A day in the life of most people can be varied but as a Scrub Nurse, Amira faces challenges that we may not otherwise consider. In this piece, she outlines a day in her role as a Nurse in Theatre.
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Beginning The Day
My usual work day starts at 8am.
I check which Theatre I have been allocated to and then I go ahead and check that the Theatre is fit for purpose.
This means checking things like suction, diathermy machine and stocking up.
We need to make sure we check things like the operating lights, suction and diathermy.
This is because these three things are essential when performing surgery therefore if they're not in working order then the list cannot go ahead.
If something wasn’t working then it would be our responsibility to ensure it’s been reported.
For example, a couple of weeks ago, we had a hernia list but I came into Theatre and it was around 5 degrees which was too cold.
I tried to turn up the temperature in Theatre but our thermostat didn’t seem to respond.
Due to this, we had to delay our list as we had young babies that were on it and the temperature wasn’t suitable at all.
I called estates straight away and they said they were working on it but this meant we couldn’t start our list until the Theatre was at least 18 degrees which was deemed a suitable temperature.
Once all the Theatre checks are done, I look at the what's on the operating list and ensure we have the correct equipment and sets out for it.
After this, one of the scrub practitioners would check the drugs with ODP.
We check drugs before and after every list.
In the meantime, the other scrub person would ensure that things like fridges are checked and relevant paperwork such as the covid check list is completed.
For example, if I was in the trauma and orthopaedic Theatre, I’d ensure that we have stocked up orthopaedic drapes, ensure that we will have x-ray if needed for the cases and also consumables for a washout.
Once you start doing certain lists or have a home Theatre, you automatically know what you’ll need for lists and cases.
After setting up, we wait for team brief which usually happens around 8:30-8:45 am.
This is when the scrub team, Anaesthetist, Surgeons and ODP brief about the list.
We discuss each individual Patient and their care.
This is a opportunity to ask Surgeons about any queries we may have and to ensure that we have the correct kit.
This is because before team brief the Surgeons go and see Patient therefore the plan of care might change.
In addition to this, the Anaesthetist also informs us of any relevant care history and discusses how the Patient will be put to sleep.
After briefing about the Patients, we go through our emergency role allocations.
This is when the team leader allocates an emergency role to staff members.
For example, surgeons would be on compressions, ODP on emergency drugs, non-scrub would scribe, someone (support worker/scrub) would call for help, someone would grab the defib trolly (support worker or scrub) Anaesthetist would be the team leader.
It's essential that we do the role allocation at the start of every list so everyone has their own individual role.
This is because if we ever do an emergency in Theatre, no two people would be running to complete the same task and we would know that everything has been done.
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Attending To The Patient
Once we’ve done team brief, we would then start to send for our first Patient, if the team was happy.
Normally we either call the ward to send for the Patient of we send down an orderly.
When sending for the Patient we check their name, date of birth, hospital number and the last time they had anything to eat and drink.
It’s vital that we know when the Patient had anything to eat or drink before having general anaesthetic, because there’s a risk of vomiting or bringing food up into your throat.
This is especially dangerous when a Patient has been tubed as their airway will be compromised.
Even drinking water can lead to pulmonary aspiration.
This means that the water can enter the lungs and potentially block the airway (this would end up causing infections such as pneumonia).
Once we have sent for the Patient the person who is scrubbing for the case will get ready and scrub whilst the circulating staff members would ensure the kit is open and ready for the Scrub Nurse to use once they’re sterile.
During this time, we also ensure we’ve told the surgeons we’ve sent for the Patient so they can also be ready and we’d also make sure that we’ve notified anyone else we would possibly need for the case such radiographers or clinical photographers.
Moving The Patient To Theatre
Once the Patient has been anaesthetised and comes into the operating Theatre, we start our WHO time out.
This is when we all pause what we’re doing and focus on the Patient.
We ensure it’s the correct Patient by checking their wristband, consent form and pre operative paperwork.
We check that we’re performing the correct procedure on the marked operative site.
The time out checklist ensures that we’re all on the same page which the procedure.
For example, it asks whether we have the correct equipment, if there’s any major loss of blood and if blood products are available.
Once we have completed the time out the surgeons proceed with knife to skin.
The circulating staff will then record all operating times and complete ORMIS. The circulating staff will then ensure the Scrub Nurse has everything they need and complete swab counts.
After the surgery is over, we complete the WHO sign out.
The sign out is usually completed before the Patient leaves to go to recovery, therefore we ensure that the recovery Nurse is called into the Theatre.
The sign out asks:
Whether the operation has been completed as listed on the consent form? Were the swabs, needles and instruments counts correct including explanted items and throat packs?
Were there any samples or specimens?
Are there concerns about the Patient for recovery?
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Once The Patient Is In Recovery
After this the Patient goes to recover, the practitioner who scrubbed for the case will go over with the Anaesthetist and ODP to handover the Patient.
After this, we will ensure the Theatre has been cleaned and is ready to send for the next Patient.
If it is the end of the list, then we give the Theatre a proper clean with bleach, so the operating floor can be cleaned by domestics.
We ensure all the bags of clinical waste and linen bags are properly disposed of and used equipment has been put away to be washed and sterilised.