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Operating Room
Orientation For
Medical Students
Angela L. Lawrence, BSN, RN, MPA, CNOR
After today you should be able to:
Describe surgical attire Discuss “OR etiquette” List principles of aseptic
technique Discuss safety
considerations
In Separate Groups we will:
Find the Locker Rooms Obtain scrubs from the
Pyxis Scrub Station Meet Angela at the Main
OR Front Desk(Where’s the desk?)
Tour the Operating Room (the 10¢ tour)
Observe scrubbing, gowning and gloving procedure (Any volunteers??)
Surgical Attire
Green Scrub suit (obtain from Pyxis)(What about tee shirts? What
about jewelry? Nail polish?) Hospital photo ID badge Hat or hood Shoe covers (Optional PPE) Mask (when sterile setup is
present) Eye protection (Required
PPE)
OR Etiquette/Customs
Introduce yourself to OR nurse
Write your name (legibly) on the white board(there’s one in each Operating Room)
Offer to obtain your gown or gloves, PRN
Principles of Aseptic Technique
1. Scrubbed persons function within the sterile field.
Scrubbed persons:
Scrub, gown and glove
Sterile touches only sterile
Sterile areas of gown:
• In front from 2” below neck to table level
• Sleeves from 2” above elbow to stockinette cuff
Principles of Aseptic Technique
2. Sterile drapes should be used to establish a
sterile field. Drape from incision area to periphery
The sterile field is the top surface of the draped tables and the patient
Any point below the sterile level is unsterile
Anything permeating the sterile field contaminates it, including moisture
Principles of Aseptic Technique
3. All items used in a sterile field should be
sterile. Anyone opening and dispensing an item is accountable for its sterile integrity
Shelf life of a packaged item is event-related
Principles of Aseptic Technique
4. All items introduced onto the sterile field should be opened, dispensed and transferred by methods that maintain sterility and integrity. Check outer wrapper for
integrity Inspect indicators on outside Check dates, if applicable If sterility is in doubt, do not
use the item
Principles of Aseptic Technique
5. A sterile field should be maintained and monitored constantly.
Scrubbed persons will keep the sterile field in direct view at all times and not turn his/her back to the sterile field.
Principles of Aseptic Technique
6. All Personnel moving within or around a sterile field should do so in a manner to maintain the integrity of the sterile field.
When scrubbed persons move around each other they should keep:
Unsterile to unsterile (“back to back”)
orSterile to sterile (“belly
to belly”)
Principles of Aseptic Technique
7. Policies and procedures for maintaining sterile field should be written, reviewed annually and readily available within the practice setting.
Where do you find them?
Surgical Conscience
Builds on principles of asepsis
Allows no compromises in aseptic technique
Requires regulation of ones own practice
Demands recognition and correction of breaks in technique including reporting ones own breaks in technique
Doing the right thing even when no one is watching!
Our Ultimate Goal: Patient Safety
More Safety Considerations
etc. Do Not touch anything on the Mayo Stand
Do Not Argue if someone says
“It’s contaminated.”
Masks are either tied properly on your face or in the trash.
Dual Frame of Reference: Anything touching the patient
should be sterile, anything that has touched the patient is contaminated.
Introduction to the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™
The Universal Protocol applies to all surgical and nonsurgical invasive procedures. Evidence indicates that procedures that place the patient at the most risk include those that involve general anesthesia or deep sedation, although other procedures may also affect patient safety.
Introduction to the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™
Hospitals can enhance safety by correctly identifying the patient, the appropriate procedure, and the correct site of the procedure.
Introduction to the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™
The Universal Protocol is based on the following principles:
Wrong-person, wrong-site, and wrong-procedure surgery can and must be prevented.
Introduction to the Universal Protocol
for Preventing Wrong Site, Wrong
Procedure, and Wrong Person
Surgery™ A robust approach using
multiple, complementary strategies is necessary to achieve the goal of always conducting the correct procedure on the correct person, at the correct site and on the correct side.
Introduction to the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™
Active involvement and use of effective methods to improve communication among all members of the procedure team are important for success.
To the extent possible, the patient and, as needed, the family are involved in the process.
Time Out:
Is performed immediately prior to incision or when a Regional Block is performed.
The Attending Physician, Anesthesia care provider, Circulating RN, and Scrub person must be present.
All members of the team should be actively involved in the time out. If any member is not paying attention during the time out, stop, gain their attention and restart the time out.
Time Out:
The circulator will document this verification in the electronic medical record
Time Out:
A complete TIME OUT is performed prior to the start of subsequent procedures and includes the NEW attending physician.
Exceptions are not routine. Should an exception exist, in the event of an urgent surgery, the TIME OUT, in its entirety, must be performed as soon as possible
Time Out:The following items are to be stated in the time out: The following will be
verbalized: Correct procedure Correct side/ site Correct position Antibiotic started, if
applicable Prep dried
Endoscope Use
Scope tracking is now a required element by the Joint Commission. Tracking is imperative and has major implications for both Medicare our reimbursement and accreditation!
The resident/medical student must sign the EGD cart out when it leaves the unit and when it is returned. This includes all scopes that are utilized outside the OR.
EGD Tower and Instrument Tray Sign Out Sheet
DateItem
Description Name LocationRetur
n Date Initial
White Bag Contents
Each group will
Meet at the Main OR Front Desk
Discuss the OR schedule board
Tour the Operating Room Suites
Observe scrubbing demonstration
Observe gowning and gloving demonstration
Questions?
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