Sciubba, Daniel M., Clarke Nelson, Patrick Hsieh, Ziya L. Gokaslan, Steve Ondra, and Ali Bydon. "Perioperative challenges in the surgical management of ankylosing spondylitis." Neurosurgical Focus 24, no. 1 (January 2008): E10. http://dx.doi.org/10.3171/foc/2008/24/1/e10.
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✓ Patients with ankylosing spondylitis (AS) who present with spinal lesions are at an increased risk for developing perioperative complications. Due to the rigid yet brittle nature of the ankylosed spines commonly occurring with severe spinal deformity, patients are more prone to developing neurological deficits. Such risks are potentially increased not only during surgical manipulation or deformity correction, but also during image acquisition, positioning within the operating room, and intubation. In this review the complications of AS are reviewed, and recommendations are provided to avoid problems during each stage of patient management.
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Lindwall, Lillemor, and Iréne von Post. "Habits in Perioperative Nursing Culture." Nursing Ethics 15, no. 5 (September 2008): 670–81. http://dx.doi.org/10.1177/0969733008092875.
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This study focuses on investigating habits in perioperative nursing culture, which are often simply accepted and not normally considered or discussed. A hermeneutical approach was chosen as the means of understanding perioperative nurses' experiences of and reflections on operating theatre culture. Focus group discussions were used to collect data, which was analysed using hermeneutical text analysis. The results revealed three main categories of habits present in perioperative nursing culture: habits that promote ethical values (by temporary friendship with patients, showing respect for each other, and spending time on reflection on ethics and caring); habits that hinder progress (by seeing the patient as a surgical case, not acknowledging colleagues, and not talking about ethics); and habits that set the cultural tone (the hidden power structure and achieving more in less time).
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&NA;. "Operating Room Nurse Day." Plastic Surgical Nursing 6, no. 3 (1986): 126. http://dx.doi.org/10.1097/00006527-198600630-00009.
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Ji, Yisi D., Paul M. Cavallaro, and Britlyn D. Orgill. "Perioperative considerations in the management of cold agglutinin disease in laparoscopic surgery." BMJ Case Reports 14, no. 5 (May 2021): e241294. http://dx.doi.org/10.1136/bcr-2020-241294.
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An 80-year-old man with idiopathic cold agglutinin disease presented with acute cholecystitis. We describe operating room and anaesthetic considerations for patients with cold agglutinin disease and measures that can be taken to prevent disease exacerbation in this case report. Multidisciplinary collaboration and planning between the operative room staff, anaesthesia team and surgical team are needed to ensure safe surgery and optimal patient outcomes.
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Liu, Qingyan, Juan Wang, Jie Han, Tongyang You, and Lijuan Li. "Effects of Seamless Operating Room Nursing Combined with Multistyle Health Education on the Psychological State, Rehabilitation Quality, and Nursing Satisfaction in Patients with Internal Fixation of Femoral Fracture." Journal of Healthcare Engineering 2022 (April 5, 2022): 1–7. http://dx.doi.org/10.1155/2022/5196363.
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Objective. To explore the effects of seamless operating room nursing combined with multistyle health education on the psychological state, rehabilitation quality, and nursing satisfaction in patients with internal fixation of femoral fracture. Methods. Eighty patients who received internal fixation of femoral fracture in our hospital (November 2020–November 2021) were chosen as the research objects, and their clinical data were retrospectively analyzed. They were divided into experimental group and control group according to the sequence of hospital admission. In perioperative period, the control group received routine nursing measures and the experimental group received seamless operating room nursing combined with multistyle health education. The patients’ psychological state, rehabilitation quality, and nursing satisfaction after intervention were compared between the two groups. Results. Compared with the control group, the experimental group achieved remarkably lower score of Profile of Mood States (POMS) after nursing ( p < 0.001). The experimental group had much higher cognitive level scores, Harris hip score (HHS), Functional Independence Measure (FIM) score, and nursing satisfaction score in comparison with the control group ( p < 0.05). In perioperative period, the experimental group had much lower total incidence of complications in comparison with the control group ( p < 0.05). Conclusion. Seamless operating room nursing combined with multistyle health education, as an effective measure to improve the rehabilitation quality of the patients with internal fixation of femoral fracture, has better effects on improving the patients’ psychological state and reducing complications in perioperative period in comparison with the routine nursing intervention. Further studies are conducive to providing a better solution for the patients with internal fixation of femoral fracture.
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Mirbagher Ajorpaz, Neda, Mansoureh Zagheri Tafreshi, Jamileh Mohtashami, Farid Zayeri, and Zahra Rahemi. "The effect of mentoring on clinical perioperative competence in operating room nursing students." Journal of Clinical Nursing 25, no. 9-10 (March 16, 2016): 1319–25. http://dx.doi.org/10.1111/jocn.13205.
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Zhu, Xiaomin, Ying Xu, Xuefei Hu, Hong Ye, and Jun Xiao. "The Application Value and Influence of Integrated Nursing of Operating Room and Disinfection Supply Center Combined with 6Sigma Management in Operating Room Instruments." Computational and Mathematical Methods in Medicine 2022 (August 16, 2022): 1–6. http://dx.doi.org/10.1155/2022/8490473.
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In this study, 897 surgical instruments used for comprehensive management of hand supply from January to December 2019 were selected as the control group. Similarly, 1086 surgical instruments administered with 6Sigma from January to December 2020 were selected as the observation group. By observing and comparing the differences between the two groups of patients in the operating room equipment cleaning pass rate and general indicators, other related pass rate, operating room equipment defects, and doctors’ satisfaction with equipment, to explore the application value and influence of comprehensive nursing in operating room and disinfection supply center combined with 6Sigma management in operating room equipment management. The results show that the application of hand-supply integration combined with 6Sigma management has a good effect on operating room equipment management, which significantly improves the qualified rate of operating room equipment cleaning and the satisfaction of doctors to the equipment, and reduces the defects of operating room equipment, which has a certain reference value for operating room equipment management.
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Marrone, Stephen R. "Perioperative accountable care teams: Improving surgical team efficiency and work satisfaction through interprofessional collaboration." Journal of Perioperative Practice 28, no. 9 (July 23, 2018): 223–30. http://dx.doi.org/10.1177/1750458918788975.
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The purpose of this performance improvement project was to design, implement and evaluate an interprofessional education initiative intended to improve surgical team efficiency, communication and work satisfaction. The development of interprofessional perioperative accountable care teams in three surgical specialties, cardiothoracic, neurosurgery and orthopedics, demonstrated a reduction in turnover time, increased staff, patient and surgeon satisfaction, and increased operating room (OR) revenue generated by the surgical specialties within one year of implementation.
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Husein, Omar F., and Douglas D. Massick. "Cricoid Palpability as a Selection Criterion for Bedside Tracheostomy." Otolaryngology–Head and Neck Surgery 133, no. 6 (December 2005): 839–44. http://dx.doi.org/10.1016/j.otohns.2005.08.008.
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OBJECTIVE: To prospectively evaluate the significance of cricoid cartilage palpability as a selection criterion for bedside tracheostomy and to prospectively compare a cohort of patients undergoing bedside tracheostomy with another cohort receiving operating room tracheostomy. STUDY DESIGN/SETTING: Prospective trial comparing 2 cohorts of patients receiving tracheostomies at a tertiary care center (university hospital). In all, 220 consecutive intubated patients selected for elective tracheostomy were enrolled. Of them, 134 patients had palpable cricoid cartilage and underwent open surgical tracheostomy at the bedside. The remaining 68 patients received open surgical tracheostomies in the operating room. Demographic data, patient anatomic features, and perioperative complications were prospectively recorded. There were no statistically significant differences in age, gender, reason for admission, indication for tracheostomy, Acute Physiology and Chronic Health Evaluation II score, number of days intubated, or time required to perform the procedure for those patients whose tracheostomies were performed in the operating room versus the intensive care unit. RESULTS: Patients with a palpable cricoid cartilage had a significantly reduced perioperative complication rate compared with those without a palpable cricoid cartilage (2% vs 22%, P < 0.001). Comparison of cervical girth, mental-to-sternum distance, and thyroid-notch-to-sternum distance showed no significant difference between the 2 groups and did not further define selection criteria. CONCLUSION: This investigation prospectively confirms the safety of bedside tracheostomy placement in properly selected patients. Complication incidences are defined for open surgical tracheostomy at the bedside and in the operating room. Palpability of the cricoid cartilage has significant value as a selection criterion for bedside tracheostomy. SIGNIFICANCE: These findings will aid in the development of protocols and pathways for surgical airway management in critically ill patients to maximize cost-effective, high-quality care. EBM RATING: B-2
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Culp, William C., Bradly A. Kimbrough, and Sarah Luna. "Flammability of Surgical Drapes and Materials in Varying Concentrations of Oxygen." Anesthesiology 119, no. 4 (October 1, 2013): 770–76. http://dx.doi.org/10.1097/aln.0b013e3182a35303.
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Abstract Background: Over 600 operating room fires occur annually although many cases go unreported. Over 81% of operating room fires involve surgical drapes, yet limited data exist on the differing degrees of flammability of drapes and other surgical fuel sources in varying oxygen concentrations. The purpose of this study is to assess the flammability characteristics of fuels in the operating room under varying oxygen concentrations. Methods: Five fuel sources were analyzed in three levels of oxygen: 21%, 50%, and 100%. Three test samples of each material were burned in a manner similar to that established by the Consumer Product Safety Commission. Time to sample ignition and time to complete burn were measured with video analysis. Results: The median [minimum, maximum] ignition time in 21% oxygen was 0.9 s [0.3, 1.9], in 50% oxygen 0.4 s [0.1, 1.2], and in 100% oxygen 0.2 s [0.0, 0.4]. The median burn time in 21% oxygen was 20.4 s [7.8, 33.5], in 50% oxygen 3.1 s [1.4, 8.1], and in 100% oxygen 1.7 s [0.6, 2.7]. Time to ignite and total burn times decreased as oxygen concentration increased (P < 0.001). Flammability characteristics differed by material and oxygen concentration. Utility drapes and surgical gowns did not support combustion in room air, whereas other materials quickly ignited. Flash fires were detected on woven cotton materials in oxygen-enriched environments. Conclusions: Operating room personnel should be aware that common materials in the operating room support rapid combustion in oxygen-enriched environments. The risk of ignition and speed of fire propagation increase as oxygen exposure increases. Advances in material science may reduce perioperative fire risk.
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Yavuz van Giersbergen, Meryem, Esma Ozsaker, Elif Dirimese, and Aliye Okgun Alcan. "The Operating Room Experiences of Nursing Students: A Focus Group Study." Journal of PeriAnesthesia Nursing 31, no. 2 (April 2016): 146–53. http://dx.doi.org/10.1016/j.jopan.2014.11.017.
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Vermillion, C. "Operating room acquired pressure ulcers." Plastic Surgical Nursing 10, no. 4 (1990): 181. http://dx.doi.org/10.1097/00006527-199001040-00016.
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Jain, Mehr. "Improving surgical safety checklist completion using distributed responsibility of checklist item completion among operating room team members: A quality improvement project." University of Ottawa Journal of Medicine 10, no. 1 (September 4, 2020): 40–46. http://dx.doi.org/10.18192/uojm.v10i1.4630.
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Background. Surgical safety checklists are a standard of care for safe operating room practice, but their use has not been associated with reductions in adverse perioperative outcomes in some settings. Non-adherence and partial checklist completion may contribute to this lack of effect.
Objective. To examine whether a surgical safety checklist using distributed responsibility of checklist item completion, by allocation of questions and responses among operating room staff, increases surgical safety checklist compliance.
Methods. With Quality and Risk Management approval, a multicomponent strategy consisting of novel surgical safety checklist focused on distributed responsibility of checklist item completion was evaluated in orthopaedic operating rooms at The Hospital for Sick Children, Toronto, from July to August 2016 using a before-and-after study design. The intervention consisted of a wall-mounted reusable checklist with questions and responses designated to specific operating room team members. Team training was provided beforehand, operating room team leaders were identified to promote the intervention, and revisions to the checklist content and process were implemented based on feedback on feasibility and clinical sensibility.
Results. A total of 45 and 59 children were included in pre-intervention and intervention groups, respectively. Overall, 87% (1,354/1,560) of checklist items were observed. Checklist item completion was significantly increased in the post-intervention group (77% [615/802]) compared with the pre-intervention group (27% [150/522]) (P<0.001).
Conclusions. These findings suggest that a multicomponent strategy of designating responsibility for item completion among operating room team members and using a memory aid can improve compliance with surgical safety checklist item completion.
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Kelly, Barry, and Edmund Carton. "Extended Indications for Extracorporeal Membrane Oxygenation in the Operating Room." Journal of Intensive Care Medicine 35, no. 1 (April 23, 2019): 24–33. http://dx.doi.org/10.1177/0885066619842537.
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Background:The use of extracorporeal life support (ECLS) for cardiorespiratory support is increasing. Traditional absolute contraindications are currently deemed relative contraindications. Extracorporeal life support is now considered for a wider cohort of patients on a case-by-case basis.Method:We performed a review of the literature and examined current Extracorporeal Life Support Organization guidelines that support the use of ECLS in the operating room, based on the underlying pathology and surgical procedure proposed. We discuss specific surgical populations and different modes of ECLS and cannulation strategies.Results:Based on the available literature, veno-venous extracorporeal membrane oxygenation (ECMO) can be used for the management of complex tracheobronchial and lung surgery, both in the elective and in the emergent setting. Elective veno-arterial (V-A) ECMO for cardiocirculatory support should be considered in high-risk patients undergoing ventricular tachycardia ablation. Extracorporeal life support should be considered as a potential life-saving intervention in almost all parturients with severe respiratory failure or refractory cardiogenic shock. V-A ECMO should be considered in unanticipated intraoperative cardiac arrest in patients without preexisting end-organ failure.Conclusion:As the number of indications for ECLS in the operating room is growing, anesthesiology and surgical staff should become familiar with the perioperative management of patients on ECLS.
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Waddell, Ashley W. G. "Cultivating Quality: Implementing Surgical Smoke Evacuation in the Operating Room." AJN, American Journal of Nursing 110, no. 1 (January 2010): 54–58. http://dx.doi.org/10.1097/01.naj.0000366057.14229.6d.
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Grujic, Dejan, and David Martin. "Perioperative Clopidogrel is Seven Days Enough?" American Surgeon 75, no. 10 (October 2009): 909–13. http://dx.doi.org/10.1177/000313480907501009.
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Despite the prevalence of surgical candidates on clopidogrel, no definitive guidelines exist for stopping the drug preoperatively. A 7 day off-clopidogrel period is commonly considered safe with regards to bleeding complications. We sought to put the 7-day window to the test with regards to major bleeding events requiring either blood transfusions or return trips to the operating room. We collected data for patients taking clopidogrel in the perioperative period between 2005 and 2007 (n = 170). This data was then compared with the data of all of the patients undergoing surgery at our institution for the same time period (n = 34,480). Patients taking clopidogrel experienced a significantly higher rate of return trips to the operating room (6.5%) compared with nonclopidogrel patients (0.015%). Interestingly, we found no significant difference between those stopping clopidogrel more than 7 days preoperatively and those that did not (5% and 7.5%, respectively). There did not seem to be a significant difference in blood transfusion rates between the two clopidogrel groups. Patients on perioperative clopidogrel require reoperations for bleeding at a significantly higher rate compared with patients not taking clopidogrel. Discontinuing clopidogrel 7 days before surgery is not enough to negate this difference and these patients still experience a drastically higher rate of reoperations for bleeding.
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Bowen, Carol P. R., Larry R. Whitney, Jonathon D. Truwit, Charles G. Durbin, and Marcia M. Moore. "Comparison of Safety and Cost of Percutaneous versus Surgical Tracheostomy." American Surgeon 67, no. 1 (January 2001): 54–60. http://dx.doi.org/10.1177/000313480106700113.
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Tracheostomy continues to be a standard procedure for the management of long-term ventilator-dependent patients. Traditionally the procedure has been performed by surgeons in the operating theater using an open technique. This routine practice has recently been challenged by the introduction of bedside percutaneous dilatational tracheostomy (PDT), which has been reported to be a cost-effective alternative. The purpose of this study is to evaluate and compare the safety, procedure time, cost, and utilization of percutaneous and surgical tracheostomies at a university hospital. A retrospective medical chart review was performed on all ventilator-dependent intensive care unit patients at the University of Virginia Medical Center undergoing tracheostomy during a 23-month period beginning December 26, 1996. Of the 213 patients identified for review, 74 and 139 patients received percutaneous and surgical tracheostomies, respectively. Of 74 percutaneous tracheostomies, 73 reviewed were performed by general surgeons, pulmonary physicians, or anesthesiologists in the intensive care unit; all open tracheostomies were performed by surgeons in the operating room, and one percutaneous procedure was performed in the operating room. Perioperative complications occurred in five of 74 patients (6.76%) during PDT; of these, three patients (4.1%) experienced major complications requiring emergent operative exploration of the neck. Three patients (2.2%) experienced perioperative complications during surgical tracheostomy. The mean procedure time was significantly shorter for the percutaneous procedure. Average charges per patient in an uncomplicated case including professional fees, inventory, bronchoscopy (if performed), and operating room charges were $1753.01 and $2604.00 for percutaneous and standard tracheostomies, respectively. These charges do not include the charges associated with surgical intervention after PDT complications. In contrast to previously published reports showing complications clustered during a physician's first 30 percutaneous cases, our study demonstrated no relationship between complication occurrence and physician experience. That is, no learning curve associated with performing PDT was evident. In addition there was no association seen between physician specialty and complication rate. PDT in the intensive care unit costs less than surgical tracheostomy performed in the operating room and can be performed in less time. Several other studies have recommended that bronchoscopy during PDT provides additional safety; however, in our series all three major complications took place during bronchoscopy-assisted percutaneous procedures. Our series suggests that PDT carries an appreciable risk of major complications. Careful patient selection and additional experience with the procedure may decrease complication rates to an acceptable level.