SUR 110 Introduction to Surgical Technology

1. Week 1 SUR 110Introduction to Surgical Technology

2. On matters of style, swim with the current, on matters of principle, stand like a rock. Thomas Jefferson

3. Outline • 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 • Blood Borne Path Training

4. Class Rules • The “I told you in 110” story (in other words, these rules will apply throughout this program) • We are a family. • Class rules reflect OR rules. • Personal Hygiene (+ no jewelry in SUR 111 lab/clinical) • TAKE NOTES IN CLASS!!!! All covered material AND material stated in the syllabus are testable. • CCLD – Tad Williams - Otherland

5. Class Rules • Show Respect – when another person is talking, you are not! • Turn off your cells and place them in the blue bowl sitting on the instructors desk. • If a student fails to place their cell phone in the blue bowl and their phone rings during class, the student will be excused from class. The student will then receive zero’s for any assignments that is due from that point on. • No Texting/IM’ing, paging, talking or making calls while in class.

6. Class Rules • Bathroom breaks will be given. Please stay in class until the class breaks as a whole. It is very disruptive to the class if a student gets up and leaves in mid-lecture. Plus, you’ll most likely miss a test question while you’re gone! (students- give me a hint!) • Do not eat or drink in the classroom. Leave your food/drinks outside the door (this is a Biohazard room). DO NOT LEAVE YOUR DRINK OR FOOD WRAPPERS OUTSIDE THE DOOR AT THE END OF THE DAY. CLEAN UP YOUR OWN MESS.

7. Class Rules • All homework is due as you walk in the door at the beginning of class. If you are not in class by the time it supposed to begin, you will not be able to turn in your homework or take the test. Therefore you will receive a zero for each missed assignment due that day. • No late homework or test makeup's are allowed.

8. Class Rules • You will have a test at the beginning of each class. All tests are cumulative. Most tests will be in a computer lab. • Once the test is graded, if you have a question about an answer that you feel has been graded incorrectly, email me the reason you think the question has been graded incorrectly. Be sure to send supporting evidence (i.e. page 14 says in the ST book says….).

9. Class Rules • Show up early, not late. The door will be closed at the beginning of whichever SUR class your in that day and will not reopen until the last person completes his/her test. We are preparing you for the punctuality of the O.R. • This means that if you are late to class, you will not only not be able to turn in your homework, you will also miss a test and a receive a zero for both assignments.

10. Class Rules • If you have a class before this one, just let me know. Other instructors might effect your ability to make it to class on time. • Do not count on being able to park close to our building – Rhododendron. You may have to walk. • Set your clocks to the room clock (which is set to the computer/internet time) before you leave today.

11. Class Rules • Check your email, text and Moodle often. I communicate quite a bit via the computer/cell. • I will send out information via your student email account. This is the only account we can use for electronic communication via the computer. • You will held responsible for all information passed to you via email.

12. Class Rules • All work is to be completed in BLACK ink; graded in RED ink (there will be times we will grade tests/homework in class). • Obtain 2 large notebooks. 1 for SUR 110 and 1 for SUR 111. You will need to keep all returned paperwork and be able to keep it separate.

13. Class Rules • Always feel free to asks questions. This includes emailing me questions. I will respond as quickly as possible. • Any questions about the class rules?

14. 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)

15. 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.

16. 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.

17. 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.

18. 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!

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

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

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

22. Operative Timeframes • Pre-operative – pre-op to incision • Intra-operative – incision to dressing application • Post-operative – dressing application to patient leaving the unit.

23. 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.”

24. 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.”

25. 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

27. 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)

28. 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.

29. 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

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

31. 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

32. 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

33. 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

34. 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

36. 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.

37. 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

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

39. 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

40. 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)

41. 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

42. 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.

43. 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

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

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

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

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

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

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

50. 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