A.HOWARD OCTOBER 11

NORTHUMBRIA HEALTHCARE N.H.S.TRUST

WANSBECK HOSPITAL

OPEARATING DEPARTMENT

THEATRE, ANAESTHETICS &

RECOVERY

POLO File

WELCOME AND GENERAL INFORMATION

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Welcome to theatre.

We want you to enjoy working in the theatre department. Your initial

feelings on joining the theatre teams will be a combination of apprehension

and anticipation. The environment in the operating theatre is totally different

to anything you may have experienced before in nursing. The workload is

specialised, demanding and at times stressful.

We appreciate that you will not be able to operate to your usual high

standards and it is not expected that in the short period of time you will be

able to function as a ‘theatre nurse’, this takes time to adjust and learn the

necessary skills.

The overall aim of the theatre experience is that you will be able to

participate, with understanding, in the total care of the surgical patient

having gained skills, knowledge and attitudes to meet the needs of patient

during the pre, intra and post operative phases.

Your first day in theatre can be a frightening experience, as we all

remember. The uncertainty of what lies ahead can seem daunting, but all of

the staff will only be too willing to help you and ensure that you gain the

most from your placement with us. When you arrive in the department, we

have an induction programme prepared for you and you will be allocated a

mentor who will undertake to help you achieve your learning outcomes

within the learning environment of the theatre department.

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Department Philosophy

The philosophy of this unit is to provide a safe and caring environment, to

assist the individual sick and well, in the performance of those activities

contributing to health and its recovery, that he or she would perform unaided

if he or she had the necessary strength, will or knowledge, and to do this in

such a way as to help him or her maintain dignity and gain independence as

rapidly as possible.

The staff are committed to gaining the knowledge required to respond

quickly and effectively in emergency situations, making quick decisions

accurately and independently, functioning as an effective member of the

team in potentially stressful situations, and using specialist knowledge,

pertaining to the care of the post-operative patient.

We acknowledge that as practitioners we have a responsibility to be

involved in continuing education, to be aware of recent research and base

our practice upon this.

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Operating Department Objectives

The operating department is at the heart of the critical care unit, and we care

for a wide range of patients of all ages, some requiring only minimal

surgical intervention as day cases, to patients undergoing major emergency

or elective procedures.

Primary objectives:

1. Commitment to ensuring that every patient has a positive experience and

the best possible outcome from their stay in the theatre unit.

2. Implementation of research based, patient centred care.

3. The continued promotion of the individuality and dignity of all patients is

paramount.

4. Provision of safe and efficient services for all patients, requiring any

surgical or anaesthetic intervention.

5.Ensuring all Trust policies and procedures are implemented. Encouraging

an open culture to allow effective learning from incidents.

6. Sharing best practice from local level, Trust wide and nationally.

Implementing best practice through the use of evidence based care.

7. Provision of training, education and supporting professional development

for all staff within the unit.

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Our theatre unit

The operating department at Wansbeck District General, consists of 8

theatres, with the obstetric theatre in the maternity department and a 13

bedded recovery suite.

On arrival in the unit patients are transferred immediately to the anaesthetic

room.

The theatres in the department are:

Trauma/ Emergency theatre

3 Orthopaedic theatres

3 General surgery theatres

1 gynaecology theatre

1 Dental theatre

Each operating theatre consists of an anaesthetic room, operating room,

clean utility room and a dirty utility room.

All theatres are operational five days a week between the hours of 8am. and

5pm. For elective surgery. The trauma/ emergency theatre has 24 hour cover

7 days a week.

The recovery suite is open from 8am. Until 12 midnight seven days a week

and has the facility for patients requiring assisted ventilation.

Additional satellite areas are covered these include ECT, CT scan room, pain

clinics and accident and emergency.

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Off duty

There are a variety of shift patterns worked within the unit. This is to

accommodate both the needs of the department and the staff.

Duty rosters are displayed in a clearly marked file kept in the department.

There is a book provided for off duty requests. These requests are usually

honoured provided sufficient notice is given.

Sickness and absence

The department must be informed of any sickness leave or other absence as

soon as possible on the first morning of absence. Staff must report this to a

senior member of staff.

A certificate is required for all sick-leave, either from a doctor or a self

certificate. A return to work interview is held by a senior nurse and a return

to work form must be completed.

Personal property

You will be provided with a locker for your personal property and clothing.

Please provide a small padlock to ensure your locker is made secure.

Northumbria Healthcare Trust accepts no responsibility for loss of personal

property, either lost or stolen.

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Theatre staff

Mrs Jackie Hall is the theatre manager. Her office is located next to the

coffee room, should you require her assistance.

Within the department we have a large number of staff, including Sisters,

Charge nurses, Registered nurses, Operating Department Practitioners,

Healthcare Assistants, Porters, Housekeepers and domestic staff.

Sister Alison Howard and Charge Nurse Paul Johnson are responsible for

education and training within the department for student nurses, trainee

ODP’s and newly qualified members of staff. Sister Chris Hart is

responsible for N.V.Q. level 2 training.

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Theatres

Theatre one, two, three and six – orthopaedics/plastic surgery

Sister C. Hart, Sister A. Howard, Sister S. Richmond,Sister V Gomez,oda P

Vasey, Sister D Acero, Sister L Harkess

Mr J. Candal-Cauto

Mr I. Carluke

Mr K. Emmerson

Mr C. Gibbons

Mr S. Jones

Mr C Joseph

Mr A Kasis

Mr J.M. Leitch

Mr A. Malviya

Mr S Muller

Mr Murty

Mr P. Partington

Mr J Powell

Mr M. Reed

Mr J.L. Sher

Theatre three, four and five – General surgery/ urology/ laproscopic/

plastic surgery

PODA C Stanners, Sister D Thompson, Sister L Snowball

Mr S. Bawa

Mr M. Bradburn

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Mr M. Carr

Mr T Dorkin

Mr P. Gallagher

Mr N. McClean

Ms S. Mills

Ms P Serra

Mr M Shaw

Ms S Robinson

Mr D. Thomas

Mr M. Youseff

Theatre seven – Gynaecology

Sister R. Cavill, Sister S. Floyd, Sister J Barrett

Mr P. Franks

Dr S. Mackenzie

Mr P.R. Sill

Mr T. Sproston

Anaesthetics

Charge Nurse P. Johnson, P.O.D.A. N. Sharp, Sister O. Garthwaite, Charge

Nurse B. Marshall, SODA G Henderson

Recovery

Sister S Barber

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Consultant Anaesthetists

Dr P. Archer

Dr S. Bache

Dr T. Bamigbade

Dr G. Cavill

Dr C. Coe

Dr A. Conn

Dr J. Duggan

Dr L. Edmondson

Dr I. Harper

Dr J. Howie

Dr J. Laurenson

Dr F. McMenemie

Dr J. Parkins

Dr M. Piper

Dr G. Riddell

Dr J. Rushmer.

Dr E Sykes

Dr A Syndercombe

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Training Co-ordinator Theatres and Sterile Services

Miss Lillian Broatch

Lillian is the trust wide co-ordinator for education and training in theatres

and sterile services.

Should you require any information or advice on training issues or you wish

to discuss anything in the strictest confidence she will only be too willing to

help.

Her office is at North Tyneside, however she covers the whole Trust and is

therefore not always on site.

Lillian can be contacted as follows:

Tel: NTGH – 0191 259 6660 ext: 2121 (Answerphone when out of office)

Email: Lillian.Broatch@northumbria-healthcare.nhs.uk

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Useful Information

Prior to you allocation

We suggest that you contact the department approximately two weeks before your allocation. If you wish you can arrange a visit to discuss your off duty, learning requirements and if possible meet your mentor. This would further give you the opportunity to discuss any other concerns or queries you might have pertaining to your allocation with us.

Uniform

You will be provided with Theatre uniform (scrubs) and theatre shoes during your allocation. However, we suggest that you bring with you your ward uniform, as part of your experience may be gained outside of the department.

Scrub suits must be changed following infected or high risk procedures, and prior to working in another theatre.

YOU MUST NOT GO OUT OF THEATRES WEARING THEATRE CLOTHING!!!

Locker

You will be provided with a locker, during your allocation. However it is your responsibility to provide a small padlock. Valuables must be locked away at all times as the Trust accepts no responsibility for lost/stolen items. Any valuables brought into the department are brought at your own risk!

Meal / coffee breaks

Breaks may be taken on or off the department. If we wish to bring meals with you, fridges are available for storage; we also have microwaves, toasters and sandwich maker available.

Off duty

Off duty will be arranged with your mentor. We have a flexible approach to off duty hours and understand that some of you have family commitments and childcare arrangements to organise. Under

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normal circumstances you will not usually work late shifts, weekends or night duty due to the unpredictability of `out of hours` patient case load. However, if it is felt advantageous to your learning competencies, this can be arranged with your mentor.

Sick Leave

In addition to informing the appropriate authority at the University, if you are unable to attend for duty due to sickness or other reasons you must inform the senior nurse in charge of theatres at your earliest convenience. Contact theatre on 01670 521212 ext 3522 to inform of your absence. This is very important.

Mentors

You will be allocated a mentor who will work with you for the greatest period of time during this placement, this will be a minimum of 50% of your allocation. You will spend 5 weeks with your mentor and then be allocated to recovery and anaesthetics for a week each. Your final week can be spent in the different specialities which can assist in achieving the required learning outcomes.

In order to gain the most from your allocation and to achieve

any specific learning competencies you may have, you will be allocated to an associate mentor/or qualified member of staff to work with.

Whilst you will spend the majority of your allocation with your mentor, you will be given the opportunity to `follow through` some patients from reception, to discharge from recovery. This is to ensure you gain an insight into the total perioperative patient experience.

If you have any specific learning requirements please discuss these with your mentor and we will endeavour to ensure that these competencies are achieved.

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Reflective diary

Throughout your allocation we ask that you complete a reflective diary of your experiences/learning. These forms will be provided on the first day of your allocation.

Pregnancy

If you are pregnant or think that you may be pregnant, it is important that you ensure your mentor is aware of your condition (in confidence). It is important that you avoid exposure to x-rays that may potentially harm your baby.

Research has also suggested a link between exposure to anaesthetic waste gases, and increases in rates of either, spontaneous abortion or congenital abnormalities, (Cohen et al, 1971; Vessey and Nunn, 1980). By informing your mentor we can ensure that yourself and your baby are not exposed to any potential harm.

Conscientious Objection

If you have any objection to participating in certain procedures, i.e. Termination of pregnancy, please inform your mentor in order that we ensure you are not involved in these procedures.

However, you should be aware that conscientious objection has been interpreted as those who assist with the abortion itself - whether in the operating room or by giving abortifacient drugs in a ward. The Royal College of Nursing suggests that it does not apply to nursing care given before or after the abortion (RCN.Guidelines on the termination of pregnancy, London, May 1997).

Evaluation of allocation

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At the end of your allocation we would be most grateful if you could spend a few minutes to complete an evaluation of your experience. This will give us the opportunity to evaluate the learning environment we provide, and listen to any suggestions you may have to improve the future experience of other students We sincerely hope that you enjoy your theatre placement, please

do not hesitate to ask if you have any further questions.

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THEATRE MANAGER

MRS J HALL

PODIETRY

ANAESTHETICS CN P JOHNSON/ SR O GARTHWAITE PODA N SHARP/ CN B MARSHALL/

PODA G HENDERSON

PAIN CONTROL SR KELLY

RECOVERY NURSES

SR S BARBER

GYNAECOLOGICAL SUGERY

SR R CAVILL/SR S FLOYD/SR J BARRETT

UROLOGY SURGERY

GENERAL SURGERY

PODA C STANNERS/SR D THOMPSON/ SR L SNOWBALL/

RADIOGRAPHY PERIOPERATIVE / SPECIALS

ORTHOPAEDIC SURGEONS

OPERATING DEPARTMENT LEARNING ZONE

GYNAE SURGEONS

E.C.T

OBSTETRICS CAESARIAN SECTIONS

H.D.U

MINIMAL ACCESS

SURGERY

GENERAL SURGEON

S

DENTAL SURGER

Y

ORTHOPAEDIC SURGERY

SR C HART/ /SR A HOWARD/ SR S RICHMOND/ SR V GOMEZ/ SODA P VASEY/ SODA M BROWN/ SR L HARKESS/ SR D ACERO SR A NICHOL

TRAINING CO-ORDINATOR

MISS L BROATCH

EMERGENY SURGERY

CN G ROBINSON

EMERGENCY SURGERY

I.T.U

BREAST SURGERY

SURGICAL DAY UNIT

MIDWIVES

PSYCH. NURSES

OOPPEERRAATTIINNGG

DDEEPPAARRTTMMEENNTT

DENTISTS DENTAL NURSES

ANAESTHETISTS

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LEARNING OPPORTUNITIES

KEY ELELMENT – CLINICAL SKILLS

LEARNING OPPORTUNITIES RESOURCE / RELEVANT PERSONEL / DEPARTMENT

Pre operative Phase Admission of patient to theatre Patient transfer Welcome Safety checks – Team briefs (WHO checklist), pre op checklist Psychological/physical and administration preparation Anaesthetic Nursing Preparation of patient for anaesthesia Preparation of equipment Preparation of IV equipment Assisting the anaesthetist Monitoring the patient Intra operative Phase Preparation of the operating theatre Transfer of patient onto the operating table Positioning the patient for surgery Preparation of the patient (sterile field/skin) Preparation of equipment Preparation of surgical team Aseptic behaviour Skills of circulating nurse Skills of scrubbed nurse Use of electrosurgical equipment Count procedures Female urinary catheterisation Preparation of sigmoidoscopy equipment

Theatre staff / Escort nurse Theatre safeguards / policies Anaesthetic staff Theatre staff Theatre staff Theatre staff Theatre staff Theatre staff / Safeguards document Theatre staff

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Post operative Phase Care of airway Assessment of conscious level Assessment and control of pain Use of patient controlled analgesia Monitoring of patient Checking of emergency equipment Care of the ventilated patient

Recovery/ theatre staff Pain control team- Sr. Kelly Recovery nurses

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KEY ELELMENT – INTERPERSONAL SKILLS

LEARNING OPPORTUNITIES RESOURCE / RELEVANT PERSONEL / DEPARTMENT

Use of telephone Answering calls Making calls Answering bleep system Taking and relaying of messages Use of computer Internet access Intranet access Communication – Verbal Patients – (and tactile) Relatives Nursing staff / Theatre staff Medical staff Ancillary staff Non – verbal communication and team working Caring for patient undergoing local Anaesthesia Handover to ward staff

Theatre nursing and ODP staff Theatre staff Theatre seminar room Nursing staff (trained) Multi disciplinary team All nursing and ODP staff within theatre and recovery Theatre nurses Theatre/recovery nurses

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Reception of pre operative patient

Theatre nurses and ODP staff

KEY ELELMENT – HEALTH DEVELOPMENT

LEARNING OPPORTUNITIES RESOURCE / RELEVANT PERSONEL / DEPARTMENT

Use of patient controlled analgesia Post operative instructions Dental care advice Deep vein thrombosis prevention

Sr L. Kelly and pain team Anaesthetic staff – theatre staff Dentist / dental nurses Theatre/ anaesthetic and Recovery

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KEY ELELMENT – ORGANISATIONAL AND MANAGERIAL ISSUES

LEARNING OPPORTUNITIES RESOURCE / RELEVANT PERSONEL / DEPARTMENT

Organisation and structure of unit Layout/ location/ aseptic zones/ traffic Relationship between operating and other units Multidisciplinary personnel Administration of operating department Occupational Health and Safety Working hours and schedule Possible emergency situations Formation of a surgical team Materials management Clinical governance To include all aspects of individualised care for patients for each speciality of surgery Management of quality assurance

Theatre staff Senior nursing and ODP staff Theatre manager Theatre staff Theatre and Anaesthetic Staff Theatre staff Mrs.Bivona- Clinical Governance Nurse Theatre staff Theatre staff

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KEY ELELMENT – PATHOPHYSIOLOGICAL PROCESSES

LEARNING OPPORTUNITIES RESOURCE / RELEVANT PERSONEL / DEPARTMENT

Maintaining body temperature Use of warming devices Tissue Viability Use of pressure relieving devices Use of anti-embolitic devices Anatomy and Physiology The structure of The circulatory system The respiratory system The neurological system The digestive system The urinary system Defence systems The importance of homeostasis Physiological changes caused by anaesthesia and surgical intervention

Anaesthetic and theatre staff Anaesthetic and theatre staff DVT Nurse specialists Anaesthetic / theatre staff Medical staff Theatre library and seminar room Anaesthetic staff / seminar room / library

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KEY ELELMENT – PATHOPHYSIOLOGICAL PROCESSES

LEARNING OPPORTUNITIES RESOURCE / RELEVANT PERSONEL / DEPARTMENT

General Surgery Anatomy and physiology of abdomen Biliary disease Aetilogy of herniae Tumours Gastro-intestinal disorders Tumours Gastro-intestinal disorders Enlarged thyroid Gynaecological Surgery Anatomy and physiology Hysterectomy (Vaginal and abdominal) Investigations and treatments Repair procedures Dental procedures Use of intra operative X Ray

Relevant theatre staff Medical Staff Nurse Specialists Theatre seminar room / library Internet Dental staff Radiographers

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KEY ELELMENT – PATHOPHYSIOLOGICAL PROCESSES

LEARNING OPPORTUNITIES RESOURCE / RELEVANT PERSONEL / DEPARTMENT

Urology Surgery Cystoscopy Circumcision Prostatectomy Bladder tumours Ureteric catheterisation Minimal Access Surgery Creating pneumoperitoneum Cholecystectomy Upper G I hernia repair Inguinal hernia repair Fundoplication Orthopaedic Surgery Anatomy and physiology of bones and skeletal muscle Treatment of trauma - fractures Total Hip Arthroplasty Total Knee Arthroplasty Investigations Shoulder surgery Hand surgery Foot surgery

Relevant theatre staff Medical staff Nurse Specialists

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KEY ELELMENT – PATHOPHYSIOLOGICAL PROCESSES

LEARNING OPPORTUNITIES RESOURCE / RELEVANT PERSONEL / DEPARTMENT

Infection Control Theatre Ventilation System Personal hygiene and behaviour Aseptic classification of surgical procedures Spread of infection Aseptic working methods Use of theatre clothes / masks Universal precautions Handling and disposal of waste Principles of cleaning Disinfection Sterilisation Anaesthetic pharmacology Medicines used during induction, maintenance and reversal of anaesthesia Medicines used during C.P.R. Infusions and transfusions Methods / types of anaesthesia Factors affecting choice of anaesthesia Examinations required by anaesthetist Knowledge of surgical techniques Abdominal surgery Minimal invasive surgery Orthopaedic and trauma surgery Urological surgery Surgery of the breast Surgery of the Thyroid Ear, Nose and Throat surgery Gynaecological surgery

Theatre staff Theatre staff/ infection control policy Theatre staff Sterile services (SASD) Anaesthetic Staff Theatre staff Relevant surgical staff

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Emergency surgery Dental procedures Anatomy and physiology Of all organs and organ structures related to the above mentioned

Theatre / Anaesthetic and Medical Staff