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Operation Theater List and Record Maintenance

Chapter · June 2018

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Srikanta Kumar Padhy

L V Prasad Eye Institute
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Operation Theater List and Record Maintenance
Most of the ophthalmic surgeries are elective cases
with few exceptions like post-traumatic open globe
injury, perforated cornea ulcer, endophthalmitis,
orbital cellulitis, acute angle closure glaucoma and
fresh rhegmatogenous retinal detachment (RRD) with
macula attached which require urgent intervention.
The operation theater list prepared for elective and
emergency surgeries holds an area of prime importance.
This enables the nursing staff to prepare the operation
theater (OT) for the next day surgery and to avoid last
minute confusions in the OT.
THE OPERATION THEATER LIST
To prepare for the surgical procedures, it is important to
provide the nursing staff in advance with a meticulous
operation theater (OT) list which gives the following
details:
•• Date of the surgery
•• Patient details: Name/Age/Sex/Contact Number/
Ward and Bed number of the patient
•• Diagnosis of both the eyes
•• Systemic illness (if any) such as diabetes mellitus,
hypertension, asthma, coronary artery disease, etc.
•• Need for oxygen supplementation
•• Presence of high risk factors such as HIV/HbsAg/
HCV
•• Surgical plan: A clear description of the type
of operation to be performed and the eye to be
operated. This is important to prevent an operation
being performed on the wrong side or the wrong
operation.
CHAPTER 5
Pranita Sahay, Srikant Kumar Padhy, Neelima Aron
•• Surgeon details: Name of operating surgeon and
assistant
•• Any investigation which needs to be checked on the
day of surgery
•• The scheduled time for the operation should also
appear on the list. If the surgeon decides to do a
patient earlier or later on the scheduled list or cancel
an operation, the OT nurse must inform the nurse in
the particular ward of the change on the operating
list immediately.
•• Mode of anesthesia: Local anesthesia/Topical anes­
thesia/Cardiac monitoring/General anesthesia.
These details enable the nursing staff to be prepared
well in advance both for the routine surgery as well as
the anticipated complications by the information from
the OT list. A specimen OT list is shown in Figure 5.1.
Recommendations
•• The operation list should preferably be sent at least
12 hours before the day of surgery.
•• The operation list should be handed in physically or
by fax or email and not telephonically.
•• The name and contact details of the doctor/nurse
who compiled the theater list should be clearly
indicated.
•• The surgeon should discuss the operation list in co-
operation with the OT nurse-in-charge.
•• The operation list must not exceed the permitted
time allocated to it. This does not refer to the time
during an operation of an individual patient.
 Ocular Infections: Prophylaxis and Management
Figure 5.1  A representative operation theater list showing the date of surgery, the sequence of operations planned, the identification
details of the patient, diagnosis, surgical plan and eye to be operated, the operating surgeon and assistant and the type of anesthesia
•• The operation list should preferably be put on a
notice board near the patient’s admission/ entrance
to the OT.
SPECIAL CONSIDERATIONS WHILE
PREPARING AN OPERATION THEATER LIST
•• Age of the patient—infants and children below 6
years of age are posted at the beginning of the OT list
with the cases being arranged in the chronological
order of age.
•• Types of surgery—major operations are always
booked at the beginning of the OT list.
•• Patients with active eye infection such as infective
keratitis, endophthalmitis and panophthalmitis
should be posted at the end of the OT list to avoid
30
cross infection. A prehand information of the
infected cases enables the nursing staff of the OT to
keep the instruments tray for septic OT ready.
•• Patients with positive serology such as HIV, HbsAg
and HCV should be placed at the end of the list. A
clear mention of the serology status of the patient
enables the nursing staff to keep the things ready for
OT preparation and disinfection of the OT thereafter.
•• Patients with diabetes mellitus must not be starved
for long periods as there is risk of hypoglycemia and
hence should be placed in the beginning of the OT
list schedule.
•• Patients with cardiac illness should also be posted
early and should be put in the beginning of the list.
•• Abbreviations should never be used as it may cause
confusion.

DISTRIBUTION OF THE OPERATION
THEATER LIST
It is pertinent that the operation theater (OT) list is first
checked and signed by a resident before distribution to
avoid any hassles in the OT. A copy of the complete list
is then distributed to the following:
•• The nursing staff of respective wards from where the
patients are posted—this helps the ward nursing
staff to prepare and counsel the patients in advance
for the surgery.
•• The operating surgeon and assistants—so that they
are aware of their respective cases and are on time
in the OT. This avoids wastage of the precious OT
time.
•• The anesthetist—so that they can do a proper pre-
anesthetic check-up and advise the necessary
investigations when required, a day prior to the
surgery. This avoids unnecessary cancellation of
cases on the day of surgery and keeping nil per oral
of patients who are not fit for anesthesia.
•• The nursing staff of OT—so that they can sterilize
and prepare the set of instruments in advance that
will be required on the day of surgery.
•• The day care facility—so that they are aware of the
number of patients posted on the coming day.
RECORD MAINTENANCE IN
OPERATION THEATER
Different registers are used in the OT, namely:
•• Operation registers
•• Daily register
•• Sterilization register
•• Temperature and humidity control register
•• Microbiology register
•• Water analysis and culture register
•• Instrument register
•• Central sterile supply department register(CSSD)
•• Linen stock register
•• Complaints register.
OPERATION REGISTER
Every operation done in the OT, whether under general
or local anesthetic, must be recorded in the operation
register.
Operation Theater List and Record Maintenance
The operating register is a legal document which
must be stored in the records section for enquiry as
well as statistical purposes for at least five years. All
the information and particulars of the patient must be
complete:
•• The patient’s full name, age and sex
•• Registration number
•• Ward in which the patient is admitted
•• Full description of the surgery performed
•• Name of anesthesiologist
•• Name of the operating surgeon and assistant
•• Anesthetic agent used for anesthesia
•• Name of the scrub nurses
•• Name of the OT assistant
•• Operation theater table on which the patient was
operated
•• Indicate whether the patient underwent major or
minor surgery
•• Duration of the operation.
DAILY REGISTER
It is a detailed record regarding the infection control
activities of OT. It mentions the following:
•• Name of the concerned cleaning staff on duty.
•• Assessment of temperature control
•• Samples sent from the OT for microbiological tests
•• Biomedical waste management
•• The fumigation details of the OT with the name of
chemical reagent used is documented.
STERILIZATION REGISTERS
It mentions the following details:
•• The number of instrument sets that are sterilized
along with the method of sterilization. Specific
indicators are placed on all the instrument boxes
to indicate the method of sterilization (plasma,
ETO, Autoclave). A change in color is noted in these
indicators if proper sterilization has been done.
•• The total time taken for sterilization along with its
starting and ending time is also documented
•• The nursing staff responsible for sterilization is
documented.
•• The various files for maintaining records are steam
sterilization indicator file, steam autoclave receiving
and issued record, high speed autoclave indicator
31
 Ocular Infections: Prophylaxis and Management
file, chemical integrator file, biological indicator
file, Bowie Dick test file and ethylene oxide things
receiving and issued record, fumigation record and
autoclave maintenance record.
TEMPERATURE AND HUMIDITY
CONTROL REGISTER
The temperature and humidity of the OT is checked
every 2 hours and documented. If any deviation from
the ideal temperature is noted then immediate action
is taken.
MICROBIOLOGY REGISTER
Samples are sent from every new batch of ringer lactate
and viscoelastic before it is used. Samples are sent from
various areas of the OT every week for both fungal and
bacterial culture. Samples are also sent from the air
conditioning system ducts. The microbiology report of
these is attached in the register.
WATER ANALYSIS AND CULTURE REGISTER
Water samples for microbiological tests are sent from
various areas of the OT like scrub room and sterilization
room and a record of the same is maintained.
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INSTRUMENT REGISTER
It mentions the total number of instrument sets that
are used in a single day in the various OTs. This helps
in keeping a track of the OT instruments to prevent loss
of instruments.
BIOMEDICAL WASTE MANAGEMENT
REGISTER
This includes the record maintenance of proper waste
disposal from OT along with date and time.
CENTRAL STERILE SUPPLY DEPARTMENT
REGISTER
It mentions the details of the quantity of linen sent
for sterilization and received after the sterilization
procedure is over.
LINEN STOCK REGISTER
It mentions in detail the linen type and quantity that
the OT has, like bed sheets, towels, gowns, eye towels,
trolley cover, etc.
COMPLAINTS REGISTER
All complaints for the OT are recorded in this register
and necessary action is taken accordingly by the OT in-
charge.