SUR 110 Introduction to Surgical Technology

1. Week 1 SUR 110Introduction to Surgical Technology

2. History of Surgical Technologist • Post WWII created nursing shortage in ORs nationally • Military Corpsman position created a position that caught on nationally and thus became the “operating room technician” (ORT) • Not created to replace nurses, but to supplement the needed personnel to provide patient care • 1969 nursing and surgeon organizations created the AORT (Association of Operating Room Technicians) • 1974 LCC-ORT (Liaison Council on Certification for the Operating Room Technician) established and the certification exam was born to provide a means of establishing competency for the ORT • 1978 ORT became the ST (surgical Technologist) which changed the names of the AORT to AST (Association of Surgical Technologists) and the LCC-ORT became the LCC-ST (Liaison Council on Certification of the Surgical Technologist) which is now the NBSTSA (National Board of Surgical Technology and Surgical Assisting)

3. Organizations • JCAHO • Joint Commission on Accreditation of Healthcare Organizations. • Private organization. • Evaluates US hospitals for their compliance with federal regulations. Issues fines if not in compliance. • DFS – Department of Facility Services • Similar to JCAHO, but state run department.

4. Organizations • AST - Association of Surgical Technologists • Responsible for the Core Curriculum • Provides educational services. • Our professional organization that we belong to. • CAAHEP – • the largest programmatic accreditor in the health sciences field. CAAHEP reviews and accredits educational programs.

5. Organizations • ARC-ST – Accreditation Review Committee on Education in Surgical Technology • Directly oversees academic accreditation for the ST field. • NBSTSA – National Board of Surgical Technology and Surgical Assisting • Responsible for our credentials (ST, CST, CFA) and administering the CST exam.

6. Surgery classifications • Emergent – a “must do now to save the life of the pt.” case. • Urgent – a “ must do soon” case • Elective - procedure is beneficial to the patient but does not need be done at a particular time • Optional – give me an example!

7. Reasons For Surgery • Diagnostic • Palliative - treatment that provides symptomatic relief but not a cure • Prophylactic - Preventative • Restorative

8. Surgical Specialties • General • Obstetrics/gynecology (OB-GYN) • Genitourinary • Otorhinolaryngology (ENT) • Orthopedics • Peripheral Vascular • Cardiothoracic • Neurosurgery • Ophthalmology • Plastics/Reconstructive • Oral/Maxillofacial

9. Primary Goal of Surgery • Return the patient back to their best possible state of physical and mental health

10. Operative Timeframes • Pre-operative – admission to incision • Intra-operative – incision to dressing application • Post-operative – dressing application to patient discharge.

11. Surgical TechnologistProfessional • Definition (JCAH)-”An allied health professional who works closely with surgeons, anesthesiologists, registered nurse, and other surgical personnel delivering patient care and assuming appropriate responsibilities before, during, and after surgery.”

12. Expectations of Scrub Tech • Provide quality patient care by giving assistance to the operating surgeon he/she is working with. • #1 Task: Anticipate the surgeon and patient needs during the operative procedure. • To accomplish #1 Task, the ST will “learn to think like the surgeon.” • ST will be knowledgeable in “anatomy, pathophysiology, and microbiology.” • ST will be one of a team of OR staff who “monitor the surgical environment.”

13. Competencies/Roles of the ST • Founded by 3 principles: • Education, competency, legal requirements of a health care professional • Certification • Follows state laws and hospital policies

15. Competency • Level 1 Entry Level (less than 1 year experience/certified/independently scrubs basic procedures) • Level 2 Proficient (more than 1 year experience/can perform most surgical procedures) • Level 3 Expert (superior and broad knowledge base/role model/leader)

16. The OR Team • Definition of Team- A group of people working together to achieve a common goal. For the OR team, that goal is to provide the highest quality of patient care, while promoting surgeon satisfaction as well as each team member’s own satisfaction.

17. Responsibilities of the OR Team • Patient positioning • Grounding pad • Skin prep • Sterility maintenance • Aseptic environment maintenance • Blood loss surveillance • Keeping track of medications administered on sterile field

18. Surgical Team Members Duties • Preoperative Case Management • Intraoperative Case Management • Postoperative Case Management

19. Preoperative Case Management • PPE • OR preparation • Obtaining supplies, instruments, and equipment • Creation, maintenance, and monitoring of surgical sterile field • Scrubbing and donning sterile OR attire • Organizing sterile field • Counting supplies and instrumentation • Assisting other sterile team members as they enter the sterile field • Providing exposure of the operative site via prepping and draping

20. Intraoperative Case Management • Sterile field maintenance and monitoring • Providing instrumentation, supplies, and equipment to the surgeon and his or her assistant as needed in the proper order • Preparation of and handling medications within the sterile surgical field • Counting supplies and instrumentation • Handling and caring for specimens • Preparation of and application of sterile surgical dressing

21. Postoperative Case Management • Sterile field maintenance and monitoring until patient is safely transported from the OR suite • Taking down or disassembling the sterile field • Removal, handling, and maintenance of supplies, instruments, and equipment according to institutional policy within or from the OR • Preparation of the OR for the next operative procedure

22. Sterile: STSR Surgeon Surgical Assistant Nonsterile: Circulator Anesthesia provider Other: Anesthesia RN assist Radiology tech Pathologist Anesthesia tech Nursing assistant/clinical tech Perfusionist Perfusionist tech OR Roles

24. Circulator • Circulator-A registered nurse (RN) with the ability to move about the room and leave if necessary to acquire needed items. • Duties: • Position patient • Skin prep/initial scrub prep • Communication between sterile and nonsterile areas • Opening of supplies before and during surgical procedure • Assistance to other team members not involved directly with the sterile field.

25. Surgical Technologist • Scrub tech duties: • Help with OR room/suite preparation • Helps with opening supplies/instruments • Surgical hand scrub • Putting on/donning sterile gown and gloves • Working within the boundaries of the surgical sterile field • Preparing/passing needed instruments/supplies to surgeon and his/her assistant • Monitoring/maintaining the sterile field • Assisting as needed (prn) on the surgical field

26. Primary Surgeon • Primary Surgeon-physician/medical doctor (MD) performing the operative procedure. He or she is ultimately in charge.

27. Primary Surgeon Duties • Determines need for and the type of surgical procedure to be performed • Discussed surgical procedure and its risks with the patient and family • Offers alternatives to surgery to the patient if available • Performs actual surgical procedure • Provides and plans care for the patient post-operatively

28. Assistant to the Surgeon • Assistant (to the surgeon): • other surgeons • Physician’s assistant (PA) • Registered nurse • Registered nurse first-assist (RNFA) • Surgical technician (may be concurrent with primary duties) • Surgical technician first assist (STFA)

29. Surgeon Assistant Duties • Aides with patient positioning • Assists with draping the patient • Aides surgeon by providing visualization of the operative site by retraction, suctioning and sponging • Aides to achieve hemostasis • May close body planes or suture body planes • Determines type of dressing and may apply or direct application of dressing

30. Anesthetist/Anesthesiologist • Anesthesiologist-responsible for sedating or anesthetizing patient. Often act as a supervisor of this action. • Certified registered nurse anesthetist (CRNA)-An RN with extensive critical care experience and a master’s degree in anesthesia specialization. Will be the person actually performing the anesthesia in most facilities today.

31. Other • Other: • Anesthesia RNs • Anesthesia technicians (techs) • Nursing assistants/Clinical technician • Housekeeping • Sales representatives (Reps) • X-ray/radiology technician • Electroencephalography technician (EEG tech) • Laser/Video Technicians also called Minimally Invasive Surgical Technicians (MIST team) • Cell saver technicians • Perfusionist • CPD Central Processing Department

32. Patient Care Departments • Divided into 2 types: 1. Direct • Contribute directly to patient care 2. Indirect • Contribute indirectly to patient care

33. Direct Patient Care Departments • See Text Table pg. 21 • Nursing Care Units • Diagnostics • Laboratory • Pharmacy • Physical Therapy (PT)/Occupational Therapy (OT)

34. Indirect Patient Care Departments • Hospital administration • Maintenance/Engineering • Housekeeping • Food/Nutrition Services • Purchasing/Central Supply Services • Medical Records

35. Hospital Organizations • Institutional organization • Departmental organization • See Text Figure pg. 20

36. Job Description Components • Job Title • Requirements • Nature of Position • Duties • Accountability • Immediate Supervisor

37. Financial Reimbursement for Surgery • 5 Methods in the United States: • Private Insurance • HMO • PPO • Medicare • Medicaid

38. Private Insurance • Works by insurance premiums paid by individual insured, deductibles paid, insurance company pays agreed upon or contracted percentage of costs incurred for health care

39. HMO • Health Maintenance Organization • Contractual arrangement between hospital and physician involved in patient’s health care • Payments are limited to set pre-agreed upon amounts • Hospitalization is determined based on the patient’s diagnosis and or surgical procedure being performed

40. PPO • Preferred Provider Organization • Set up same as HMO

41. Medicare • Federal government administers • Patient care reimbursed to following: • Qualified over 65 years of age • Eligible for social security disability payments for 2 years minimum • Working and their families who require organ transplants or kidney/renal dialysis • Part A: reimburses hospitals • Part B: reimburses physicians and other departments such as lab, radiology, etc.

42. Medicaid • State and federal funding • Provided to low-income families who meet the criteria

43. The Lifestyle of a Surgical Technologist

44. Considerations • Foreign environment: cold, quiet, dark, isolated • Will know more than 95% about the human body than the general population and anyone who lived prior to the 20th century • Take part in surgical procedures the public see as miraculous • Work life alien to family and friends • Must face and deal with emotional and psychological events few will ever face • Must be prepared to be available when called upon

45. Impact on you,the Surgical Technologist • May have to leave family at inconvenient times • If “on call” cannot have drinks with your friends or family • Obligated to protect yourself from communicable disease in order to protect your patients • Will be privy to things about other’s lives (patient) that cannot be shared with your family or friends • May find that family and friends do not want to “hear” about your work that you consider exciting and at times humorous

46. Personal and Professional Live as a Surgical Technologist • 2 key principles: • Professional obligations proceed personal freedom at times • Will be isolated from the public

47. Critical Considerations • Physical strain • Emotional strain • Psychological strain • Obligations/personal considerations • Confidentiality • Commitment to patient safety

48. Summary • Class Rules • History • Surgery classifications/timeframes • ST definition/roles • Competencies/job descriptions • OR team/roles • Direct verses Indirect Departments • Hospital/Departmental Organization • Lifestyle of the ST

49. " The nose of the Bulldog is slanted back, so that he can still breathe without ever letting go." • Winston Churchill

50. ABTCCBlood Borne Pathogens Training