JCIA OR
Care not documented is
care not given
Holding Bay ( Preoperative Care)
• Pre operative Verification
• Correct patient, procedure, and site
• All relevant documents, images, and studies are available, properly
labeled, and displayed
• Any required blood products, special medical equipment, and/or implants
are present
• Surgical Site Marking
• SSI Bundle
• Patients Valuable
• Patient Education
• Handover
• Receiving the patient in OR
• Handing over to Intra-op
What is an SSI bundle ?
• Hair removal with Clipper
• Chlorohexidine Bath
• Blood Sugar Level
• Body Temperature
• Antiseptic prophylaxis
Intraoperative Care
• Complete Handover using SBAR
• Surgical Safety Checklist
• No other activities
• Sign-In
• Patient/parents must be involved.
• All team must be present.
• Time-Out
• Do not fill in the form beforehand.
• No distractions
• Listen Carefully and respond
• Sign-Out
• Equally important
• Verify carefully
Intraoperative Care
• What is the procedure of surgical counts in case of life threatening
emergency surgery.
• How do you label solutions in sterile field.
• What PPEs are used inside OR.
• What is the sequence of donning and doffing of PPEs.
• What are the special guidelines for OR , during COVID period.
• Do you store any items in OR.
• How do you manage temperature and humidity in OR.
• How do you handover Patient?
Intraoperative Care
• Where do you document implants?
• How do you document implants without lot number ?
• How do you ensure accurate charging of supplies?
• What is the process of getting surgical supplies from Store.
• Do you require more than one timeout procedures for same patient,
when? Why?
• How do you clean OR for next patient? Where do you document it.
Medical implants
1.
A record of all implantable medical devices will be maintained by the individual
departments.
2.
The hospital ensures that all relevant medical implants are present at the time of usage.
3.
Qualified representative from the medical implant providing company may be present at
the time of the procedure.
4.
Detailed information must be given to the patient regarding maintenance, precautions
and proper functioning
5.
In the event of recall notification of implanted device, responsible physician or designee
shall contact the patient within 24 hours of the official recall notification and document in
the clinical notes.
Post Operative Care
• Are surgeon’s notes mandatory before shifting the patient to PACU?
• What is PACU admission criteria?
• What is PACU discharge criteria?
• How do you assess pain in PACU?
• What are the element of pain assessment?
• Do you have any devices with clinical alarms?
• Show me how do you set alarms ?
• When you can disable the alarm?
• Who decides discharge of patient from PACU/CR?
• What is the process of patient discharge from PACU?
Post Operative Care
• How do you clean bed and other used item to be used next patients.
• What is the procedure to use single use devices?
• How do you transport used items to CSSD?
PACU ADMISSION CRITERIA
• Recovering from Monitored Anesthesia Care
• Mechanical ventilation and/ or airway protection
• Invasive hemodynamic monitoring
• Noninvasive ventilation post anesthesia
• If ICU/HDU bed not available.
PACU discharge criteria ?
• Modified ALDRETE score
1.
2.
3.
4.
5.
Respiration
Oxygen saturation
Circulation
Level of consciousness
Movements
Sentinel Event
• Sentinel event is an unexpected occurrence involving death or serious physical or
psychological injury, or the risk thereof.
• Permanent harm
• Suicide
• Abduction of any patient receiving care
• Prolong fluoroscopy with cumulative dose >1500 Rads to a single field
• Wrong site wrong patient surgery
• Retained foreign body
Anesthesia and sedation care
• Who is responsible for sedation in this hospital?
• How has this hospital ensured standardisation of procedural
sedation? (Question for all HODs, Consultants and Anesthesia
Doctors)
• Do you take a separate consent when performing a procedure
requiring procedural sedation?
• Do doctors and nurses undergo any special training for sedation?
• What assessment is done prior to sedation?
• What monitoring is done for patients whilst under sedation?
• Do you conduct a pre-anesthesia assessment?
• Does the patient undergo any specific assessment immediately prior
to induction, if so, what are the components of it?
• What education is provided to patient and family prior to
administration of anesthesia?
• What monitoring is done for patients whilst they are under
anesthesia?
• What monitoring is done post anesthesia?
• How do you decide which patients go to PACU and which are
discharged from OR to ICU/Ward?
• Do we have a discharge criteria from PACU?
• What handover is done;
• From OR to PACU
• From PACU to ward/ICU.
• What is the minimum assessment required prior to planning a
surgery?
• What education is given to patient prior to surgery?
• What are the components of your surgical/procedure note?
• Who does site marking?
• How do you ensure availability of implants prior to surgery?
• Who approves the implants used in your hospital?
• What safety precautions do you take to ensure safe use of implants?
• How does the hospital trace implantable medical devices?