The importance of correct patient positioning in theatres and implications of mal-positioning”, Journal of perioperative practice, vol. 20, no. 4, pp. 143.
Hana is 72 years old
Previous Medical History:
Hana had gastroscopy before twice. The first time was when she complained of pain in her stomach. Tofind out what the cause was she was given sedation so that the surgeon can have a look in to her stomachand duodenum if there is any bacterial infection. Gastroscopy is performed to see if there is any abnormalities in the upper gut.
Hana is having hysteroscopy to diagnose abnormal bleeding, due to heavy length menstrual flow.
Hana had three previous anaesthetics, which did not have ill effect, Hana induction was achieved by using.Hana had general anaesthetic, blood pressure cuffs was put on her to monitor her blood pressure. She first had iv access in to her arm a cannula was inserted for fluid. The type of drugs she was give whereondansetron, fentanyl , and propol. Once she moved into theatre she was given sevoflurane According trust policy and also with the national guideline an accurate contemporaneous record of anaesthesia is documented for every patient the record is kept which should document.
Hana was put in lithotomy position her body in supine position. betadine antiseptic
was used to prep. Warming blanket was to keep Hana temperature from falling from safe levels due to
anaesthesia. Sterile instruments where prepared on trolleys. Warm saline was used for irrigation. The
saline was pressureized using pressure bags 300mmHg
The sending slip was sent to the ward with her details. The sending slip was delivered by the porter. The nurse brought Hana to the anaesthetic room with her medical note. The Operative Theatre Practitioner (ODP) opened the medical records and proceeded checklist and showed Hana the consent form to confirm the right patient was in theatre and asked if the signature was hers, and she replayed “that is correct”. Also the name corresponded to Hana name tag. There was little spoken by the nurse who was handing over the patient.
Health professionals must have obtained valid consent from the patient for any examinations/surgery/treatment or care in accordance with Department of Health policy and guidance for England (DH 2009).
When Hana came to the theatre, it was a different setting for her from the ward. When Hana was met on the ward in her room, she was with her husband. They were both very welcoming. Hana was forthcoming for the type of information I was looking for to be able to complete the study case. If she was worried about the procedure, she was not showing it. Being accompanied by her member of family may have put her at ease. Although position of Hana’s hands clasped may have been sings of anxiety about her procedure from my experience.
This was Hana’s second time to have this type of surgery and in the same operating place. She was familiar with the hospital The fact that the day of the operation was in the afternoon and the weather was warm, She felt less anxious about the surgery. She felt on her first visit to this hospital; the lights were not on. she felt confused as why was no one here to meet her. Patients need to know who is expecting them. She was the happy easy going character she explained about her previous experience how she felt the first time she came to the hospital. It was winter time everything was dark in the reception where patient usual wait. The reason they remain in the reception area in the morning was so they can be escorted to the floor when they have been allocated a room.
This procedure was a standard general anaesthesia which was done on the table using the pat-slide. The doctor supported the head end and two people one each side of the table, and one was at foot ready to transfer Hana. The transfer to the table was completed.
The surgeon and scrub staff went through the WHO checklist (WHO 2009) and documented by circulating the correct book, this was done before Hana was put in lithotomy position.
As she had a red band this meant, she was allergic to Elastoplast, to confirm with the patient the ODP showed Hana the type of plaster and she confirmed it correctly. It is good practice to involve the patient in their care, after all, it the patient who will have direct information.
Identifying allergies on a patient is vital as it has serious conscious to patient health.
During the hysteroscopy procedure, Hana lied supine with legs raised onto lithotomy boots. These can support the calf to the ankle, or just the ankles are secured. The patient’s arms are secured across their chest while the end of the table was removed. The legs were elevated and positioned simultaneously to prevent lower back injury, sacroiliac ligament damage and pelvic asymmetry (Adedeji, R., Oragui, E., Khan, W. & Maruthainar, N. 2010,).
Nerve damage can occur from pressure applied directly from lithotomy strips that are inadequately padded to the medial or lateral side of the leg. A lumbar support should prevent.
Hana was physically well supported at all times during transfer and positioning while she was anesthetized. Injury to the radial nerve can occur if the arms are left dropping down over the edge of the operation table. In families that support the patients should be given information to care for the patient needs referred to as patient-centred care (NICE 2003).
The patient journey could be enhanced when they make their way from the ward to the theatre. The corridor can in some occasion be full of medical equipment such as x-ray machine that is used in the operating room by the radiographers. In this situation, medical equipment can be moved where patients cannot see them or until they required for surgical procedures.
The day Hana had her surgery the theatre area which lead to the operating room was neatly kept. The only thing was the layout of the corridor to the theatre it happens have coffee room. Patients coming to have their operation done would walk past the coffee room. When door to the coffee room is opened patient can see staff eating, and they could also smell the food. The patients have been fasting for 12 hours prior to their procedure do not need to be a reminder of food. The hospital recently improved patients experience in the hospital by relocating/ closing the coffee room because patients complained. As a result patients are not put in this position again. The hospital has given thought and consideration to patients need and appropriate methods have been put in place to encourage giving feedback and responded to it.
Environmental factors contribute to patient anxiety that’s why the theatre doors are locked so that patients like Hana do not see the inside of the operating room itself which increase worry about her operation. Hana was having this procedure for the second time, although she may be familiar with the staff, hospital and with some procedure, like with any operation involving instrumentation of the uterus, hysteroscopy can be associated with pain, anxiety and embarrassment. Anxious patients need reassurance (Nursing Times 2011). Patients should be well informed about their procedure and any changes that might occurred. Encourage patients to express their concern, worries and personal needs. The staff in return should listen and acknowledge their concern. This would alleviate patient’s anxiety and make them at ease. This can be done by establishing effective communication (NICE 2012). Easy simple language that patient can understand can be used when explaining medical terms. The practitioner has to be sensitive to different culture values. Where there is language barrier or in place of family member, an interpreter, or a patient advocate can be used respectively to meet patient individual needs. Clinical guidelines state Healthcare professional must show competency in relevant communication skills (NICE 2012). Although with Hana her first spoken language was English she did not find communicating with the health care staff too difficult.
All hospital has a duty to comply with the national guideline. Elderly patients should have well-structured care plan for their individual needs. A particular patient who may not have family member accompanying them to the hospital and the care they need after leaving the hospital can be addressed. This provides reassurance and alleviates patient’s anxiety.
There is not adequate time to prepare the service user, like Hana to make them feel comfortable before they are sent to the theatre. It is good practice for theatre staff to visit wards before a patient is brought down to the theatre. They have enough worries of unfamiliar surroundings, and about their operation.
Health care practitioners are accountable for their action. Once the patient arrives there is a lot to dobefore they can be sent to the theatre. The patient should not be sent for until every document has been completed. This reduces delays and alleviates patient’s anxiety.
The reason Hana was having this procedure is to diagnose the cause of abnormal bleeding in the uterus ( Liberis, V., Tsikouras, P., Christos, Z., Ammari, A., Dislian, V., Koutlaki, N., Liberis, A. & Maroulis, G. 2010). The ODP was well-experienced staff member he made the patient feel at ease was already introduced to Hana before, on the wards. The ODP introduced the student on placement again to Hana, but she replied to the ODP she had met the student beforehand on the ward. The handover was remarkably quick. The ward nurse and the ODP checked the patient medical notes.
The team briefing was done correctly before the start of the operation; the case was hysteroscopy which she had previously had the same operation. The team briefing allows surgeon, anaesthetist; ODPS and scrub staff in the theatre to be informed about Hana’s condition and what type of procedure she was having.
Different members of the healthcare team work in coordination to care for patients. Their roles and responsibility should be informed and communicated. In this case the porter, nurse, anaesthetist and the ODP work together to deliver safe and smooth procedure thereby putting patient at the centre and minimise the impact on the patient.
Department of Health (DH 2009) Reference guide to consent for examination or treatment. [online]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/138296/dh_103653__1_.pdf [Accessed 9 May 2015]
Nursing Times (2011) Reducing anxiety in elective surgical patients. [online] Available from:
http://www.nursingtimes.net/nursing-practice/specialisms/perioperative-care/reducing-anxiety-in-elective-surgical-patients/5024376.article [Accessed 10 May 2015]
National Institute for Health and Care Excellence (2012) Patient experience in adult NHS Service: Improving the experience of care for people using adult NHS services. [online]. Available from: https://www.nice.org.uk/guidance/QS15 [Accessed 10 May 2015]
Adedeji, R., Oragui, E., Khan, W. & Maruthainar, N. 2010, “The importance of correct patient positioning in theatres and implications of mal-positioning”, Journal of perioperative practice, vol. 20, no. 4, pp. 143.
Touqmatchi, D., Boret, T. & Nicopoullous, J. 2010, “The quality of
operative consenting against RCOG advice as standard”, Journal of Obstetrics & Gynaecology, vol. 30, no. 2, pp. 159-165.
Liberis, V., Tsikouras, P., Christos, Z., Ammari, A., Dislian, V., Koutlaki, N., Liberis, A. & Maroulis, G. 2010, “The contribution of hysteroscopy to the detection malignancy in symptomatic postmenopausal women”, Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy, vol. 19, no. 2, pp. 83-93.
Siddiqui, J. & Tuffnell, D. 2005, “Minimising risk in gynaecological surgery”, Reviews in Gynaecological Practice, vol. 5, no. 3, pp. 152-158.
When a patient like Hana was admitted to hospital she already had received preoperative instruction with regards to how she needed to prepare for the day of her surgery (i.e., fasting), including arrangements she had to organise with someone to accompany her to the hospital. Also after surgery, before she was discharged who was going to take her home. In this instant it was the husband who has come to the hospital who will be looking after her needs.
Hana has had this surgery previously, so she was more educated about the process that she will go through. From talking to her, she was calm about the surgical procedure she was having. The care plan questions will pick up the experience she had before whether it was negative or positive experience so improvement can be made. The fact practitioner gathers information from patient helps them to create individuals care.
Ted stocking worn by patients have to be the correct size if the stocking is bigger it will not be effective against DVT. The speed of admitting the patient to the ward should not compromise patients safety health care worker must methodically go through the care plan. Following the care plan is a team effort to support patient their journey through pre and postoperative care.
The care plan should be revised as necessary of the patient needs so that the steps that the ward nurses take when going through the care plan correct to get the patient ready. It is vital that theatre department give enough time to the wards staff to prepare patients for surgery.
Once I became a practitioner, I would encourage ward round that would improve the patient care plan. A Patient who has been well informed beforehand about their surgery have improved outcome and need reduce analgesia during the postoperative recovery phase.
Although the patient I was involved with was brought on time on occasions, there has been a long wait after the surgeon and anaesthetist have come to the theatre, after consenting patient on the ward. To improve delays to patients coming to theatre can be alleviated by having a dedicated lift to allow patients to be transported to the theatre area efficiently.
The staff had good communication with each other considering the patients age and followed the correct procedure when transferring to the operating; patient like Hana age have to be treated with care. As we get older, our skin becomes thinner, reduced elasticity occurs that leads to damage to the skin due to age. The area that the skin came in contact with must be well cushioned.
The case study has improved my understanding why the elderly patient is prone to pressure area ulcer.
It is essential to plan patient care in a multi-professional environment to ensure highest care is provided. The care given by practitioners in theatre has to be communicating with the ward nurse to create a uniform standard of care. Hana stay in hospital will be enhanced by following good practices.
It is well-known fact, as we age, we are prone to hypothermia so it is vital to keep patient warm especially during anaesthesia phase. Hana procedure took 15 minutes in total and throughout the procedure warming blanket was used to keep her body temperature at safe levels.
In major case, the patient might have spent a while longer in the anaesthetic room before they are
transferred onto the operating table. From what I have learnt I will have knowledge and reason behind why patients particularly elderly patient needed to be kept warm during surgery procedures.
When transferring the patient to the operating table, sufficient numbers of staff are recommended and no transferring of a patient should take place without the supervision of the anaesthetist.
Having experienced being a patient once myself, I have some understanding the emotional side that the patients go through. I feel I am in the ideal position to support patients who have different types of surgical procedures. Hana was very appreciative about the care she was given. I shared my experience of being in the hospital with her and I talked to her how I felt during and after the procedure. I have understood what emotion she is going through.
It is one thing to advocate personal care plan, but where the individual is unable to say who they are, through disability, and then there is a danger of care falling short of the ideal. Hana can speak for she she has no disability she had mature understanding about the procedure she was having.
Patients are very attached to items they bring from home. It is extremely important for theatre staff to look after patients belonging. Therefore when patient come down to the theatre before they go to sleep, their glasses are removed and explain beforehand that their belongs will be kept safe until they wake up in the recovery room.
Hana’s experience was positive she was smiling and happy when she was leaving recovery to go back to the ward. I believe it was down to communication between healthcare staff centre to having a good team interaction. If everybody knows their role within a team, the theatre activities go smoothly.
Having close working relations improves safety aspect within the theatre environment. Patient pick up on around them whether it good or bad. Recently we had feedback from the head of the hospital telling us to smile. I already smile when I meet patients as I have learned from the different roles I have done during my employment.
My view is patients need to feel welcomed and listen too. When I was speaking with Hana, she was so willing to explain to me how she felt. From asking her questions, I would find out about what she would be doing if she were not here at the surgery. This kind of conversation to patients takes their mind off from the procedure they have to feel less stressed about it. From the case study I have learned valuable experience, communication with the patient in correct manner.
the case study is 2000 words and the reflection on the case study is 1000.
i want you to improve the writhing some are not relevant . more on patient anxiety. the reflection should mirror the case study. research why people of this age need to be scope .
COMMENT TO IMPROVE THE ESSAY
The standard of English in this assignment is not good enough to meet the requirements at this level. In many cases the sentences make no sense at all, the tenses are mixed, and plurals are inserted inappropriately.
Aside from the standard of written English, you have failed to meet the requirements for this piece of work at all. You do not discuss this patient’s individualised care in any detail, instead you have written a lot about the step by step process of the patient being taken to theatre.
You have included some references – often for no apparent reason, and you do not indicate how those references should be applied to your particular case. You also have got the technique of referencing wrong in both the list, and the citations in the text. This at least could be sorted by using the Helpsheet from the library about how to use references correctly.
You need to plan your work more effectively so you do not have so much repetition of information. (for example you say that this lady has had this surgery before, and you say that several times). You need to think about the issues for this patient which may have contributed to her anxiety, how this was managed, and whether anything more could be done to make her experience less of an ordeal. You need to read more about patient anxiety and apply those things to the example you are discussing, in order to demonstrate sound understanding of the issues.
Aside from all of this, the patient you are describing is 72 years old and you say she is being investigated for heavy menstrual flow. A woman of this age would be long past the menopause, and any bleeding at that stage of her life would be investigated because there would be a worry about a serious illness. This would make her particularly anxious because it would be likely that she had cancer – yet you do not even consider any of this – in fact you do not even indicate that you think this is unusual, which shows a worrying lack of understanding.
Another issue which demonstrates unsafe level of understanding is your comment about red wrist bands telling us that the patient is allergic to Elastoplast. Red wrist bands tell us the patient is allergic to “SOMETHING”. It is merely an alert mechanism to make us look further to see what the allergy is – it does not automatically mean an allergy to Elastoplast.
There are many, many, comments on your work – these should help you with the poor English and the referencing, as well as the things you have included which are not relevant.