Module 2 Perioperative Nursing Roles PDF 2023

MODULE 2: Perioperative Nursing Roles Suggested Readings Alexander’s Care of the Patient in Surgery (2022) Chapter 4 p. 86 - 100 ORNAC Standards 2023 Section 1: Practice Sta...

MODULE 2: Perioperative Nursing Roles Suggested Readings Alexander’s Care of the Patient in Surgery (2022) Chapter 4 p. 86 - 100 ORNAC Standards 2023 Section 1: Practice Standards and Competencies p. 1-1 – 1-24 Section 3: Management of Perioperative Care: Phases of Care: p. 3-1 – 3-20 Learning Outcomes Understand the three Review Section phases 3 Phases p. 3-7 – 3-23 of perioperative of Care: patient care. Distinguish between the scrub and circulating nurse roles. The Two Nursing Roles: Scrub and Circulating Nurses Throughout a surgical case, there are two nursing roles in two distinct areas of the operating room. 1. Scrub Nurse This nurse can be an RN or RPN and works within the sterile field. In this role, the nurse is scrubbed in the sterile surgical gown and gloves and is directly assisting the surgical team by handling of surgical instruments, specimens, etc. 2. Circulating Nurse This nurse must be an RN and works outside of the sterile field area. The circulating nurse controls and directs activities outside of the sterile field such as opening supplies, managing documentation, specimens, surgical counts, assists the anesthetist, and provides direct patient care. Occasionally an RPN may resume the circulating role, however this must be under the direct supervision of an RN. Prior to starting the surgical case, the RN and RPN work together to ensure the operating room and case cart are set up accordingly. The case cart that arrives from MDRD must be picked with surgical packs, instruments, sutures and supplies required for the case. The operating room bed and equipment must be set up as including the completion of all safety checks (OR lights, suction, etc). The furniture (mayo stands, back table, Gerhart table) are set up in an organized manner for the case and the sterile packs are then opened and set up using aseptic technique. Module 2: Nursing Roles The individual roles will then become more distinct in that the scrub nurse will complete the surgical hand scrub, don sterile gown/gloves and begins to set up the sterile surgical table. The circulating nurse will retrieve the patient and assist the anesthetist with induction. For the remainder of the surgical case, the scrub and circulating nurse work as a team to meet the needs of the surgeon and ensure safe patient care. The roles and responsibilities of the RPN and RN in the operating room will be embedded in the hospital specific OR policies. As an RPN, you will have an emphasis on the scrub nurse role. Responsibilities in the Phases of Perioperative Care Preoperative Set Up Scrub Nurse Circulating Nurse Completes surgical hand scrub as per Check case cart for sterile and non-sterile ORNAC and hospital policy supplies Ensure the OR furniture, lights and Dons sterile gown and gloves equipment and suction are turned on and Drape Mayo Stand, Back Table, or working Gerhart Table aseptically Complete pre-op patient assessment and Set up back table or Gerhart in an checklist and transfer patient to OR. organized manner Assist the anesthetist for induction and Arrange sterile Mayo tray with position patient accordingly. instruments needed to start the operation Prep surgical site with prep solution (Betadine or Chlorhexidine) Arrange surgical drapes and supplies on Assist surgical team into position to start Mayo Stand or table in a convenient the case. manner Prompt Surgical Time Out as per Ensure all instruments are Surgical Safety Checklist assembled correctly and working properly Assists Scrub Nurse Organize suture packages from surgeon's preference sheet Tie scrub nurse and surgical team gowns Prepare ligatures (ties) and sutures in Open sterile solutions, surgical packs, sequence as surgeon ordinarily uses them equipment and supplies Count all sponges, needles, sharps, and Complete count with scrub nurse instruments with circulating nurse as per Connects suction tubing and cautery cord hospital policy and surgical case (Minor ends from scrub nurse to equipment or Major) Place kick buckets in convenient position Ensure Medications and solutions are labeled on sterile setup Assist in gowning and gloving the surgeon and assistants. Assist in draping the patient and surgical field (as needed) Module 2: Nursing Roles  Move sterile tables to the surgical field Place all sterile cords and tubing (suction, electrosurgery, etc.) close to the surgeon Pass ends of cords to the circulating nurse Place radiopaque sponges on field Intraoperative Care Scrub Nurse Circulating Nurse Maintain asepsis and sterile technique Opens sterile supplies for surgical team throughout the case Anticipate the needs of the surgical team Adjusts lights and equipment accordingly Pass surgical instruments in safe and Assists the anesthetist as needed (Blood effective manner order, crosscheck, IVs, thermoregulation, Maintain an organized mayo stand and blood loss) back table Completes surgical count with scrub nurse Keep instruments clean with sterile water Ensures safe management and handling of Safe handling of sharps specimens Hold retractors in a safe and effective Anticipate surgical emergencies manner (if applicable) Completes OR documentation Communicates effectively with OR team Safe handling and management of and Charge Nurse specimens Direct and coordinate nursing activies in Good communication with surgical team the OR and the surgical list including circulating nurse Initiates and completes surgical count at appropriate time Supply sterile dressings Module 2: Nursing Roles  Postoperative Care Scrub Nurse Circulating Nurse Apply or provide sterile dressing supplies Complete post-op patient skin assessment Discard surgical drapes and disposable Apply patient’s gown and warm blanket equipment in appropriate receptacle Assist the anesthetist with extubation Safely dispose of sharps in sharps Participate in Surgical Debrief container Complete OR documentation Return all surgical instruments to Transfer patient with surgical team to appropriate pan post-op unit (PACU, ICU, NICU) Dismantle surgical table set up Assist with room turnover and Label instruments for repair (if preparations for the next case applicable) Wash hands Sign surgical count sheet Assist with turnover as required Prepare for next case Guidelines and Precautions in Accordance to Aseptic Technique and Effective Patient Care It is important to consider time, efficiency, and the maintenance of surgical asepsis with every surgical case. Good anticipation, organization and team communication are all contributing factors in providing efficient and effective patient care throughout their perioperative experience. Minimizing room traffic, ensuring room turnover cleaning is complete, and completing all surgical safety checks will help reduce errors, distractions, and surgical site infections. Ensure sterility by: - Maintaining good surgical conscience - Team members passing back to back when moving within the sterile field - Be aware of the surrounding environment and parameters around furniture - Unopened sterile supplies are kept in a clean dry area - If an opened sterile supply falls on the floor it is contaminated and cannot be used Module 2: Nursing Roles