Operating Room Policies and Procedures

The Operating Room of Cotabato Regional and Medical Center is located on the second floor. It has six operating room suites with a manpower of 1 Supervising Nurse, 2 Senior Nurses, 7 Staff Nurses, 4 Nursing Attendants, 3 Institutional workers and 1 Contractual. We cater patients from Region XII and ARMM with a maximum of 15 patients per day and 250 patients per month. Operating day for elective cases are done from Monday to Saturday.

RESILDA B. GO

SUPERVISOR

VERNON UY Senior Nurse

MA. SOCORRO S. CAOAGDAN Senior Nurse

STAFF NURSES

HENRY BIRUAR

MERCELITA PAREDES

ROMIE-LOU ASIS

JAY SENO ROTCHEL CAMBRI

DAVE BUENO

ADELINE REYNO

NURSING ATTENDANTS

ELSA ANGELES SUSAN MAGLINTE

BAITONGGAL SAUDAGAL RAMONITA SALAYSAY

UTILITY WORKERS

ROMEO GALERIO ROMEO MAYO

LUCIO LEDESMA

MOHADJOB CANA

CORD DRESSING AREA

PATIENT CARE MANAGEMENT

 All patient should be treated with utmost care and confidentiality. The surgeon is responsible for relaying information of the surgical outcome of the patient. A Resident Physician must be assigned to all cases (private or charity) and is responsible in notifying the consultant concerned.

 Pediatric cases must be prioritized. Elective cases: a. adult- 40 yrs and above b. pediatric-13 years and below * must be cleared at least a day prior to operation and before the anesthesia visit The chart of the patients must be completed prior to operation as regard of the ff:

a. complete history and physical examination b. all laboratory results c. blood crossmatching sheets d. CP clearance if required The Resident in charge should be responsible for the procurement of medicines, blood, all necessary clearances, laboratory results and ensures that IV lines are patent or CVP lines are inserted if necessary.

 The Resident in charge should not leave the patient once the patient is wheeled in the operating Room and until the patient is discharge from the Operating Room. The Resident in charge as well as the nurse should have the full knowledge of the case (history, PE and diagnosis) and the contemplated procedure prior to surgery.

GUIDELINES AND POLICIES

I. Requirement:

Staff nurse assigned at the operating room must have a clinical or ward experience of at least 6 mos.

Standard Operating Room Procedure

1. The personnel and students should wear the prescribed uniform/attire which consists of
A. Attire

a. clean scrub suit preferably pants style suit

b. cap worn fully cover the hair at all times C. mask should always cover the nose and mouth 2. Clean slippers or shoes 3.Wearing of street clothes underneath the scrub suit are not allowed 4. Personnel and students should change the scrub suit to street clothes or uniforms before going out the operating room

 OR attire soiled during performance of the procedure should be changed with a new set. Wearing of smock gowns on top of the scrub suit outside the operating room is not recommended except in extreme emergency like life threatening situation.

B. Hand scrubbing

1. All personnel and affiliating students should meet specified requirements prior to beginning of surgical scrub.

A. jewelries should be removed from the hands and forearms. B. fingernails nails should be free from polish and should be trimmed short.

GOWNING AND GLOVING

1. Proper technique shall be observed by all personnel and students

2. Gown worn by the scrub nurse should be considered sterile in front from chest to level of sterile field.

3. Sleeves should be considered sterile from above the elbow to stockinette cuff.

4. The neckline, shoulder, areas under the arms and back of the gown should be considered unsterile.

5. Punctured OR gloves shall be replaced as soon as detected. The use of recycled gloves is to be discouraged.

6. Double gloving is recommended for procedures or proven HIV or Hepa B carriers patients.

D. Sanitation

1. Prior to the first scheduled procedure of the day, horizontal surfaces should be dump dusted (routine mopping of chlorox or lysol is recommended)

2. All items that have

been in contact with the patients should be considered contaminated a. sharps should be handled and disposed according to hospital policy

b. disposable suction tubing should be soaked because of the difficulty encountered in cleaning the lumen.

C. glass suction containers should be clean and terminally sterilized D. disposable endotracheal tubes should be discarded after used. The area or floor must be aired or dry prior to the next surgical procedure for at least 15 mins with the use of chlorox or lysol solution

3. At the completion of day schedule each operating room suite and scrub utility area and corridors should be cleaned.

4. Suction contents
should be disposed in the toilet rather than in conventional sink, care should be taken to avoid spillage during transport and disposal.

PRE-OPERATIVE PREPARATIONS

1. Shower-patient for elective surgery

should have a shower pre-operatively within 12 hours prior to the operation before pre-medications are given. 2. Shaving- shaving of the incision site is done inside the operating room before the surgical procedure 3. Skin drapes-use of cotton fabric drape is recommended, should be properly sterilized, packed, stored and handled

4. Skin preparation before surgery- agents

used-hexachlorophene, chlorhexidine or povidone iodine should be used for skin preparation prior to surgery

5. Catheters/tubes-urethral catheters and open venous access lines should be inserted preferably inside the operating room

6. Endotracheal tubes/anesthesia conduit-endotracheal tubes/ connectors must be sterile 7. Patients attire- laundered gown without any underwear must be the proper attire of the patient before being brought to the operating room. A cap which cover the hair should be worn upon entry to the operating room

III. INFECTION CONTROL

A. Infectious cases 1. All infectious and dirty cases should be done after scheduled elective cases regardless of whether they are house or private case. 2. All instruments should be washed and soaked with a lysol solution for 24 hours then rinsed, dry, wrapped and ready for autoclaving for two times

3. Room should be cleaned with soap and water, and chlorox including equipment that made contact with the patients. 4. Proper disposal of all materials used during the procedure must be observed. 5. All infected/contaminated operation must be done in the dirty operating room.

B. CLEANING OF INSTRUMENTS

1. all instruments used must be cleaned

with soap and water then rinsed with Cydezime solution for 30 mins, dry before packing for sterilization.

2. rinsing trays, pick up forceps containers must be changed daily

CLEANING OF EQUIPMENT 1. Suction apparatus a. cleaning of suction apparatus must be done every after use. b. proper disposal of secretions must be done properly and avoid spillage 2. Operating room tables a. thorough cleaning of operating room tables must be done very week

and except in emergency cases with the use of soap and water/chlorox, mattress should be aired B. operating room tables must be cleaned every after procedure with soap and water and chlorox 3. Stretchers a. all stretchers used must be dump cloth with chlorox after patient is transported.

B. Patient transported to the operating room must be transferred to the operating room inside stretcher. All equipment that come from the outside must be cleaned with chlorox prior bringing them inside the operating room. C.All carriers and wheeled stretchers should be cleaned after every use.

IV. Policies on admission and discharge 1. Written request form must be accomplished by the ward nurse and must be received or signed by the operating room nurse or nursing attendant 2. All patient must have a preoperative orientation before transporting to the operating room suite

3. Upon discharge, a written status should be entered on operating room record 4. All patient discharge from the operating room should be transported safely to the ward after status report has been given by the anesthesiologist and accompanied by the operating room nurse or nursing attendant on duty and endorsed properly to the ward nurse

V. Policies on Records and Reports

1. The patients record should reflect the peri-operative assessment and planning carried out by the peri-operative nurse. 2.Patients record should reflect the care given by members of the surgical team and its outcome. The care should be documented to patients chart 3. All tissues removed during surgical procedure must be handled and preserved properly before sending to the laboratory

with proper labeling. Request for biopsy should be accomplished by the surgeon 4. Foreign bodies that are removed from the patients must be placed in a container with complete labeling are being sent to cashier office for safekeeping with proper documentation. 5.Logbook should be provided and records all operations done. 6. All total number of surgical cases perform in operating room are submitted to the Medical record Section Monthly.

ROLE OF THE SCRUB NURSE

 Maybe a registered nurse or a surgical technologist

 Assist the surgeon during the procedure by handling instruments, sutures and other supplies

 Maintain accurate count of sponges, sharps and instruments on the sterile field during surgery

 Maintains good order of the field(sterile)

 Observe the team on the break of aseptic technique

 Gives post-operative care

ROLE OF CIRCULATING NURSE

 A circulating nurse is the unsterile person who assist the entire team and the patient and is the overseer of the room during the procedure to maintain the sterility. Checks that all instruments/equipment is working properly before surgery Ensures the sterility of instruments for surgery Assist with positioning the client Alert team members to any break in sterile technique

 Assist the anesthesiologist or anesthesist with monitoring the vital functions, such as urine output and blood loss Label specimens Coordinates activities with other departments such as x-ray and pathology Documents care provided Assists in counting the sponges, sharps and instruments Removing unneeded items or specimens

II. Pre-operative and postoperative care of patient

A. Pre-operative care 1. Pre-operative visit one day prior to surgery in order to establish rapport and to gain trust 2. Receives the endorsement from the ward 3. checks the consent for the operation and anesthesia

Checks the presence of contraptions a. note the kind of IVFs, the IVF level or with drug incorporated b. check the IV line for any bulging or redness c. presence of foley catheter, note the color and level of the urine in the bag d. nasogastric tubings, note the presence and color of secretions e. blood transfusion-level the blood type and the serial #

5. Pre-operative shaving6.change the patients attire with patients gown 7.Check the vital signs-PB, CR, Temp.,RR and PR 8.Develop or establish rapport to the patient, encourage verbalization of feelings 9.Know the members of the surgical team

B. Post-operative care
Begins when the patient return from the operating room to the recovery room and ends when the client is discharged A. Raise the side rails-to avoid or prevent the patient from falling B. oxygen administration-to maintain the pulmonary ventilation C. Vital signs monitoring and report for any unusual signs and symptoms D. check for any signs of bleeding (hypotension, pallor, soaked dressing with blood) E. proper endorsement (condition of patient, vital signs, presence of contraptions and due meds)

MEMBERS OF THE SURGICAL Sets up the instruments, Chief or TEAM supplies head of the
and assist the operation operation Gives the anesthesia Assist the surgeon

SURGEON

ANESTHESIOLOGIST
SCRUB NURSE

ASSISTANT SURGEON
Assists the entire team & the patient. Anticipates the needs of the surgical team

CIRCULATING NURSE