Life in the Operating Room
What actually goes on in an operating theatre? Is it all blood, guts and drama? Well in a nutshell…..
There is often an air of uncertainty and mystique when it comes to the operating theatres. People commonly have a preconceived idea of what they think they are going to expect once they see a sign saying “Operating Theatres – No Unauthorised Entry” or “Theatre Attire only beyond this point”. Mystery surrounds the department. Patients will have seen TV programs that have to show drama and devastation otherwise no-one would bother watching it. In reality, theatres look after patients who feel vulnerable and nervous, having procedures that can be routine (for us anyway) and life saving or life changing. The ultimate aim for the staff working in theatres is that the patients journey through the department is carried out in a safe and sterile environment with a surgical insult that causes the least harm to that patient.
There are 3 distinct areas in theatres where Nurses, Operating Department Practitioners (ODP’s) and support staff work. These are Anaesthetics, Scrub and Recovery. Staff, if suitably up-to-date with their skills, can move around and work in all these different areas however many choose to specialise and stay in one particular domaine. Whilst there is very much an ethos of team working in theatres, every registered practitioner has a responsibility for the patients safety and welfare whilst they are in their care.
Specific Roles and Responsibilities
One of the principle responsibilities of an Anaesthetic Nurse/ODP is to check the anaesthetic and theatre equipment is clean and in working order. They prepare for the list they are assigned to, making sure that the anaesthetist has everything they will need to give an anaesthetic as well as making certain access to emergency equipment is available. They are the first line checkers! In other words they have a responsibility to ensure consent forms are correct, surgical sites are marked where applicable and the pre-operative checks are satisfactory so the patient can safely be brought to the Anaesthetic Room. Their role is to then assist the anaesthetist during induction, maintenance and emergence of anaesthesia. They are responsible for the safe positioning of patients, ensuring that pressure areas are padded to prevent potential nerve damage and they should be competent in the use equipment such as diathermy machines, infusion pumps, defibrillators and suction systems. At the end of the operation, they will then assist with the safe transfer of patients to the Post Anaesthetic Care Unit.
Scrub Nurses are responsible for liaising and working with the surgeon during the procedure ensuring all the instruments are sterile and any necessary equipment is available. However one of the most important responsibilities that a scrub nurse has is the instrument count, swab and needle count. This should be done before the procedure starts, before the closure of a cavity which should be prior to the final wound closure and again at the start of wound closure or at the end of surgery. Ultimately it should be common practice to complete 3 checks during a procedure and this should be completed by 2 personnel and fully documented.
Recovery Nurses receive the patients once they have had their procedure done. They ensure the patients airway is safe, vital signs are within an acceptable range, the patient has adequate analgesia, scores of post-operative nausea and vomiting are low and they are normothermic. They are trained to be able to administer prescribed medications through a variety of routes such as intravenous, via an epidural or central line. Monitoring of wounds, drains and catheters is also a fundamental part of their role and acting upon their findings may mean they need to alert the surgical team. Recovery staff have to ensure that the patients are stable enough to be transferred to either a ward or High Dependancy Area.
Every registered practitioner who works in theatres, be that a Nurse or ODP, follows a professional Code of Conduct. They are legally bound by a duty of care to protect their patients and by following the set of standards they are aiming to achieve a benchmark. Following local trust protocols and policies and the implementation of the the WHO checklist as an example. should minimise the risk of harm however any deviance from these could be seen to be negligent particularly if harm was caused.
The notion of ‘safer surgery’ is something that has become more prominent in recent years. Indeed Health Education England (2014) collected data on ‘never events’ and interestingly quite a few are directly linked to the operating theatres or have the potential to arise in theatres. The following are recorded ‘never events’ –
- Wrong site surgery
- Retained swabs or instruments
- Wrong prosthesis or implants
- Wrong route of administration of medicines
- Blood transfusion problems
Whilst it is rare that any healthcare professional would deliberately cause harm to a patient, negligence can arise as a result of a number of reasons. The operating department is surrounded by hazards if the staff fail to take the necessary steps to prevent them from causing harm. In the ever evolving speciality of surgery, it is commonplace to be exposed to new or different equipment in theatres or different techniques. However registered practitioners have a responsibility for ensuring they have received adequate training or supervision. They should know what their local trust standard operating policies contain but foremost they are autonomous practitioners who should only practice within the boundaries they feel competent in.
Nurses/ODP’s are the patients advocate because ultimately the patients in our care are circumstantially vulnerable. Operating theatres are quite a unique area to work in but its not all blood and drama.