SHARING GOOD PRACTICE
Placement name and organization
Theatres (Peri-operative care)
Swindon & Marlborough NHS Trust
The learning tool we have devised is
Peri-operative Placement Guide
It is particularly useful for
Student Nurses
Student Operating Department Practitioners
If you would like more information about this please contact
Mark Turnbull
Development and Training Manager (Peri-operative Care)
Great Western Hospital
Swindon & Marlborough NHS Trust
01793 604145
N.B. We do not wish you to adapt or use this material without consulting us first
Useful links
http://www.afpp.org.uk/
http://www.aodp.org/
http://www.virtual-anaesthesia-textbook.com/index.shtml
http://www.aorn.org/
http://www.rcoa.ac.uk/
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Your Perioperative Practice Placement
The most striking difference between your previous placements and this one is predominantly
that the environment is totally different from what you may have experienced before.
Your placement will be divided into time spent working in anaesthetics scrub and recovery
placements. Your timetable usually consists of either three or four 8am to 6pm shifts all during
the week.
In order to have enough support during your placement you will mainly work during the week;
however, if for specific reasons you cannot work the hours set, it may be possible to make
arrangements for you to work out of hours.
At the beginning of the placement you may feel overwhelmed by this environment and the
complex instrumentation and equipment. Please be assured that most of the operating theatre
personnel have experience of this and will help you to become familiar with the area you are
working in.
MENTORS
Here in the Operating Department we adopt a team mentorship approach. This is because we
run a 24hr service and not all mentors are available during the week, therefore you may work
with various different mentors during your 3 placements.
The role of the Development and Training Manager and the Clinical Placement Facilitator is to
oversee all the mentors and resolve any issues that may crop up during your time in the practice
area.
Please feel free to come and discuss any problems in confidence with any one of us as we
can usually resolve the issue there and then.
COMPETENCIES
In order to achieve your competencies whilst in placement, you will need to arrange a meeting
with either the Development and Training Manager or the Clinical Placement Facilitator in your
first week of placement. They will discuss how you can achieve your competencies and arrange
subsequent meetings to review your learning outcomes.
If you have further queries regarding competencies please feel free to discuss these as
soon as possible so we can address them.
Enjoy your placement!
Mark Turnbull
Development and Training Manager
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Expected learning outcomes of perioperative placement
1. Orientation to the department
 Who’s who? Identify members of multi-disciplinary
team. The wearing of ID badges is essential in the
operating theatres, as everyone looks the same once
in ‘blues’.
 Layout of theatre department.
 Identification of key elements of the roles and
responsibilities of the anaesthetic, scrub and recovery
practitioners.
 Location of policies, procedures and protocols.
 Emergency procedures: fire, major incident.
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2. Management of risks in the operating department.
All the below relate to your competencies. Use the following list to identify the
competencies and how they relate to your experience.
Patient safety and avoidance of harm underpin all aspects of perioperative care.
Theatre staff undertake and record checks to ensure that:
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The patient understands what is happening at all times in order to minimise
anxiety.
THINK! Consent, communication, therapeutic relationships.
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The correct planned procedure is carried out on the correct patient on the
correctly marked side.
THINK! Careplans, communication, teamwork.
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The patient is safely transferred onto the operating table according to the
safe system of practice.
THINK! Risk assessments, communication, MSD policies.
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All swabs, needles, blades and instruments are correctly accounted for and not
inadvertently retained.
THINK! Why? MDT teamwork, risk assessment, communication.
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The patient is protected from untoward injury from electrosurgical equipment.
THINK! Communication, risk assessments, care planning.
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The avoidance of incorrect patient positioning causing nerve or other damage.
THINK! Preoperative assessments, communication
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The avoidance of drug incidents in the interest of the patient, practitioner and
Employing Authority.
THINK! Safe systems of work, careplans, checklists, communication
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3. Infection Control in the operating theatre
Infection control practices are implemented for the prevention of
surgical site infection. This is based on evidence and confirmatory
scientific knowledge. Some of the practices routinely used by surgical
teams cannot be rigorously studied for ethical and logistical reasons
(e.g. wearing vs not wearing gloves).
Try to identify areas and patients most at risk.
The theatre practitioner’s role in the prevention of risk of acquiring
infection includes the following:
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Understand sterility and disinfection
Handwashing and basic hygiene
Maintenance of a sterile field
Use of masks
Scrub technique
Gowning and gloving
Pre-op shaving
Antiseptic skin preparation
Ventilation, keeping theatre doors closed
Restricting personnel
Checking sterility of instruments
Traceability of instruments
Adopting a sterile conscience
Referring to Infection Control team policy
Knowledge of specific organisms
Prophylactic antibiotics
The implementation of universal precautions
Avoidance of needlestick/sharps injury
All of these are related to your competencies. Make a note of which
competencies these are associated with – it’ll help with the sign off!
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4. Communication and documentation of perioperative care
Information technology has reached the operating theatres! It is the
responsibility of the trained theatre personnel to input patient
information to our Theatre System (database). Each theatre has a
theatre register and every patient is accompanied by a patient care plan
and preoperative checklist, which begins on the ward and follows through
theatre into recovery.
Other documentation includes:
Specimen forms
Xray requests
E-register
Written register
5. Teamwork
The operating theatre teams work interdependently. The aims of the
team are to provide a safe environment and to avoid untoward harm to
patients and staff.
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The anaesthetic assistant conveys any relevant pre-op patient
information to the rest of the team.
The safe patient transfer to the operating table is initiated
by the anaesthetist.
Any changes in the order of the list are communicated to the
whole team to avoid error and confusion.
Handover to the recovery team enhances continuity of care,
patient safety and interdepartmental communication.
THINK! Who is in the ‘team’?
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6. Accountability and Theatre Practice
The theatre nurse is personally accountable for his/her
practice and must, “Work in a collaborative and cooperative
manner with health and care professions and others involved in
providing care, and recognise and respect their particular
contributions within the care team.” UKCC (1996)
A.
For care to be effective, theatre personnel must all work
towards a common goal, directed towards meeting the
needs and serving the interests of the patient.
B.
Your assessor will be able to advise you if you are asked to
undertake a role that you feel may be outside the bounds
of your ability and experience. If in doubt, always ask.
According to the UKCC code of professional contact, clause 4
states that in the exercise of professional accountability, the
registered nurse must, “Acknowledge any limitations in your
knowledge and competence and decline any duties or
responsibilities unless able to perform them in a safe and
skilled manner.”
However, as your exposure to the skills and procedures
increases, you will be given encouragement to do more. Keep a
diary in your Learning Record as you may not work with the
same practitioner on subsequent shifts; this will help your next
practitioner to gauge where you are.
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LEARNING RECORD
Please use this document as a brief record of knowledge, skills and
experiences gained whilst working in the operating theatre.
Week One:
Monday
Tuesday
Wednesday
Thursday
Friday
Ask the education team for more copies!
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Week Commencing:
Monday
Tuesday
Wednesday
Thursday
Friday
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Learning Outcomes for Student Nurse Role
of the Anaesthetic Practitioner
Knowledge:
1. Anatomy and physiology of respiratory system
2. Cardiovascular system
3. Definition of anaesthesia
4. Anaesthetic techniques – local anaesthetic blocks
- anaesthetic gases
- vaporisers
5. The triad of anaesthesia - analgesics, muscle relaxants
6. Anaesthetic agents – actions and side effects
7. Monitoring – circuits, ET tubes, LMAs, airways
8. Emergency and problem anaesthetics – malignant hypothermia
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Role of the Anaesthetic Practitioner
Use the notes below as guidance for your learning outcomes.
Preparing, checking and testing all necessary equipment:
1. In the anaesthetic room
2. In theatre
Reassurance of patient pre-operatively:
Procedure for checking patients into the anaesthetic room:
Apply pre-operative monitoring:
Preparation of necessary intravenous fluids:
Assist in gaining intravenous access:
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Assist with spinal/epidural anaesthesia. Preparation, patient positioning,
reassurance, monitoring:
Assist the anaesthetist at induction of anaesthesia:
Assist in the safe patient transfer on and off the operating table:
The administration of medicines and controlled drugs:
The application of universal precautions in the anaesthetic room:
Care of the anaesthetised/unconscious patient:
DVT prophylaxis
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Theatre Practitioner Objectives
Working alongside a scrub practitioner, you will be able to develop
knowledge and understanding of:
Patient diagnosis and reason for surgery
Checking of consent
Relevant anatomy and physiology
Main steps of surgery
Instrumentation required
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Supplementary items
Implants, drains, dressings and sutures
Correct position of patient to facilitate surgery, including table
attachments
Potential intra-operative complications and actions taken to deal with
them
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Reading list for operating theatre practitioners
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Clarke P, Jones J, eds (1998) Brigden’s Operating Practice
Damani N, (1998) Manual of Infection Control Procedures
Gruendemann B, Fernsebner B, (1995) Comprehensive Perioperative
Nursing Vols 1 & 2, Jones & Bartlett
Hawthorne J, (1994) Understanding & Management of Nausea &
Vomiting, Blackwell Science Ltd
Hawthorne J, Redmond K, (1998) Pain Causes & Management,
Blackwell Science Ltd
Hind M, Wicker P, (2000) Principles of Perioperative Practice,
Churchill Livingstone
Meeker & Rothrock, (1999) Alexander’s Care of the Patient in
Surgery
Mallet & Bailey, (1996) Manual of Clinical Nursing Procedures,
Royal Marsden NHS Trust
National Association of Theatre Nurses (1998) Principles of Safe
Practice in the Perioperative Environment
National Association of Theatre Nurses (1998) Safeguards for
Invasive Procedures
NVQ Level 3 Standards (1998) Operating Department Practice
Pudner, (2000) Nursing the Surgical Patient
Rushman GB et al, (1998) Lee’s Synopsis of Anaesthesia
Butterworth & Heinemann
Sasada, (1999) Drugs in Anaesthesia
Tingle J, Cribb A, (1995) Nursing Law and Ethics, Blackwell Science
Torrance, Serginson, (1996) Surgical Nursing
Journals
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British Association of Day Surgery
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British Anaesthetic & Recovery Nurse Association
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Anaesthesia and Intensive Care Medicine
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Journal of Perioperative Nursing
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Journal of Operating Department Practice
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Surgery
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