WATAUGA MEDICAL CENTER OPERATING ROOM PRECEPTOR CHECKLIST Preceptee Name: ___________________________________ Week 1 Date Completed:____________ Chapter 1 Test Chapter 2 Test Chapter 7 Test Seek and Find List # 1 Activity Record Completed and Signed Week 2 Date Completed:____________ Chapter 4 Test Chapter 5 Test Chapter 6 Test Seek and Find List # 2 Activity Record Completed and Signed Week 3 Date Completed:____________ Chapter 9 Test Chapter 3 Test Chapter 8 Test Chapter 10 Test Seek and Find List # 3 Activity Record Completed and Signed Week 4 - 12 Date Completed:____________ Chapter 11 Test Chapter 12 Test Seek and Find List # 4, 5, 6 Fire, Malignant Hyperthermia, Cardiac, Disaster Tests Activity Record Completed and Signed Practical Evaluation Completes CBO Orientation Program Preceptor to initial where appropriate WATAUGA MEDICAL CENTER OPERATING ROOM SELF ASSESSMENT Instructions: Place a C and/or S in each box to indicate level of proficiency in the circulating and scrub roles. Rate your skills from 1 to 4 using the following scale. 1 - No experience. You have never done the stated task/skill 2 - Minimal experience. You have performed the task/skill infrequently. 3 - Moderate experience. You can perform the task/skill independently with the help of resource person. 4 - Extensive experience. You can perform the task/skill proficiently without assistance. Task/Skill Rating PERIOPERATIVE PATIENT ASSESSMENT 1. Patient Interview ______ 2. Develop nursing diagnosis and care plan ______ MONITORING VENTILATION, CIRCULATION, AND INTAKE AND OUTPUT 1. Assist anesthesia personnel during induction ______ 2. Application of cardiac monitor electrodes ______ 3. Application of antiembolitic compression units a. DVT ______ b. TED hose ______ 4. Operate defibrillator ______ 5. Read cardiac monitors ______ 6. Use automatic blood pressure monitors ______ 7. Administration of blood and blood products ______ 8. Urinary bladder catheterization ______ 9. Aseptic connection of drainage devices ______ 10. Monitoring patient under IV conscious sedation/local anesthetic ______ PRACTICE ASEPTIC TECHNIQUE 1. Proper surgical attire ______ 2. Surgical hand scrub ______ 3. Gowning and gloving a. closed gloving self ______ b. open gloving self and others ______ 4. Creating and maintaining sterile field ______ 5. Preoperative skin preparation ______ 6. Universal precautions ______ 7. Decontaminating instruments ______ 8. Wrapping and packaging items for sterilization ______ 9. Verification of the sterilization process ______ HANDLING EQUIPMENT 1. Electrosurgical units a. monopolar, Valley Lab, Force 2, sse2k, sse3b b. bipolar c. Argon beam coagulator, Birtcher d. Wolf monopolar e. Elmed monopolar 2. Microscopes 3. Steam Sterilizer WATAUGA MEDICAL CENTER OPERATING ROOM SELF ASSESSMENT Instructions: Place a C and/or S in each box to indicate level of proficiency in the circulating and scrub roles. Rate your skills from 1 to 4 using the following scale. 1 - No experience. You have never done the stated task/skill 2 - Minimal experience. You have performed the task/skill infrequently. 3 - Moderate experience. You can perform the task/skill independently with the help of resource person. 4 - Extensive experience. You can perform the task/skill proficiently without assistance. Task/Skill Rating HANDLING EQUIPMENT (cont'd) 4. EKG monitor 5. Laser a. CO2 6. Laparoscope 7. Insufflator 8. Suction/Irrigators GYN 9. Pneumatic tourniquet 10. Powered surgical instruments 11. Irrigation and aspiration w/Avit 12. Phaco unit 13. Hypo/hyperthermia units 14. Fiberoptic light sources and cords 15. Chest drainage units 16. Stirrups: Crutch, hanging, Allen 17. Tables 18. Fracture table, Telos GASTROINTESTINAL SURGICAL PROCEDURES 1. Appendectomy 2. Bowel resection a. colectomy b. colostomy c. sigmoid resection d. low anterior with stirrups 3. Cholecystectomy 4. Feeding gastrostomy 5. Esophageal resection 6. Esophagoscopy 7. Gastrectomy 8. Gastroplasty 9. Gastroscopy (EGD) 10. Hemorrhoidectomy 11. Laparoscopic cholecystectomy 12. Liver a. biopsy 13. Pancreatectomy 14. Splenectomy 15. Hiatal herniorrhaphy 16. Vagotomy/Pyloroplasty WATAUGA MEDICAL CENTER OPERATING ROOM SELF ASSESSMENT Instructions: Place a C and/or S in each box to indicate level of proficiency in the circulating and scrub roles. Rate your skills from 1 to 4 using the following scale. 1 - No experience. You have never done the stated task/skill 2 - Minimal experience. You have performed the task/skill infrequently. 3 - Moderate experience. You can perform the task/skill independently with the help of resource person. 4 - Extensive experience. You can perform the task/skill proficiently without assistance. Task/Skill Rating GASTROINTESTINAL SURGICAL PROCEDURES (cont'd) 17. Autosuture instruments a. non-disposable b. disposable GENITOURINARY SURGICAL PROCEDURES 1. Ureteroscopy: flexible and rigid 2. Cystoscopy 3. Cystotomy 4. Hydrocelectomy 5. Ileal loop 6. Marshall Marchetti Krantz 7. Nephrectomy 8. Penile prothesis, inflatable 9. Burch procedure 10. Prostatectomy a. Retropubic radical b. Suprapubic c. Transurethral resection 11. RAZ 12. Cystoscopy a. retrogrades b. stone manipulation 13. Ureterolithotomy REPRODUCTIVE SYSTEM SURGICAL PROCEDURES 1. Abdominal hysterectomy 2. Anterior/Posterior repair 3. Augmentation mammoplasty 4. Breast biopsy 5. Caesarean section 6. D&C 7. Laser laparoscopy 8. Mastectomy 9. Tubal reanastomosis 10. Laparoscopic tubal (clip or cautery) 11. Peritoneoscopy/laparoscopy 12. Laparoscopically assisted vaginal hysterectomy 13. Tubal irrigation, Cohen's cannula 14. Tubal ligation, laparotomy WATAUGA MEDICAL CENTER OPERATING ROOM SELF ASSESSMENT Instructions: Place a C and/or S in each box to indicate level of proficiency in the circulating and scrub roles. Rate your skills from 1 to 4 using the following scale. 1 - No experience. You have never done the stated task/skill 2 - Minimal experience. You have performed the task/skill infrequently. 3 - Moderate experience. You can perform the task/skill independently with the help of resource person. 4 - Extensive experience. You can perform the task/skill proficiently without assistance. Task/Skill Rating REPRODUCTIVE SYSTEM SURGICAL PROCEDURES (cont'd) 15. Vaginal hysterectomy 16. Vasectomy OTHER PROCEDURES 1. Transvenous pacemaker 2. Colonoscopy 3. Sigmoidoscopy 4. EGD 5. Choledochoscope 6. Hysteroscope RESPIRATORY SYSTEM SURGICAL PROCEDURES 1. Bronchoscopy 2. First rib resection 3. Laryngoscopy 4. Lobectomy 5. Mediastinoscopy 6. Pneumonectomy 7. Thoracotomy 8. Thorascopy 9. Tracheotomy PERIPHERAL VASCULAR SYSTEM SURGICAL PROCEDURES 1. Abdominal Aortic Aneurysm 2. Aorta-femoral bypass 3. Axillo-femoral bypass 4. Carotid endarterectomy 5. Embolectomy 6. Femoral-Popliteal bypass 7. Insertion vena caval filter 8. Saphenous vein ligation/stripping 9. Dialysis access graft/fistula 10. Autotransfuser NEUROLOGICAL SYSTEM SURGICAL PROCEDURES 1. Lumbar laminectomy WATAUGA MEDICAL CENTER OPERATING ROOM SELF ASSESSMENT Instructions: Place a C and/or S in each box to indicate level of proficiency in the circulating and scrub roles. Rate your skills from 1 to 4 using the following scale. 1 - No experience. You have never done the stated task/skill 2 - Minimal experience. You have performed the task/skill infrequently. 3 - Moderate experience. You can perform the task/skill independently with the help of resource person. 4 - Extensive experience. You can perform the task/skill proficiently without assistance. Task/Skill Rating SENSORY SYSTEM SURGICAL PROCEDURES 1. Acoustic neuroma 2. Blepharoplasty 3. Cataract extraction 4. Corneal transplant 5. Enucleation 6. Facial nerve decompression 7. Glomus tumor 8. Intraocular lens implant 9. Labyrinthectomy 10. Mastoidectomy 11. Myringotomy with ear tube insertion 12. Rhytidectomy 13. Scleral buckle 14. Stapedectomy 15. Strabismus 16. Tonsillectomy and adenoidectomy 17. Tear duct exploration 18. Tympanoplasty 19. Vitrectomy MUSCULOSKELETAL SYSTEM PROCEDURES 1. Amputation 2. Archbars 3. Arthroscopy a. ACL reconstruction b. Ankle c. Knee d. Shoulder e. TMJ f. Elbow 4. Arthroscope, shaver, character generator, picture taker 5. Bunionectomy 6. Carpal tunnel syndrome 7. Closed reduction 8. Compression hip pinning, Versa FX 9. External fixation devices: EBI, monotube 10. Thompson prosthesis 11. Modular Moore WATAUGA MEDICAL CENTER OPERATING ROOM SELF ASSESSMENT Instructions: Place a C and/or S in each box to indicate level of proficiency in the circulating and scrub roles. Rate your skills from 1 to 4 using the following scale. 1 - No experience. You have never done the stated task/skill 2 - Minimal experience. You have performed the task/skill infrequently. 3 - Moderate experience. You can perform the task/skill independently with the help of resource person. 4 - Extensive experience. You can perform the task/skill proficiently without assistance. Task/Skill Rating MUSCULOSKELETAL SYSTEM PROCEDURES (cont'd) 12. Hip reconstruction Harris/Gallante a. with cement b. without cement 13. Intermedullary nailing, Kuntscher 14. ZMS intermedullary nailing Femur/Tibia 15. Knee reconstruction Miller/Gallante 16. Knowles pins 17. Ligament reconstruction 18. Mandibular osteotomy 19. Maxillary osteotomy 20. ORIF of fractures 21. Synthes set 22. Shoulder reconstruction 23. Magna Fx cannulated hip screws 24. ECT set 25. Silastic implants 26. Skeletal traction 27. Tendon repair 28. Tibial osteotomy 29. Zygomatic fracture ENDOCRINE/LYMPHATIC SYSTEM PROCEDURES 1. Adrenalectomy 2. Axillary node dissection 3. Parathyroidectomy 4. Radical Neck dissection 5. Staging laparotomy 6. Thyroidectomy WATAUGA MEDICAL CENTER OPERATING ROOM OR LINGO BUG JUICE - NOT an extract from flies and mosquitoes, BUT A solution used for irrigation of a wound for purposes of using antibiotics topically. It usually consists of a mixture of physiologic solution (saline) and antibiotic drugs added as specified by the surgeon. The proportion of the drugs to the solution will vary. This solution will be prepared by the circulating nurse. Usage of solution is charted on the Intraoperative Nursing Record, but the words "bug juice" are not the ones used. (AKA: "Irrigation") CHRISTMAS TREE - NOT a decoration for the holidays, BUT A metal holder shaped like an "L" which holds anesthesia tubing OR A metal adapter that fits on a syringe to enable it to fit into a catheter. STIRRUPS - NOT an accessory for your favorite horse, BUT Operating room table accessories that are attached to the table to function as supports for the patient's legs and feet when in LITHOTOMY position. There are several types. PULLING OR PICKING YOUR CASE - NOT an attempt to move a crate BUT Obtaining all supplies, positioning equipment, instrumentation and so forth required for a particular surgical procedure using the doctor's preference cards or service procedure books as a reference. CLOSING - NOT necessarily completing the purchase of a new house BUT The time at which the primary portion of the procedure has been completed and the beginning steps are taken to close the various layers of the surgical wound. TURN OVER TIME - NOT the time to change to the other side of the cassette tape. BUT The amount of time that has elapsed between the time one patient leaves the room following a procedure and another patient is brought into the same room for the next case. FROZEN SECTION - NOT the microwave food aisle at the grocery store BUT A method of preparing a surgical specimen for microscopic examination. This tissue is rapidly frozen, then sliced extremely thin so it can be better visualized under high magnification. This is usually done when cancer is suspected or positive immediate identification of a specimen is needed. OR LINGO (page 2) HEADLIGHT - NOT one of the glass globes at the front of a car BUT A powerful fiberoptic light source worn on the surgeon's head during an operation to increase and focus the illumination on the operative field. BEANBAG - NOT something to throw through a hole at the carnival BUT A positioning support called a vac pac that is made functional by applying suction to the suction plug inlet. This causes the vac pac to mold to the desired shape and support the patient's position. FLASH - NOT the term used to describe a streaker running through the park BUT The term used to describe a method of steam sterilization. Autoclaves are located within each core, are small in size, and designed to sterilize instruments and other items. The cycle for sterilization is five minutes with a temperature of 270 (f) and under the pressure of 30 lbs per square inch.(PSI) The timing cycle on these units can be adjusted if a longer sterilizing cycle is warranted. (ie. mixing types of materials or instruments having coding tape need a longer cycle) GAS - NOT something used to heat your house BUT A type of sterilizing agent called ethylene oxide gas (EO). It is used to sterilize items that cannot be steam sterilized. It is administered during the sterilization cycle at a temperature of 150 (f). If the item is gas permeable, it must be additionally airtreated by another device (aerator) so that the residual ethylene oxide is dispelled. The residual gas is hazardous to patients and the staff dealing with it if not removed by aeration. Examples of items "gassed": rubbergoods, heat sensitive items, those that would melt. WATAUGA MEDICAL CENTER THINGS A PACU NURSE NEEDS TO KNOW- BUT MAY NOT HAVE TIME TO ASK Name: What they prefer to be called Procedure: What was done? Staples or Sutures? Drains and their location; Local injection per surgeon, Unusual positioning intraop Output: Total emptied by OR, in & out cath? Allergies: Special Orders(not routine) i.e.: breathing problems, aerosol, X-Rays in PACU. PreOp Level of consciousness and mood: oriented, sleepy, confused, scared, calm, etc. Physical Limitations: Hard of hearing, limb weakness, speech slurred, poor vision. These items are especially important for carotid and neuro patients. Skin Integrity: Preop rashes, scratches, bruises, cuts, or reddened areas. For Infants: Do they take/or can they have a bottle? All children on stretchers need bumper pads. Some adults would benefit from them, too. When and OR nurse relieves on a case, this same report should be given to "Pass it on." Other Helpful Information: We appreciate your report and help. Since a safe transition for the patient is our goal, please understand if we don't look at you while assessing airway, attaching monitors, and checking patient, we are listening to you (unless a stethoscope is in our ears)! - If a patient's airway is compromised and PACU is trying to manage airway, the OR nurse can help by attaching monitoring equipment. - When we all have patients and someone is not immediately available to accept you patient, please choose a station, start O2, and apply monitors. We'll be there ASAP. - Since PACU time is expensive for the patient, we try to keep the stay to a minimum. Please keep the conversation "focused" on the patient. Don't think we're rude if we don't "socialize" with you at this time. - At the time of PACU admission, please remember that we need to have access to the patient and pertinent information quickly so where you stand or sit is important. WATAUGA MEDICAL CENTER OPERATING ROOM The orientation experience is dependent on case availability. The orientation process centers on providing basic knowledge on which the preceptee can build upon and apply to future cases. Basis goals of your orientation are: 1. To learn aseptic technique. 2. To learn safety precautions for personnel and patient, i.e., universal precautions, burn prevention, nerve damage, etc. 3. To identify legal implications of the perioperative experience. 4. To learn location and operation of equipment and sterile supplies. 5. To learn location of appropriate reference materials and resource personnel. 6. To identify the needs of the varied population served e.g., pediatric patients, geriatric patients. 7. To learn methods of assisting in gathering CQI information. 8. To read and understand O.R. policies and procedures. 9. To accept that orientation cannot teach you everything. The orientation is a broad and varied learning experience that depends on you to integrate and apply the information. Following the formal orientation process, we expect you to continue seeking and initiating learning experiences, i.e., request unfamiliar procedures. Your formal orientation experience is concluded when you are assigned to call. WATAUGA MEDICAL CENTER OPERATING ROOM NAME OF TEAM MEMBERS Director of Nursing, Surgical Services: Charge Nurse: Clinical Nurse Specialist: CSR Supervisor: Staff: OR/RN LPN CST PACU/RN Charge Nurse: Staff: Out Patient Department ADON: Staff: Workroom/Housekeeping OR Secretary Anesthesia Dept CRNA Anesthesiologist X-ray WATAUGA MEDICAL CENTER OPERATING ROOM DISASTER MANUAL TEST 1. Describe your actions during a hospital "Code Orange" drill. 2. How would you respond to a bomb threat? 3. When helping with a bomb threat search, you cannot turn on any switches, but must use a flashlight. T or F 4. What does "Code One" announce? 5. During a "Code One" you may be called at home to return to the OR, even when not on call. T or F 6. During a "Code One" that is the result of a mass casualty, the OR continues with elective cases. T or F 7. During a telephone outage, the beeper system continues to work. T or F. If false, how would on call staff be notified and what should your response be? 8. What does "Code Grey" signify? 9. What is the expected response in the OR? 10. A "Code 500" announces a . 11. If the "Code 500" is not in the OR, what is your response? WATAUGA MEDICAL CENTER OPERATING ROOM DISASTER TEST ANSWERS 1. Listen for locations, close all doors, check smoke detectors, check for fire, if unassigned, report to the front desk. If assigned, continue case, mentally prepare for evacuation. 2. Make notes, keep person talking, calmly and quietly notify another employee to activate the fire alarm system, discuss only with nursing supervisor, hospital administrator or hospital police, remain on duty. 3. T 4. External disaster, mass casualty, natural disaster, state of emergency. 5. T 6. F 7. False, a messenger will be sent to your home. You must return to the hospital until telephone communications are re-established. A file with maps to all OR call team members is maintained by the hospital police. 8. Infant/child abduction. 9. Have all exits monitored. The department is secured. 10. Hostage situation. 11. Continue with schedule as usual. Be prepared to evacuate. WATAUGA MEDICAL CENTER OPERATING ROOM MALIGNANT HYPERTHERMIA TEST 1. _____________ is a muscle relaxant that is a primary trigger for malignant hyperthermia. 2. MH is a ___________________________________ state. 3. Can MH be anticipated? Y or N (explain) . 4. What drug needs to be immediately available to treat MH and where do we store it? 5. Is this drug ready to be administered if needed? 6. During MH crisis, the patient is in respiratory and metabolic __________________________ 7. ______________________________ are early symptoms of an impending MH crisis. 8. What supplies are necessary for mixing dantrolene? . 9. ____________________________ is used to confirm diagnosis in suspect individuals. 10. Symptoms that may be noted by surgical team are: . 11. WMC does not use inhalation agents that are capable of triggering MH. T or F 12. Increased body temperature is a good indicator of MH crisis. T or F 13. List drugs available in the MH cart: 14. How will you cool the patient? WATAUGA MEDICAL CENTER OPERATING ROOM MALIGNANT HYPERTHERMIA ANSWERS 1. Succinylcholine (anectine) 2. Hypermetabolic 3. YES, history of personal/family anesthesia complications or death. 4. Dantrolene, MH cart in holding area. 5. NO, must be mixed. 6. Acidosis 7. Jaw rigidity, increase in end tidal CO2. 8. Sterile H20, dispensing syringe or 60cc syringe. 9. Skeletal muscle biopsy test 10. Mottling of skin, palpable warmth of viscera, fever 11. F (halothane, enflurane, isoflurane) 12. F often occurs after other signs 13. Dantrium, Sodium Bicarbonate, Solu Cortef, Furosemide, Procainamide, Mannitol 14. Hypothermia pad, ice (2W), cold NS IV, gastric, wound, rectal lavage with cold saline. WATAUGA MEDICAL CENTER OPERATING ROOM EMERGENCY CARDIAC CARE 1. Where are the crash cart and defibrillator stored? 2. What are some staff safety considerations during defibrillation? 3. During code "Blue" in the OR, who will be the director? 4. Who will initiate chest compressions? 5. Does hospital code team always respond to OR codes? 6. How are the defibrillator paddles routinely positioned? 7. How far apart should the paddles be placed? 8. List primary duties of circulator during code. 9. List duties of scrub nurse during a code. 10. Which emergency drugs can be administered via an endotracheal tube? 11. How much pressure should be applied to the defibrillator paddles? 12. What energy sequence for delivery might you expect to use? 13. What are the maximum number of shocks given? 14. Some possible causes of asystole intraoperatively or immediately post op are ______________ and ______________________ . 15. Do you ever countershock at less than 200 joules? 16. If defibrillating a patient with a transvenous pacemaker are there any special precautions? 17. What determines whether synchronized or asynchronized countershock is used? 18. What special dosage considerations are made in the pregnant patient? WATAUGA MEDICAL CENTER OPERATING ROOM EMERGENCY CARDIAC CARE ANSWERS 1. PACU 2. Dry hands, dry floor, "stand clear order" 3. Anesthesiologist 4. Surgeon, if present 5. NO 6. One electrode just to the right of upper sternum below clavicle, the other is left of cardiac apex (left of nipple along mid axillary line) 7. More than 2" 8. a. record time/start elapsed time clock b. notify OR desk c. help reposition patient if necessary d. obtain crash cart and defibrillator e. assist anesthesia provider as necessary f. maintain accurate counts g. document 9. a. remain sterile, keep mayo and back table sterile b. prepare sponges to pack wound c. keep track of sponges, sharps and instruments d. assist surgeon as necessary 10. Lidocaine, epinephrine and atropine 11. Firm pressure, about 25 lbs. 12. VF 200j 200-300j, 360j followed by 360j 13. No maximum number, determined by response 14. Hypoxia, hypothermia 15. Yes, atrial flutter, atrial fibrillation, internal paddles 16. Place paddles at least 5" from generator 17. Whether patient has a pulse, is "synchronized" when patient has a pulse. 18. NONE WATAUGA MEDICAL CENTER OPERATING ROOM FIRE SAFETY TEST 1. What is the telephone number for reporting a fire? 2. List some causes of OR fires: 3. What situation in the OR causes fires to rapidly escalate? 4. What is RACE? 5. Where do most OR fires occur? 6. If you are involved in an OR fire, where would you take evacuated patients? 7. Describe actions after "Code Orange" is activated. 8. If you are unassigned at the time of a fire drill, you should ________________ 9. If cautery instrument works, a break or nick in insulation is insignificant. T or F 10. The circulator should take what steps to prevent a fire on a patient. 11. The scrub nurse should take what steps to prevent a fire on the patient. 12. All fiberoptic light cables provide a cool source of light, you need not be concerned if placed on drapes. T or F 13. If you have a small fire in the OR that you quickly control, (1) do you still need to report it, (2) can the room be cleaned as usual? 14. The wound must be closed before evacuating the OR and patient extubated. Tor F 15. To evacuate, a patient must be moved onto a stretcher. T or F 16. When the main power switch on the panel is turned off, will the room be without any electricity? 17. Primary evacuation usually occurs . WATAUGA MEDICAL CENTER OPERATING ROOM FIRE SAFETY TEST ANSWERS 1. 4400 2. Lasers, ESU, argon beam coagulator, faulty electrical equipment, extension cords. 3. O2 enriched atmosphere 4. Rescue and remove, alarm, contain, extinguish 5. On the patient 6. Another OR, (possibly 7 & 8), PACU, CC, OP, IMCU, OB, ER, 2W 7. Circulator goes into hall to hear locations, notify the team, search immediate area for signs of fire, close all doors, mentally prepare for possible evacuation. 8. Report to the front desk 9. F 10. Grounding pad placement, avoid pooling of prep materials. 11. ESU in holsters, listen for sound of activation of unused ESU or Shaw scalpel. 12. F 13. (1) Yes (2) No 14. F 15. F 16. No, have lights only 17. Laterally WATAUGA MEDICAL CENTER SURGICAL PROCEDURE CHECKLIST TYPE DISCUSSED SECOND FIRST CIRCULATE CRICULATE DEMO SCRUB SCRUB AFTER HELP ALONE 1. ABDOMINAL Appendectomy Herniorrhaphy Bowel Resection Laparoscopic GB Hiatal Hernia 2. GENERAL SURGERY Breast Biopsy Radical Mastectomy Thyroidectomy Hemorrhoidectomy 3. OB/GYN D&C TAH TVH A&P Repair C-Section Laparoscopy Hysteroscopy 4. CARDIOVASCULAR Endarterectomy Embolectomy Vascular Bypass Vein Ligation Pacemaker 5. THORACIC Thoracotomy Mediastinoscopy 6. EYE ECCE/PHACO 7. ORTHOPEDIC Arthroscopy (knee, shoulder, ankle) Lumbar Laminectomy Hip Pinning Compression Hip Prosthesis ORIF Ankle TKR THR WATAUGA MEDICAL CENTER SURGICAL PROCEDURE CHECKLIST TYPE DISCUSSED SECOND FIRST CIRCULATE CRICULATE DEMO SCRUB SCRUB AFTER HELP ALONE 7. ORTHOPEDIC (cont'd) Bone Cement Mixing 8. ORAL SURGERY Mandibular Osteotomy ORIF Mandible Donor Bone Reconstitution 9. GENITOURINARY Prostatectomy Radical Turp TURB Cystoscopy Ureteroscopy 10. ENDOSCOPIC Bronchoscopy Laryngoscopy EGD (esophagogastroduodenoscopy) Colonoscopy 11. ENT Nasal Reconstruction Tympanostomy Tube T & A Tympanoplasty WATAUGA MEDICAL CENTER EQUIPMENT CHECK LIST TYPE OF LOCATE DISCUSSED ACTUAL PT USE DISCUSSED EQUIPMENT DEMONSTRATE DATE/INITIAL DATE/INITIAL AIR INSTRUMENTS ALCON UNIT ARTHROSCOPY CART X 2 AUTOSUTURE AUTOTRANSFUSION SETUP BLOOD SCALES CAST CART CHANGING N2,O2,CO2 TANKS CODE CART COMPUTER CONSTAVAC CRICOTHYROTOMY CANNULA DEFIBRILLATOR DENTAL CART DENTAL SUCTION/DRILL CART DENTAL XRAY DERMATOME DVT HOSE ELECTROCAUTERY/ARGON BEAM EYE MAGNET FRACTURE TABLE (STANDARD AND INTERMEDULLARY SETUPS HAND TABLES HEAD LIGHTS K-THERMIA UNIT, BAIR HUGGER LAPAROSCOPIC GB EQUIPMENT LASER LAVH CART MALIGNANT HYPERTHERMIA CART MESHGRAFT MICROSCOPES MONITORS-EKG,OXIMETER,BP OR Tables (Shampaine, AMSCO, Radiop, Uroview) OVERHEAD LIGHTS PACEMAKER ANALYZER PATIENT STRETCHERS PEDIATRIC CART POSITIONING AIDS: AIRPLANE ARMREST BLUE CHEST PILLOW BUTT BOARD DONUT/FOAM HEAD REST PILLOWS, BLANKETS, EGGCRATE, SHEEPSKIN SANDBAG SHOULDER BRACES WATAUGA MEDICAL CENTER EQUIPMENT CHECK LIST TYPE OF LOCATE DISCUSSED ACTUAL PT USE DISCUSSED EQUIPMENT DEMONSTRATE DATE/INITIAL DATE/INITIAL STIRRUPS-HANGING, ALLEN CRUTCH VACPAC SHAW SCAPEL STRYKER SURGILAV SUCTION D&C SUCTION SETUPS TOURNIQUETS (AIR, ELECTRIC) WOLFE MACHINE XOMED POWER DRILL * Report malfunctions and remove from room. WATAUGA MEDICAL CENTER OPERATING ROOM DATE: Perioperative Orientation Activity Record - Scrub Nurse Week I I. Objective: Develop an understanding of the overall environment of the perioperative area. Learning Activities: 1. Shadow the preceptor 2. Observe the overall physical structure,layout and traffic pattern of the OR. 3. Obtain and dress in appropriate OR attire (B & K #11) 4. Read pertinent reference materials and EPN chapters 1,2,7 5. Read WMC policies concerning: PPE, surgical attire 6. Complete introductory workroom experience 7. Complete seek and find # 1 8. Complete tests 1,2,7 II. Was the objective met? yes/no Were the activities completed? yes/no III. Please describe your thoughts and feelings regarding your clinical experience and how you met your clinical objectives (use the back of this form if needed): IV. Comments (preceptor) Preceptor's Signature: Preceptee's Signature: WATAUGA MEDICAL CENTER OPERATING ROOM Date Perioperative Orientation Activity Record Week 2 (Scrub) I. Objective: Develop an understanding of establishing and maintaining sterile field Learning Activities: 1. Shadow the preceptor 2. Scrub with preceptor on selected cases, (observation) 3. Perform scrub duties with assistance and independently on selected cases. 4. Read pertinent reference materials and chapters 4,5,6 EPN (Duties of Scrub Nurse) 5. Shadow the preceptor during next day case preparation. 6. Complete, seek and find # 2 7. Complete tests 4,5,6 II. Was the objective met? Yes / No Were the activities completed? Yes / No III. Please describe your thoughts and feelings regarding your clinical experience and how you met your clinical objectives (use the back of this form if needed): IV. Comments (preceptor) Preceptor's Signature: Preceptee's Signature: WATAUGA MEDICAL CENTER OPERATING ROOM Date Perioperative Orientation Activity Record Week 3 (Scrub) I. Objective: Develop a more complete understanding of the role of the scrub nurse. Activities: 1. Establish and maintain sterile field 2. Participates in draping procedures 3. Identify and handle instruments during selected cases. 4. Participates in counting sponges, needles, and instruments according to hospital policy 5. Read pertinent reference materials and chapters 8,9,10 EPN 6. Pull packs on selected cases 7. ESU safety 8. Wound closure materials 9. WMC policies: counting and ESU 10. OSHA regulations - hazards in the work place 11. Complete, seek and find # 3 12. Complete tests 8,9,10 II. Did you meet the above objectives? Yes / No Were the activities completed? Yes / No III. Please describe your thoughts and feelings regarding your clinical experience and how you met you clinical objectives (use the back of this form if needed): IV. Comments (preceptor) Preceptor's Signature: Preceptee's Signature: WATAUGA MEDICAL CENTER OPERATING ROOM Date Perioperative Orientation Activity Record Weeks 4-9 (Scrub) I. Objective: Develop a more complete understanding of the role of the scrub nurse. Suggested Activities: 1. Establish and maintain sterile field. 2. Apply basic knowledge to new surgical procedures. 3. Participate in sponge, needle/sharps and instrument counts according to hospital policy. 4. Read pertinent reference materials and EPN chapter II. 5. Read WMC policies: pt. safety polices (all), specimen, emergency situations, Laser. 6. Laser safety (B&K). 7. Use of powered instruments. 8. Seek and find #4,5 9. Complete test 11 II. Was the objective met? Yes / No Were the activities completed? Yes / No III. Please describe your thoughts and feelings regarding your clinical experience and how you met your clinical objectives (use the back of this form if needed): IV. Comments (Preceptor) Preceptor's Signature: Preceptee's Signature: WATAUGA MEDICAL CENTER OPERATING ROOM Date Perioperative Orientation Activity Record Week 10 - 12 (Scrub) I. Objective: Perform in role of Scrub Nurse Activities: 1. Develop independence 2. Begin call experience 3. Completes review of all suggested policies. 4. Seek and find # 6 5. Completes tests: Emergency situations 6. Completes all materials in orientation packet 7. Final evaluation with DON SS, Clinical Supervisor and Preceptor. II. Was the objective met? Yes / No Were the activities completed? Yes / No III. Please describe your thought and feelings regarding your clinical experience and how you met your clinical objectives (use the back of this form if needed): IV. Comments (Preceptor): Preceptor's Signature: Preceptee's Signature: WATAUGA MEDICAL CENTER OPERATING ROOM DATE: Perioperative Orientation Activity Record (Circulator Nurse) Week 1 I. Objective: Develop an understanding of the overall environment of the perioperative area. Learning Activities: 1. Shadow the preceptor 2. Observe the overall physical structure,layout and traffic pattern of the operating room (EPN). 3. Obtain and dress in appropriate OR attire (B&K # 11) 4. Read pertinent reference materials and EPN chapters 1,2,7 5. Read WMC policies concerning: PPE, surgical attire 6. Complete introductory workroom experience. 7. Complete, seek and find # 1. 8. Complete tests 1,2,7 II. Was the objective met? Yes / No Were the activities completed? Yes / No III. Please describe your thoughts and feelings regarding your clinical experience and how you met your clinical objectives (use the back of this form if needed): IV. Comments (Preceptor): Preceptor's Signature: Preceptee's Signature: WATAUGA MEDICAL CENTER OPERATING ROOM DATE: Perioperative Orientation Activity Record Week 2 (Circulator) I. Objective: Develop an understanding of establishing and maintaining sterile field. Learning Activities: 1. Shadow the preceptor 2. Scrub with preceptor on selected cases, (observation) 3. Perform scrub duties with assistance and independently on selected cases. 4. Read pertinent reference materials and chapters 4,5,6 EPN (Duties of Scrub Nurse) 5. Shadow the preceptor during next day case preparation. 6. Complete, seek and find # 2 7. Complete tests 4,5,6 II. Was the objective met? Yes / No Were the activities completed? Yes / No III. Please describe your thoughts and feelings regarding your clinical experience and how you met your clinical objectives (use the back of this form if needed): IV. Comments (Preceptor): Preceptor's Signature: Preceptee's Signature: WATAUGA MEDICAL CENTER OPERATING ROOM DATE: Perioperative Orientation Activity Record Week 3 - 5 (Circ) I. Objectives: Develop an understanding of the role of the circulator. Learning Activities: 1. Shadow the preceptor 2. Observe case preparation of supplies, equipment and personnel 3. Observe pt. safety measures 4. Observe pt. interview and holding area routine 5. Observe circulator role during intraoperative phase. 6. Complete seek and find # 3 7. Read appropriate reference materials, chapters concerning preps and positioning. 8. Read chapters 3,8,9,10 EPN, and complete tests 9. Pull packs for selected cases 10. ESU safety 11. Participates in surgical counts 12. WMC policies: OSHA regulations, counts and ESU II. Was objective met? Yes / No Were the activities completed? Yes / No III. Please describe your thoughts and feelings regarding your clinical experience and how you met your clinical objectives (use the back of this form if needed): IV. Comments (Preceptor): Preceptor's Signature: Preceptee's Signature: WATAUGA MEDICAL CENTER OPERATING ROOM DATE: Perioperative Orientation Activity Record Week 6 - 9 (Circ) I. Objective: Perform role of circulator Activities: 1. Prepares room for procedure 2. Performs pt.interview and holding area routine 3. Performs measures for pt. safety 4. Apply basic knowledge to new procedures 5. Facilitates turn over time 6. Delivers pt. to PACU and reports pertinent information to PACU nurse 7. Reads applicable reference materials 8. Laser safety - understands, demonstrates 9. Completes pt. safety policies: laser, specimen handling, emergency situations. 10. Completes seek and find # 4,5,6 11. Completes tests 11,12 II. Was objective met? Yes / No Were the activities completed? Yes / No III. Please describe your thoughts and feelings regarding your clinical experience and how you met your clinical objectives (use the back of this form if needed): IV. Comments (Preceptor): Preceptor's Signature: Preceptee's Signature: WATAUGA MEDICAL CENTER OPERATING ROOM DATE: Perioperative Orientation Activity Record Week 10 - 12 (Circ) I. Objective: Perform role of circulator Activities: 1. Develops independence 2. Begins call experience 3. Completes review of all suggested policies 4. Completes seek and find # 6 5. Completes emergency situation tests 6. Completes all material in orientation packet 7. Final evaluation with DON SS, Clinical Supervisor, and Preceptor II. Was objective met? Yes / No Were the activities completed? Yes / No III. Please describe your thoughts and feelings regarding your clinical experience and how you met your clinical objectives (use the back of this form if needed): IV. Comments (Preceptor): Preceptor's Signature: Preceptee's Signature: WATAUGA MEDICAL CENTER OPERATING ROOM SEEK AND FIND I Blue Room Breaker boxes CCA Code Blue buttons Communication book C-Section room CSR dummy Fire extinguishers and smoke detectors Gift fund Holding area Intercom / room phones Manuals (Disaster, Hazardous Materials, Policy, Procedure, Infection Control) Medicine Cart OPS 8 ORs & OB Orthopaedic room PDO request calendar Peggy's office Plastic closet Recovery room (PACU) Schedule board and assignments Supply areas Time sheet/work hours Turn off valve for rooms Warmers Workroom Xray dummy WATAUGA MEDICAL CENTER OPERATING ROOM SEEK AND FIND II Ace Bandage Bladder Drainage Bag Cameron Miller Caps and masks: OB Chest Bottles Chest Cabinet Cysto Cabinet Cysto Irrigation Tubing Electrical Cords Formalin Container 16 Fr Foley Grounding Pad (stock) GYN Cabinet Kittners (peanuts) Lab GB Monitor LAVH cart Light gloves Magnetic Pad Needle Count Pad Olympus light source Pacemaker Cabinet Penrose Drains Procedure Card Files Skin Gun Specimen Containers Suction/light WATAUGA MEDICAL CENTER OPERATING ROOM SEEK AND FIND III Air Strip BJ lap sponges Blood scales C arm drapes (CAPS) 5 n 1 connectors Control syringe Crash cart Culture tubes Cytology requisition Defibrillator Dr R lap sponges Endowrap camera drape Fred Gelfoam GI clamp covers Hanging stirrups Knee boat K-Y (stock) Lugol's solution O'Connor O'Sullivan Poole suction Step ladder Sterile Debakey Stirrup holders Suction D&C machine Syringes (2 places, stock) Trach tray Vaginal packing Wolfe machines Xray apron storage area and gloves WATAUGA MEDICAL CENTER OPERATING ROOM SEEK AND FIND IV Abduction Pillow Band Allen stirrups Adrenalin Arthroscopy Cart Blue Swivel adaptor for bronchoscope Bone cement Bovie extension Buckets for placenta Cardiovascular suture 3000 cc bags saline, glycine C-Section instruments Cetacaine CO2, O2 tank Colostomy Rods Cone tip catheter Cord clamps Cricothyrotomy cannula /OB Cut down tray Cysto Pack Disp Ellik evacuator Donor bone Doppler unit Ellis's cabinets Ethicon applicator Finger K wires Flexible Biopsy forceps French eye needles 22 Fr 2-way 30cc catheter Gelfilm Glue Bowl .038 Guide wire Hyskon ID band/sheet newborn Infant warmer K-pad / k thermia unit Lactated ringers Leveen inflator syringe Leg strap for Foley Malecot/mushroom catheters Micro oscillator power source Nail polish remover pads N/G Tube OB bulb syringe OB linen closet Open GB instruments Owens silk Pediactric suction cath Placenta Scales Plastic/metal eye shields Red/Lavender top tubes for cord blood Refrigerator for cord blood Rigid Sigmoidoscopy tray Scarlet Red Segura basket Shaw scalpel Silastic tubing / connector Sterile K-wire / steinmann pins Sterile taper jaw Storage area for prep pads Surgicel Tinkle tester (3/4 dilator) TLS drain TMJ camera Toomey Total knee pack T tubes TUR drape Ureteral Cath adapter Vice grip pliers V. Mueller dilators Warmer cabinet/OB Wavy knee holder 3 way stopcock Weck applicator Wet field cautery Wire driver Xeroform gauze Y connector WATAUGA MEDICAL CENTER OPERATING ROOM SEEK AND FIND V Air strip ALARM Albumin Ambu bag Arm sling Autosuture Avitene Banana blade Banana cuff Batteries Bean bag Blood infusion set Catheter introducer 100cc bags of saline Cerclage wire set Cerebellum Rectractor Consta vac drain Cushing forceps Doppler probe DVT pressure boots EEA sizers Emergency hysterectomy set Endotracheal tube Envelope for arthroscope pictures Envelope for BJ's pictures Ethrane Fogarty catheters Gastrostomy tube Glue Pedal Hand tables (2) IV lidocaine IV pressure bag Jackson Pratt drain Lambottes Laminectomy rope Lead introducer Linvatec Interference scrow Microscope light bulbs Micro-oscillator saw Nasal Cannula Nerve Stimulator Non-sterile stockinet OB dressing room Ortho glass splint and scissors Oscillator blade Plasmanate / hespan Positioner ilomed Replacement light bulbs Ethrane Sterile duckbill Sterile lowman retractor Stryker irrigation unit Sump drain Suprapubic tube Thrombin Tibial bolt & webb Tracrium Umbilical tape Vascular grafts Vessel loops Vessel paws Xray from orthopaedic office WATAUGA MEDICAL CENTER OPERATING ROOM SEEK AND FIND VI Autovac transfuser Ball Tip Guide Wire ZMS Bassett knee splint Calgiswabs Cerclage replacement wire Choledochoscope Coban Cricothyrotomy cannula Dacron Deep gelpi Dental xray unit Dixon blade retractor EBI external fixator ECT replacement screws Endoloop Epistat catheters Eye magnet Eye magnet/power source Finger cage/tube gauze Flexible reamers ZMS Flexible ureteroscope Gelatin capsules Gill biopsy brush Interceed Intermedic screw driver Knee immobilizer Laser Linvatec Awl Liver suture Magnafx system Maltz rasps Middle ear implants Mitek Moleskin Nikon lens Ortho burr rust ring remover Pacemaker magnet Paper & ink replacement arthroscopy printer Prostatectomy sounds Prosthesis, radial head, great toe, Swanson finger Pull out wire Ring extractor Rush rod tray Single J ureteral diversion stent Site machine 6" 18 g spinal needle S.S. wire Steinmann pin cutter Sterile buttons 2 ticron Trephine blades Versafx system Xray tunnel WATAUGA MEDICAL CENTER COMPETENCY BASED ORIENTATION OPERATING ROOM I. Demonstrates knowledge of cleaning, sterilization / disinfection and packaging as a RN or LPN in Surgical Services at Watauga Medical Center. PERFORMANCE LEARNING EVALUATION TEACHING EVALUATION CRITERIA OPTIONS METHOD METHOD DATE/INITIALs A. Demonstrates ability to clean Preceptor Preceptor and organize instruments and equipment for wrapping. B. Use of instrument card file. Preceptor Preceptor C. Ability to correctly package Preceptor Preceptor, Complete supplies for sterilization. EPN, B&K EPN, Self Tests 1. Knowledge of types of wraps. a. Muslin b. Kimberly Clark c. Peel Packs d. Bemis cases e. Monarch cases 2. Select mode of sterilization EPN/B&K Complete EPN Self /disinfection of instruments and Test equipment with proper operation of that mode. a. Steam autoclave b. Sterad Sterilizer c. Cidex d. Ionizing radiation 3. Select monitoring method for EPN/B&K sterilization. a. Graphs b. Biological indicator c. Indicator strips d. Indicator tape 4. Check package integrity and Preceptor shelf life, if applicable, prior to use. 5. Knowledge of handling and Preceptor storage of sterile items. D. Care of the OR 1.Cleaning after routine cases. EPN/B & K Preceptor 2. Room set up after cleaning. Preceptor Complete EPN Self 3. Restocking rooms / special Tests assignments. WATAUGA MEDICAL CENTER COMPETENCY BASED ORIENTATION OPERATING ROOM II. Performs Basic Skills of the Scrub Nurse. PERFORMANCE LEARNING EVALUATION TEACHING EVALUATION CRITERIA OPTIONS METHOD METHOD DATE/INITIALs A. Don OR attire according to B&K EPN Preceptor, Complete policy. EPN Self Tests B. Scrub according to policy and Preceptor Preceptor procedure. C. Create sterile field. Preceptor Complete EPN Self 1. Gown and glove self EPN Tests 2. Gown and glove other scrub B & K team member 3. Change gown and/or glove during case 4. Set up sterile table 5. Set up mayo stand 6. Drape or assist in draping 7. Remove gown and glove at case completion D. Implement practices for the Preceptor Preceptor prevention of infection. EPN Complete EPN Self 1. Recognize and report breaks Test in aseptic technique in self and others 2. Take corrective action to remedy contamination errors 3. Insert urinary catheter 4. Demonstrate knowledge of distinction between "clean" & "sterile" 5. Confine contamination to area around sterile field 6. Minimize talking & noise level in room 7. Recognize limitations of sterile areas on a. gown b. table c. operative field E. Care of Speciality Patient B&K, POL B&K, POL, B&K, POL, Populations ART ART ART 1. Pediatric Completion of Completion of 2. Pregnant Self Learning Self Learning 3. Elderly Module Module 4. Latex sensitive Performance Criteria WATAUGA MEDICAL CENTER COMPETENCY BASED ORIENTATION OPERATING ROOM II. Performs Basic Skills of the Scrub Nurse. (cont'd) PERFORMANCE LEARNING EVALUATION TEACHING EVALUATION CRITERIA OPTIONS METHOD METHOD DATE/INITIALs F. Demonstrate Knowledge of: B&K EPN 1. Passing surgical instruments Completes EPN Self in functional position Tests a. Clamps & grasping instruments b. Sutures c. Blades & Scissors d. Retractors 2. Suture a. Type 1. absorbable 2. non-absorbable b. Suture needles 1. Shape 2. Point 3. Eye of Needle 3. Surgical drains & catheters 4. Surgical dressings 5. Count sponges, sharps, & instruments according to hospital policy 6. Method to decrease the operative time of the pt by: a. Using MD pref cards b. Practing unfamiliar skills c. Anticipating needs of the team d. Using proper resource personnel 7. OSHA Standards- a. radiological hazards b. chemical hazards 8. FDA reporting 9. ESU use & safety 10. Blood transport 11. Use safe practice with tissues and specimens within the sterile field. 12. Proper containment and disposal of all sharpes and hazardous materials. 13. Proper handling of medication in sterile field. WATAUGA MEDICAL CENTER COMPETENCY BASED ORIENTATION OPERATING ROOM II. Performs Basic Skills of the Scrub Nurse. (cont'd) PERFORMANCE LEARNING EVALUATION TEACHING EVALUATION CRITERIA OPTIONS METHOD METHOD DATE/INITIALs G. Demonstrate ability to function during urgent & emergency situations 1. Implement STAT orders appropriately 2. Location & use of fire extingishers, cut off switches for electricity, O2, N20 (for OR & PACU), Fire pull boxes, emergency exits, evacuation routes 3. Knowledge of pre-operative predictors of malignant hyperthermia, location of cart, system for diluting Dantrium 4. Knowledge of response to air embolism 5. Knowledge of OR response to Code Grey, Code 500, bomb threat, and Code One WATAUGA MEDICAL CENTER COMPETENCY BASED ORIENTATION OPERATING ROOM III. DEMONSTRATES KNOWLEDGE OF BASIC SKILLS OF THE CIRCULATING NURSE PERFORMANCE LEARNING EVALUATION TEACHING EVALUATION CRITERIA OPTIONS METHOD METHOD DATE/INITIALs A. Performs preoperative preparation of room & equipment based on patient & surgical needs by: 1. Damp dust all horizontal surfaces including lights 2. Acquire appropriate supplies & equipment for procedure 3. Implement practices to prevent infection: a. Open sterile items without contamination b. Pour solutions correctly c. Tie gown of scrub team members d. Place furniture within sterile field e. Monitor self & others in & out of sterile field f. Report breaks in aseptic technique g. Take corrective action to remedy contamination errors h. Prep patient according to policy & physician preference i. Insert urinary catheter without contamination. j. Minimize flow of traffic in & out of room k. Minimize talking & noise level B. Performs preoperative patient assessment & transfer to OR. 1. ID patient by: a. Having pt. state name, doctor, surgical procedure & operative site. b. Checking ID band & comparing name & number with chart & name plate. 2. Confirm with pt. & chart: a. Surgical consent b. Allergies, dentures, contact lenses, jewelry, hearing aid c. H&P WATAUGA MEDICAL CENTER COMPETENCY BASED ORIENTATION OPERATING ROOM III. DEMONSTRATES KNOWLEDGE OF BASIC SKILLS OF THE CIRCULATING NURSE (cont'd) PERFORMANCE LEARNING EVALUATION TEACHING EVALUATION CRITERIA OPTIONS METHOD METHOD DATE/INITIALs d. Labs & xrays as ordered e. Availability of blood/consent for blood f. Coughing & deep breathing discussed g. Physical limitations/prosthesis 3. Transfer pt. from holding to OR bed a. Maintain pt. privacy C. Intraoperative phase Provide for pt's safety a. Secure safety strap b. Pad heels & elbows c. Insure visual surveillance of pt. at all times d. Ground pt. for electrosurgical safety e. Count sponges, sharps, & instruments f. Stand at pt's side during induction to assist & provide protection g. Take appropriate action when counts are incorrect h. Prepare medications correctly 2. Position pt. to promote : a. Circulatory homeostasis b. Respiratory homeostasis c. Neuromuscular homeostasis d. Patient Privacy e. Exposure for operative procedure f. Administration of anesthesia 3. Page surgeon and anesthesia at appropriate time 4. Position pt. in the following positions with or without the use of positioning aids: a. Supine b. Prone c. Lithotomy d. JackKnife e. Lateral f. Semi-lateral WATAUGA MEDICAL CENTER COMPETENCY BASED ORIENTATION OPERATING ROOM III. DEMONSTRATES KNOWLEDGE OF BASIC SKILLS OF THE CIRCULATING NURSE (cont'd) PERFORMANCE LEARNING EVALUATION TEACHING EVALUATION CRITERIA OPTIONS METHOD METHOD DATE/INITIALs g. Sitting h. Semifowler i. ENT j. Fracture table k. Trendelenburg / or reverse Trendelenburg l. Knee-chest 5. Prepare surgical site: a. Remove hair as indicated b. Utilize prep solutions per physician preference 1. Expose & prep correct area(s) 2. Prevent pooling of solution's under pt. 3. Maintain proper body alignment during prep 6. Handle blood & tissue specimens by: a. Labeling specimen correctly b. Select appropriate container for specimens c. Follow procedure for handling specimens 1. Transport of specimens for frozen sections (FS) 2. Routine specimen with formalin 3. Cultures 4. Amputation 5. Bronchial washings 6. ABG 7. Cord blood 8. Cord pH 9. Placenta & cord 10. Lymp nodes d. Documentation of deposition of specimens 7. Assist with decreasing the operative time by: a. Using physicians' preference cards b. Practicing unfamiliar skills c. Anticipating needs of the team d. Sending promptly for subsequent pt. WATAUGA MEDICAL CENTER COMPETENCY BASED ORIENTATION OPERATING ROOM III. DEMONSTRATES KNOWLEDGE OF BASIC SKILLS OF THE CIRCULATING NURSE (cont'd) PERFORMANCE LEARNING EVALUATION TEACHING EVALUATION CRITERIA OPTIONS METHOD METHOD DATE/INITIALs e. Using resource personnel f. Informing appropriate individuals of changes in patient's condition 8. Assist with dressing/cast/splint /sling at end of procedure 9. Completes documentation appropriately on: a. Intraoperative record b. Count sheets c. Charge sheets 1. supplies 2. sutures d. Narcotic record e. Pathology sheet f. Unusual occurrence sheet 10. Demonstrate cost effectiveness by a. Completing charges b. Using supplies judiciously 11. Classify wounds 12. Participate as team member D. Postoperative Phase: 1. Remove intraoperative equipment 2. Transport patient to PACU or Pt. Care unit and give report 3. Return unused suppplies 4. Place specimens, xrays, preference cards, etc. in proper locations 5. Clean & stock room for following procedures. REFERENCE KEY Title Key Atheison, L. Berry & Kohn's Operating Room Technique B & K Spry, C. Essentials of Perioperative Nursing EPN OSHA Handbook OSHA Disaster Manual MAN MSDS Manual MAN AORN Standards and Recommended Practices STAN WMC Policy & Procedure POL Article File ART WATAUGA MEDICAL CENTER OPERATING ROOM INSTRUMENT SETS ACMI Cystoscope ACMI Micro-Ureteroscope ACMI Resectoscope (New) ACMI Resectoscope (Old) ACMI/Circon Resectoscope Actabular gauge set Adenoid set Anspach Fixation System Arthroscopic extra Arthroscopic instrument tray Bankhart shoulder repair kit Breast Biopsy tray Bronchoscope and accessories Cardiovascular Tray Carpal Tunnel Tray Cerclage Wire System Colon Resection/Hiatal Hernia Tray Common Duct Exploration Instrument Compression Hip/Knowles Pin Inst Compression Hip/Versa Fix Cone/Leep set Corneal Transplant Inst CRT Tray Cut down set Cysto extras D&C Tray Hanks/Hagar DCR Tray Dental Restorations Instrument Dental Retractor Set Distal Targeting device (IM Nail) Dr. Flemming's Hand Tray Dr. Freeman's Laparoscopic Inst Tray Ear Miscellaneous EBI Wrist Fixator ECT Instrument Set ECT Mini Fragment Set Emergency Thoroscopy Inst Endoscopic Sinus Tray Esophagoscope (Rigid) and Dilators External Eye Tray I & II Extraction Set Eye Trauma Tray Facial Plastic Set GI Tray Head and Neck Set Hemorrhoidectomy Tray Herbert Bone Screws Hernia/Appendectomy Tray Hiatal Hernia Extras HSC set (Hysteroscopy) Page 2 (cont.d) Insitu Tray Interlocking Nail general Inst with Retractors Intracone Intramedullary Reamer System (IM Nail) Intraocular Tray I & II Knee Arthrotomy set LAVH Tray Lambotte Osteotomes Laminectomy Laminectomy Extras Laparoscopic cholecystectomy tray Laparoscopic cholecystectomy extras Lithotripsy Percutaneous Inst Linvatec ACL set Major set with retractors Major without Magna Fix Tray Mastectomy Tray Mediastinoscopy Tray Micro Hand Tray Middle ear Basic Set Modular Austin Moore Trays x 3 Monotube External Fixation system Nasal Inst Nasal Extras Olympus Cystoscope Olympus Resectoscope Open Gallbladder Oral Supplement Set Plastic Set Pediatric Sinus Set Pediatric Sinuscopes Post Partum Tubal tray Rectractor Tray Rotator Cuff Repair Tray Rush Rod Tray Shoulder Tray Shutt Master Set Single puncture scope Site system Skeeter Ear Drill Soft tissue set Stapes Set Staple Set Storz Cystoscope for Lithopoxy Storz Ureteroscope Synthes set and screws Synthes small fragment set T & A inst TAH extras TAH Tray (Total Abdominal Hysterectomy) Tear Duct Probe Set Thompson/Endoprosthesis set Page 3 (cont.d) Thoracic Extras Thoracic Trays I & II Total Hip General Inst THR (Total Hip Trays) Thyroid Extras Total Knee General Inst TKR (Total Knee Trays) TMJ extras Total Hip General Inst Total Knee General Inst Tracheotomy tray Trauma/Aneurysm Tray Trauma/Osteotomy Set TVH Tray (Total Vaginal Hysterectomy) Tympanic Tubes set Urology Tray I & II Visual Urethrotome Wolf Laparoscopic Tray ZMS Femorial/Tibial Inst