Protect the Innocent

1. Beautiful Golden Gate Bridge

2. Protect The Innocent Rachel Ray AAS, CST, SFA Arkansas State Assembly President

3. No�.Not that Rachael Ray

4. y This one�� Ryan and Rachel Ray

5. Protect the Innocent Webster�s Dictionary Protect means: To cover or shield from exposure, injury, harm or destruction. Innocent means: Free from guilt or sin through lack of knowledge or evil.

6. Protect the Innocent We already know and have been taught all of the things I will be discussing today. Maybe some things you have forgotten? Maybe you already do these things on a daily basis and this will be just a refresher.

7. This should be a group effort by ALL involved in the room with the patient.

8. Modern Surgery, Modern Times, Modern Ethics

9. How do we do this??? Know your rights as a CST Surgical Ethics Civil Liability Intentional Torts Protect the Patients Property Protect the Patients Environment Protect the Patients Mind Protect the Patients Dignity Protect the Patients Body Protect Yourself Educate yourself

10. Know your rights as a CST!!! You have the right to speak up if you think the patient is in danger of having nerve damage or a tear of the skin, or anything that could cause potential harm to the patient. As a CST you DO have the right to include input on how the patient is positioned. DO NOT allow someone to bully you from your educated suggestions!!!! Remember, your name is on the Operative Record as well, so do not think your not held accountable just like everyone else.

11. Surgical Ethics �Ethical behavior in the operating room is inseparable from surgical conscience. It requires a high level of moral conscience coupled with sound judgment and professional honesty. Numerous practices in surgery are affected by professional ethics of the employee. � 1 Patients have an ethical and legal right to privacy for themselves.

12. Surgical Ethics If mistakes made behind the Operating Room doors, then they are made by humans. As humans if we contribute in any harm done to a patient then we have to figure out how to make that not occur again.

13. Surgical Ethics Any action in surgery that can cause potential harm to the patient is called an incident. If an incident were to occur, one or more of the team members should provide a written account of the occurrence and turn it into the designated person in charge. I strongly suggest you make a copy of the document before turning it in. Someone else may submit an incidence, where you may be called into the office to give your account of the occurrence.

14. Surgical Ethics You will be required to write down exactly what happened, who was in the room, and the time and date of the event. This is not a comfortable place to find yourself in. However, sometimes it is unavoidable because you are the scrub assigned in that room. You can not control someone else's actions, but you can do what is right to protect your patient.

15. Surgical Ethics There are many examples of incidents, here are some of the common ones--- Inaccurate sponge and needle counts. We certainly have to try and protect our patient from this mistake. This requires an X-ray to rectify our mistake. Any type of gross contamination caused by staff.

16. Surgical Ethics Any injury a patient might endure as a reflection of a staff member not taking proper precautions to protect their needs. This could be substance abuse witnessed or suspected by a staff member. Misconduct by a staff member during their shift. Equipment failure resulting in injury to the patient or staff. Patients falls�this does include if the staff prevented the patient from hitting the floor.

17. Surgical Ethics There are things that need to be measured and added into these reports on how to fix the problem. Ultimately these reports are in place to allow a solution at the end of the day for a potential disaster to be avoided in the future.

18. Outcomes May Vary!!!

19. Civil Liability Negligence--- This is defined as �the failure to exercise due care, or the care that an ordinary prudent person would exercise under the circumstances.� 1 It is your responsibility to do the right thing for the patient at all times.

20. Intentional Torts A negligent act is considered an accident in which there is no intention of harming any person, yet there has been harm done. If you have an operating room employee that commits an intentional act against a patient, it is not considered a crime, yet you can still be reprimanded for it. There is also something called an intentional tort. There is two types of this: Defamation-this is an opinion that is shared with someone outside of the operating room in a derogatory manner.

21. Intentional Torts If the comment is made in writing it is then considered �Libel�. If the comment is made orally then it is considered slander. Both of which you can be sued over if in the event they are found innocent of the accusations made. This is food for thought�be careful what you say outside of the Operating Room doors.

22. Protect the Patients Property Clothes Shoes Teeth Personal items such as canes, or other items they may have on them upon admittance with no family around to hang on to it for them. If they have wallets, purses, money accounts numbers, or any Identification on them, you need to call Security and they should be able to lock it up in a locker for them for safe keeping until the surgery is over and the anesthetic agents have worn off.

23. Protect the Patient�s Property This does not just include monetary things--- This includes properly taking care of the patient�s specimens. This involves labeling them correctly. Laterality, proper site recognition, list them as frozen sections, permanents, or cultures, or looking for margins in a resected specimen. Cytology specimens� these need to go down separate. This is usually collected in a suction canister separately. Lukens tube specimens, culture tubes, gram stains, fungal stains, TB stains, aerobic, anaerobic, etc.

24. Protect the Patient�s Property Example: If you are doing a Thoracotomy, you can have Lukens tubes for stains, lymph nodes for cultures, and lymph nodes for permanent. You can have a wedge resection of lung that can go part for culture, part for frozen, and part for permanent. You can have a canister for cytology. This can all be for just one case. You should be ready with a marker and several specimen cups. You need to label each accordingly.

25. Protect the Patient Environment Warmth to the patient. Our patients are being wheeled around in a skimpy gown throughout the cold hallways, pre-op, and then into a really cold OR room. Provide a warm blanket and try not to fan the patient as you exchange the cold one for the new one. DO NOT SLAP A COLD GROUNDING PAD ON SOMEONE UNTIL THEY ARE ASLEEP!!!!! That is an extremely poor practice and should not be tolerated.

26. Protect the Patient Environment After the patient is asleep the Bair hugger will help with the maintaining the warmth of the patient. Some facilities use under the body warming blankets as well. It just depends on where you are working. You need to make sure that all equipment is functioning properly before the patient is wheeled into the room.

27. Protect the Patient�s Environment This also includes taking care of the room with your counts and other things that you are responsible for. Make sure you know what procedure you are doing and have all our your equipment and supplies available outside of the room in the event you may need them so the circulator does not have to run for them. This will create a stress free environment and it will take time off of the case by having things readily available.

28. I am sorry sir, I thought the consent was for vasectomy, not a tonsillectomy??????

29. Protect the Patient�s Environment Counts� They need to be done before any incision is made. They need to be done before a cavity is closed, based on your hospitals protocol there may be other rules you need to follow. C-Section cases DO NOT BE BULLIED out of a count at any time. If you feel this way then you need to report it, because this is a safety concern for the patient. This needs to be done audibly, and visually by the CST and the RN that are counting. These items should be seen and NEVER assumed!!! It is your responsibly to make sure they are done at the appropriate time and in a timely manner.

30. Make your patient feel comfortable!

31. Protect the Patient�s Mind It is our job to put the patient at ease when they are rolled into the room. We need to make them feel as comfortable as possible. Engage in conversation with them, even if it is small talk it will still be talk. It could be the very thing to divert their mind from the current pain they may be in.

32. Protect the Patient�s Dignity Assure the patient that their body will be kept at the utmost discretion. You do this by pulling the blinds down when a patient comes into a room so the people in the core cannot see into the room. You make the effort to keep their body covered as much as it is possible while they are still awake. Even when the patient goes to sleep and is getting ready to be positioned & prepped you & everyone else in the room must at all times keep any & all comments to yourself.

33. Protect the Patient�s Body Cuts, Tears, Bruises, Burns, Nerve damage and any harm that can come to the patient at our hand. Padding--- This includes many things people disregard. Safety straps across the legs. Velcro straps across the arms. Headrests, gel pads, pillows, foam, side rails, and so much more. Time Outs (audible or written), bracelet checks, allergy checks (meds, latex, adhesives, etc.)

34. Protect the Patient�s Body Cuts---- Make sure you place all sharps back onto your mayo or back field while not in use.

35. Protect the Patient�s Body Tears or shearing- Be ever so careful when taking adhesive tapes, op-sites, steridrapes, ioban, or any other thing that could tear the skin or cause a blood blister to appear. When moving a patient with a roller board be careful not to tear the skin. When pulling a draw sheet, linen sheet, a towel, leads, or cautery grounding pads you need to watch not to shear the skin as well.

36. Protect the Patient�s Body Bruises� We need to be aware when we are retracting not to hit an eye, nose, or anywhere on the body unexpectedly. We also need to help the nurse recognize when a patient has a pre-existing bruise so it can be documented. We do not need to find ourselves leaning on a patient during the procedure because we could create a pressure bruise.

37. Protect the Patient�s Body Burns� Preps should be done based on the guidelines stated on the package. If you are using Chloraprep or Duraprep, then it is stated to wait a minimum of 3 minutes before covering the prep up with drapes. If you don�t wait you will trap the alcohol vapors under them causing a fire when the cautery is engaged. Ask me how I know�.It�s not pretty!!!!!!! Anytime you have prep and a cautery involved you should have NaCl on the field so you can extingish any unwanted fires.

38. Protect the Patient�s Body Burns�The bovie should always be holstered when not it use. The holster should always be placed up on the drapes in reach of the surgeon. What if the surgeon refuses to use it? Place it on the drapes anyway. You cannot make them, however you have taken all precautions to protect the patient.

39. Protect the Patient�s Body Padding� Make sure the patient has all bony prominences protected with padding. It does not matter whether is patient is small or large all the body must be considered. Many cases involve a position that requires you to pad breasts and genitals, we need to watch for these sensitive areas. Skin should never be touching metal. Put yourself in that position in your mind, and think if that looks comfy to you. Place the body in normal positions as much as possible.

40. Protect the Patient�s Body Nerve damage is horrible also. There is a young woman from our area whom is in her early 30�s when she had her first child. This is supposed to be the most awesome experience of a woman's life. It was not until she woke after the emergent C-Section when she noticed she did not have movement of her right arm. Whomever placed her arms on the arm board had done it in such a manner to where one of them was hyperextended enough to cause major damage. 2

41. Protect the Patient�s Body Her arm was like this for the entire time of the Section where she was under anesthetic. She had a dead arm when she woke. The child is three years of age now, and for this entire time she has been under rehabilitation and still yet has very minimal function from it. How sad, and it all could have been prevented had someone positioned her correctly.

42. Protect Yourself at all times!!!!

43. Protect Yourself Use your head� Use your training!!! PPE Personal Protective Equipment Put on your exam gloves when touching a patient or a patients belongings or bedding. Wear your eye wear, whether that be your regular eye wear with shields to prevent blood or body fluid from splattering into your eyes, or your laser goggles when using a laser. Double glove when working with bones or heavy instruments that could cause you to tear your glove. When doing a total joint some facilities require a hood to be worn during the procedure.

44. Protect Yourself Steer clear of artificial nails Get your immunizations, stay current If you are stuck, cut, burned, or otherwise wounded during a case you must protect yourself by going to the ER and getting checked out. You will need to take a patient sticker with you when you go. They will draw your blood and the patients blood as well.

45. Protect Yourself from potential things you could contract from a patient.

46. Protect Yourself I know a scrub whom was stabbed in the hand between the thumb and the pointer finger with an 11 blade. The blade was thrown in anger by the surgeon. The patient was having a carotid endarterectomy done. The patient was in their 40�s. The patient was covered in tattoos.

47. Protect Yourself After the case was completed she went to the ER to have her blood drawn and have the wound cleaned out. After she got home that evening she was called back to the ER to have more blood drawn. The patient had tested positive for HIV. The scrub was horrified!!

48. Protect Yourself This scrub was a young new mother of a daughter she was still breast feeding. She was told to pump her milk and throw it away, she was told to not kiss her husband or to be intimate with him in any way until told otherwise. They put her on medication until they were to retest her and the patient again. Four days past and blood was redrawn, and then redrawn again. Luckily it was re-spun and it was a FALSE POSITIVE.

49. Protect Yourself The scrub was overjoyed to find out all was well, and all the precautions she was taking she could then stop and she could then resume normal life activities. She was retested for the next consecutive 6 years to make sure all was well, and it was. 3 BE SURE TO PROTECT YOURSELF!!!

50. Protect Yourself That scrub is me�.. I almost had a heart attack myself!!! Oh yes,,,,, the surgeon????? Let�s just say we had a meeting at the flag pole!!!!!! And we were not saluting the flag!!! Never let anger lead your emotions in the Operating Room. It�s childish, immature, and dangerous for all involved.

51. Educate Yourself Keep yourself in the �KNOW�!! No one can educate you, but you. Stay current on your CEU�s (Continuing Education Units). This is something you do anyway being a CST. This doesn�t give you a license to argue. This gives you the power to keep your patient and everyone in the room safe based on educated conversations pertaining to the case at hand. If you know the dos and don�ts of products, suture, autoclaves, etc., then you open yourself up for success. Having said that---if you are unsure of something lay Mr. Pride down so that you can go ask someone who does know about the case and the how toss that go along with it.

52. Educate Yourself Be prepared to back up your statements with a book, a product pamphlet, or online information. Do not get yourself fired over stating the facts, but feel confident in stating helpful information that will benefit the patient. Do this in a way of respect and use it as an opportunity as a learning tool for all in the room. Simply not thinking and using your brain can be a major source of a tragic accident in the O.R. There are always 2 kinds of people in the Operating Room: You are part of the problem, or you are part of the solution. WHICH ONE ARE YOU?????

53. 49ers!!! Joe Montana!! Oh Yeah!!!

54. Thank you for you time. Have a great rest of you conference here in California.

55. References 1. Surgical Technologist Joanna R. Fuller Third Edition W.B. Saunder Company Philadelphia, London, Toronto, Montreal, Sydney, Toyoko c 1994 2. Dr. Rowland P. Vernon Cardiovascular/Thoracic Surgeon Fort Smith AR 3. Life Experiences from 1995 to present.