Manual of Perioperative Care

An Essential Guide

Kate Woodhead, Lesley Fudge

• Publisher: Wiley-Blackwell
• Year: 2012
• ISBN:
  9781118302354
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Manual of Perioperative Care is a comprehensive manual of principles of care designed to support the clinical practice of perioperative practitioners, whether they are nurses or operating department practitioners. This book meets the needs of those studying perioperative practice as well as those who would like an up-to-date comprehensive reference on their bookshelf. It covers the fundamentals of perioperative practice, placing them within the wider context of modern surgical care.

With a practical, accessible focus, aided by full colour illustrations, this book follows the journey that the patient makes through their surgical care, with sections on:

• The foundation for safe and effective perioperative care
• Infection prevention and control
• Patient safety and managing risks
• Different patient care groups
• Approaches to surgery

This bookis essential reading for all students on perioperative courses, as well asnewly qualified perioperative nurses and operating department practitioners.

Foreword 1

Perioperative practice unifies the many disciplines that work toward the assurance of good clinical outcomes and patient safety in operating rooms of inpatient and ambulatory services, providing elective, urgent and emergency surgery. Surgical suites are unquestionably exciting, energy charged and stimulating environments and highlight on a daily basis the priorities of accountability, advocacy and ethical care, the challenges of complexity and human error that can so easily be compounded by complacency or disregard for patient and staff safety, the aggressive march of technology and innovation that tests us all, the contribution of effective teamwork and communication and the vital importance of compassion and professional commitment to safeguard patients, when they are at their most vulnerable.

Throughout my career first as a student enjoying placement, a ‘newbie’ staff nurse, post-qualifying green hat or ‘course nurse’ (a title reserved those fortunate to pursue a JBCNS or ENB programme in the 1980s), Sister, Manager, Commissioner, Educator and National Advisor, I have been engaged in and associated with the perioperative arena. I could not imagine working in a speciality more rewarding, stimulating and exciting and I consider myself privileged to have enjoyed the career path that I have and to have worked with so many exceptional perioperative staff and leaders, willing to take the risks that they have to benefit patients, to ask the difficult question to safeguard safety and who have championed change, to realise service improvements at scale.

Although my current portfolio means I am engaged in research and Board Assurance, and less frequently involved in direct patient care (regular bank shifts still keep me current and clinically credible), I am acutely aware that the central tenets of perioperative practice (clinical quality, patient safety, governance, controls assurance and clinical effectiveness) are enduring and focused themes of my work, as relevant to my practice today as they were when I first set foot in an operating theatre. I also know in my heart that my passion for our discipline is as strong today as it was when I started out 30 years ago and that the many opportunities and challenges I have encountered working in this environment have shaped who I am, how I think, how I care, how I lead and the career choices I have made over the years.

Would I have done anything differently? Not a bit of it. Might another speciality have given me and tested me as much? No way. As all the students I have encouraged to take up this discipline will testify, this environment, our practice, is like no other and gets under your skin. While surgery is not without stress, and delivering patient care in the circumstances and conditions that we do can be uniquely challenging, it is none the less an incredible privilege that encourages us to give of our best every day.

Sound knowledge and honed skills are key to us giving of our best and underpin our individual clinical competence and team effectiveness. This manual outlines the background knowledge required of staff who wish to ensure they deliver good safe and effective perioperative care, and have ambitions on advancing their career through the specialty.

It is practical in focus, addressing principles rather than procedures and logically structured around the patient’s journey, the five discrete sections providing further structure to guide the reader. Each chapter, prepared by respected leaders and academics of the field, contains useful guidance and the theoretical underpinning of the core subjects pertaining to perioperative practice; as an ‘essential guide’ it provides nurses and operating department practitioners (ODPs) with answers and rationales to many of the questions that arise in the day-to-day delivery of care. Although aimed principally at nurses and ODPs, the quality and depth of the information is so extensive it will prove an excellent reference resource for those (medical and nursing students, surgical trainees and industry partners) seeking to understand the dimensions and diversity of the discipline.

At a time when the rising popularity of handheld electronic devices raises questions regarding the long-term future of hard copy, I think we can be confident that however we avail ourselves of the information we need, the greater priority will always concern the quality and validity of what we access rather than how. The principles and foundations of each chapter, once understood, internalised and practised will facilitate the delivery of high-quality, evidence-based, patient-focused perioperative care and I commend them to you.

Jane H. Reid, RN, DPNS Enb 176, BSc(Hons), PGCEA, MSc
President International Federation of Perioperative Nursing
Visiting Professor Bournemouth University
Fellow NHS III Safer Care and Improvement Faculty

Foreword 2

Teamwork in the perioperative environment is a fundamental aspect of professionals working together to deliver the best care possible for patients undergoing surgery. One of the key aspects of good surgical practice, from all team members is situation awareness; the ability to ‘see’ or hear the clues in the environment, analyse the situation with sufficient knowledge to apply it to what is occurring and be able to make judgements about their relevance to the patient, at that moment. As a practising surgeon, it goes without saying that reducing risks to patients and awareness of patient safety is implicit in each practitioner’s practice in the perioperative environment.

There has been a renewed emphasis on the importance of patient safety within the surgical environment since the work undertaken by the World Health Organization’s second Global Challenge ‘Safe Surgery Saves Lives’. The National Patient Safety Agency’s publication of the surgical checklist and the subsequent acceptance of this in operating theatres throughout the UK and beyond has without doubt helped teams to focus on what is important in the minutes before surgery starts. This has ensured that everyone in the team concentrates on the patient not only at that point in the surgery but as the operation proceeds.

Organisations need to be flexible in order to demonstrate that they understand the requirement to continuously improve the quality of care to patients. Clinicians should focus on the evidence and being knowledgeable practitioners so that they have the ideas and energy to innovate. Many of the actions which denote quality care and an improved patient experience can be shown to come from ideas generated in clinical practice, such as the redesign of care pathways and the changing roles and responsibilities of staff delivering the care. Innovation may come from inspired leadership or quite simply from a group of staff asking the question ‘how can we do this differently?’

For the individuals and team members, answers to that question may come from ideas gleaned from any number of sources. The expertise of the authors in this book, the Manual of Perioperative Care – An Essential Guide, should help to generate solutions and be the inspiration for innovation.

Patient safety is a key theme running through almost every chapter of this book. The book is helpfully divided into sections, so that the key subjects are highlighted. All the customary chapters that you would expect to find in a perioperative text book are included and in addition a section on different patient care groups which further defines how perioperative practice can be delivered with particular focus on the patient’s age or specific physiological considerations. A final section on the new approaches to traditional surgical approaches highlights the dynamic and ever changing face of surgery.

The purpose of new textbooks especially when a fundamentally practical approach is taken to the topics in hand is to add to the body of knowledge which is practised every day and for every patient. All practitioners in the team are expected to maintain and improve their knowledge in order to provide evidence-based care, focused on each individual patient. Lifelong learning is a concept which is well rehearsed within healthcare in the twenty-first century and applies to each member of the team.

Professor Lord Ara Darzi PC, KBE
Paul Hamlyn Chair of Surgery, Imperial College London

Section 1

Foundation for Safe Perioperative Care

Chapter 1 The Context of Perioperative Care

Kate Woodhead and Lesley Fudge

Chapter 2 Preoperative Assessment

Jane Jackson

Chapter 3 Communication

Libby Campbell

Chapter 4 The Perioperative Environment

Hazel Parkinson

CHAPTER 1

The Context of Perioperative Care

Kate Woodhead and Lesley Fudge

What is Perioperative Practice?

The word ‘perioperative’ is a fairly recently devised term. The Association for Perioperative Practice (AfPP 2005) describes the perioperative environment as the area utilised immediately before, during and after the performance of a clinical intervention or clinically invasive procedure.

Previously, the care of the patient undergoing a surgical procedure was separated into distinct and separate areas of care. In the case of elective surgery the majority of patient journeys began with a visit to the GP, followed by a wait, hopefully appropriate to the urgency of their disease needs, for a referral to a specialist surgeon to come to fruition and then again, subject to urgency, another wait for an admission date to a hospital for surgery possibly after a series of investigations. Once admitted, the patient started on another journey in less familiar surroundings which, dependent on age, ethnicity and language, competence and understanding may have caused anxiety and fear which the healthcare professionals responsible for the care of the patient must make every effort to resolve as part of their service to the people who need their help and support.

It was then at this point that the perioperative care in anaesthesia, surgery and postanaesthetic recovery took place as suggested by the AfPP.

More recently, the patient has been considered holistically and the term ‘perioperative’ now much better describes the care of the patient from initial referral and diagnosis to full recovery, or as full as that recovery might be for their physical condition. That final outcome may inevitably be death and it is not necessary to deem that conclusion as a failure.

The word ‘peri’ derives from the Latin ‘around’, so perioperative means around the operation or intervention. Therefore perioperative care should start with good-quality information-giving and sharing with the patient from the first time they interact with a healthcare professional in the doctor’s surgery or possibly in the emergency department of a hospital. Today’s elective patients are likely to have investigated their own symptoms, often using unregulated internet sites and may arrive for their first healthcare consultation believing that they have already discovered their own diagnosis. The patient’s first interaction and continuing care may be as part of the caseload of a surgical nurse consultant or advanced surgical care practitioner, who may care for the patient throughout their surgical journey and should be considered as perioperative.

All patients should be treated as individuals and not as a diagnosis or surgical operation. Sometimes, in this busy pressurised world, there may a tendency to forget that the patient does not experience the surgical environment every day as do the specialised healthcare professionals. Even the least complex procedure in the perioperative environment may be a major event for the patient.

Where Does it Take Place?

Historically, perioperative care was undertaken in an operating theatre or suite of theatres in an acute hospital, but more recently the settings for surgery have expanded after recognition that as long as the allocated area meets standards required for asepsis and infection management, conventional environments are not necessarily the only available option. These various settings can include doctors’ surgeries and treatment centres for routine and more minor cases, keeping the acute or tertiary setting for the most complex and urgent surgeries. Patients can therefore access their surgical care closer to home and with less personal inconvenience and, it is hoped, with reduced waiting times. Healthcare is unfortunately enmeshed with the political system, but one of the better outcomes for patients over the last decade is that they usually have to wait less time than previously to see a specialist and receive appropriate treatment for non-urgent surgery.

In addition, in the current climate of global unrest, life-saving surgery is undertaken in conflict zones across the world and standards expected in more settled places may not be able to be fully met, the first priority being the saving of life. For example, surgery takes place in mobile operating rooms, in vehicles and ships, tents and other settings which will be completely alien to the practitioner who works in a standard hospital operating room. Working in the armed forces, for non-governmental organisations, charities and ...

Table of contents

• Cover
• Title page
• Copyright page
• About the Editors
• Contributors
• Foreword 1
• Foreword 2
• Section 1: Foundation for Safe Perioperative Care
• Section 2: Infection Prevention in Perioperative Care
• Section 3: Patient Safety and Managing Risks in Perioperative Care
• Section 4: Different Patient Care Groups
• Section 5: Different Approaches to Surgery
• Index