SURGERY AND

DELIVERY UNIT
 BEFORE WE START ...
Topics

Basic Policies in Surgery and Delivery Unit

Roles and Responsibilities of OR TEAM

Forms used in the Operating Room

Skills Lab

Exam and Return Demo

PRAYE
R
 REMEMBER:

IF IN DOUBT,
THROW IT OUT
 The TriCity Medical Center –
Operating Room and Delivery Room
(OR/ DR) envisions itself as a
paradigm in rendering safe and high-

VISION: quality perioperative care to all

patients via multidisciplinary
collaboration among all the health
care professionals involved in the
surgical aspect of the patient's care.
 The Tri-City Medical Center – Operating Room and
Delivery Room commits itself to:

• Being equipped with competent and highly-

qualified OR/ DR staff who are knowledgeable

MISSION: about the standard perioperative care

procedures, and are well-acquainted with their
roles and responsibilities in providing safe and
high-quality patient care.
• Supporting, acknowledging, and nurturing one
another, thereby creating an environment of
mutual respect and caring.
• The consistent delivery of quality health care
by adhering to the highest standards of
professionalism.
 OR/DR
COMPLEX
GANIZATIONAL
CHART
 DRESS CODE
“Surgical Attire” includes scrub clothes,
hair coverings, mask, protective eyewear,
and other protective garments, provide a
barrier to contamination that may pass
from personnel to patient as well as from
patient to personnel.
 SURGICAL AREAS:
1. RESTRICTED: Surgical and delivery suites, the
hallway after the dressing room and after the
Delivery Unit nurse.
2. Semi-Restricted: Hallways within the surgical
suite (where open sterile supplies or scrubbed
persons may be located)
3. No Restrictions: The Dressing Room (Areas
allowing street clothes)
 PPE
1. Hats/head covers: All head and facial hair must be completely
covered. All cloth hats must be covered with a disposable hair
cover. All disposable head covers will be removed when leaving the
operating room suite.
2. Masks:
a. Masks should be changed when they become moist or
soiled or if leaving the O.R. suite and restricted area
b. A new facemask shall be used for each
surgery/procedure.
c. Never lower the mask to hang loosely around the neck,
never place on top of the head, and never place in pockets after
use. Avoid disseminating microorganisms.
d. Face masks must be removed and discarded upon
leaving the surgical/procedural area or in lounge areas
e. Change the mask frequently. Do not permit the mask to
become wet. Limit talking to a minimum.
f. For staff moving quickly from one OR room or procedure
suite to another via semi-restricted halls, a mask may be kept on
but should be left in place. If found dangling, it should be removed.
 PPE
3. Shoe Covers: Fluid-resistant shoe covers should be worn
when it is anticipated that splashes or spills may occur. If
shoe covers are worn, they should be changed whenever
they become torn, wet, or soiled, and they should be
removed and discarded in a designated container before
leaving the surgical area.
4. Eyewear and Gloves: Gloves and protective eyewear or
face shields shall be worn by all operating room personnel
when performing duties that require direct patient contact or
contact with contaminated items. Gloves and protective
eyewear should be changed after such contacts and before
exiting the room.
CLOTHING &
PERSONAL ARTICLES
Personal clothing worn to and from Cloth Hats: All cloth hats must be covered with a
work should be consistent with
hospital policy. Scrub attire must
disposable head cover during the procedure.
Cloth hats must be laundered daily.
not be worn arriving or departing
from the hospital grounds.
A cover garment such as a clean lab coat other
than the one worn in the restricted/semi-restricted
Jewelry: All scrub personnel area is required to be worn when leaving the
entering the semi-restricted and restricted/semi-restricted peri-operative areas to
restricted areas of the
. surgical protect the scrub clothes from becoming soiled.
suite are required to have all The cover garment must be removed before re-
jewelry removed or confined. entering a restricted/semi-restricted area.

Facial makeup should be Large bags, backpacks, suitcases, or other

minimal. personal clothing, etc. that are not wipeable (i.e.
of porous materials) are not to be carried into
the semi-restricted or restricted areas.
 ROLES AND
RESPONSIBILITIES

ES IA
PERI-O LABOR ROOM S TH
PERAT A N E RS E
NURSE IVE NURSE OST E N U
P CAR
 SURGEON
• Supervises the maintenance of strict
• has overall command responsibility asepsis throughout the surgery.
for the surgery being performed. • Coordinates with the scrub nurse and
• Responsible for the immediate pre- checks the inventory of all countable
operative preparation of the patient items, i.e. sponges, needles, and
• Supervises positioning, area instruments.
preparation, and draping of the • Completes all necessary records, e.g.
patient. Informs the OR staff about Operative Technique, etc.
any special instruments/ equipment
required for the operation.
ASSISTANT SURGEON
• assists the surgeon in performing
the surgery.
ANESTHESIOLOGIS
• Performs the pre-anesthetic visit and
T evaluation of surgical cases prior to
surgery.
• Renders immediate post-operative
care of all surgical patients
• Obtains a comprehensive medical history • Follows up post-operative patients
and performs a complete physical and manages post-anesthesia
examination related conditions
• Evaluates the patient’s general condition • Completes all anesthesia records
• Orders for pre-medication
and the list of medicines and
• Administers anesthesia during surgical
supplies used during the operation
procedures such as elective and
emergency cases, and during diagnostic
and therapeutic procedures, if necessary
SCRUB NURSE
STERILE TECHNIQUE
• Scrubs, gowns, and gloves,
PREPARES using the closed gloving
• Sterile instruments and supplies method
• Works in concert with the • Establishes the sterile field
circulating nurse to set up the OR • Facilitates the surgical
• Surgeon’s specific procedural procedure
needs • Anticipates the needs of the
• Procedure specific needs sterile team
• Hemostatic techniques • Gowns other team members
• Suture and Closure materials using the open-assisted
gowning and gloving technique
SCRUB NURSE
ACCOUNTABILITY
• Establishes baseline counts with
ADAPTABILITY the circulating nurse
• Remedies any breach of • Informs the circulating nurse of
the items placed inside the
sterile technique patient
• Requests and prepares • Double checks items dispensed
materials needed by the to the sterile field
• Labels all medication containers
surgeon and delivery devices
• Keeps the sterile field neat • Reports volume of drug
and functionaL administered to patient for
documentation by circulating
nurse
CIRCULATING NURSE
DIRECT PATIENT CARE
INDIRECT PATIENT CARE • Patient identification
• Assists with OR preparation • Patient assessment
• Opens sterile supplies • Identification of correct surgical site
• Prepares medication for use in • Transfers patient between cart and
the OR bed
• Maintains patient confidentiality • Assists the anesthesia provider
• Communication with surgical • Provides skin antisepsis
• Provides thermoregulation
service personnel • Prevents electrosurgical injury
• Pretests equipment • Collaborates with patient fluid
• Plans postoperative care intake and output
• Initiates discharge planning • Monitors vital signs as needed
• Provides dressings and drains
CIRCULATING NURSE
ANTICIPATES
COORDINATES • Sequence of the procedure
• Plans for each member of the • Needs of the sterile team
sterile team to enter the sterile field • Breaches of sterile technique
• Positioning, prepping, and draping • Hemostatic needs
• Connection of surgical machinery • Radiation (ionizing and nonionizing)
• Laboratory tests protection for sterile team
• Potential for patient’s physiologic
• Diagnostic activities changes
• Multidisciplinary team • Wound class at conclusion of the
• Emergency response to patient procedure
crisis • Patient response to care
• Communication with patient’s • Significant other’s response to
significant others patient’s condition
CIRCULATING NURSE
ACCOUNTABILITY
• Validates implants
• Documents patient care
• Hands off report to postoperative
caregiver
• Specimen care and reporting
• Promotes a culture of safety
• Accountability for instruments,
sponges, and sharps
• Patient’s advocate
• Evaluate patient outcomes
• Sits with and monitor patient throughout ( before/during/ after)
the labor
• Monitors contractions and helps patient with breathing
techniques
LABOR
ROOM
• Initiates IV access
• Administers pain medication as ordered
• Takes and records patient’s vital signs, ascertains if problematic
• Reads fetal monitor & ascertains if there is a problem with
baby’s heart rate NURSE
• Identifies & manages life-sustaining physiological functions in
unstable patients
• Cares for patients on OXYTOCIN, MgSO4 & continuous lumbar
epidural
• Ensures patient is in proper position for delivery & all
monitoring equipment is functioning properly
• Aids doctor with drapes, gloves, gowns, etc.; hands doctor
delivery instruments as needed during birthing process
• Encourages patient to push at proper time(s)
• Records time of birth
• assist the Labor and Delivery Unit nurse in labor
monitoring and delivery
• help in positioning patient.
• examine and monitor pregnant women.
• monitor contraction and to help patient with proper
MIDWIF
breathing technique.
• pack surgical sets, instruments, and regular surgical
E
dram.
• perform the autoclaving procedure in the unit.
• do the inventory of consumable supplies and
instruments every shift.
• deliver specimen in the laboratory for
histopathology.
• help in transferring of patient.
• attend meetings and conferences as necessary.
• perform other duties as may be required by the
• Carrying out all post operative orders for patients
admitted at PACU.
• Maintaining the cleanliness and orderliness in the unit
• Initiating cardiopulmonary resuscitation in case of an
emergency
• Administering medications ordered by the concerned PACU NURSE
doctors
• Notifying the concerned doctor regarding any
untoward signs and symptoms manifested by the
patient
• Notifying the ward nurse when the patient is ready for
transfer to the ward
• Observing accurate and detailed documentation in
each patient’s chart
• Replacing all stock medicines and supplies used by
the patient during the shift
• Refraining from leaving the PACU, unless another
responsible nurse is present to watch over patients
• Assists Staff Nurses as needed especially in patient care
• May act as a Scrub Nurse for Minor Cases with the presence of a Circulating
Registered Nurse.
• Positions the patient during anaesthesia induction and surgical preparation
• Maintain the orderliness of the stock rooms and dressing rooms
•
•
Monitor and request for linens as needed
Assists in cleaning instruments and packing of sterile items/ supplies
NURSING
• Assists in the after care of patients and operating theater post procedure
•
•
Autoclaves/ Sterilize items as needed
To do inventories of supplies weekly and monthly
ASSISTAN
• Compiling, sorting of Patient’s File
• Storing completed documents in appropriate locations T/
• Assisting in office management and organization procedures
• Organizing and scheduling meetings and appointments
• Maintaining files and records so they remain updated and easily accessible ENCODER
• Transcribing data from a variety of sources into an electronic format
• Updating existing data records
• Rechecking of Charges
• Responsible in transcribing patients data into the bizbox system and
charging the used items for each patient
• To perform other duties as may be required by the management
• Ensures cleanliness and orderliness of the dressing rooms and
comfort rooms, lounge , theaters and NICU
• Assists in transferring patients and ensures safety
• Maintains cleanliness of SDU/NICU complex at all times including
cleaning of equipment.
• Ensures proper disposal of waste materials and used supplies
• Helps in positioning patient and holding extremities of patient
ORDERLY
during skin preparation in orthopedic cases
• Delivers the specimen for laboratory purposes
• Pick up replenishments from CSSR and Pharmacy
• Restock supplies and linens, paper towels, soaps as needed
• Clean stretchers and beds and replaces sheets
• Manipulate OR Table and checking of bed accessories
• Dispose linen and trash in appropriate manner
• Mop floors in all areas on a daily basis
• Answer phone calls in the absence of nurse and other staff in
the station then relay message or call to the concerned person.
• To perform other duties as may be required by the management
Inter-Departmental
Relationship • Laundry – for the linens
• Laboratory – for the clinical
specimens, blood transfusion, and
other laboratory works required for a
procedure
• Maintenance – for the equipment
• Pharmacy – for the procurement of
medicines needed
• Central Supply Room – for the
general supplies
• X-ray during intra-operative
procedures
• Administrative Office and Billing
Section – for charges and other needs
NOTE: All clinical specimens, including tissue, cultures, and
smear, are forwarded to the TCMC laboratory, unless otherwise
ordered by surgeon.
1. Specimen Identification
• CN places the specimen in the appropriate container and solution, and
labels it appropriately with the patient’s name, room number, date of
surgery, name of surgeon, and the type and source of the specimen.
Specime
• The CN fills out the Laboratory Request Form and delegates an
Orderly/ NA to deliver it to the laboratory. n
2. Handling of Medico-Legal Specimens (foreign body – e.g. bullet, coin)
• CN properly labels the specimen container with the name, age, room,
case number, date of operation, and the type and source of specimen,
Handling
and endorses it to the Head Nurse.
3. Disposal of Dismembered Parts of the Body
• CN places the amputated body part in an appropriate container with
proper label as cadaver tag.
• CN secures the signature of relatives who will receive the specimen
• Accomplish Certificate of dismembered body part
• Elective cases are scheduled on a first-come-first-serve basis. .
• A telephone or verbal notification from the surgeon is accepted,
provided that it is followed by a written notification. The written
notification will be used for reservation purposes only. Aside
from the written notification, the nurse who receives the call
must also document the scheduled surgery in the Operating
POLICY ON
Room Scheduled Cases Logbook.
• Admitted patients scheduled for an operation should have a
SCHEDULIN
written notification (OR Schedule Notification slip) from the
ward
G OF CASES
• For emergency cases coming from the ER, an OR notification
should also be forwarded to the OR
• Emergency cases will always be given priority over elective
cases.
• Strict implementation of the “scheduled time is cutting time”
policy should be observed at all times
• A cardiopulmonary (CP) clearance is required for all patients
aged 35 years and above, who will undergo a major procedure
or any procedure with anesthesia except for local anesthesia. A
CP clearance is required for patients aged 40 years and above,
who will undergo uncomplicated obstetrical procedures
• A CP clearance issued will be acceptable for a period of one PRE-OPERATIVE
month for normal cases and two weeks for patients with PREPARATION
comorbid conditions.
• In the event that the surgeon insists on proceeding with the
contemplated procedure without a valid CP clearance, the
surgeon must document in the doctor’s order that the patient
has ‘no need for CP clearance.’
• In the event that the surgeon is also an internist and insists that
the patient is CP cleared according to his assessment, the CP
clearance from that surgeon will be considered valid.
 • A pediatric clearance must be performed by a pediatrician for all
patients aged 3 months to 12 years. A neonatologist must issue
the CP clearance for patients below three months of age. The
pediatric clearance for patients above 12 years of age shall
depend on the discretion of the surgeon or anesthesiologist. This
applies to all cases, i.e. elective or emergency. The clearance PRE-OPERATIVE
should be provided by a pediatrician/ neonatologist who is an PREPARATION
active staff of TCMC. A pediatric clearance is only valid for 2-3
days from the date of issue.
• A properly accomplished informed consent must be signed prior to
transfer to the operating room.
• No patient shall proceed with the scheduled operation without the
appropriate accounting, industrial, and CP clearance.
• Patients wheeled to the OR should have the proper ID band or
bracelets.
• An eight-hour NPO status should be observed for patients who will
require general / regional anesthesia.
• All pre-operative shaving for elective cases should be
performed in the ward
• All dentures, jewelries, clothing (including underwear), nail
polish, and contact lenses should be removed before the
patient is transferred to the OR/ DR complex. A cleansing
PRE-OPERATIVE
enema should be performed in the ward or in the patient’s
room. Only fleet enemas will be permitted in the Labor Room. PREPARATION
• Patients should be transported to the OR 45 minutes- 1hour
before the scheduled time of the procedure.
• A pre-operative checklist and site verification must be filled out.
• For newly admitted patients for surgery from admitting or ER,
they may be endorsed to OR directly even 2hrs prior, provided
OR requirements for the procedure are accomplished, and
unless no available staff to receive the patient. There must be
proper coordination.
PRE-OPERATIVE
PREPARATION
PRE-OPERATIVE
PREPARATION
• ‘Sign In’ - refers to the period before the
induction of anesthesia. WHO
• ‘Time Out’ - refers to the period after
SURGICAL
the induction of anesthesia and before
creating a surgical incision. SAFETY
• ‘Sign Out’ - refers to the period during CHECKLIST
or immediately after wound closure but
before removing the patient from the
operating room.
 WHO
SURGICAL
SAFETY
CHECKLIST
 All patients who have undergone surgical procedures
should stay for a minimum of two (2) hours, until vital
signs are stable, or for a specific duration depending on
the discretion of the anesthesiologist. PACU
 If the patient’s condition warrants intensive care, as
deemed by the attending physician or the POLICY
anesthesiologist, the patient may be transferred to the
ICU.
 Accomplishment of PACU form
 Clearance from Anesthesiologist, Surgeon, ROD or
JCON prior to transfer with latest vital signs and status
of patient.
 Patient Transport
 Endorsement

If a Code Blue event occurs upon receiving the patient in the
holding area, the Code Blue Team will be called to respond.

If a Code Blue event occurs inside the OR suite before, during, or
after a surgical operation, the Anesthesiologist and the rest of the
surgical team are responsible for resuscitation. In the event that
resuscitation attempts occur during the intraoperative procedure, CODE BLUE
the Scrub Nurse should deliver the best efforts in maintaining the
sterility of the surgical site and the surgical instruments.

If the resuscitation attempt is successful, the Anesthesiologist and
the Surgeon shall decide if the surgical procedure will proceed.

If the resuscitation attempt is unsuccessful, the surgical site will
be closed and proper documentation shall be made on the
operative record.

If a Code Blue event occurs in the recovery room, the Code Blue
Team of TCMC will be called to respond.
 SKILLS
• SURGICAL HAND WASHING
• SURGICAL HAND SCRUB
• GLOVING
• GOWNING
• SETTING UP THE STERILE
FIELD
SURGICAL
HAND
WASHING
 SURGICAL
HAND SCRUB
GOWNING
CLOSED
GLOVING
 OPEN
GLOVING
THANKS FOR
LISTENING!