Second part
- Standards for surgical operations
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A policy of accurate and documented identification of the patient before the operation and also immediately before the start of the surgery
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Policy: Use a documented method to ensure the correct patient, correct procedure, and correct part before beginning a procedure or other interventional procedure.
Purpose: To achieve patient safety by ensuring the correct patient and the correct location for surgical or other interventions.
Working procedures:
1. The nurse responsible for receiving the patient for operations receives the patient’s medical record and verifies the patient’s basic data.
2. The nurse asks the patient about his name, matches what is written on the identification bracelet to his file, asks the patient about the procedure required of him, and determines the location of the prescription for the procedure.
3. The nurse matches the patient’s information with what is recorded in the medical record and for the six procedures she performs (operations, endoscopy, interventional radiology, etc.).
4. The surgeon, anesthesiologist, and operation nurse ask the patient about his name, the operation, and the location of the interventional procedure (operations, x-rays, endoscopy, etc.) before anesthetizing the patient on the operating table.
Responsible: Doctors and nursing staff.
Models: Safe Surgery Model.
References: International standard precautions for patient safety.
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The policy of ensuring all documents and equipment necessary to perform the surgery
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Policy: Use a checklist to ensure that all documentation and all equipment needed to perform operations and other interventional procedures are available, correct, and working efficiently before starting any of them.
Purpose: To achieve patient safety when undergoing surgery or any other interventional procedure.
Working procedures:
1. The charge nurse obtains a copy of the operating list (for six operations).
2. The responsible nurse ensures the cleanliness of the operating rooms, including the operating room lights, the operating table, and all the room furniture and equipment it contains.
3. The operations supervisor ensures the safety of anesthesia equipment, electric shocks, operating tables, air conditioning, and lighting.
4. The operations supervisor ensures that the machines and various surgical packages are received according to the needs of the patient, and reviews the safety of sterilization for each one separately.
5. The operations supervisor ensures the safety and availability of devices, equipment, and supplies for each operation in the operations list.
6. The operations supervisor ensures that operations times are properly arranged and organized.
7. Check the suction machine to ensure proper operating conditions by the responsible nurse.
8. The operating nurse receives the medical record of the operating patient from the department nurse.
9. The operating nurse and the department nurse examine the patient’s medical record before operations to ensure:
· Patient's name and file number
· Patient preparation model for operations.
· Declarations regarding performing surgical operations and offering anesthesia before operations.
· Patient analysis results.
· Patient's x-ray reports.
· Implementing pre-operative treatment for the patient.
· Matching the previous data with what is listed in the six operations.
10. The department nurse asks the patient about the presence of artificial dentures or loose natural teeth, and about contact lenses.
11. The surgical nurse provides psychological support and rehabilitation to the patient in preparation for the operation.
12. The anesthesiologist, surgeon, and nurse ensure that the patient is identified before administering anesthesia and that the patient knows the name of the surgeon, the type of operation required, and the location of the operation.
13. A hand washing policy is implemented in accordance with infection control policies.
14. The head of operations or the nurse working with the anesthesiologist will ensure the preparations related to anesthesia are: -
· It is forbidden to use any flammable or flammable anesthetic materials or that could lead to an explosion in anesthesia areas.
· Ensure that the ground electrode of all electrical devices is connected properly.
· Only cotton outerwear is used in the anesthesia site.
· Wires, switches, and electrical and electronic tools are checked regularly by the Engineering Department and the Head of Operations for follow-up.
· The anesthesia equipment and devices used in operations are examined by the anesthesiologist who will use the device to ensure its safety.
Administrator:
· Doctors, operations nursing staff, and maintenance and cardiac catheterization department members.
Models:
· Department case record - safe surgery form.
The Reviewer:
· International standard precautions for patient safety.
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The policy of determining the location of surgery before starting it
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Policy: Doctors are committed to placing a distinctive sign indicating the location of the surgical intervention in order to preserve the patient’s safety
Purpose: To keep the patient safe by placing the mark to determine the correct surgical intervention site.
Procedures:
1- The surgeon, provided that he is a participant in the operation, determines the location of the surgical intervention by placing a distinctive mark (circle or dash) with a non-removable marker on the location of the operation in the department.
2- The nurse in the department checks the mark before the patient goes to surgery, after asking the patient or indicating with his hands the location of the operation.
3- The operating nurse receives the patient and double-checks the location of the mark in the part to be intervened on.
Administrator :
· The doctors.
· Nursing.
Models:
· Patient preparation form before the operation.
· Safe surgery model.
The Reviewer:
· Patient safety standards according to international quality and health organizations.
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The policy of ensuring an accurate count of the number of pads, needles, and devices before and after the surgical procedure
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Policy: Use a documented method to ensure the correct number of cotton, gauze, abdominal towels, surgical instruments and needles used before or after surgical intervention.
Purpose: To achieve patient safety by protecting him from leaving any foreign body in his body following surgical intervention.
Working procedures:
1. The nurse ensures during operations that the operating theater is free of any cotton, gauze, abdominal towels, tools, and surgical needles used other than those prepared for the current operation.
2. The sterile nurse and the handling nurse, before the surgery begins, count the instruments, bandages, and needles together, loudly, and separate each item in the counting process.
3. This basic count is recorded immediately after the handling nurse takes it on the Instruments, Dressings, and Needles Count form.
4. All instruments, dressings, and needles added to the operating area during surgery are counted by the sterile nurse and the handling nurse and recorded by the handling nurse immediately.
5. The attending nurse during the surgical procedure does the following:-
· Conduct a loud count of all dressings removed from the operating area together with the sterile nurse.
· Separate dressings into units.
· Put the numbered bandages according to their units into sterilization bags.
6. The attending nurse and the sterile nurse in front of the surgeon, before starting to close the peritoneal cavity, count together and out loud the following:-
· All instruments, bandages and needles in the operating area that were counted before surgery and those added during surgery.
· All tools, bandages and needles that are excluded from the operation area
· The handling nurse records the number in the required column 'before peritoneal closure'.
· The attending nurse reports the count results out loud to the surgeon.
7. The sterilizing and handling nurses, before starting to close the skin, count out loud together all the tools that were used after closing the peritoneum and all the items listed in the section of the register for counting tools, bandages, and needles:-
· This final count is recorded by the on-call nurse in the required column marked 'Final Count'.
· The sterile nurse and the on-call nurse write their names in the designated space in the counting register.
8. The difference in counting tools:-
When reporting a discrepancy:
- The surgeon is notified immediately
- A thorough research is conducted as follows:-
o The location of the operation by the surgeon and assistants.
o The sterilized area by the person responsible for sterilization.
o Operating room by the on-call nurse.
When the difference cannot be reconciled:
- The person who discloses this discrepancy completes an accident report for an accident
- An X-ray picture of the operation site is taken before the patient leaves the operating room.
Administrator:
· Doctors and nursing staff
Models:
· Counting list
The Reviewer:
· International standard precautions for patient safety.
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