How to Survive Minimally Invasive Surgery<br />The Perioperative Nurse’s Survival Guide<br />
Preoperative Planning:  Setting the Stage for Success<br />
Thanks for letting me know I have a Lap Chole to follow, going to check the room now. <br />
Setting the Stage for Success<br />	Schedule the case but….<br />What is so important about scheduling the case?<br />
Make sure its scheduled correctly, why is this important? <br />
Keep preference cards updated<br />Can this really be done?<br />Who is responsible? <br />
Provide realistic time estimates<br />How can this be done and who is<br />responsible? <br />
Team Work= Dedicated Team<br />
Pre-operative Teaching: Setting the Patient up for Success<br />
Pre operative Teaching<br />Minimally invasive surgery instructions<br />General outline of pre-op questions<br />Procedur...
Let’s pretend you are the patient and you are at the doctor’s office…<br />You do not know about your condition, <br />You...
So now what?<br />
Let’s try it again…<br />
In simple terms please? <br />
Teach to the level of the participant<br />
In small quantities of content in simple terms<br />
Provide opportunity for questions and encourage questions<br />
Pre-operative Teaching: Setting the Patient up for Success<br />Provide minimally invasive surgery instructions<br />Provi...
To  assess what the patient knows first before tackling the questions they may ask<br />
To ask open ended questions to solicit information <br />
Top Ten Questions<br />How long will the surgery take?<br />How long will I be in the hospital?<br />What can’t I do when ...
But what they really want to know…<br />
When can I drive?<br />Will I need further treatment?<br />When can I go back to my normal activities?<br />Size of scar?<...
When can I resume my normal activities?<br />
Number One Question<br />
Who will be doing my surgery?<br />
Pre-operative Teaching: Setting the Patient up for Success<br /><ul><li>Minimally invasive surgeryinstructions
General outline of pre-op questions
Procedure specific consent checklists
Reliable internet sources</li></li></ul><li>Preparing the patient for surgery <br />
We do this….<br />
In the form of this….<br />
To avoid this….<br />
What should be included in this stuff? <br />
Procedure Specific Consents<br /><ul><li>Checklist format to avoid oversights
Indications for surgery
Description of the procedure
Common or serious risks
Alternatives
Questions</li></li></ul><li>Example ofInternet Patient Education<br />Crohns and Colitis Foundation (www.ccfa.org)<br />Am...
Showtime:Intra-operative Execution<br />Pre-operative briefing<br />Extended Surgical timeout<br />Debriefing<br />
Pre-operative Briefing<br />Key element is two way communication<br />Clarify any questions the team might have about the ...
Extended Surgical Timeout<br />
WHO Surgical ChecklistSafe Surgery Saves Lives<br />Haynes, et al. NEJM 2009<br />
There is nothing so annoying as to have two people talking when you’re busy interrupting.<br />Mark Twain<br />
Debriefing<br />Closing Counts?<br />Labeling of specimens?<br />EBL?<br />Any equipment problems?<br />What went well?<br...
Team: A group of people with a full set of complementary skills that work together interdependently & cooperatively to com...
Key markers associated with superior team performance:<br />Leadership<br />Assertive  Communication<br />Situational    A...
Leadership<br />Accept risk and responsibility<br />Seek the collective wisdom of the team<br />Create an atmosphere condu...
Assertive Communication<br />…an obligation, not just a right<br />…must be timely<br />…must not be criticized or ridicul...
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Mis houston,chicago,nyc how to survive minimally invasive surgery

  1. 1. How to Survive Minimally Invasive Surgery<br />The Perioperative Nurse’s Survival Guide<br />
  2. 2. Preoperative Planning: Setting the Stage for Success<br />
  3. 3. Thanks for letting me know I have a Lap Chole to follow, going to check the room now. <br />
  4. 4.
  5. 5.
  6. 6. Setting the Stage for Success<br /> Schedule the case but….<br />What is so important about scheduling the case?<br />
  7. 7.
  8. 8. Make sure its scheduled correctly, why is this important? <br />
  9. 9.
  10. 10. Keep preference cards updated<br />Can this really be done?<br />Who is responsible? <br />
  11. 11.
  12. 12. Provide realistic time estimates<br />How can this be done and who is<br />responsible? <br />
  13. 13. Team Work= Dedicated Team<br />
  14. 14. Pre-operative Teaching: Setting the Patient up for Success<br />
  15. 15. Pre operative Teaching<br />Minimally invasive surgery instructions<br />General outline of pre-op questions<br />Procedure specific consent checklists<br />Reliable internet sources<br />
  16. 16. Let’s pretend you are the patient and you are at the doctor’s office…<br />You do not know about your condition, <br />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.<br />
  17. 17.
  18. 18.
  19. 19.
  20. 20. So now what?<br />
  21. 21. Let’s try it again…<br />
  22. 22. In simple terms please? <br />
  23. 23. Teach to the level of the participant<br />
  24. 24. In small quantities of content in simple terms<br />
  25. 25. Provide opportunity for questions and encourage questions<br />
  26. 26. Pre-operative Teaching: Setting the Patient up for Success<br />Provide minimally invasive surgery instructions<br />Provide general outline of pre-op questions<br />Inform the patient regarding:<br />procedure specific <br />consent checklists<br />Verification checklists and/or pre-procedure checklists<br />Provide Reliable internet sources<br />
  27. 27.
  28. 28. To assess what the patient knows first before tackling the questions they may ask<br />
  29. 29. To ask open ended questions to solicit information <br />
  30. 30. Top Ten Questions<br />How long will the surgery take?<br />How long will I be in the hospital?<br />What can’t I do when I get home?<br />What will I need help with when I get home?<br />Will I be on a special diet?<br />
  31. 31. But what they really want to know…<br />
  32. 32. When can I drive?<br />Will I need further treatment?<br />When can I go back to my normal activities?<br />Size of scar?<br />
  33. 33. When can I resume my normal activities?<br />
  34. 34. Number One Question<br />
  35. 35. Who will be doing my surgery?<br />
  36. 36.
  37. 37. Pre-operative Teaching: Setting the Patient up for Success<br /><ul><li>Minimally invasive surgeryinstructions
  38. 38. General outline of pre-op questions
  39. 39. Procedure specific consent checklists
  40. 40. Reliable internet sources</li></li></ul><li>Preparing the patient for surgery <br />
  41. 41. We do this….<br />
  42. 42.
  43. 43. In the form of this….<br />
  44. 44.
  45. 45. To avoid this….<br />
  46. 46.
  47. 47. What should be included in this stuff? <br />
  48. 48. Procedure Specific Consents<br /><ul><li>Checklist format to avoid oversights
  49. 49. Indications for surgery
  50. 50. Description of the procedure
  51. 51. Common or serious risks
  52. 52. Alternatives
  53. 53. Questions</li></li></ul><li>Example ofInternet Patient Education<br />Crohns and Colitis Foundation (www.ccfa.org)<br />American Society of Colon and Rectal Surgery (www.fascrs.org)<br />Wikipedia <br />
  54. 54.
  55. 55. Showtime:Intra-operative Execution<br />Pre-operative briefing<br />Extended Surgical timeout<br />Debriefing<br />
  56. 56. Pre-operative Briefing<br />Key element is two way communication<br />Clarify any questions the team might have about the procedure or the equipment<br />Checklists on grease-boards are utilized in the pre-op area to insure that the whole team is on the same page<br />
  57. 57. Extended Surgical Timeout<br />
  58. 58. WHO Surgical ChecklistSafe Surgery Saves Lives<br />Haynes, et al. NEJM 2009<br />
  59. 59.
  60. 60.
  61. 61. There is nothing so annoying as to have two people talking when you’re busy interrupting.<br />Mark Twain<br />
  62. 62. Debriefing<br />Closing Counts?<br />Labeling of specimens?<br />EBL?<br />Any equipment problems?<br />What went well?<br />What could we do different next time?<br />
  63. 63. Team: A group of people with a full set of complementary skills that work together interdependently & cooperatively to complete a task.<br />
  64. 64. Key markers associated with superior team performance:<br />Leadership<br />Assertive Communication<br />Situational Awareness<br />
  65. 65. Leadership<br />Accept risk and responsibility<br />Seek the collective wisdom of the team<br />Create an atmosphere conducive to assertive communication<br />Remember the leader of the team is a part of the team<br />
  66. 66. Assertive Communication<br />…an obligation, not just a right<br />…must be timely<br />…must not be criticized or ridiculed <br />…is critical to patient safety in the OR<br />
  67. 67. Situational Awareness<br />Understanding what is happening in the surrounding environment and why<br />Monitoring the current situation and accurately predicting what is likely to happen next to help the team prepare for the anticipated outcome<br />
  68. 68. Better said….<br />
  69. 69. EQUALS <br />Patient Advocate<br />
  70. 70. Nurse vs Physician perception<br />Nurses describe good collaboration as having their input respected <br />Physicians describe good collaboration as having nurses that anticipated their needs and followed direction<br />
  71. 71. Who’s on your team?<br /> 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<br />
  72. 72. Bibliography<br />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. <br />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.<br />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.<br />Stokowski LA. Perioperative Nurses: Dedicated to a Safe Operating Room. Available at www.medscape.com/viewarticle/562998 Accessed February 15, 2010<br />

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