How to Survive Minimally Invasive Surgery

The Perioperative Nurse’s Survival Guide

Preoperative Planning:

Setting the Stage for Success

Thanks for letting me

know I have a Lap Chole

to follow, going to

check the room now.

Setting the Stage for Success

Schedule the case but….

What is so important about scheduling the case?

Make sure its scheduled

correctly, why is this

important?

Keep preference cards updated

Can this really be done?

Who is responsible?

Provide realistic time estimates

How can this be done and who is

responsible?

Team Work= Dedicated Team

Pre-operative Teaching:

Setting the Patient up for

Success

Pre operative Teaching

• Minimally invasive surgery instructions

• General outline of pre-op questions

• Procedure specific consent checklists

• Reliable internet sources

Let’s pretend you are the patient and you are at the doctor’s office…You do not know about your condition, You don’t know how to read…and the receptionist put you in the “special room, where the diplomas are, the golf pictures and the “I love my accomplishments” wall.

So now

what?

Let’s try it again…

In simple terms please?

Teach to the level of the participant

In small quantities of content in simple terms

Provide opportunity for questions and encourage questions

Pre-operative Teaching: Setting the Patient up for Success

• Provide minimally invasive surgery instructions

• Provide general outline of pre-op questions

• Inform the patient regarding:

– procedure specific

– consent checklists

– Verification checklists and/or pre-procedure checklists

• Provide Reliable internet sources

To assess what the patient knows first before tackling the questions they may ask

To ask open ended questions to solicit information

Top Ten Questions

• How long will the surgery take?

• How long will I be in the hospital?

• What can’t I do when I get home?

• What will I need help with when I get

home?

• Will I be on a special diet?

But what they really want to know…

• When can I drive?

• Will I need further

treatment?

• When can I go back to my

normal activities?

• Size of scar?

When can I resume my normal activities?

Number One Question

Who will be doing my surgery?

Pre-operative Teaching: Setting the Patient up for Success

Minimally invasive surgery instructions

General outline of pre-op questions

Procedure specific consent checklists

Reliable internet sources

Preparing the patient for surgery

We do this….

In the form of this….

To avoid this….

What should be

included in this

stuff?

Procedure Specific Consents

Checklist format to avoid oversights

Indications for surgery

Description of the procedure

Common or serious risks

Alternatives

Questions

Example ofInternet Patient Education

• Crohns and Colitis Foundation

(www.ccfa.org)

• American Society of Colon and Rectal

Surgery (www.fascrs.org)

• Wikipedia

Showtime:Intra-operative Execution

• Pre-operative briefing

• Extended Surgical timeout

• Debriefing

Pre-operative Briefing

• Key element is two way communication

• Clarify any questions the team might have

about the procedure or the equipment

• Checklists on grease-boards are utilized in

the pre-op area to insure that the whole

team is on the same page

Extended Surgical Timeout

WHO Surgical ChecklistSafe Surgery Saves Lives

Haynes, et al. NEJM 2009

There is nothing so annoying as to have two people talking when you’re busy

interrupting.

Mark Twain

Debriefing

• Closing Counts?

• Labeling of specimens?

• EBL?

• Any equipment problems?

• What went well?

• What could we do different next time?

Team: A group of people with a full set of complementary skills that work together

interdependently & cooperatively to complete a task.

Key markers associated with superior team performance:

• Leadership

• Assertive Communication

• Situational Awareness

Leadership

• Accept risk and responsibility

• Seek the collective wisdom of the team

• Create an atmosphere conducive to assertive

communication

• Remember the leader of the team is a part of

the team

Assertive Communication

• …an obligation, not just a right

• …must be timely

• …must not be criticized or ridiculed

• …is critical to patient safety in the OR

Situational Awareness

• Understanding what is happening in the

surrounding environment and why

• Monitoring the current situation and

accurately predicting what is likely to

happen next to help the team prepare for

the anticipated outcome

Better said….

EQUALS

Patient Advocate

Nurse vs Physician perception

• Nurses describe good

collaboration as having their

input respected

• Physicians describe good

collaboration as having nurses

that anticipated their needs

and followed direction

Who’s on your team?

Strong leadership, assertive communication and situational awareness bridge the gaps between team members and are essential for safety in the OR as well as in the cockpit

Bibliography

• American College of Surgeons, Committee on Development of High Performance Teamwork in Surgery through Education. Statement on high-performance teams. Bulletin of the American College of Surgeons 2010; 95:23-24.

• Haynes AB, Weiser TG, Berry WR, et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. N Engl J Med 360:491, Jan 29, 2009.

• Makary MA, Sexton JB, Freischlag JA, et al. Operating Room Teamwork among Physicians and Nurses: Teamwork in the Eye of the Beholder. J Am Coll Surg 2006; 202: 746-752.

• Stokowski LA. Perioperative Nurses: Dedicated to a Safe Operating Room. Available at www.medscape.com/viewarticle/562998 Accessed February 15, 2010