Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Medical EthicsIn The Operating Room

a Reminder

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Objectives

• A reminder to us all

• Why ethics ?

• Examples of some existing problems.

• Examples of some practical solutions.

• Conclusions & Suggestions.

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Why Ethics ?

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Why Ethics ?

• In medicine we deal with confidential issues (related directly to people’s lives, history, behavior, body, health & disease).

• Patients put their trust in medical professionals & expect high ethical standards.

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Why Ethics ?

• Health providing teams are expected to know & maintain a high level of ethical standard.

• Most ethical issues are standard.

• Some special ethical issues are related to:– religion, culture, …etc

• Deficiencies in practical application of known ethical standards exist.

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Why Ethics ?

• Ethical issues are always of concern to the public.• Any breach of ethical standards leaves harmful

effects shaking the confidence in the system.

( media controls the public opinion)

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Current Situation

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Current Situation

• Written ethical standards:– ? not widely applied in all hospitals.

– ? not known and/or not fully applied to all personnel using the Operation Room.

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Role of Hospitals

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Role of Hospitals

• Provide the best medical treatment as well as ethical standards.

• Leading hospitals & institutes should:– Apply the highest ethical standards,– Teach them to the future generations of medical

personnel.

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Some Ethical IssuesIn OR

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Some Ethical Issues in The OR

I. Exposure of body.

II. Dress.

III. People gathering and traffic.

IV. Noise.

V. Comments and behavior.

VI. Honesty.

VII. Consent.

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I. Exposure of body

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Exposure of body

• Parts of body should not be exposed to others ( governed by religion )– men : from umbilicus to knees.– ladies : all body.

• Exceptions are allowed when necessary according to a definite need.

• Exposure of some body parts is often necessary, depending on procedure.

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Exposure of body - Examples

• Preparation for anesthesia

• Chest auscultation & inspection.

• Insertion of folly catheters.

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Exposure of body - Examples

• Patient’s transfer to & from:– Operating table,

– Recovery,

– The ward.

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Exposure of body - Examples

• Positioning of patient.• Application of tourniquet.• Cleaning & draping.• Removal of draping &

tourniquet.• Application of cast.

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Exposure of body

Whenever exposure is necessary,it should be :

• Limited to parts needed only.• In the presence of limited number of people.• For the shortest period of time.

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Exposure of body –when necessary

• Limited to parts needed only.

Often over exposure takes place !

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Exposure of body - when necessary

• In the presence of limited number of people.

Often too many people around(Drs. / Nurses / Technicians / Students/ workers)Often unnecessary

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1 23

4 56 7 8

9

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Exposure of body - when necessary

• For the shortest period of time.

• Not to call in the cleaners early (to save time).

Do we really apply this ?

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A sign “Female patient” or “Do Not Enter” outside of the operating room.

Suggestion

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II. Dress

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Dress - patient

• A single piece,

• Does not expose selected parts only,

• Does not cover well behind, often torn strip ends,

• Ladies:– Sleeves short,

– Head, face and neck cover not adequate.

• Not good for both sexes,

Not descent by any standard !

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Dress - patient

• Underwear by some policies should be removed

( even if operation is at neck ! ).

• Problems with patient’s underwear :– uncleanliness / metal parts / nylon ?

• Solution:– ensure and allow clean underwear.

– Provide proper disposable underwear .

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Suggested Patient’s Dress

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Suggested Patient’s DressCriteria

• Should provide adequate cover according to local standards (religion).

• Should provide adequate local (selective) exposure.

• Should allow quick & practical wide exposure in emergency situations.

• Should look descent.

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Suggested Patient’s Dress

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Suggested Patient’s Dress

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Suggested Patient’s Dress

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Suggested Patient’s Dress

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Dress - staff

• Lady staff Drs., nurses, students.

• Does not meet required standards regarding :– Design,

– Width & length,

– Areas covered ( head & body) ,

– Practicality.

( ask our lady colleagues ! )

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New Staff’s Dress

Suggested and designed by our lady colleagues

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Suggested Staff’s Dress

• Proper head cover.• Proper neck cover.• Proper forearm cover.• Buttons on side.• Wide.• Comfortable.

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Suggested Staff’s Dress

• Sleeves can be rolled up above elbow for draping.

• Fixed by press button on strips pulled from inside.

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Lady Surgeons Scrub Area

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Scrub Area

Man Lady

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Scrub Area

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III. People’s gathering & traffic

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People’s gathering and traffic

• Often too many people in the corridors, receiving area & OR causes inconvenience to patients & staff.

• Problem related to :

- behavior of staff & students.

- limited space.

(Both should be discussed & improved)

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People’s gathering & traffic

Traffic at the receiving area

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IV. Noise

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Noise

• Patients coming to OR are worried need privacy, silence & reassurance.

• Noise should be kept to minimum.

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Noise

Discussions & stories should be in staff rooms only, away from patients !

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V. Comments & Behavior

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Comments & Behavior

• Jokes & laughing:– Loudly,– In front of patients, – In a language not known to them !– Before anesthesia,– During procedure with local/spinal anesthesia.

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Comments & Behavior

• Comments & remarks on patient’s:– Disease,

– Body shape or weight,

– Behavior …etc.

That would not be said if patient is awake

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Comments & Behavior

• Patients might see instruments before anesthesia:– Scissors,

– Drills,

– Scopes,

– Saws .. etc

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Comments & Behavior

Examining patients

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Comments & Behavior

Examining patients

In the OR, in front of othersbefore or after anesthesia

In the receiving area or in the corridors!

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VI. Honesty

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Honesty

• Patients often ask who performed surgery• The answer should be honest & concentrate on :

– Concept of team work.

– Quality is assured.

– Supervised by the consultant / senior staff.

– Teaching / training does not reduce standards.

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Honesty

Tell the truth !

• What went wrong.• Complications.• Unexpected incidence.

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VII. Consent

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Consent

Should not be taken in the operating room !

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Conclusions & Suggestions

• Ethical issues are sensitive & important.• Ethical standards according to religion and culture

must be met.• Deficiencies exist in the application of some

ethical standards.• Need to revise policy of patient’s dress & the

ladies dress to meet local ethical standards.

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

• Preserve Patients’ dignity during all phases of transportation.

• Patients should not be exposed unnecessarily regarding:– The area exposed,– The duration of exposure,– The number of people present during exposure.

• Patient examination if needed should be inside the operating room only, with privacy & limited exposure.

Conclusions & Suggestions

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

• During patient positioning & preparation should only allow those whose presence is absolutely necessary :

Allow other staff and students in only after the patient is draped.

(not just for lady patients)

Conclusions & Suggestions

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

• The consultant surgeon is responsible to ensure all medical staff are aware of & follow the OR ethical guides (especially regarding female patients).

• The charge nurse of every OR should have the authority to limit the number of personnel in the OR during preparation & surgery especially for female patients.

Conclusions & Suggestions

Medical Ethics In The Operating RoomMedical Ethics In The Operating Room

Further work & discussion is still required.

Conclusions & Suggestions