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Operating Room

Transcript: Typical Day There is not ever really a typical day in the OR but the day before your shift you'll also know what nurse you'll be, either a scrub nurse or a circulatory. Scrub nurses work directly with the doctor and sterile equipment. Circulatory nurse work outside the sterile field. An anesthesiologist puts the patient under and positions the patient according to the type of surgery they will have. Then the patient will be moved into the Post Anesthesia Care Unit to recover. After completing the patient's chart the whole process begins again with the next surgery The most common procedure in the OR is a tonsillectomy. First the patient is administered anesthesia and once the person is asleep an instrument is used to keep mouth and tongue depressed. The tonsils are then cut away with a scalpel and is cauterized. Once the procedure is done the anesthesiologist will wake up the patient and is allowed to leave home to recover. Educational Requirements Medical Equipment in the OR Medical Conditions/Surgeries Most common surgeries in the U.S. include: Lens and Cataracts(lasik eye surgery) Muscles and tendons(tonsillectomy) Breasts Augmentation Appendectomy Coronary Artery Bypass Surgeons treats,operates manually to treat deformality/disease Anesthesiologist induces pain and unconsciousness: monitors vital signs Circulating Nurse makes sure the room is safe and sterile; helps set up operating room; monitors procedure Scrub Nurse know and identifying each instrument; monitors vital signs and hands instruments Patient Nurse Care Care for patients in general by: Sadie Salgado Who will you be seeing in the OR? Tonsillectomy Procedure What is the OR? Anesthetic machine supports the administration of anesthesia Probes & Directors slender,flexible, with a bulbous tip to explore wound/cavity Needle Holders holds a suturing needle for closing wounds during surgical procedures Forceps hand held hinged instrument used to hold or grasp something Surgeon undergrad program in bio/chem, 4 years in medical school, a three year residency, multiyear internship in surgery dept. Anesthesiologist strong background in chemistry,biology, and mathematics, 4 years of medical school and a 3 year residency. Circulatory nurse certified RN or minimum of Associates degree in nursing. Scrub Nurse RN or continue for a bachelors in a nursing Patient Care Nurse Most likely to be certified in CPR or EMT, some sort of hands on training and a completion of a nursing assistant program. The operating room, sometimes called the OR, is where surgery takes place in a hospital. Emergency surgery-saves person life ‘Elective’ surgery-not urgent but must be done at some point Major surgery- long recovery and high risks Minor surgery-quick recovery and low risks Operation: Operating Room!

Operating Room

Transcript: Qlik substantially aids clinicians and managers with their day-to-day tasks by providing reliable, up-to-date information on a range of metrics. Drawing information from disparate sources and presenting it on-screen for real-time analysis, Qlik applications allow users to drill down to individual patient level for a clear and detailed view of performance. Example clinical applications include: 18-Week Wait Time Analysis Resource Planning A&E Performance Monitoring Theatre Management Patient Pathway Tracking Cancer Pathway Analysis Qlik and the partner community have built a number of ‘QlikView Apps’ to help healthcare organizations like yours seize every opportunity to improve OR and A&E performance. With QlikView, you can: • Assess historical data and analyze demand to maximize the use of facilities such as OR, ED, ICU, and patient beds • More effectively schedule equipment, staff, specialists, and patient tests to drive efficiencies and maximize quality • Monitor patient census fluctuations and adjust staffing requirements while taking account of parameters such as staff vacations, sick days, holidays, family leave, weather emergencies, retirements, etc. • Maximize supply chain efficiencies to ensure the availability of all medical supplies Hospital Solution Generating almost 70% of your hospital’s revenue and over half of the most serious errors, surgery and anesthesia demands information that makes an impact. Data discovery solutions specifically designed to present actionable information are critical to operational, clinical, and financial excellence in your operating room Workforce Clinical • Evidence- and prevention-based • Interdisciplinary and coordinated • Transparent, accessible, accurate, and understandable • Focused on improving patient outcomes and experience • Reduce variation in spend • Improve Patient Care • Decrease Clinical Variation • Visionary in their long-term thinking Primary Care Analysis Now GPs can use Qlik to examine patient information and assess the best steps for providing the most appropriate level of patient care. Due to the intuitive QlikView interface, clinicians gain a better understanding of the treatments a patient has received to date. This can be anything from looking at the situation in which a patient has been discharged from hospital and taking steps to avoid re-admission, to seeing which patients are coming into A&E with minor ailments or signposting when patients could be receiving treatment or care at home or in the community. Operating Room An NHS Trust in the North of England deployed Qlik to consolidate data from 45 financial and purchasing systems – a project which took less than 12 weeks to implement. Qlik has since delivered procurement cost savings of £42 million and freed up hundreds of hours previously spent on manual reporting and analysis. You too can expect ROI in a matter of weeks. It delivers valuable and dramatic insights into general financial performance, profit and loss improvements, patient level costing / service line reporting and suppliers – all from one platform, and in minutes, not days. Qlik builds executive dashboards from transaction level data so users can go from high level costs to individual line item detail in seconds. This ability to truly understand what makes up the high level numbers enables the right decisions to be made more quickly and with more certainty than ever before. One Qlik Hospital is a 180-bed acute care, inpatient teaching facility that supports 7 operating rooms and conducts roughly 7,000 surgeries per year. This hospital uses Qlik to gain insight into the utilization and performance of surgical rooms – which helps increase coverage, on-time starts, and surgeon satisfaction. This trust were able to: • Increase on-time case starts from 48% to 85% • Boost charge capture by 30% • Increase surgical throughput with streamlined processes • Green light the opening of a dedicated trauma room • Gain the freedom to analyze data without the need for IT Hospital Emergency Room Procurement Financial Effectiveness Labor management is all about assigning the right employees with the right skills to the right job at the right time. Qlik for Workforce Management helps tie together siloed systems, making key data more visible to support better decision-making, collaborating with multiple business functions, and solving business problems related to staff. Users streamline immense employee relation documentation and support that requires efficient contract administration and reporting to work with multiple business partners. Operational Effectiveness

Operating Room

Transcript: Surgery by Caroline Hernandez The Surgical Unit Most people think of a Surgical Unit, a.k.a the operating room (OR), as quite scary but out of all honesty its the unit that needs to provide impeccable care to their patients. In this unit it's a matter of life or death and what goes on in that room is extremely crucial. The OR is where all types of surgery happen, no matter how minor. It's a place full of stress! An OR is a room in a hospital specially equipped for surgical operations. The Health Care Providers behind it all. . . The health care providers that you usually find in the operating room are surgeons, whom could be specialized in something specific like neuro surgery; as well as OR Nurses. OR Nurses are nurses completely specified to work in the operating rooms and while on duty can have one of two main jobs, either be a "scrubs" or a "circulation"; these are simply names that describe the specific job they are performing. For example, a "scrubs" will be working with the surgeon around the sterilized area, while a "circulation" will not go near the sterilized area and only observe and help from afar. Other health care providers usually are an anesthesiologist and a surgical technician- this is the person who prepares the room before surgery. The Education Needed You will not be able to get out of going to school if you wish to work in the OR. OR Nursing- A Bachelor’s of Science in Nursing (BSN), a registered nurse license, at least 1 year's experience in a nursing setting, a graduates degree for OR nurse assistance or nurse anesthesia, and lastly you must pass a national certification exam. Surgeon- a Bachelor's degree in science, four years of medical school to become an M.D., and 3-8 years of surgical residency at a hospital as well as certification to practice legally. Anesthesiologist- a Bachelor's degree in science, medical school to become an M.D. and then 4 years of residency. Surgical Technician- an Associate's degree in appropriate field and certifications such as a CST (Certified Surgical Technologist). Medical Conditions found Reasons for needing surgery can vary and trust me there's a huge variety. The medical conditions can range from getting your tonsils taken out, because your constantly getting infections, to needing brain surgery. The most common reason for brain surgery is Oedema, which is basically swelling of the brain and surgery is needed to change or move some brain tissue. Cancer patients are also seen in the OR because they may need to remove a cancerous tumor or they may have to have a bone marrow transplant. The Environment Brightly lit, cold and stressful would be your typical day in the operating room. Everything is completely sterilized and disinfected. You wouldn't even be caught dead without a mask, gloves, scrubs on top of scrubs, and shoe covers. Trust me they do everything physically possible to prevent the spread of germs in the OR. It's usually fast past with patient right after patient and very tough. The staff undergoes quite a bit of pressure trying to remain calm for the patients sake but also having to get the job done smoothly and correct. Example of PPE: Equipment The type of equipment you would normally see in the surgery unit are things like an operating bed and patient monitors; as well as diagnostic tools, respiratory and cardiac support. You would also see tools such as various types of surgical scaples, surgical staples and sutures, which are usually laid out on a cart near the surgeon. Emergency Equipment Something Special The surgery department is the only true place that perform complete surgeries. An interesting surgery that is performed, is a CABG, which stands for Coronary Artery Bypass Grafting. A CABG surgery is done in order to create new routes, around any and all arteries that may be blocked or are too narrow, for sufficient blood flow through the heart. The surgery is interesting because it basically requires the surgeon to stop the heart. What the surgeon has to do during this operation is he has to open up the chest and cut the sternum in half in order to get to the heart. Then he must stop the heart and use a heart lung machine to keep the blood flow going. The surgeon then forms the graft (which is usually taken from the legs) to where it can bypass the blockage, basically rerouting the blood flow. CABG Image •Crash cart— include medications and defibrillators, is to stabilize a respiratory or cardiac emergency •Hyperthermia cart—To treat a potential fatal reaction to anesthesia •Tracheostomy tray—To maintain an emergency airway •Jet ventilator—To assist with adult respiratory distress syndrome •Suction apparatus—To remove fluid such as blood or respiratory secretions •IV (intravenous) set-ups—To administer blood or IV fluids such as saline or lactated ringers. The Dictionary Definition:

Operating Room

Transcript: Operating Room Nurse Late 1800s-1900s Although there is evidence of surgery taking place back in prehistoric times, the late 1800s is when it became noticeably more advanced. Medical developments like anesthesia, antibiotics, and antisepsis made surgery a more popular, safe, and a beneficial option for patients. This is when perioperative nursing really started to develop, because there was a need for qualified professionals to assist the surgeon, and most believed that this was the nurse’s role. Perioperative nursing was considered very prestigious around the time of the 1880s, and the operating room nurse’s salary was higher than that of what was called a “general duty nurse.” These nurse’s responsibilities ranged from sterilization of the instruments to assisting the surgeons in general. 1940s-1950s One of the main responsibilities of the operating nurse at this time was still the sterilization of instruments by washing them by hand, assembling them in appropriate sets, and sterilized them in what was called Bard Parker solution, which was a combination of formaldehyde and alcohol. It was also the nurse’s responsibility to wash, dry, and inspect the gloves that were used, because there were not any disposable gloves. OR nurses were also responsible for “recovering” their own patients, because there were no recovery areas at this time. Throughout this time period the operating room nurse’s role was beginning to be viewed as a technical one instead of a caring role. Because of this, some felt as though this specialty lost some of its prestige. The Association of Perioperative Registered Nurses (AORN) formed in 1954 1960-1980 The debate about whether or not perioperative nursing was just a technical skill intensified even more in the 1960s. Many people believed that the technicality of operating room nursing was not compatible with the caring aspect of nursing. In the early 1960s people also started to consider the operating room nurse as just the “handmaiden” of the surgeon. Because of this, perioperative nursing was less respected. In the late 1960s, the operating room nurse’s training centered mainly on technical skills, which made even more people believe that it was technical trade rather than a nursing specialty. Also, this time period is when operating room nursing was removed from the academic curriculum of most nursing schools. Therefore, students were not exposed to operating room nursing, and were less likely to choose this specialty upon graduating. Hospitals then had to create their own operating room training programs, but many were not taught using holistic practice based on nursing theory. This also furthered the belief that perioperative nursing was a technical trade. The Standards for Administrative and Clinical Practice in the Operating Room, now called Perioperative Standards and Recommended Practices, was published in 1965 by the Association of Perioperative Registered Nurses (AORN) 1980-2000 During this time period is when hospitals really began to hire more operating room nurses with a BSN. There were still misunderstandings about what perioperative nurses did, and there was another debate that began about replacing operating room nurses altogether with other less trained and less expensive technicians. 2000-2010 There has been an ongoing debate over whether perioperative nursing should be considered a technical skill or “real” nursing since it became a specialty. This type of nursing is still evolving because of the constant developments in surgical technology. Throughout the 21st century so far the perioperative nursing specialty has been facing major recruitment and retention issues. Today many operating room nurses have heavy workloads, high patient acuity, and staffing shortages. The perioperative nurse specialty is facing some difficulties and there is a great need to make nurses, nursing students, and society in general, understand that this nursing specialty is important and needed because nurses are considered to be the most qualified professionals who can assist with surgery and be the best patient advocates. Many operations were performed in private homes. Wooden furniture, walls, floors and seating capacity for the medical audience in typical hospital operating rooms were seen as creating unclean conditions. •Early recognition of the importance of hand washing. •Gradually, cloths, instruments and dressings were meticulously cleaned. •The practice of asepsis was advanced. •Due to the Influence of Louis Pasteur, Various Types of Sterilizers Were Developed and Asepsis Became the Standard •Rubber gloves were introduced and later the face mask was adopted •The student nurse was responsible for sterility of equipment. •She prepared the room, scrubbed the floor and walls with antiseptics. •Dressings were boiled, soaked and wrapped in antiseptic towels or large glass jars. •She prepared everything that was needed including: •Hot water bottle •Stimulants •Clean towels •Soft rags

Operating Room

Transcript: Emergency Surgery Fishbone Diagram Are we doing it right?? Arrival Data: Patient’s Length of Stay This will be the primary KPI the project team will be looking to improve. Process Cycle Time The processes include: check in, pre operation, operation, turnaround time, post operation, and discharge. Patient Waiting (Queue) Times This KPI measures how long each patient is waiting between each of the process steps. 6. Inventory Obsolete patient data Unused storage of medicines which expire 7. Motion Searching for patients’ records, medicines and supplies 8. Employee Underutilization of S/K/C Skilled nurses performing jobs that could be performed by lower level technicians Lack of performance indicators (KPIs) and improvement objectives Effect on Length of Stay Animation Data For Simulation Model During this phase, the improvements will be evaluated, monitored, and standardized. SPC Chart and SOPs: The SPC can be used to detect and react to any visible process changes. In order to standardize the solutions proposed by the team’s kaizen events, SOPs can be developed. Closure Action Log: Closure log will be used in order to record and document all of the significant actions during the project. Waste Identification PFMEA Kaizen Events: Considered Wastes that had an RPN value of 150 or above- 1. 5s of Supplies and medications in the operating room department Waste: Searching for Supplies (Motion) – RPN = 576 Waste: Unneeded supplies and medications being stored in the OR (Inventory) – RPN = 360 2. Parallel task scheduling for the OR turnaround process Waste: Waiting due to prolonged turnaround (Waiting) – RPN = 400 3. Standardization of pre and post operation procedures Waste: Unneeded blood tests and information collected (Overproduction) – RPN – 280 Waste: Excess charting of patients (Overproduction) – RPN – 280 Waste: Doing unwanted work / Wasting time. Literature Review Operating Room Efficiency Efficiency is doing things right; effectiveness is doing the right things. Are we doing it right?? Future Work Source: IIE/RA Contest Problems Waste: Failure to obtain right resources at right time Resource Allocation and costs If patient volume increases; more resources will be needed to reduce the patient length of stay, which in turn will lead to more costs. The costs related to adding more resourses can be an area for future research. PFMEA 1. Defects Temporary breakdown of equipment Delivery of incorrect supplies Discharge medical errors Mislabeled medicines 2. Overproduction Unneeded blood tests and information collected Excess charting of patient Preparing for procedures not yet scheduled 3. Waiting Patients waiting for recovery beds in PACU Patients and surgical team waiting for surgeon Patients waiting for holding room 4. Non value-added processing Excess supplies and materials used Redundant information gathering 5. Transportation Excess traveling to retrieve supplies Patient transport from holding room to OR and OR to PACU What Tool and Why?? N Calculation Project Charter Why Simulation? What If Analysis The team has decided to include both lean and six sigma in the methodology in order to look at the operating room efficiency from both a qualitative and quantitative side. Why Lean? Lean allows the team to observe the operating room process from a qualitative overhead view and identify any actions that are slowing down operations efficiency. The wastes that can be delaying the efficiency of the operating room process by increasing cycle times, queue times, and overall lead time. Why Six Sigma? Six sigma allows the team to observe the process from another angle that lean does not target as six sigma is more data driven. Root causes of operations inefficiency can be identified more easily. Thank You! PFMEA Project Scope The overall operating room process will be included in the scope of the project. This includes the check in, pre operating, operating, turnaround, post operating, and discharge processes. Not in scope: Processes that do not take place in the operating room department. Processes before operating room check in and after patient discharge or transfer from the operating room Constraints: No capital expenditures, limited access to data sets, and short project timeline are constraints to this project. Schedule & Deliverables: Define (10/27/2014) Measure & Analyze (11/10/2014) Implement & Control (11/17/2014) Final project presentation (11/24/2014) Final report (12/1/2014) Project Charter “An estimated one of every 25 people around the globe undergoes some form of major surgery in an operating room every year” (Weiser et al, 2008). In 2006, nearly 46 million surgical procedures occurred in American hospitals, over one-third of these were on patients 65 years and older (DeFrances, Lucas, Buie & Golosinskiy, 2008). Warm up= 100 Hours Waste Identification Measurement Parameters Scheduled Surgery VSM Introduction “I have no idea what that thing is either. Let’s just take it out, stitch him up, and see if he

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