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ARMY FORCE COMPHENSIVE SPECIALIZED HOSPITAL OR

DEPARTMENT STANDARD /SOP/

NURSING DUTIES

 Assess patients prior to surgery (e.g. NPO status) and alleviate their concerns

 Gather all supplies needed for the operation

 Assume responsibility of keeping the operating room sterilized

 Position and prepare patient on operating table

 Pass medical instruments or other objects to the surgeon during operation

 Monitor patient’s vital signs to detect anomalies

 Evaluate patient in postoperative phases

 Adhere to safety standards and precautions

 Assume duties within or out of the sterile field as assigned

PHYSICAL PREPARATION

Preparations for surgery depend on your diagnosis. Your physician will discuss with you how to prepare
for your surgery. However, if you will undergo general anesthesia, you may be asked to do the following:
Stop drinking and eating for a certain period of time before the time of surgery
Bathe or clean and possibly shave the area to be operated on
Undergo various blood tests, X-rays, electrocardiograms, or other procedures necessary for surgery
Next step is to list the instruments needed to the procedure the OR runs and the surgeon for the
next day.

The circulating nurse should check the operating room. Remove unnecessary materials from the
operating room/table. Check the lamp suction motion functional. then bring equipment to CSSR.

NURSING PAHSES / NURSING PROCESS

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Preoperative phase

During the preoperative assessment, you’ll make sure a patient is fully informed about the risks
and benefits of the operation and that that they are in a good state of health for surgery. You’ll
provide information about the operation and give the patient the opportunity to ask questions.
This also reduces the risk of a late cancellation and resources being wasted.

In this:

Duty of nurse

 Check the patient

 Consent form
 Site mark/position
 Patient name
 Surgeon name
 procedure

INTRA OP PHASE

The intraoperative phase extends from the time the client is admitted to the operating room, to the time
of anesthesia administration, performance of the surgical procedure and until the client is transported to
the recovery room or post anesthesia care unit (PACU)

THE DUTIES OF CIRCULATING NURSE

A circulating nurse works inside the operating room as a patient advocate. As the circulating nurse, your
responsibilities are to ensure the operative procedures have the patient's best interest in mind. You
perform your duties outside of the sterile area in the operating room. You work in collaboration with the
anesthesiologist, surgeon, and surgical assistants to create a comfortable and safe environment for the
patient. You are also responsible for charting the surgical events and keeping an inventory of supplies and
equipment used for the procedure.

Follow up

 Vital sign
 Glucose level

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  Position the patient
 Oxygen saturation
 ?

Post op from the time of transfer to the recovery

Follow up

Nurse duty

 Check Vital sign

 Oxygen saturation
 Follow IV fluid if needed
 Control urine
 Control urine output
 Follow up blood site/ surgery site

SURGICAL CHECKLIST

1. Time in
This is the duty of circulating nurse
Bring the patient from waiting room to operating room.
2. Time out this process the agreements to starting the procedure.

Before starting the procedure duty of circulating nurse

 Self introduce
 Patient name
 DX
 Procedure
 Surgeon name
 Assistant name
 Anesthetic name

During this time

1. to the surgeon
2. to anesthetist

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 Your preparation for this procedure
 The phase of anesthetic
 If needed bag of blood
3. ……..to the scrub nurse
 ……..the sterility
 Indicter
 Time sterility

After agree all the …….starting the procedure

This the duty of circulating nurse

SIGN OUT

Nurse verbally confirms with the team:

The name of the procedure recorded that instrument, sponge and needle counts are correct (or not
applicable)

How the specimen is labeled (including patient name) l whether there are any equipment problems to be
addressed

Surgeon, anesthesia professional and nurse review the key concerns for recovery and management of this
patient

This process is after finishing the procedure time. Circulating nurse should perform counting gauze and
equipment scissors before the laboratory is closed.

HADE OFF: - during the transfer of the patient from recovery to the w/p / s/w after ???

Counting method after and before

1. Counting during Assemble / during preparation

2. Counting scrub nurse and circulating nurse before ?.....
3. Counting after the procedure before close the……..in the 3 rd counting there are 3 types of
…..counting
1. Field counting duty surgeon and assistances
2. Floor counting to circulating nurse.

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SCRUB NURSE

A scrub nurse is a nursing professional who works alongside surgeons and other surgical staff. They are also
called preoperative or operating room (OR) nurses. Scrub nurses use their expertise and calm demeanor to help
surgeons perform surgery and sometimes lifesaving operations on patients.

Before an operation
 Ensures that the circulating nurse has checked the equipment
 Ensures that the theater has been cleaned before the trolley is set
 Prepares the instruments and equipment needed in the operation
 Uses sterile technique for scrubbing, gowning and gloving
 Receives sterile equipment via circulating nurse using sterile technique
 Performs initial sponges, instruments and needle count, checks with circulating nurse
During an operation
 Maintain sterility throughout the procedure
 Awareness of the patient’s safety
 Adhere to the policy regarding sponge/ instruments count/ surgical needles
 Arrange the instrument on the mayo table and on the back table
Before the Incision Begins
 Provide 2 sponges on the operative site prior to incision
 Passes the 1st knife for the skin to the surgeon with blade facing downward and a hemostat to the
assistant surgeon
 Hand the retractor to the assistant surgeon
 Watch the field/ procedure and anticipate the surgeon’s needs
 Pass the instrument in a decisive and positive manner
 Watch out for hand signals to ask for instruments and keep instrument as clean as possible by
wiping instrument with moist sponge
 Always remove charred tissue from the cautery tip
 Notify circulating nurse if you need additional instruments as clear as possible
 Keep 2 sponges on the field
 Save and care for tissue specimen according to the hospital policy
 Remove excess instrument from the sterile field
 Adhere and maintain sterile technique and watch for any breaks
ROLL OF SCRUB NURSE
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Scrub nurses, also called perioperative nurses, are registered nurses who assist in surgical procedures
by setting up the room before the operation, working with the doctor during surgery and preparing the
patient for the move to the recovery room. Scrub nurse’s work in various clinical settings, including
hospital surgical departments, private physicians’ offices, clinics and ambulatory or “day surgery”
centers.
CURCULATING NURSE
The circulating nurse, an integral part of the perioperative team, serves as an advocate for patients
who are under anesthesia and/or sedation. Responsibilities include ensuring that surgical asepsis is
adhered to during the surgical procedure, keeping track and conducting an inventory of supplies and
equipment used during and after the surgical procedure, or calling for a time-out. The Joint
Commission has specified a “time-out” immediately before surgery to prevent surgical errors.
Duties of circulating nurse
 Before an operation
 Checks all equipment for proper functioning such as cautery machine, suction machine, OR light
and OR table
 Make sure theater is clean
 Arrange furniture according to use
 Place a clean sheet, arm board (arm strap) and a pillow on the OR table
 Provide a clean kick bucket and pail
 Collect necessary stock and equipment
 Turn on aircon unit
 Help scrub nurse with setting up the theater
 Assist with counts and records
During the Induction of Anesthesia
 Turn on OR light
 Assist the anesthesiologist in positioning the patient
 Assist the patient in assuming the position for anesthesia
 Anticipate the anesthesiologist’s needs
 If spinal anesthesia is contemplated:
 After the patient is anesthetized
 Reposition the patient per anesthesiologist’s instruction
 Attached anesthesia screen and place the patient’s arm on the arm boards
 Apply restraints on the patient

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  Expose the area for skin preparation
 Catheterize the patient as indicated by the anesthesiologist
 Perform skin preparation
During Operation
 Remain in theater throughout operation
 Focus the OR light every now and then
 Connect diatherapy, suction, etc.
 Position kick buckets on the operating side
 Replenishes and records sponge/ sutures
 Ensure the theater door remain closed and patient’ s dignity is upheld
 Watch out for any break in aseptic technique
End of Operation
 Assist with final sponge and instruments count
 Signs the theater register
 Ensures specimen are properly labeled and signed
 After an Operation
 Hands dressing to the scrub nurse
 Helps remove and dispose of drapes
 Helps to prepare the patient for the recovery room
 Assist the scrub nurse, taking the instrumentations to the service (washroom)
 Ensures that the theater is ready for the next case

ROLE OF CIRCULATING NURSE

Responsible for managing the nursing care of the patient within the OR and coordinating the needs of the
surgical team with other care provider necessary for completion of surgery
Observes the surgery and surgical team from broad perspective and assists the team to create and
maintain a safe and comfortable environment for the patient
Asses the patient’s condition before, during and after the operation to ensure an optimal outcome for the
patient
Must be able to anticipate the scrub nurse’s needs and be able to open sterile packs, operate machinery
and keep accurate records