The Surgical Team or who are all these

The Surgical Team or -- who are all these people?

Organizational Structure • The Perioperative Nursing Division is made up of 4 clinical nursing specialties: 1. 2. 3. 4. • Operating Room Cardiovascular Operating Room (CVOR) Post Anesthesia Care Unit (PACU) AM & Same Day Admissions (Prep/Hold) and 1 Non-nursing Specialty area: Central Sterile Services- which processes surgical instruments and stocks case carts

The Surgical Team The OR is based on a team approach: Everyone in the OR – OR nursing staff, surgeons, anesthesia providers, and all support staff & departments focus on working together to achieve the best possible outcome for the surgical patient

The Surgical Team • • • Nursing staff Surgeons Anesthesia Providers & support staff Pre/Hold & PACU Support services – – – – Pharmacy Radiology Biomedical Engineering Maintenance Anesthesia Lab Blood Bank Pathology, Frozen Section Lab

Nursing Staff • Circulating Nurse – registered nurse • Scrub Person – may be an RN, LPN or Scrub Tech • • RN First Assistant (RNFA) Team Leader Charge Nurse Support Staff – – – OR Care Techs (ORCT) – General OR PCTs – CVOR Office Services Specialists (Secretarial Staff) Supply Techs Computer Techs

Nursing Staff Circulating Nurse • Non-sterile team member • Plans, coordinates, delivers and evaluates nursing care for patients during surgical procedures in collaboration with other surgical team members – (AORN, 2007, Standards, Recommended Practices & Guidelines)

Nursing Staff Scrub Person • Sterile team member • Sets up & maintains sterile field • Anticipates, plans for & responds to the needs of the patient, surgeon and other team members

Nursing Staff RNFA • Performs surgical first assisting under the direction of the surgeon • Qualifications: – Demonstrated proficiency in the perioperative nursing role as both a scrub and circulating nurse – CNOR certification – Successful completion of an RNFA program

Medical Staff • Surgeons – – – Attendings Fellows Residents Medical Students Surgeons’ Assistants (SA, aka Surgical PA) – SA Students • Anesthesia – – – Anesthesia Attendings Anesthesia Residents CRNAs Support Staff: Anesthesia techs, anesthesia lab staff

CVOR: CV Perfusion • Perfusionists • Perfusion Assistants

The Chain of Command & Escalation • Whenever there are: – patient or employee safety concerns -- all perioperative team members can go up their chain of command to seek assistance with resolving conflicts or disputes, or -– any situation in which you need additional information to make a clinical decision

Escalation: Chain of Command for Nursing Staff Nurse Team Leader Charge Nurse Manager Administrative Director or AVP

Escalation: Chain of Command for Medical Staff Resident Chief Resident Attending Surgeon of the Day Department Chair Or OR Executive Steering Committee

Escalation: Chain of Command for Anesthesia/PACU Staff Anesthesia & PACU Staff More senior Anesthesia Care Provider CRNA Chief CRNA Anesthesia Attending Surgeon of the Day Department Chair

When can I initiate the escalation process? • Whenever in your professional judgment you feel that the escalation process is needed • You do not have to obtain permission from a physician or administrator

How do I initiate the escalation process? • Communicate with the control desk personnel or contact the next person in the chain by using paging system, call system, telephone or verbal requests • If time does not permit contacting the next person on the chain go up the chain until you make contact successfully • Notify your immediate supervisor as soon as possible of the situation

Questions? Please ask your educator or preceptor if you have any questions about OR team member roles or about the OR escalation policy