SCENARIO: #1 Operating Room Emergency Cesarean Section with Hysterectomy

JOINT COMMISSION INTERNATIONAL SAFE CLINICAL OPERATIONS READINESS EVALUATION (SCORE)

Process Owner/ Needs/Requisites
Patient Flow
Steps Existing Policy Process Responsible Materials/supplies/ Knowledge/ Status
Area
Person equipment Training/Skills
Furniture:
1.) Trakcare
Operating 1. Courtesy call from the L&D Perioperative admission 1. Courtesy call from L&D and OR 2.)
Room nurse for the scheduled and discharged (IPP) the L&D nurse for the Chairs Communication
Admission and emergency cesarean section scheduled emergency Digital Clocks workshop
Discharged. with Hysterectomy to the CS-OR Patient Identification Policy cesarean section with Working table 3.) Downtime
reception nurse (PCP). hysterectomy to the CS White boards forms training.
OR reception nurse 4.) ACLS
2. OR reception nurse will
inform the OR, surgical and
Informed Consent (APP)
2. OR reception nurse OR
Consumabl
anesthesia team. Correct Site, Correct informs the OR, es: I.D. Band,
Procedure and Correct surgical and anesthesia Disposable Head
3. Operating room team Patient Surgery (IPP). team. Covers, Shoe
prepares for the Surgery. L&D and OR Cover, mask,
Collecting/Transporting 3. The OR reception suction tubing,
4. OR Reception Nurse calls the Contaminated Reusable nurse will call the L&D diathermy pad,
L&D nurse to bring the patient Medical/ Instrument Device nurse to bring the cautery pen,
to the CS-Prep/PACU Unit (CSSD). patient to the OR and sponges, sutures,
confirms the needles, needle
5. OR Reception Nurse informs Surgical Hand Scrubbing, availability of the counter, gloves,
the PACU/Holding Nurse that the Gowning and Gloving (IPP). following: packs, gowns,
patient is on the way to the unit. - Informed consent. drapes, blades, skin
Operating Room Attire - NPO (Time) prep solutions,
(DPP). - Laboratory work ups. specimen
6. L&D nurse will bring the
patient to the CS-OR -Indwelling Catheter container, sutures
Electro Surgical Unit (DPP). inserted and draining swab, cautery tip
PACU/Holding unit.
well cleaner, Bairhugger
Principle of Aseptic - Blood Availability and blanket, syringes,
7. Hand-over of patient between
the L&D Nurse and PACU Technique (IPP). Consent for transfusion dressings, under
- Preoperative pads, OB pads,
/Holding Nurse.
Specimen Handling (IPP). medication plastic sponge
- Intensive Care Unit counter, drains,
9. PACU/Holding nurse informs Blood and Blood Products bed reservation. OR surgical hand scrub
Administration (APP) - If NICU is informed to brush and
the Reception Nurse that the
receive the newborn
patient is ready for the Safe Practice Inside the solutions, skin
scheduled surgery. Operating Room (DPP). 4. Reception Nurse PACU/Holding marker pen, hair
note the time of call. Nurse and OR clipper, Oxygen
10. OR Reception Nurse will Position of patient in mask, Fluids for
inform the surgical and Operating Room table irrigations
anesthesia team that the (DPP). 5. Reception Nurse
patient is ready for OR.
Surgical Count (DPP).
informs the
PACU/Holding Nurse
PACU/Holding
Nurse and OR
Instrume
11. Hand-over of patient that the patient nt set:
between CS-OR PACU/Holding Medication Labelling (IPP) scheduled for surgery
CS Set or
Nurse and the Circulating Nurse. is on the way.
Hysterectomy Set
Surgical Skin Preparation
12. Signing-In takes place (IPP). 6. Patient arrives in L&D and
between the patient, circulating
nurse, surgeon and anesthesia Universal Protocol for
PACU/Holding Unit. PACU/Holding
Equipmen
team. Invasive Procedure Surgery 7. PACU/Holding Nurse t:
(APP) receives patient and Back table, mayo
13. Wheel patient to OR. Appendix: Safety Checklist performs AIDET. table, ESU machine,
Policy suction machine,
14. Time-out process takes 8. Handing over of PACU/Holding Bairhugger, Infant
place between the surgical and Hand-over Communication patient from the L&D nurse and OR Warmer, weighing
anesthesia team before the Policy (APP) nurse to CS-OR scale, DVT
surgical incision. PACU/Holding nurse machine, foot
Intra-facility Referral, following the OR stools, blood and
15. Surgical Procedure takes Transfer and Transport Perioperative checklist. fluid warmer, alaris
place. (Emergency Cesarean Policy (APP) infusion pump, OR
Section with Hysterectomy). 12. PACU/Holding bed table with
Nurse informs OR PACU/Holding complete
16. Blood transfusion takes Reception nurse that nurse and OR accessories, gel
place. the patient is ready for pads, OR lights,
OR. stretcher, roller
17. Sign-out between surgical board, Oxygen
team and anesthesia team. 13. OR Reception cylinders, oxygen
Nurse will inform the OR, Anesthesia regulators, Fluid
18. The circulating nurse will circulating nurse, and Surgery and linen warmer
call the reception nurse that the surgeon and the
procedure is finished and anesthesiologist.
patient is ready for transfer to Stationeri
ICU then the Reception nurse 14. Handover of
calls ICU. patient between es:
PACU/Holding Nurse OR, Anesthesia Logbooks, Board
19. ICU nurse brings the bed to and Circulating Nurse and Surgery marker, erasers,
the OR. following the sequence Carbon, permanent
and contents of pre- marker
20. Patient wheels to Intensive operative checklist.
Care Unit. OR, Anesthesia
15. Circulating Nurse and Surgery
21. Hand-over between initiate Sign-in Downtime
surgeon, anesthetist, circulating process by following
nurse and ICU Physician and the sequence of the Forms:
staff nurse. universal safely Pre-
checklist with the operative
22. Post-surgery, the scrub surgeon and checklist
nurse transfers soiled anesthesia team. OR, Anesthesia forms
instruments into transportation and Surgery Anesthesi
trolley and the circulating nurse 16. Wheel the patient a
will spray it with the approved to the Operating Room OR, Anesthesia clearance
solution. by the circulating and Surgery form
nurse, surgeon and Laborator
23. Scrub nurse brings soiled anesthesia team. y results
instruments to OR-CSSD form
decontamination Room. 17. Safely transfer the Consent
patient from the forms
General
24. The circulating nurse hands stretcher to Operating
over specimen to the assigned Room table to be admission
OR staff for laboratory analysis. assisted by the Anesthesia consent
circulating nurse, forms
Informed
surgeon and OR, Anesthesia
Consent
anesthesia team. and Surgery
Form
Blood
18. Position patient
consent
safely and comfortably Anesthesia and
form
on bed. OR Patient
stickers
19. Scrub nurse opens Whole
the sterile set and Surgery patients
performs surgical hand file
scrubbing, gowning Admission
and gloving. Set-up history
sterile field and do Surgery and OR Form
initial counting of the Consultati
instruments, sharps on forms
and sponges together OR, Anesthesia Specimen
with the circulating and Surgery Histopath
nurse. Forms
Peri-
20. Induction of OR, Anesthesia operative
Anesthesia. and Surgery Forms
Anesthesi
21. Position the patient a Forms
safely and comfortably Operative
according to the Technique
procedure. Surgery, NICU Forms
Surgical
22. Application of Safety
diathermy pad and Bair Checklist
hugger blanket. Form
Instrumen
Anesthesia
t
23. Surgical skin
Counting
preparation with
Form
aseptic technique
Blood
using the approved Surgery
Transfusio
solution.
n Form
24. Drape Surgery and OR
appropriately
according to the
procedure.
Linen
25. Initiate Time Out OR Scrub Suits,
by surgical and Surgery and OR Patient Gowns,
anesthesia team. Blankets

26. The circulating

nurse notes the time Others:
when the surgical
1. Telephone
procedure started as
2. Desktop
well as the time the
Computers
baby is delivered.
3. TrakCare
(Electronic
27. The OB surgeon Surgery and OR
Documentation)
hands over the baby to
4. Patient Stickers
the NICU nurse and
extracts the placenta
thereafter.
28. Blood transfusion Surgery and OR
as ordered and
administered by the
anesthesia team.

29. The OB surgeon

performs
hysterectomy.
Surgery
30. Specimen out,
handled properly by
the Scrub Nurse and
handed over to the
Circulating Nurse on a
specimen container. OR, Anesthesia
and Surgery
31. Circulating Nurse
labels the specimen
container properly with Surgery and OR
correct patient name,
medical record
number, surgeons
name, name of
specimen and date as OR, Anesthesia
confirmed by the and Surgery
surgeon and enters
into the OR specimen
logbook

28. Second surgical

count is perform before
closure of the cavity by
the surgeon, scrub OR and ICU
nurse and circulating
nurse.

29. Final surgical count

before closure of the
skin by the surgeon,
scrub nurse and
circulating nurse and
sterile dressing applied
after closure of the skin
by the surgeon.

32. The OB surgeons

expels the clots
vaginally and performs
post-op care and
cleanse the patient
thoroughly. OR and
Laboratory
33. Sign out takes
place by the surgical
and anesthesia team.

34. The surgeon and

the scrub nurse
remove used gowns OR, Anesthesia
and gloves according and Surgery
to the set standards.

34. The surgical and

anesthesia team
assess the status of OR, Anesthesia,
the patient before Surgery and ICU
transferring the patient
to the ICU bed
(Airway, breathing and
circulation, site of OR, Anesthesia,
diathermy pad, surgical Surgery and ICU
site)

35. Circulating nurse

informs the Reception OR and CSSD
Nurse about the
following:
Status of the
patient.
Calls ICU to
bring the bed
to OR with
necessary
airway
 maintenance
equipment
To assign
another staff
to collect the
specimen and
brings to the
main
laboratory.

36. The circulating

nurse will hand over
the specimen to the
assigned another staff
including the specimen
logbook and brings to
the laboratory.

35. The surgical team

transfers the patient
from OR table to the
ICU bed safely and
comfortably.

36. The anesthetist,

main surgeon,
circulating nurse and
the ICU nurse wheel
the patient from CS-OR
to ICU.

37. Handover of
patient by the
anesthetist to ICU
doctor and circulating
nurse to ICU nurse.

38. The scrub nurse

wipes the soiled
instruments then
sprays with the
approved solution,
covers and transports
to CS-OR
decontamination room.