Navigating Perioperative Realms: A Comprehensive Exploration of ODP Roles and Practices

Introduction

The essay examines the perioperative working environment and the principles and concepts underpinning perioperative practices. It outlines the roles of the Operating Department Practitioner (ODP) in addressing the needs in each phase of care within ethical, professional, and legal parameters. Besides, this paper examines a reflection of role in meeting holistic and individual needs of services users during the complete preoperative journey which includes introduction to perioperative environment and familiarizing with the OPD roles in every phase care, visiting a pre-assessment clinic and observing service users undergoing anaesthesia and surgery assessments, undertaking a placement on surgical ward to observe and get involved with service users during admission, surgery preparation, informed consent and escorting the service users to theatre reception. Lastly, it defines and justifies the experience of at least one week in anaesthetic practice, one-week intraoperative practice and experience a one week in post-anaesthetic practice.

Pre-assessment in Preoperative Care

Pre-assessment of perioperative patients is crucial in preparing the patient for surgery, anaesthesia, recovery, ensuring a patient understands surgical and anaesthesia procedures as well as patients postoperative recovery period (Rodger & Mahoney, 2017).The operating department practitioner (ODP) and nurses execute the role of pre-assessment of perioperative patient and they are expected to understand patients psychological status to inform perioperative staff including surgeons, anaesthetists and perioperative practitioners of the patient issues (Grocott et al.,2017).

Cousley & Martin (2016) argue that preoperative assignment is an opportunity to establish comorbidities that trigger patient complications during surgical, anaesthetic, or postoperative periods as well as ensuring patient’s safety during the journey of care. Cousley and colleague further outline that patients scheduled for elective procedures attend a preoperative assessment 2 to 4 weeks ahead of their surgery date. Preoperative evaluation is a necessity before various surgical procedures, primarily ensuring patient's fitness before undergoing surgery and also identifies issues to be dealt with by the anaesthetic or surgery teams (Rothrock,2019). The postoperative regulation of elective surgical patients starts during the perioperative period, and various health professionals are involved, including ODP (Stables, Seal & Mercer, 2018). Ideal monitoring and repeated clinical assessments involving all major organ systems, for instance, renal function and electrolyte and fluid balance, cardiorespiratory function, and awareness for early surgical complications signs such as infection and bleeding are crucial to trigger symptoms of surgical complications to be adequately and swiftly recognized.

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Vital signs - baseline observations

Radford, Williamson & Evans (2011) highlight that critical sign assessment is fundamental in determining the patients' health status. Precise knowledge and measurement techniques of a particular patient's normal range in vital signs ensure the patients are suitably monitored, enabling operative department practitioners to prevent adverse events and successful surgery. An alteration in the vital signs of a patient provides objective evidence of a patient's body response to psychological and physical stress or physiological function changes

Radford, Williamson & Evans (2011) argue that vital sign is a fundamental component for taking care of a patient awaiting surgery to detect procedural complications, examine treatment effects and establish earlier clinical deterioration signs. The operative department practitioners are required to use their clinical judgment regarding the observation frequency at all times (Freathy, Smith, Schoonhoven & Westwood, 2019). If the patient is unstable, there is a need for frequent monitoring and continual observation of vital signs until they are stabilized and reviewed. The operative department practitioners consult more senior staff for clarity or activate the Clinical Emergency Cardiac Arrest system immediately so that timely care can be delivered. The patient should have vital signs (blood pressure, respiratory rate, pulse level of consciousness, and temperature) recorded on admission and then the operative department practitioners record three times a day as a minimum (Downey et al.,2018). All the observations must be chartered at the registration time. The operative department practitioners examine the patient’s respiratory rate and record with every observation. On the other hand, if the patients are dyspnoeic or tachypneic, oxygen saturations are considered. The operating department practitioners take the blood pressure readings, and if they are found to be abnormal as recorded on an automatic machine, the OPDs check manually. Gabr (2019) highlights that if the cardiopulmonary resuscitation (CPR) is inappropriate; the OPDs activate the Clinical Emergency Cardiac Arrest systems.

Height/ weight - for drugs calculations

Bougeard, Brent, wart & Snowden (2017) highlights that the majority of obese patients going for surgery are normally healthy, and their perioperative risk is comparable to patients with normal weight. Patients with metabolic syndromes and central obesity are at higher risk of perioperative complications as opposed to those with isolated extreme obesity (Al-Benna, 2011). Operative department practitioners record the patient weight and height and the calculated BMI in the operating list to inform the team that additional equipment, time and preparation that may be needed. The primary advantage in estimating the adjusted body weight and lean and recording the results in patients record is that it helps in calculation of drug doses. The operative department practitioner bases the diagnostic testing on the need for co-morbidity evaluation and the surgery complexity as opposed to the presence of obesity.

Fasting instructions

Adults are required to fast before anaesthesia to reduce aspiration of gastric contents and regurgitation risks. However, prolonged fasting periods are unnecessary and are likely to trigger complications. Operative department practitioners offer fasting guidelines to patients waiting to go for surgery (Jibawi, Baguneid & Bhowmick, 2018).Practising a patient-centred and evidence-based preoperative approach fasting improves patient satisfaction and comfort (Hamid, 2014). Correct fasting instructions diminish the necessity to delay or cancel a surgery triggered by incorrect fasting intervals, improve postoperative well-being, and reduce medical complications. All hospital departments are encouraged to audit their fasting instruction practices to help them ensure the best policy is followed when dealing with patients.

Ward assessment

Vital Signs

McGarvey, Chambers & Boore (2000) highlights that the operative department practitioner helps patients when they arrive in the department of theatre ahead of the surgery. The ODP communicates with the patient and carries out vital signs tests ahead of the surgery and answers any question that might be troubling the patient. OPD also prepare the equipment’s necessary during operation such as intravenous equipment, anaesthetic machines, pressure area care, patient positioning aids, emergency equipment and patient warming equipment. Earlier detection of patient's deteriorating health and adverse events prevention are critical challenges to patient safety (Prgomet et al., 2016). The operative department practitioner identifies patients at risk of deterioration using a combination of visual assessments and vital signs. The preoperative department practitioner uses accurate vital signs monitoring equipment and intermittent observation frequency. Both ensure that doctors and nurses are enthusiastic about continuous monitoring prospect and perceive that it allows earlier identification of patients deteriorating health, support interdisciplinary communication, and provides reassurance to the patient.

Allergies

Confino-Cohen et al. (2012) highlight that discrepancies between allergists and internists drug allergy diagnosis are common. The operative department practitioners use of simple structured questionnaires or allergist consultation is beneficial for accurate determination of drug allergies (Peate, 2015).

ID bracelets

Correct patient identification is characterized by a patient’s initial contact with the service, and all the staff involved in the process of admission, administrative, and clinical are responsible for incorrect patient identification (Hains, Strand & Turner, 2017). They ensure that correct patient details are acquired and recorded, and any inaccurate queries are highlighted and attended to earlier. The operative department practitioners ensure that patients have ID bracelets to identify patients identity, for instance, in some clinical circumstances such as medication administration and blood transfusion. The ID bracelets offer patients safety, especially handover, transfer and recognition of roles played by non-clinical staff.

Gown/ TED stocking

A surgical patient is exposed to various risk factors for DVT. According to (Morgan Walker & Viggars, 2014).Therefore during the pre-operational assessment, the operative department practitioner is responsible for assessing the patient for all that a patient should use; for instance, graduated elastic compression stockings GECS as it is useful in the description of drugs given to preoperative patients before leaving the ward( Tjandra, Clunie, Kaye & Smith,2015).

Pre-op checklist

Operative department practitioner examines a pre-op checklist to determine if the patient is safe for the surgery and anaesthesia (Cadman, 2016). Part of the process is an assessment to check it is safe to proceed with anaesthesia and surgery. The pre-op checklist also allows the patient to ask questions that they may have and also discuss any concerns with the operative department practitioner. Some of the standard tests examined by the ODP include; X-rays and Chest X-rays that helps to diagnose chest pain, shortness of breath, certain fevers and cough, Electrocardiogram (ECG) that tests the electrical activity of the heart, urinalysis, white blood count, MRSA screens, and blood pressure checks (Peate,2015).The ODP also enquires about the patient’s social support upon discharge. The ODP ensures that the patient have these tests completed 30 days before surgery.

The World Health Organization’s safer surgery checklist is a crucial part of UKs operating theatres standard practice. The use of a checklist by operative department practitioner in the theatre reduces patient’s mortality and morbidity, reduces operating time, improves communication and reduces theatre costs (Moule,2015). Operative department practitioner is prepared better as a result of improved communication, for instance, availability of equipment’s in the theatre that addresses potential events as opposed to later retrieval when an event occurs, thus causing delays. Cadman (2016) highlights that, items relating to allergies, site marking, blood loss and patient identification help to ensure that both the ODP and the patient are adequately prepared for theatre, thus avoiding imposing delays later on.

Anaesthetic Visits

ODP anaesthetic practitioner in the UK ensures that all equipment and environment is safe and adequately set to accept the patient (Wise, 2019). The ODP provides this by checking medical equipment such as vital signs monitors and anaesthetic machines and provides that all equipment is safe to use and clean. The ODP also communicates with all the theatre team members to ensure the safety of both the team and the patient. The ODP anaesthetic practitioner discusses the patient's planned care with the anaesthetist and prepares the procedures management and monitors necessary equipment’s (Evley et al., 2010) Often the ODP anaesthetic is the first person a patient meets, and it is vital to establish a good rapport with the patient from the outset. Once the patients are in the anaesthetic room, the ODP applies vital signs that monitors the patients and subsequently assists the anaesthetist while they administer the type of anaesthetic choice. Upon anaesthetization of a patient, the ODP ensures that the patient on the operating table is safely positioned and they are kept secure and warm throughout.

Consent form

Nurses should ensure that the patient fills a form before the medical procedure, confirming that he or she is in agreement with the process and is aware of any risk that might occur during the procedure (Phillips, 2017). The primary purpose of signing a consent form is to provide evidence that the patient agrees to the procedure in question.

Reception Handover

Consent Form

The Operating department practitioner examines the patient consent form. Hinton, Locock, Long, & Knight, 2018) highlights that a consent form is signed by a patient before surgery to confirm that he or she agrees to the procedure and is aware of any ramification that might occur during operation. The primary purpose of a consent form is providing evidence that the patient authorized the procedure. The OPD verifies patient details, consent form, intended surgical site and allergies.

Marking Patients

The ODP prepares the operating theatre for surgery and monitors patients so that anaesthetist can attend to their need, track all the surgical equipment’s necessary for operations and ensures that a patient is healthy enough to return to their ward (Smith, & Mishra, 2010). The ODP provides that the surgeon marks the surgical site on the patient's body before any intervention and the marking aligns with the scheduled procedure (Edwards, 2006). The operative site marking should be done in a manner that ensures that when a patient/limb is placed in a different position or turned the mark is still clearly visible to the surgical team.

ID

The Operating department practitioner assesses the patient identity and confirms that it aligns with the details written in the consent form (Stoodley & Stuart, 2004). .When a patient is to be admitted to the theatre, the theatre ODP ensures that the patient ID matches with what is written in the consent form

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Bracelet

The ODP ensures that a reception nurse gives the patient a wrist band or a bracelet after verifying all the patients’ details are correct, and he or she is ready to be in the theatre (Taylor & Campbell, 1999). The bracelet is necessary for the safety of the patient ensuring that there is proper identification of patients’ needs (KARACA, AKIN & AKTEN, 2019)

Preparation of surgical environment

The Operative department practitioner ensures that the operating room (OR) is sterilized and organized. The health care providers enter the OR during surgical procedures to or set up before surgical procedures. Phillips (2017) highlights that there is a need to understand how OR area functions and how to enter OR to maintain a sterile environment. Surgical team members work hard collaboratively to ensure the care and safety of their patients is achieved. The surgical teams make decisions on patient care and are in charge of OR (Paterson & Wallar, 2017). The OR environment consists of non -sterile and sterile areas as well as non- sterile, for example, circulating nurse, anaesthesiologist and technologist, observer or student, and sterile personnel, for instance, surgical assistant, surgeon and scrub nurse.

Avery (2017) highlights that there are specific requirements for health practitioners entering the OR to control the spread of microorganisms and maintain OR environment sterility. Before joining the OR, the health practitioners are required to show their hospital-issued ID and inform the staff in charge of the theatre the aim of the visit.

According to (Williams & Smith (2008) before entering the OR there is a checklist for specific steps to take: The required supplies to OR are brought and sterilized as needed, practitioners and any visitor are required to show their ID, artificial nails are not allowed, and nail polish should be fresh not more than four days and not cheeped, all pieces of jewellery should be removed except wedding bands permitted by agency policy, surgical attire should be worn only in surgical areas, and the top should be tucked into pants, shoes should be covered in alignment with policy agency, a surgical hand scrub should be performed according to agency policy, before entering the OR semi-restricted or restricted areas one should apply a mask, use head coverings to cover beards, earnings, and sideburns and once in the OR introduce yourself to the surgical staff and enquire about non-sterile and sterile area.

References

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Avery G. (2017) Law and Ethics in Nursing and Healthcare 2nd Edition, Sage, London.

Bougeard, A. M., Brent, A., Swart, M., & Snowden, C. (2017). A survey of UK peri‐operative medicine: pre‐operative care. Anaesthesia, 72(8), 1010-1015.

Cadman, V. (2016). The impact of surgical safety checklists on theatre departments: a critical review of the literature. Journal of perioperative practice, 26(4), 62-71.

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Downey, C. L., Chapman, S., Randell, R., Brown, J. M., & Jayne, D. G. (2018). The impact of continuous versus intermittent vital signs monitoring in hospitals: A systematic review and narrative synthesis. International journal of nursing studies, 84, 19-27.

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