Part Two
- The policy of determining the place of surgery procedures before starting it
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Policy: the commitment of doctors to the need to put a distinctive sign indicating the place of surgical intervention in order to preserve the patient's safety
Purpose: to keep the patient safe by placing the marker to determine the place of the correct surgical intervention.
Actions:
1-the surgeon, provided that he is a participant in the operation, determines the place of surgical intervention by placing a distinctive sign (circle or dash ) with a non-removable marker on the place of the operation in the Department.
2-the nurse in the Department verifies the mark before the patient goes to the operations after asking the patient or pointing with his hands to the place of the operation.
3-the operating nurse receives the patient and once again confirms the location of the mark in the part to be intervened in.
In charge :
* Doctors.
* Nursing.
Models:
* Sample preparation of the patient before the operation.
* Safe surgery model.
References:
* Patient safety standards according to international quality and health organizations.
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Politics:
Use a documented method to confirm the correct patient, the correct procedure and the correct part before starting the operation or any other interventional procedure.
Purpose:
Achieve patient safety by making sure the right patient and the right place for surgical intervention or other interventions.
Working procedures:
1. The members of the nursing staff responsible for receiving the patient in the operations receive the patient's medical record and confirm the patient's basic data .
2. The nursing staff members ask the patient about his name and match the writing on the identification bracelet with his file and ask the patient about the procedure required for him and specify the place of the procedure prescription .
3. The nursing staff matches the patient's information with what is recorded in the medical record and has six procedures ( operations - endoscopes – interventional radiology- .....Etc.).
4. The surgeon, anesthesiologist and operation nurse ask the patient his name, the operation and the place of the interventional procedure ( operations – radiology – endoscopes - .....Etc.) before anesthetizing the patient on the operating table.
Responsible: doctors and nursing staff.
Models: safe surgery model.
References: universal standard precautions for patient safety.
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Policy: use a checklist to make sure that all the documentation and all the 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 performing surgery or any other interventional procedure.
Working procedures:
1. The responsible nurse will obtain a copy of the list of operations ( for six operations ) .
2. The nurse in charge makes sure that the operating rooms are clean, including the operating room lights, the operating table, and all the room furniture and appliances .
3. The operating supervisor makes sure the safety of anesthesia machines, electric shocks , operating tables , air conditioning, lighting.
4. The operating supervisor makes sure that the various surgical instruments and packages are received according to the needs of the six , and reviews the safety of sterilization individually.
5. The operations supervisor ensures the safety and availability of devices, equipment and supplies for each operation in the list of operations.
6. The operations supervisor makes sure that the dates of operations are properly arranged and organized.
7. The suction machine is checked for the safety of its operating conditions by the responsible nurse .
8. The operating nurse receives the medical record of the operating patient from the nursing department .
9. The operating nurse together with the department nurse checks the patient's medical record before the operations to make sure :
* Patient name and file number
* Sample patient preparation for operations .
* Declarations of surgical procedures and presentation of anesthesia before operations .
* The results of the patient's tests .
* Patient-specific radiology reports .
* Carrying out preoperative treatment of the patient .
* Matching the previous data with what is included in the six operations .
10. The department nurse asks the patient about the presence of artificial dentures or rarefied natural teeth and about contact lenses .
11. The nurse performs the operations with the support and psychological rehabilitation of the patient in preparation for the operation.
12. The anesthesiologist, surgeon and nurse make sure the patient's personality before performing anesthesia and the patient's knowledge of the surgeon's name, the type of operation required and the place of the operation.
13. The hand washing policy is applied in accordance with the infection control policies.
14. The Chief Operating Officer or the nurse in charge together with the anesthesiologist will confirm the preparations related to anesthesia :-
* It is forbidden to use any narcotic substances that are flammable, inflamed or lead to an explosion in the anesthesia areas .
* Ensure that the ground electrode of all electrical devices is connected properly .
* Outerwear made of cotton is used only at the site of anesthesia .
* Wires, switches, electrical and electronic tools are regularly checked by the engineering department and the head of operations for follow-up .
* The equipment and anesthesia devices used in the operations are checked by the anesthesiologist who will use the device to ensure its safety .
In charge:
* Doctors, members of the nursing staff of operations, members of the maintenance department and cardiac catheterization.
Models:
* Department status Record-Safe Surgery form.
References:
* Universal standard precautions for patient safety.
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Politics:
Use a documented method to confirm the correctness of the number of cotton, gauze, abdominal pads, surgical instruments and needles used before or after surgical intervention.
Purpose:
Achieving patient safety by protecting him from leaving any foreign object in his body after surgical intervention
Working procedures:
1. Surgical Nursing makes sure that the operating theater is free of any cotton or gauze, abdominal pads, surgical instruments and needles used other than those equipped for the current operation .
2. Sterile nursing and handler nursing before the surgery begins, after the instruments, bandages and needles are put together and loudly and each item is separated in the counting process.
3. This basic count is recorded immediately after the nursing handler takes it in the form of the number of instruments, bandages and needles.
4. All instruments, bandages and needles added to the operating area during the surgery procedure are counted by the sterile nursing and the nursing handler and recorded by the nursing handler immediately.
5. The nursing handler during the surgical procedure performs the following:-
* Conducting a count of all dressings excluded from the area of operation in conjunction with sterile nursing aloud.
* Separation of dressings into modules.
* Put the numbered bandages according to their units in sterilization bags.
6. Handler nursing and sterile nursing in front of the surgeon before starting to close the peritoneal cavity count together and loudly for the following:-
* All instruments, bandages and needles located in the operation area that were counted before the surgery and those that were added during the surgery.
* All instruments, bandages and needles that have been excluded from the operation area
* The nursing handler records the number in the required column 'before closing the peritoneum'.
* The nurse in charge reports aloud to the surgeon about the results of the counting.
7. Before starting to close the skin, the handling nurse and the sterilizer conduct a loud count together of all the instruments that were used after the closure of the peritoneum and all the items listed in the section from the record of counting instruments, bandages and needles:-
* This final count is recorded by the handling nurse in the required column with the 'final count'.
* Sterile nursing and handler nursing write their names in the designated place in the counting register.
8. The difference in counting tools :-
When reporting a difference:-
- The surgeon is notified immediately
- Careful research is carried out as follows:-
o the position of the operation by the surgeon and assistants.
o the area sterilized by the person responsible for sterilization.
o operating room by nursing handler.
When the difference cannot be ironed out :-
- The person who detects this difference completes the accident report on the occurrence of an accident
- An X-ray of the operation site is taken before the patient leaves the operating room.
In charge:
* Doctors and nursing staff
Models:
* Counting list
References:
* Universal standard precautions for patient safety.
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