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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: What is the Operating Room? Educational Requirements A day in the OR will include an intense, fast-paced, isolated environment where the staff will spend hours in. It is also a very draining job, for most surgeons will have to be on-call and also perform pre-scheduled surgeries. Stress,too, is a very big thing due to the patient not being able to communicate how he/she is feeling. Therefore, all communication must be done before the surgery in order to verify critical information. One must also be able to multi-task and prioritize in case of complications. More About the OR What you see in OR? Operating Room By:Jessica Guerra In the OR you can see almost anything. Open heart surgery- opening of chest to operate on the heart muscle, valves, arteries or other parts of the heart Plastic surgery- reconstructing body parts by transferring tissue to treat an injury or cosmetic reasons C-Section- to deliver a baby by making an incision on the mother's abdomen and uterus Amputations- removal of body extremities LASIK Eye Surgery- to improve vision Brain Tumor Surgery- the removal of a tumor in the brain Respiratory and Cardiac Support Emergency Resuscitative Devices Patient Monitors Diagnostic Tools Scalpels Blades Forceps Hammers and Mallets Anesthetic Machine OR Table Operating Room Personnel Medical Equipment Used The OR is a sterile room where all staff wears protective clothing. They must wear scrubs, gloves, masks, shoe covers, and eye shields to prevent the spread of germs. It is also a very cold room to prevent infections. The patients are transferred to the OR by a wheelchair or a gurney and onto the operation table. The patient is then conected to monitoring equipment and put under anesthesia. The patient's sedation depends on the nature of the surgery and is being constantly monitored. Typical Day It is often called the OR or Surgery Center. It is a sterile room in the hospital where surgeries take place. Having a surgery is also called an operation. Surgeons Anesthesiologists and Nurse Anesthetics Surgical Technicians Registered Nurses Surgeons and Anesthesiologist standard medical school requirements surgical or anesthesia residencies and fellowships Registered Nurses Bachelors (BCN) general medical-surgical experience specific orientation program Nurse Anesthetics graduate degree special training in anesthesia administration BSN Surgical Technician accredited program for the specialty Certification program or Associates degree

Operating Room Presentation

Transcript: 6) Kidneys: 24+ hrs Questions? Surgical Recovery Post Recovery Care 5) Pancreas: 12-18 hrs Operating Room Recovery DCD OR: Scrub, Circulator, Declaring Physican, ICU RN, ICU RT, Medical Director, CRA, Transplant Teams, CRC ICU Donor Management: Optimize organ function Additional testing/imaging Schedule with OR Allocation of Organs: UNOS Match Runs Speak with transplant physicians/coordinators Identify recipients Coordinate OR time Passing off sterile supplies Drawing medications Preparing the flush and slush Patient Prep Moment of Honor Incision and dissection (after extubation and TOD in DCD) Cross Clamp – aorta clamped, blood replaced with cold preservation solution in-situ Perfusion stops and Cold Ischemic Time (CIT) starts Induce hypothermia, minimize cell injury and death, vascular flush, optimize reperfusion Organ Backtable(s) IV Poles Suction Bovies – 2 (BD OR only) Defibrilator Cart with sterile internal paddles Bronch cart if lungs are going for transplant OR Key Players and SetUp Specifics Respect, honor and stewardship – continued care from start to finish BD OR: Scrub, Circulator, Anesthesia, Medical Director, CRA, Transplant Teams, CRC Basic major laparotomy set Vascular instrument set Basin(s) Sternal saw WRTC's Set Includes: Chest and Abdominal Retractors Lebsche Knife Mallet Respectful, regimented procedure Patient transport Follow-up Organ Recovery VS 2) Lungs: 4-6 hrs 4) Liver: 6-8 hrs 3) Intestines: 6-12 hrs Organ Procurement Organization (OPO) 1 of 58 11 regions Organ, eye, tissue recovery 1) Heart: ~4 hrs

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: 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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