Basic Perioperative Nursing · PDF fileGulf Coast Community College Learning Activity Guide Cooperative Education Clinical Internship Basic Perioperative Nursing Initiated July, 2003

Gulf Coast Community College

Learning Activity Guide

Cooperative Education Clinical Internship

Basic Perioperative Nursing

Initiated July, 2003 Libby McNaron, RN, CNOR, CST, BSN, MS

Gulf Coast Community College NUR 2949

Clinical Internship Basic Perioperative Nursing

Learning Activity Guide

Clinical Internship in Perioperative Nursing

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Syllabus…………………………………………………………………………………….3 Topical Outline…………………………………………………………………………….5 Course Objectives………………………………………………………………………….7 Requirements……………………………………………………………………………….4 Course Calendar…………………………………………………………………………....8 Theory Learning Units…………………………………………………………………….9 Perioperative Nursing – Roles Recommended A-V Viewing List…………………………………………………………11 Clinical Performance Evaluations and Guidelines……………………………………...12 Lab Skills Checklist………………………………………………………………………..9 – 14 Clinical Orientation Forms………………………………………………………………...15 -24 Evaluation – Circulator Role……………………………………………………...…………25 Evaluation- Scrub Role………………………………………………………………………26


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Gulf Coast Community College Basic Perioperative Nursing Cooperative Education 2949

COURSE TITLE AND NUMBER: Nur 2949 Clinical Internship in Perioperative Nursing PLACEMENT IN PROGRAM OF LEARNING: Elective Third Term through Fourth Term for Current Nursing Students; Open enrollment to any Florida Licensed Registered Nurse. COURSE DESCRIPTION: This course is designed to introduce the individual to Perioperative Surgical Nursing with a focus on Intraoperative Nursing. This course includes a study of the Patient’s Perioperative Experience, Roles and Responsibilities of the Registered Nurse; Principles and Practice of Sterile Technique; Sterilization and Disinfection; Operating Room Hazards; and an Introduction to Surgical Technique. CREDITS: 3 Semester Credits – Clinical Internship. Student may register and attend the classroom session. Clinical hours can be completed over a period of two semesters. Student can exit at anytime once the course objectives are completed. It is expected that course completion will be achieved within two semesters. CLOCK HOURS: Voluntary Students: Student must complete 150 voluntary work hours to complete the course. Additional Lab practice and skills check-off hours can be scheduled according to the needs of the student. Scheduled practice and skills check-off hours will count toward the total 150 hours required. Clinical hours must be scheduled with the instructor – Libby McNaron, (873-3551). Potential clinical sites to complete hours are Bay Medical Center and Gulf Coast Medical Center. Site preference will be taken into consideration, but final clinical site assignment will be made by the instructor in conjunction with the clinical site. PRE-REQUISITE: Current pre-requisites for Third term nursing (Course NUR1211C, NUR 1260C); or current proof of licensure as a Registered Nurse in the State of Florida. CO-REQUISITE: Current enrollment or previously completed lifelong learning course “Basic Perioperative Nursing Theory and Lab”. METHODS OF INSTRUCTION: Lecture, group discussion and activities, audio-visuals, self-paced modules, computer-assisted instruction, observation, skill demonstration, and return demonstration. METHODS OF EVALUATION: GCCC GRADING SCALE Clinical and Skills Lab Performance A (90-100) Written Examination B (80-89) 2 Exams: 1 at Midterm C (70-79) 1 Final Exam D (60-69) F (0-59)


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TO MEET THE REQUIREMENTS FOR GRADE: See attached current course syllabus for CO-OP Course 2949 for the current semester. ABSENTISM: As per GCC Nursing attendance policy. Not to exceed 1/8th of classroom hours to complete the course or 2 classes. All practical/clinical hours must be completed. COMPLETION OF COURSE: Please note that completion of this course does not guarantee employment or a specific position at the Hospital. RECOMMENDED TEXTBOOK: Pocket Guide to the Operating Room (1996); 2nd Ed., Goldman, F.A. Davis.

POLICIES IN THE CLINICAL SETTING: A copy of the current applicable health science student handbook will be provided. Students must follow all policies regarding clinical policies currently outlined in the applicable health science student handbook provided. ACCIDENTAL INJURY LIABILITY AND (MAL-PRACTICE) INSURANCE:

Each student must have liability and accidental injury insurance while enrolled in the program. When you pay fees for courses with clinical labs, the insurance fee is also paid. Since fees are subject to change, please consult the current Gulf Coast Community College catalog. Liability limits to coverage are $1,000,000 per incident for an individual student and $3,000,000 aggregate per incident for a group of students. The basic plan for Accidental Injury Coverage provides the following:

Coverage Accidental Medical Insurance Includes treatment as a result of exposure to a contagious and/or infectious disease including, but not limited to hepatitis, HIV, Meningococcal meningitis, TB. The policy would not include influenza, pneumonia or common colds.

$15,000

Dental - resulting from an accident $1,000 Deductible None Travel with a group under the direct supervision of insured. Yes Accidental Death or Dismemberment (AD&D) $25,000

This coverage is designed to cover the students injured as a direct result of working in the clinical setting. It is not designed to cover accidents while walking/traveling to class or sitting in a classroom. It would extend to slips or falls in clinical settings or injury due to lifting patients or equipment but most importantly, it would cover treatment for exposure to disease as stated above.

ACCIDENTAL INJURY COVERAGE (HOW TO IMPLEMENT):

Should an accident occur during a clinical affiliation, the student must report this to the instructor immediately and complete the GCCC FCC Accident-Incident Form that is available in division secretary's office in HS 202 within 24 hours of occurrence. Claim forms may also be obtained from the Health Sciences Division secretary in Room 202.


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Gulf Coast Community College

Clinical Internship Perioperative Nursing

TOPICAL OUTLINE

PSYCHOMOTOR SKILLS

1. Positioning of Surgical Patients 2. Surgical Skin Preparation 3. Scrubbing Gowning and Gloving 4. Establishment & Maintenance of a Sterile Field 5. Scrub Role Evaluation – Surgical Case Responsibilities 6. Circulator Role Evaluation – Surgical Case Responsibilities


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CLINICAL INTERNSHIP PERIOPERATIVE NURSING

COURSE OBJECTIVES

Upon completion of the course, the student will be able to: ROLE AS A CIRCULATOR WITHIN THE DISCIPLINE OF NURSING:

1. Describe the basic role and responsibilities of the Registered Nurse during the preoperative, intraoperative, and postoperative phase of the patient’s surgical experience. Identifies the role and responsibilities of the circulator as a member of the OR Team.

2. Identifies the basic principles of surgical Aseptic Technique including the

Association of Operating Room Nurses Standards of Care and the methods of sterilization and disinfection.

3. Establishes a client outcome and plan of care that focuses on prevention of

problems. Identifies potential surgical hazards and safety measures to prevent injury including patient and occupational related hazards.

4. Demonstrate ability to position and perform surgical skin preparation for the

surgical patient in the practice lab and clinical settings.

5. Demonstrate ability to establish and maintain the sterile field as a nonsterile member of the team.

ROLE AS A SCRUB WITHIN THE DISCIPLINE OF NURSING:

1. Identifies the role and responsibilities of the surgical scrub as a member of the OR team.

2. Demonstrate ability to perform the surgical scrub, gown, and glove technique

correctly.

3. Demonstrate ability to establish and maintain the sterile field as a sterile member of the team.

4. Identifies key basic surgical instruments necessary for all surgical procedures.

5. Identifies basic surgical technique principles regarding tissue handling, wound

closure, and hemostasis.


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Gulf Coast Community College Clinical Performance & Skills Lab Evaluation

Rationale:

A. Clarification of the role of faculty: In competency-based education, faculty members assume the role of transfer agents-creating conditions when expertise is transferred to novices. The responsibility of the transfer agent is to: 1. Describe what it means to be expert. 2. Create and maintain an instructional environment which students are prepared

to perform competently. 3. Design evaluative exercises to determine when students are, in fact, capable of

competent performance.

B. Facilitation of instructional accountability: We can anticipate certain results form a program of learning utilizing competency based performance criteria. The participant in such a program should demonstrate: 1. Increased levels of competency. 2. Increased awareness of what the instruction is to provide. 3. Increased awareness of their performance levels. 4. Increased accuracy of self-evaluation.

Implementation: Specific clinical performance evaluation experiences have been identified for the Perioperative Class. The performance test items varies with each testing experience and reflect the content/skills the student should have mastered during that particular portion of the term. (Please refer to the LAG) Role of Instructor/Evaluator During Testing Experience:

A. The primary role of the evaluator is objective observation. B. No assistance may be provided to the student performer. Show and tell, coaching,

excusing, and helping are all strictly forbidden. C. The evaluator will remain silent during the performance situation. The evaluator

will not give non-verbal cues such as facial expressions, and body movement. D. For process evaluation, the evaluator will remain with the student and observe all

behaviors. Role of the Student/Performer During Testing Experience:

A. Attendance for clinical performance is mandatory. The student must arrive at the designated time.

B. The student should perform as though the evaluator were not present. C. The student should not attempt to introduce the evaluator in conversation or

regard her/him as an assistant. D. All critical elements must be performed as specified. E. The student may be requested to supply a lab partner for the testing experience to

assume a role as indicated including patient, circulator, or scrub. F. The student should be prepared to self-evaluate his/her performance.

Role of Individual Assuming the Designated Role as Indicated:


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A. The individual should perform as though the evaluator were not present. B. The individual should not attempt to introduce the evaluator in conversation or

regard her/him as an assistant. C. No information regarding the task performance may be provided to the

student/performer. This includes verbal information and non-verbal cues such as facial expressions and body movements.

Critical Elements Criteria: Performance criteria identify the critical elements of the tasks. Critical elements are those aspects of care essential to protect and promote the patient’s well being. They are subdivided into three overriding areas of concern.

A. Physical Jeopardy – any act or inaction on the part of the student, which threatens the patient’s physical well being.

B. Emotional Jeopardy – any act or inaction on the part of the student, which threatens the patient’s emotional well being.

C. Asepsis – the prevention of the introduction and/or transfer of organisms. The elements are identified as critical because the omission or unsatisfactory performance of any one of them indicates the student’s failure to administer safe and effective care to that patient. By using only the prescribed critical elements of care, success on the exam is based on 100percent accuracy in performance. 1

1The New York Regent External Degrees in Nursing Historical Developments and Program Study Guides for the Associate Degree Monograph I., 1976, pp. 89-90. Accommodation for Individual Differences: Allowances are made, with certain time limitations, for a student to progress to a satisfactory competency level at their own rate. If a student fails to perform satisfactorily on an initial testing experience, they will be provided with additional supervised lab practice and an opportunity to repeat the test. All skill objectives must be mastered and validated by successful performance testing in the simulated lab before completion of the course.


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Skills Experience Course Description: Provides a setting in which the student is oriented to the Operating Room Environment. Skills are demonstrated and the student practices skills necessary for basic case preparation including instrumentation, supplies, sutures and stapling devices, electrocautery equipment, scrubbing and gowning, patient positioning and draping, creation and maintenance of the sterile field. Practice stations will be set up to allow sufficient skills practice for all students. Lab practice and skills check-off hours will be scheduled according to the needs of the student. Scheduled practice and skills check-off hours will count toward the total 180 hours required. See posted schedule when lab is available for assisted, and self-instruction practice. Objectives: Course is designed as an introductory course to the operating room environment. Upon completion of the Lab Finals the student will be able:

1. Demonstrate satisfactory proficiency in required skills as a Registered Nurse in the Operating Room.

2. Identifies safety hazards and interventions appropriate for patient and environmental safety such as counts, electrical, laser, Infection Control measures, and Personal protection requirements.

3. Demonstrate patient assessment skills such as vital signs. 4. Demonstrates and applies the principles of surgical fundamentals such as aseptic technique, storage

and handling of sterile supplies as the individual assigned the task. 5. Demonstrates case preparation skills to ensure an organized and efficient case setup especially in

regards to tourniquets, electrosurgical units, and laser equipment. 6. Identifies appropriate action to take when confronted with an equipment-related malfunction or

emergency. 7. Demonstrates patient care procedures correctly and safely such as skin preparation, positioning,

and draping. 8. Demonstrate competencies as outlined on the specified evaluation sheets with a minimum level of 4.

A level of 3 indicates a need for more experience in that area. Methods of Evaluation: Performance evaluations in the skills experiences according to established criteria.

Student will be notified via this module at the beginning of the course of the key competency skills and given the evaluation tools for each, which must be mastered. The student completes each skill and is evaluated on each skill. Student must submit one evaluation completed to the level 4-5 competency.


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SKILLS EVALUATION & COMPETENCY FORM - SKIN PREP Name_________________________Date______________Evaluator_____________________

* Items are critical items – must have a 4-5 level. MEETS STANDARDS/EXCEEDS GOALS……………………………….…….5 Standards are defined as the basic principles MEETS STANDARDS/ MEETS GOALS........…………...……………...………4 of aseptic and operating room care as MEETS STANDARDS/MET REQUIREMENTS/NEEDS TO IMPROVE….3 defined by AORN standards. Standard STATES STANDARDS / NEEDS PRACTICE.…………………………………2 Operating Room Technique INSERVICED ON STANDARDS/ GOALS NOT MET...................………….....1 Points Points 1 2 3 4 5 N/A Wt. Possible Student Comment 1. Washes Hands. 5 *20

2. Assembles supplies: Prep Tray, garbage can, positioning supplies for patient.

5 20

3. Positions patient supine with arms on armboards (does not extend arms greater than 90degrees, safety strap 2" above knees, pillow under upper thigh, foam pads under heels, arms palms up)

5 *20

4. Exposes area needed only. Maintains patient warmth above and below site.

5 20

5. Places nonsterile towels to prevent pooling. 5 20

6. Opens prep tray (away from self first) with no contamination.

5 *20

7. Don’s sterile gloves open technique without contamination.

5 *20

8. Applies sterile drapes to catch drips without contamination.

5 *20

9. Open solutions - position setup to prevent spills. 5 20

10. Begin prep with cotton swabs in umbilicus as a separate prep. States that the umbilicus is a contaminated area.

5 *20

11. Utilize scrub sponges begin prep • Begins at the incision line and proceeds outward • Utilizes circular motion to cleanse • Does not return to incision site from periphery

5 *20

12. Blots dry - does not contaminate - Peels back in a manner that does not allow contaminated edges to pass over the site.

5 *20

13. Paints from incision site outward without contamination.

5 *20

14. Preps sufficient area. (incision line is approximately 6-8" paints table to table, 2" above xiphoid process to symphysis pubis)

5 20

15. Prevents pooling under patient. (Controls amount of solution utilized)

5 *20

16. Removes towels without contaminating prep. 5 *20 Skills Lab Grade : 94–100% (A) 86-93%(B) 75-85% (C) - Satisfactory [ 65-74% (D) 0-64% (F) ] Unacceptable Grade: _____ % ____ (Divide Student Total by Possible 320 at Level 4/Satisfactory)

Possible Total 320

Total

COMMENTS(Use Back of Form PRN: Strengths identified: Suggestions for improvement:

Check One: Student Practice _______ Instructor Practice_______ Skills Lab Testing/Competency Demonstration_____Reviewed with Student: Date______________________ Student Signature_________________________________ Comments on back__ ____1st Attempt ______2nd Attempt_____3rd Attempt Instructor Signature_______________________________


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SKILLS LAB EVALUATION & COMPETENCY FORM - POSITIONING

Name______________________________Date___________Evaluator___________________ * Items are critical items – must have a 4-5 level.

MEETS STANDARDS/EXCEEDS GOALS………………………………….........5 Standards are defined as the basic principles MEETS STANDARDS/ MEETS GOALS........…………...…………………..........4 of Aseptic and Operating Room Care As MEETS STANDARDS/MET REQUIREMENTS/NEEDS TO IMPROVE ..….3 defined by AORN Standards. Standard STATES STANDARDS / NEEDS PRACTICE.…………………………………....2 Operating Room Technique. INSERVICED ON STANDARDS/ GOALS NOT MET...................…………........1 Points Points 1 2 3 4 5 N/A Wt. Possible Student Comment 1. Washes Hands 5 *20

2. Assembles supplies needed for each position prior to need. Designates number of personnel needed to assist for each positioning event.

5 20

3. Positions patient ensuring head is maintained in alignment at all times ( communicates with anesthesia & team). Turns patient as a complete unit on three. Privacy maintained as much as possible

5 *20

4. Monitors limbs - ensures limbs are under control and safely moved in normal ROM (range of motion).

5 *20

5. Supine Position: Arms on armboards not greater than 90 degrees. Arm secured to prevent falling with safety straps (2 finger check). Pillow under upper thigh (prevents back strain). Safety strap 2" above knees. Foam pads heels (elbows & wrists PRN)

5 *20

6. Prone position with arms on armboards: Chest rolls support iliac crest to shoulder/breasts free. Pillow roll under upper thigh (states checks scrotum on males) Shins supported on pillow-toes free from table. Arms rotated down and then onto armboards. Knees checked - foam pads applied if pressure detected. Labels stretcher "patient prone- do not remove"- Security –either safety strap or tape

5 *20

7. Lateral with upper arm on pillows: Two chest rolls with kerlix utilized and axillary roll. Two pillows between legs; bottom leg bent, top leg slightly bent. Two pillows between arms and secured. 3" tape to secure hips to table. Foam pads for bottom ankle

5 *20

8. Lithotomy in candy cane stirrups: Arms are to be tucked (uses foam pads and monitors fingers while foot of bed is lowered) Buttocks do not extend below table edge. Ankles padded with towels. Legs lowered & raised simultaneously, knees together until 45 degree bend then rolled outward with lower calf supported at all times.

5 *20

9. Identifies the positioning modifications possible for each basic position: Supine(trendelenburg, reverse trendelenburg, ENT, frog legged, Fowler's); Prone (knee chest, Jackknife, Kraske, Andrews table); Lateral (Bean bag, Arm suspension, Kidney position); Lithotomy ( Modified low/allen stirrups)

5 20

Skills Lab Grade : 93–100% (A) 86-92%(B) 80-85% (C) - Satisfactory [ 70-80% (D) Less than 70 (F) ] Unacceptable Grade: _____ % ____ (Divide Student Total by Possible 180 at Level 4/Satisfactory)

Possible Total 180

Total

COMMENTS (Use Back of Form PRN): Strengths identified: Suggestions for improvement:

Check One: Student Practice _______ Instructor Practice_______ Skills Lab Testing/Competency Demonstration_____Reviewed with Student: Date______________________ Student Signature_________________________________ Comments on back__ ____1st Attempt ______2nd Attempt_____3rd Attempt Instructor Signature_______________________________


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SKILLS LAB EVALUATION & COMPETENCY FORM - ELECTROCAUTERY

Name________________________________Date___________Evaluator_________________ * Items are critical items – must have a 4-5 level.

MEETS STANDARDS/EXCEEDS GOALS………………………………….........5 Standards are defined as the basic principles MEETS STANDARDS/ MEETS GOALS........…………...…………………..........4 of aseptic and operating room care as MEETS STANDARDS/MET REQUIREMENTS/NEEDS TO IMPROVE ..….3 defined by AORN Standards. Standard STATES STANDARDS / NEEDS PRACTICE.…………………………………....2 Operating Room Technique. INSERVICED ON STANDARDS/ GOALS NOT MET...................…………........1 Points Points 1 2 3 4 5 N/A Wt. Possible Student Comment 1. Moves and Positions Unit correctly. 5 20

2. Assembles all necessary supplies. 5 20

3. Obtains correct bovie grounding pad and applies correctly. (correct site for surgical procedure & protected from pooling of solutions)

5 *20

4. Checks all cords and plugs in correctly 5 *20

5. Places foot pedal appropriately. 5 20

6. Set unit controls within safe range for case. Coagulation , cutting, and blending.

5 *20

7. States settings for each when connecting bovie unit or changing settings.

5 *20

8. Demonstrates safe handling of tips (needle tip, reg. Tip, and extender)

5 *20

9. Demonstrates correct utilization of the bovie suction attachment and identifies the correct adapter.

5 20

10. Given the scenario, Identifies the correct utilization of the bipolar Vs the monopolar unit.

5 20

11. Demonstrates the control of the surgical plume. Identifies the reason for controlling the surgical plume.

5 20

12. Demonstrates correct technique for "Buzzing a hemostat".

5 20

13. Identifies troubleshooting techniques in response to surgeon's request for increased cautery. (ineffective coagulation)

5 20

14. Inspects the bovie grounding pad site after removal and documents the skin condition.

5 *20

15. Identifies the items to be documented and Documents electrocautery settings; unit number; pad site and skin condition.

5 *20

16. Stores unit correctly. 5 20 Skills Lab Grade : 94–100% (A) 86-93%(B) 75-85% (C) - Satisfactory [ 65-74% (D) 0-64% (F) ] Unacceptable Grade: _____ % ____ (Divide Student Total by Possible 320 at Level 4/Satisfactory)

Possible Total 320

Total


Reviewed with Student: Date______________________ Student Signature_________________________________ Comments on back__ ____1st Attempt ______2nd Attempt_____3rd Attempt Instructor Signature_______________________________


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SKILLS LAB EVALUATION COMPETENCY - CIRCULATOR


MEETS STANDARDS/EXCEEDS GOALS………………………………….........5 Standards are defined as the basic principles MEETS STANDARDS/ MEETS GOALS........…………...…………………..........4 of aseptic and operating room care as MEETS STANDARDS/MET REQUIREMENTS/NEEDS TO IMPROVE ..….3 defined by AORN Standards. Standard STATES STANDARDS / NEEDS PRACTICE.…………………………………....2 Operating Room Technique. INSERVICED ON STANDARDS/ GOALS NOT MET...................…………........1 Points Points 1 2 3 4 5 N/A Wt. Possible Student Comment 1. Washes hand. 5 *20

2. Sterile room pre-setup. Assembles Supplies and equipment. (drape pack, basin kit, instrument set, surgical scrub setup); Places items correctly to be opened.

5 20

3. Ensures mannequin is positioned supine with "prepped area " (Breast Biopsy) exposed.

5 20

4. Opens sterile supplies maintaining sterile technique. 5 *20

5. Preps patient - Utilize scrub sponges begin prep • Begins at the incision line and proceeds outward • Utilizes circular motion to cleanse Does not return to incision site from periphery

5 20

6. Assists Scrub: Ties up Scrub Correctly, Checks instrument tray and verifies dry. Verifies counts of raytex, laps, instruments, and suture – Utilizes count sheet.

5 *20

7. Assists with local – Pours solutions correctly. Ensures meds are transferred from labeled container to labeled container.

5 *20

8. Assists with draping and establishment of sterile field. Assists with back table.

5 *20

9. Connects suction - ensures working. 5 *20

10. Connects bovie electrocautery and notifies surgeon of settings.

5 *20

11. Pours saline correctly and sterile water for instrumentation.

5 20

12. Conserves energy-time-motion: Utilizes step stools, etc as indicated.

5 20

13. Maintains sterile technique - if breaks in technique identifies per self or responds correctly.

5 *20

14. Monitors surgical field and anticipates needs appropriately such as suture; specimen; counts; etc.

5 20

15. Secures Dressing – Ensures all prep solution clean. Checks and documents bovie site and skin condition postop

5 20

16. Completes documentation correctly and records all required information including assessment; care plan; positioning; bovie unit; prep; postop dressing and disposition. No blank lines.

5 20

Skills Lab Grade : 94–100% (A) 86-93%(B) 74-85% (C) - Satisfactory [ 65-74% (D) 0-64% (F) ] Unacceptable Grade: _____ % ____ (Divide Student Total by Possible 320 at Level 4/Satisfactory)

Possible Total 320

Total




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SKILLS LAB EVALUATION & COMPETENCY FORM – SCRUB ROLE


MEETS STANDARDS/EXCEEDS GOALS………………………………….........5 Standards are defined as the basic principles MEETS STANDARDS/ MEETS GOALS........…………...…………………..........4 of Aseptic And Operating Room Care as MEETS STANDARDS/MET REQUIREMENTS/NEEDS TO IMPROVE ..….3 defined by AORN Standards. Standard STATES STANDARDS / NEEDS PRACTICE.…………………………………....2 Operating Room Technique. INSERVICED ON STANDARDS/ GOALS NOT MET...................…………........1 Points Points 1 2 3 4 5 N/A Wt. Possible Student Comment 1. Washes hand. 5 *20

2. Sterile room pre-setup. Assembles Supplies and equipment. (drape pack, basin kit, instrument set, surgical scrub setup); Places items correctly to be opened. Assembles additional items required.

5 *20

3. Ensures mannequin is positioned supine with "prepped area " exposed for Breast Biopsy.

5 *20

4. Opens sterile supplies maintaining sterile technique. 5 *20

5. Performs Surgical Hand Scrub Correctly. 5 *20

6. Dons sterile gown and gloves using closed glove technique.

5 *20

7. Prepares the instrument Area to receive tray with a blue towel without contaminating. Lifts out the inner instrument tray. Waits for circulator to check the inside of container and verify sterility. Places tray on top of blue towel

5 *20

8. Pepares the mayo stand: Drapes mayo stand, places ties on mayo cover, towel, towel rolls. Places items without looking at diagrams given previously to receive a 4 or 5.

5 *20

9. Sets up basin. Places items out of basin in place on back table, mayo, etc.

5 *20

10. Initiates counts of raytex, laps, instruments, and suture.

5 *20

11. Prepares draping supplies (towel with bovie/suction/light handles/two laps); drape, towels, clips, surgeon's gown/gloves.

5 *20

12. Completes Back table setup. 5 *20

13. Completes Mayo stand Setup. ( 5 hemostats, 2-4 kelly's, allis's , kocker's, right angles, needle holders, retractors, pickups, etc.)

5 *20

14. Conserves energy-time-motion: does not move an item over 3 times before it is in it's setup place.

5 *20

15. Completes setup in a timely fashion. 5 *20

16. Drapes appropriately for procedure. Drapes with assistance from instructor(surgeon). (stands well back from table edge; cuffs drape over hand and steadies sheet with other hand; watches hand in motion)

5 *20

17. Passes instruments correctly as requested by "surgeon/instructor".

5 *20


5 *20

Skills Lab Grade : 94–100% (A) 86-93%(B) 75-85% (C) - Satisfactory [ 65-74% (D) 0-64 (F) ] Unacceptable Grade: _____ % ____ (Divide Student Total by Possible 360 at Level 4/Satisfactory)

Possible Total 360

Total




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Must be completed and submitted for a grade for this course. Find The Item and Write In Where You Found It. If You Have Any Problem, See Instructor.

NAME_____________________ DATE____________________ SCAVENGER HUNT Circle Site: BMC GCMC Eye77

ALLEN STIRRUPS #16 FOLEY CATH KIT AESOP ROBOTIC ARM

BASIN KIT #8 SHILEY TRACH TUBE AUTOCLAVE

BLUE FOAM PADS – elbow/heel protectors 10 CC SYRINGE SLIP TIP BEAN BAG

BMC QUICK RESPONSE CARDS ARMY NAVY RETRACTOR BONE HOOK

CO2 GAS TANKS SPARE ARTHROSCOPY MACHINE BOTTLE OF SKIN DEGREASER

DOPPLER GEL/PROBE AVITENE BRONCHOSCOPE

EEA SIZERS BEACH CHAIR POSITIONER CAST CART

ETHER SCREEN BIOHAZARDOUS BOXES CORRUGATED/TAPE CHOLEODOCOSCOPE

FRAZIER SUCTION BLANKET WARMER COLD SALINE

HEMOSTATS - PEEL PACK CAMERA CRASH CART AND DEFIBRILLATOR

ICE COOLER CANDY CANE STIRRUPS CUSA

IMPRA GRAFTS C-ARM DRAPE CYSTO TUBING

LAHEYS CELL SAVER MACHINE AND SUPPLY BOX ELECTRIC RAZOR

MICROSCOPE (S) DOPPLER FORMALDEHYDE AND GAS MASK

MICROSCOPE STERILE EYE PIECES GELPI FRACTURE TABLE

O’SULLIVAN O’CONNER GIA 55 (TLC55) STAPLES HALL DRILL

PILLING LARYNGOSCOPE GREEN RETRACTOR HAND DRAPE

PLEUREVAC GUT ALLIS PEEL PACK HARMONIC SCALPEL

PORT-A-CATH AND SENSOR HAMBURGER RETRACTOR HOFFMAN EXTERNAL FIXATOR

PREFERENCE CARDS IOBAN DRAPE HOLMAN RETRACTOR

RINGS LAP PACK ICE MACHINE

SMOKE EVACUATOR LASER ICP MONITOR

SPARE SCREWS FOR SETS LIGACLIP APPLIERS KNEE INSTRUMENTS

SPINAL TABLE PADGET DERMATONE/BLADE MSDS SHEET FOR STERIS SOL

STERILE WEBRIL 3” PHYSICIAN’S LOUPES & OPTIVISOR NEZHAT DORSEY MACHINE

STERION FILTER for instrument cases PROCTO SET UP/PLUG IN TOO PNEUMATIC TUBE SYSTEM

STERIS MACHINE or Sterrad Machine PYXIS MACHINE PORTABLE CYSTO TABLE

STERNOTOMY TRAY – Emergency Chest tray RAYTEX RONGEUR

STRYKER COMPARTMENTAL MEASURING KIT – FOR COMPARTMENTAL SYNDROME

RICHARDSON RETRACTOR PULSEVAC – IRRIGATION/ASPIRATION MACHINE

SUTURE BOOTS SHROUD KIT – for postmortem care STAMEY NEEDLE

SUTURE CART PROLENE SLUSH MACHINE SURE CLOSURE SKIN DEVICE

TONSIL SNARES SMOKE EVACUATOR FILTERS SYNTHES LARGE FRAGMENT

TRAY CHEST SPARE EQUIP LIGHT BULBS TRAY - PLASTIC - DR NUNNERY’S

TRAY ENT TOURNIQUET TRAY - LARGE BONE

TRAY GI TRACE CART - LAP CHOLE Drape pack VAN BURENS

TRAY LAP CHOLE TRAY LACRIMAL DUCT ZIMMER HIP INSTRUMENTS

VIDEO MONITORS -LAPAROSCOPIC TRAY T&A

WARMING LIGHTS FOR KIDS UNSTERILE RAZORS


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CASE PULLING ASSIGNMENT (8-10 Cases) – Day 1

Clinical Adjunct Designee or Preceptor assigns student to case preparation area to pull cases, and instructs student regarding the techniques to prepare for a case. Student will receive instruction regarding preference cards utilized including storage of sterile supplies, handling techniques to follow, supply assembly, positioning tools, and general case cart setup for specific procedures. Student is assigned to gain experience with case cart preparation and sterile supply room organization to with the preference cards, location of supplies, and case preparation. Student is to determine a plan of action for case preparation in the operating room and then assess for variances in the plan with the actual experience.

A. Assignment a. Checks case cart with preference card. b. Adds any items not pulled including positioning tools. c. Make sure next case for each room has been pulled. Makes sure any add-on

cases are pulled. d. When assigned by case pulling personnel, pushes case cart outside assigned

room (outer hall) for each case after verification for completeness

Paperwork to be Submitted for this assignment: a. Complete the case pulling assignment on the first time assigned to the supply

room. b. Evaluation: During one of your experiences (after you are comfortable

pulling cases) give preceptor that you are working with the student case preparation skills check off evaluation to complete.

Please note: anytime that you are not assigned to a clinical case due to downtime (case

canceled; delay in case, etc), you are expected to report to case pulling or the instrument room to gain further experience in these areas.


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Case Pulling Learning Activity

Utilize preference card and schedule. Pull cases when not assigned to a case or room. Need to pull at least 8-10 cases. Choose three cases to pull the first time assigned and complete the following information on each one. Submit as documentation of activity. 1. Case #1 a. Case______________________________Surgeon____________Age of Pt__________ b. Basics: Drape______________________________________________________________ Instruments_________________________________________________________ Suture______________________________________________________________ Other Supplies______________________________________________________ Dressing____________________________________________________________

Prep_______________________________________________________________ Positioning/items_____________________________________________________

Case #2

a. Case______________________________Surgeon____________Age of Pt__________ b. Basics: Drape______________________________________________________________ Instruments_________________________________________________________ Suture______________________________________________________________ Other Supplies_______________________________________________________ Dressing___________________________________________________________ Prep_______________________________________________________________

Positioning/items____________________________________________________ Case #3

a. Case______________________________Surgeon____________Age of Pt__________ b. Basics: Drape______________________________________________________________ Instruments_________________________________________________________ Suture_____________________________________________________________ Other Supplies______________________________________________________ Dressing____________________________________________________________

Prep_______________________________________________________________ Positioning/items_____________________________________________________

4. Make a copy of the three other preference cards.


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CASE PULLING EVALUATION Submitted after pulling cases. Filled out by preceptor.

NAME____________________________DATE___________EVALUATOR__________________ MEETS STANDARDS, SHOWS INITIATIVE..................................5 STANDARDS ARE DEFINED AS THE BASIC PRINCIPLES MEETS STANDARDS, MEETS EXPECTATIONS..........................4 OF ASEPTIC AND OPERATING ROOM CARE AS UNDERSTANDS STANDARDS, NEEDS MORE PRACTICE.......3 DEFINED BY AORN STANDARDS. STANDARD STATES STANDARDS, UNACCEPTABLE PRACTICE................2 OPERATING ROOM TECHNIQUE. INSERVICED ON STANDARD, UNACCEPTABLE PRACTICE..1 1 2 3 4 5 COMMENTS 1. Arrives on time

2. Utilizes preference card correctly to ensure case complete (positioning items also) for room turnover

3. Informs appropriate personnel when items are not available ASAP.

4. Utilizes correct body mechanics, work simplification techniques to reduce strain. ex. lifting trays

5. Case pulled and ready on time. ( no room delay)

6. Keeps work area neat, clean and organized.

7. Returns items to sterile supply storage correctly.

8. Correctly identifies supplies, instruments and trays

9. Checks with front desk frequently for add ons; set up next case outside the assigned room.

10. Pulls add on emergency cases in a speedy and timely manner.

11. Handles packages and supplies appropriately and stores correctly. (Does not put sterile supplies on floor/wet areas, etc)

12. Identifies breaks potential event related contamination that may occur and corrects same.

13. Handles/packages sharp items correctly

14. Shows interest/ asks questions appropriately

15. Keeps coworker/team members informed. Shares info quietly and plans ahead

16. Follows directions within a timely fashion.

17. On time returning from lunch and breaks. COMMENTS: STRENGTHS: AREAS TO WORK ON:

Reviewed with Student: Date_______________Instructor Signature__________________Student Signature_____________________ Comments attached____Yes____No


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INSTRUMENT ROOM ASSIGNMENT ROTATION (Instrument Decontamination, Identification, Preparation)

Day 2-3 (8 Hours)

Student receives instruction and experience regarding the techniques in instrument decontamination, identification, preparation, and sterilization techniques. Student is to determine a plan of action for instrument decontamination and sterilization in the operating room for flash sterilization and routine sterilization and then assess for variances in the plan with the actual experience. Assigned to assist with instrument preparation to gain experience with the instrument handling, decontamination, flash autoclave utilization, wrapping and packaging procedures, instrument count sheets, and instrument identification. 1. Assignment – Areas of training: A. Manual Decontamination aa. PPE bb. techniques cc. solutions/Safety precautions B. Operation Washer/Sterilizer C. Assembly of trays aa. inspection bb. testing cc. cleaning dd. lubrication D. Sterilization/Disinfection aa. flash Sterilizer operation*** bb. steris operation**** cc. cidex dd. biological and dart ee. preparation tests for gas (ETO) E. Transportation to CSR F. Wrapping/Tray Assembly aa. Peel pack bb. Wrappers cc. Trays

dd. Vac-pac ee. Indicators 2. Paperwork to be Submitted:

A. Evaluation: During one of your experiences (after you are comfortable in the instrument room) give preceptor that you are working with the student case preparation skills check off evaluation to complete. Gives staff preceptor the student evaluation sheet to complete.

3. Please note: anytime that you are not assigned to a clinical case due to downtime (case

canceled; delay in case, etc), you are expected to report to case pulling or the instrument room to gain further experience in these areas.


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INSTRUMENT ROOM EVALUATION Submitted during orientation to clinical site.

NAME____________________________DATE___________EVALUATOR______________ Meets Standards, Exceeds Expectations, Exceeds Goals................5 Standards Are Defined As The Basic Principles Meets Standards, Meets Expectations, Meets Goals.......................4 Of Aseptic And Operating Room Care As Meets Standards, Met Requirements, Needs to Improve ………..3 Defined by AORN Standards. Standard States Standards, Expectation not met, Needs Practice.2 Operating Room Technique. Inserviced on Standard, Expectations not met…………………...1 1 2 3 4 5 COMMENTS 1. Arrives on time

2. Duties of Instrument Technician explained

3. Utilizes Personal Protection Equipment in care of instruments.

4.Cares for and handles/cleans/inspects/tests: a. surgical instruments correctly b. powered equipment (drills/saws) c. laparoscopic equipment d. micro instruments

5. Utilizes correct body mechanics, work simplification techniques to reduce strain. Ex: lifting trays

6. Manually decontaminates instrumentation per procedure. Dons appropriate PPE.

7. Utilizes Washer/Sterilizer correctly(loading; use)

8. Utilizes instrument list to complete tray correctly.

9. Correctly identify instrument trays and contents.

10. Prepares instruments for gas sterilization correctly

11. Prepares instruments for steam sterilizing correctly

12. Secures instruments/prepares packaging correctly a. peel packs (double; indicator; appropriate) b. wrapper (folded for correct presentation) c. containers (secures correctly)

13. Labels all items correctly with process date; item; OR; external indicator and initials.

14. Transports instruments CSR correctly

15.Handles/packages sharp items correctly

16. Informs appropriate personnel of missing or defective items from trays/instrument.

17. Shows interest/ asks questions appropriately

18. Follows directions within a timely fashion.

19. On time returning from lunch and breaks.

20. Keep coworker/team members informed. Shares info quietly and plans ahead

21. Operates Steris (BMC) or Sterrad (GCMC) Sterilizer correctly per instructions.

22. Operates flash Sterilizer correctly per instructions

23. Correctly utilizes/checks cidex correctly.

24. Keeps work area neat, clean, and organized. COMMENTS: STRENGTHS: AREAS TO WORK ON:

Reviewed with Student: Date______________________ Student Signature_________________________________ Instructor Signature_______________________________


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ASSIGNMENTS – SKILLS TO BE COMPLETED

Circulator Role Scrub Role Skill Date

Completed Skill Date

Completed Completes Scavenger Hunt

Pulls case -

Position Supine Open case – Sterile Supplies using Preference Card

Position – Prone Gown and Glove Position – Lateral Observe Case

Scrubbed in

Position – Lithotomy using candy canes

Sterile Scrub in and setup a minor case

Position – Lithotomy using Allen Stirrups

Assists Surgeon to gown

Skin Prep – Abdominal Prep

Assists with Laparotomy Draping

Skin Prep – Vaginal Prep

Loads and passes suture correctly

Skin Prep – Extremity

Assembles Balfour

ESU – Application and operation of Electrocautery Unit

Disassembles case and transports instruments to processing

Laparoscopic Case – Setup with Monitors/Camera

Power Instrument – Nitrogen Connection

X-Ray Specimen Care Documentation – OR record completed correctly without assistance


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CLINICAL INTERNSHIP - NURSE (CIRCULATOR) SKILLS EVALUATION Name________________________________ Date____________________Evaluator_______________________ Lowest Possible score 104 with maximum score of 130 to meet all goals (* items require 4-5 level). MEETS STANDARDS/EXCEEDS GOALS…………………………………...........5 Standards are defined as the basic principles MEETS STANDARDS/ MEETS GOALS........…………...…………………...........4 of aseptic and operating room care as MEETS STANDARDS/MET REQUIREMENTS/NEEDS TO IMPROVE….…..3 defined by AORN standards. Standard STATES STANDARDS / NEEDS PRACTICE.…………………………………....2 operating room technique INSERVICED ON STANDARDS/ GOALS NOT MET...................…………..…..1 1 2 3 4 5 Comments 1. Arrives on time for report or to prepare for case *

2.Checks with front desk for instructions. Prepares for case. Researches assignment PRN. Communicates changes such as closing; added procedures during case

3.Checks Case Supplies. Supplements set up correctly. Utilizes preference cards correctly prior to case start.

4.Opens sterile supplies with out contaminating. Check exp. Dates indicators/event related package indications to verify sterility. Takes action PRN.

*

5. Greets & transfers patient to OR table correctly – verifies consent; chart preop checklist; site; physician; Obtains lab/x-rays/blood in a timely manner

*

6. Completes Surgical Prep according to policy. *

7. Positions patient according to policy. Protects from injury; utilizes positioning tools correctly. Modifies for age as appropriate.

*

8.Gloves using open technique correctly *

9.Maintains room clean and orderly during case.

10. Assists with Mayo and Back Table Setup/draping: standard for type case. Connects equip & pulls up.

11. Initiate/ Completes counts (sponges/needles/instruments) *

12. Keeps attention on the surgical procedure. Shows interest. Anticipates next step in procedure & establishes priorities. Reacts smoothly & quickly to surgeon/scrub requests.

13.Observes sterile field at all times. Guards sterile field assertively. Initiates action for breaks

*

14. Completes documentation completely and accurately. a. Patient Assessment completed and documented b. Documents patient identification, surgical site verification, and ensures consent/preop

checklist is present and accurate. c. Initiates Care Plan (Anxiety, Safety, Hypothermia Prevention) d. Modifies care plan and interventions appropriately for age

1. Neonate/Infant (Birth to 18 months) 2. Pediatric (19 months to 11Yrs) 3. Adolescent ( 12 – 17 Yrs) 4. Adult (18-64 Yrs) 5. Geriatric (65 plusYrs) 6. Modifies appropriately for handicaps, mental and physical conditions.

15. Handles, passes, and stores sharps safely. *

16. Assists with dressing/drain. Cleans all prep materials from patient’s skin. Secures tape correctly.

17. Removes and cares for items after the case correctly (Specimens). *

18. Assists with equipment removal and room turnover. Ensures all equip. & supplies are returned to the appropriate storage place. Meets room turnover goals.

19. On time returning from lunch and breaks.

20. Asks appropriate questions pertinent to the case. Maintains a quiet professional room. (limits noise)

21. Keep coworker/team members informed. Shares info quietly and plans ahead. ex premedicates; RR bed

22. Demonstrates Patient Centered Care. Functions as Patient Advocate while meeting patient’s needs.

Comments (Use Back PRN) To Obtain Grade Divide Total Score Achieved By The Total Number Possible (4x22 = 88points) : Strengths: Areas To Work On:

Reviewed with Student: Date______________________ Student Signature_________________________________ Comments on back__ Instructor Signature_______________________________ Need to submit at least 5 evaluations completed at weekly intervals during the 180 hours of experience. One should be completed by your preceptor on the last day of your clinical experiences.


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CLINICAL INTERNSHIP – SCRUB ROLE Name______________________________Date___________Evaluator___________________

* Items are critical items – must have a 4-5 level. MEETS STANDARDS/EXCEEDS GOALS………………………………….........5 Standards are defined as the basic principles MEETS STANDARDS/ MEETS GOALS........…………...…………………..........4 of Aseptic And Operating Room Care as MEETS STANDARDS/MET REQUIREMENTS/NEEDS TO IMPROVE ..….3 defined by AORN Standards. Standard STATES STANDARDS / NEEDS PRACTICE.…………………………………....2 Operating Room Technique. INSERVICED ON STANDARDS/ GOALS NOT MET...................…………........1 Points Points 1 2 3 4 5 N/A Wt. Possible Student Comment 1. Washes hand. 5 20

2. Sterile room pre-setup. Assembles all required Supplies & equipment. (Opens in correct sequence: drape pack, basin kit, instrument set, surgical scrub setup); Placed correctly to be opened.

5 20

3. Opens sterile supplies maintaining sterile technique. (Inspects package; opens away from self first; unsterile arm does not reach over; No unsecured edges)

5 *20

4. Dons appropriate protective personal equipment. (eyewear, mask, X-ray gown prn)

5 *20

5. Performs Surgical Hand Scrub Correctly. 5 *20

6. Dons sterile gown and gloves using closed glove technique.

5 *20

7. Prepares the instrument Area to receive tray with a blue towel without contaminating. Lifts out the inner instrument tray. Waits for circulator to check the inside of container and verify sterility. Places tray on top of blue towel

5 20

8. Prepares the mayo stand: Drapes mayo stand, places ties on mayo cover, towel, towel rolls

5 20

9. Sets up basin. Places items out of basin in place on back table, mayo, etc.

5 20

10. Initiates counts of raytex, laps, suture, instruments. Counts initial, closure of peritoneum, closure of skin. Starts at field, mayo, back table, kick bucket.

5 *20

11. Prepares draping supplies (towel with bovie/suction/light handles/two laps); drape, towels, clips, surgeon's gown/gloves.

5 20

12. Completes Back table setup. 5 20

13. Completes Mayo stand Setup for case. ( 5-6 hemostats, 2-4 kelly's, allis's , right angles, needle holders, pickups, etc.)

5 20

14. Conserves energy-time-motion: does not move an item over 3 times before it is in final setup place.

5 20

15. Completes setup in a timely fashion. (10-15 min) 5 20

16. Drapes appropriately for procedure. Drapes with assistance from instructor(surgeon). (stands well back from table edge; cuffs drape over hand and steadies sheet with other hand; watches hand in motion)

5 20

17. Passes instruments correctly as requested by surgeon. 5 20


5 *20

19. Hands: Keeps hands at table level only. Maintains hands in sight, not above shoulder height or lower than table or waist level.

20. Faces Sterile Field at all times. Does not walk between two sterile fields. Maintains 12” distance between sterile and unsterile areas.

21. Guards Sterile Field Assertively. Maintains field within sight and grouped closely together. Instructs others to maintain proper distance.

Skills Lab Grade : 94–100% (A) 86-93%(B) 75-85% (C) - Satisfactory [ 65-74% (D) 0-64 (F) ] Unacceptable Grade: _____ % ____ (Divide Student Total by Possible 360 at Level 4/Satisfactory)

Possible Total 360

Total


Reviewed with Student: Date______________________ Student Signature_________________________________ Comments on back__ ____1st Attempt ______2nd Attempt_____3rd Attempt Instructor Signature_______________________________ Need to submit at least 3 forms for 3 experiences. Scrub cases should be simple minor cases such as breast biopsy, hernia repair, excision of mass, etc.