1. How to Survive Minimally Invasive Surgery The Perioperative Nurse’s Survival Guide

2. Preoperative Planning: Setting the Stage for Success

3. Thanks for letting me know I have a Lap Chole to follow, going to check the room now.

6. Setting the Stage for Success Schedule the case but…. What is so important about scheduling the case?

8. Make sure its scheduled correctly, why is this important?

10. Keep preference cards updated Can this really be done? Who is responsible?

12. Provide realistic time estimates How can this be done and who is responsible?

13. Team Work= Dedicated Team

14. Pre-operative Teaching: Setting the Patient up for Success

15. Pre operative Teaching Minimally invasive surgery instructions General outline of pre-op questions Procedure specific consent checklists Reliable internet sources

16. 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.

20. So now what?

21. Let’s try it again…

22. In simple terms please?

23. Teach to the level of the participant

24. In small quantities of content in simple terms

25. Provide opportunity for questions and encourage questions

26. 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

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

29. To ask open ended questions to solicit information

30. 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?

31. But what they really want to know…

32. When can I drive? Will I need further treatment? When can I go back to my normal activities? Size of scar?

33. When can I resume my normal activities?

34. Number One Question

35. Who will be doing my surgery?

38. General outline of pre-op questions

39. Procedure specific consent checklists

41. We do this….

43. In the form of this….

45. To avoid this….

47. What should be included in this stuff?

49. Indications for surgery

50. Description of the procedure

51. Common or serious risks

52. Alternatives

55. Showtime:Intra-operative Execution Pre-operative briefing Extended Surgical timeout Debriefing

56. 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

57. Extended Surgical Timeout

58. WHO Surgical ChecklistSafe Surgery Saves Lives Haynes, et al. NEJM 2009

61. There is nothing so annoying as to have two people talking when you’re busy interrupting. Mark Twain

62. Debriefing Closing Counts? Labeling of specimens? EBL? Any equipment problems? What went well? What could we do different next time?

63. Team: A group of people with a full set of complementary skills that work together interdependently & cooperatively to complete a task.

64. Key markers associated with superior team performance: Leadership Assertive Communication Situational Awareness

65. 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

66. 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

67. 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

68. Better said….

69. EQUALS Patient Advocate

70. 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

71. 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

72. 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