Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed if possible.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent as far as possible (NMC [152], C).
2. 2.Show
   Prior to transferring the patient from the trolley to the operating table, check with the anaesthetist that the patient's airway is protected, patent and safe.
   To prevent complications with airway or breathing. E
3. 3.Show
   There must be adequate staff (a minimum of four is recommended) to transfer the patient onto the operating table. The team must ensure that the brakes on the trolley and operating table have been applied. Ensure the patient's head and limbs are supported when transferring them to the operating table. When transferring anaesthetized patients, the anaesthetist takes charge of the patient's head and airway and co‐ordinates the transfer.
   To prevent patient injury during the transfer between trolley and operating table (AORN [21], C).
4. 4.Show
   When positioning the patient, the theatre staff must ensure that the limbs are supported and secure on the table and that bony prominences are padded or cushioned.
   If the patient is unconscious and unable to maintain a safe environment, support is necessary to prevent injury. Nerve damage due to compression or stretching must be prevented (Welch [224], E).
5. 5.Show
   The patient's position will be dictated by the nature of the surgery and can include lateral (Action figure 5a) and prone (Action figure 5b) positions. The theatre staff must verify the position with the surgeon and anaesthetist, and prepare any required positioning equipment and devices.
   The patient is at risk from skin and nerve damage during surgery, especially if it is prolonged. Measures must be taken to preserve the integrity of the skin (e.g. use of pressure‐relieving mattress or pads). Positioning must take into account the natural movement of the back, neck and limbs to safeguard against injury (Rothrock [180], E).

Procedure

1. 6.Show
   Cover the patient with a gown or blanket. The patient must remain covered until immediately before surgery.
   To maintain the patient's dignity. To help prevent a reduction in body temperature or inadvertent hypothermia. E
2. 7.Show
   Use a warming mattress and/or blanket on the operating table (Action figure 7). Both intravenous and irrigation fluids should be warmed prior to administration. The theatre staff must ensure that patient‐ and fluid‐warming devices are available for every operating list.
   To help maintain the patient's body temperature, prevent inadvertent perioperative hypothermia and reduce post‐operative complications due to hypothermia (NICE [143], C; Rothrock [180], E).
3. 8.Show
   Ensure the diathermy patient plate is attached securely in accordance with the manufacturer's instructions and sited correctly as close to the operative site as possible (Action figure 8).
   To ensure that no injury is sustained from the use of diathermy during surgery. E
4. 9.Show
   Before, during and at the end of surgery, theatre staff must perform thorough counts of surgical instruments, swabs, sutures, needles and blades (Action figure 9). If an item is not accounted for prior to closure of the surgical wound, the surgeon must be notified.
   To ensure that all items used in surgery are accounted for at the end of the operation in order to guard against items being retained inside the patient's body following surgery (AfPP [9], C).
5. 10.Show
   The scrub nurse or operating department practitioner (ODP) is responsible for ensuring the wound(s) are covered with an appropriate surgical dressing (Action figure 10).
   The dressing facilitates healing by preventing wounds from drying out and also acting as a barrier against external contaminants, which can cause wound infection (Wicker and O'Neill [228], E). To reduce the risk of injury/infection to the patient and contamination of staff (Loveday et al. [110], C).

Post‐procedure

1. 11.Show
   After the surgery has concluded, the theatre staff must follow hospital policy regarding the disposal of sharps and clinical waste that are no longer required.
   To protect staff from injury and contamination as per all health and safety policies. E
2. 12.Show
   Any swab that is intended to be packed inside the patient (e.g. vaginal pack or abdomen pack) must be recorded clearly in the patient's care plan. The swab used as packing must be X‐ray detectable (e.g. Raytec) and clearly identified in the patient's notes, as per local policy. Orange ‘Raytec stickers’ are commonly applied to patients’ notes.
   X‐ray detectable material allows easy location of the swab for retrieval. To alert all teams caring for a patient that they have packing or a foreign body in situ. E
3. 13.Show
   The scrub nurse or ODP is responsible for ensuring that any tissue samples, organs or swabs taken from the patient during the surgery are correctly labelled with the patient's details and the exact nature of the specimen before being sent for histological or microbiological examination as specified by the operating surgeon.
   Laboratory examination of specimens will determine any subsequent treatment for the patient. It is essential that labelling and documentation accompanying the specimen are accurate and that it arrives in the laboratory within the specified time frame (AfPP [9], C).
4. 14.Show
   The scrub nurse or ODP together with the anaesthetist and the other theatre staff take responsibility for the safety, wellbeing and dignity of the patient during the phase between the surgery finishing and the transfer to the post‐operative care team. During this period, when patients who have undergone general anaesthesia are usually emerging from the anaesthetic, the theatre staff prepare to hand over the patient and ensure that the relevant documentation has been completed. This is also when the ‘Time Out’ phase of the WHO Surgical Safety Checklist is completed by the whole theatre team (see Figure 16.14). The patient will require reassurance and safe transfer from the operating table to a trolley or bed.
   To maintain the safety and dignity of the patient (NMC [152], C).