Preoperative Duties Performed to Assist the Surgeon for Maximum Patient Care, Safety, and Economy of Time

1. Sterile Technique

• Perform the appropriate preoperative skin scrub for the particular procedure and circumstance
• Demonstrate the understanding of aseptic technique and sterile vs.non-sterile areas
• Display surgical conscience for the safety of the patient, other employees and themselves
• Wear appropriate barriers as outlined in the Infection Control Manual for protection against blood and body contamination of patient and self.

2. Preoperative Preparation of the Patient

• Demonstrate timely movement of the patient to the OR
• Properly identifies the patient:
  • Verbally check with the patient (patient name, surgeon, and procedure
  • Visually checks the ID band, chart, surgery schedule and bed tag
  • Display a professional and courteous manner while reassuring the patient that asks questions; give support to the patient
  • Respect the patient's confidentiality
• Facilitate voluntarily in an assistant or non-assistant room, and work efficiently with the OR team, performing duties in an efficient and safe manner, proceeding smoothly throughout the day.
• Collect and properly display the appropriate x-rays.
• Properly measure patients for intra-operative procedures.
• Review patient chart.
• Assist anesthesia under direct supervision if time permits.
• Properly bi-valve any cast that needs to be removed, having patient safety in mind at all time
• Position the patient properly, being aware of and padding areas that require special protection, making adjustments for surgeon's preferences.
• Prepare and properly perform surgical preps and urethral catheter insertions
  • Routinely inspects the surgical site to ensure that a proper shave prep was performed according to the type of surgery and surgeon's preference
  • Routinely verify any patient allergies and changes the prep solutions accordingly
  • Display knowledge of the surgeon's preferences and prepare the prep tray in a sterile, economical, and uniform manner with the supplies needed
  • Ready to insert the catheter and/or perform the skin prep when anesthesia permits.
  • Following skin preparation, checks that there is no pooling of fluids beneath the patient or near the Bovie pad

INTRA-OPERATIVE: The Ability to First or Second Assist Any Surgeon on Any Case with Minimum Difficulty

1. Knot Tying

• Knots are square, secure and they approximate the tissue, do not slip, and have the correct number of knots required for that particular tissue
• Is familiar with tensile strength using appropriate tension for the type of suture
• Demonstrates dexterity and knowledge of one handed and two-handed ties, surgeon's knot, and instrument ties in a smooth and efficient manner.

2. Exposure of Incisional Site

• Demonstrates skill and knowledge of maintaining hemostasis by proper use of pressure, clamps, ties, suture ligatures, clips or electrocautery according to surgeon's preference
• Provides and maintains the proper exposure necessary to perform the operative procedure while protecting vital organs, tissues and other structure
• Sponges and suctions at the appropriate time without interfering with the flow of the surgery in order to allow a clear and unobstructed view of the operative field.

3. Knowledge of Equipment and Instrumentation

• Demonstrates the proper use of equipment in a smooth, safe, and efficient manner
• Demonstrates proper use of instrumentation at the field
• Selects appropriate instrument according to need and doctor's preference
• Operates instrumentation in a smooth, safe, and efficient manner to achieve the desired result
• Practices care and economy in the use of equipment and materials.

4. Cutting Suture

• When cutting suture, the assistant demonstrates promptness, proper handling of scissors, and safe cutting techniques
• Assistant displays ability to adjust cutting length to various sutures and doctor's preference.

5. Wound Closure

• Assistant closes the proper anatomical layers with the appropriate use of suture and stitch according to the surgeon's preference
• Demonstrates knowledge of suture material, various types of stitches, and properly closes the incision in a smooth and efficient manner according to the surgeon's preference
• Applies the appropriate dressing for the procedure and according to surgeon's preference.

6. Anticipation of the Surgeon's Needs

• Assistant follows the pace set by the surgeon, and without delay in the thought process, participates in the procedure to maintain a smooth and efficient flow of the operation
• Displays knowledge of the different routines, procedures and anatomy which enables anticipation of the surgeon's needs.

EXTRA-OPERATIVE RESPOSIBILITIES

1. Maintains a Professional Working Relationship with Staff and Physicians

• Changes behavior in response to guidance. Collaborates, communicates, and works harmoniously with peers and other departments.
• Observes own verbal and nonverbal communication and selects proper communication techniques.
• Demonstrates awareness of team responsibility by accepting additional duties and responsibilities to improve the SA department, OR and Aultman Hospital
• Works harmoniously with other health care personnel in the adjustment of duties in a team like fashion as necessary to attain patient care goals
• Establishes a professional rapport with physicians.

2. Self-Responsibility and Accountability for Own Practice

• Retains current with changes by promptly attending meetings, inservices, and reading meeting notes
• Gives and attends department inservices willingly and professionally
• Demonstrates a cooperative attitude toward improving the department's standing in the OR, hospital, and community
• Openly receives criticism and strives toward improvement
• Demonstrates calm and reasoned judgment in an emergency
• Recognizes the need for emergency procedures and implements accordingly. (e.g., patient in distress)
• Willingly complies with JCAH regulations concerning CPR standards

3. Adheres to Departmental Policies and Procedures

• Accountability
  • Assistant is dressed and ready to work at the start of their shift
  • When ill, calls off at least one hour before their shift is to begin.
  • When on call, the assistant is at the OR table within thirty minutes or less after being notified.
  • When leaving the department, the assistant routinely lets the Charge SA know of their whereabouts and remains within the overhead paging system or is available by beeper.
• Time sheets and beeper
  • Posts worked times daily at the beginning and end of the shift.
• Dress code
  • In the OR, the assistant maintains a professional appearance by wearing clean scrub clothes, has the appropriate hair covering and limits the amount of jewelry and colognes
  • Outside the OR, the assistant maintains a professional appearance by wearing a clean white lab coat, no mask or shoe covers and has the proper identification badge
• Communication
  • Notifies the Unit Director when a call change is made.
  • Informs the Charge SA of any changes with the daily schedule
• Is familiar with and adheres to the Aultman Employee Handbook.

4. Shows Flexibility in Working Hours and assist the department with any task or duty delegated to them within their educational ability. Manages equipment within the OR

5. Charge Responsibilities

• Assigns assisting staff according to need and skill level.
• Communicates with surgeons, staff, charge nurse, anesthesia, and the Unit Director of any status or problem areas
• Communicates with the next shift about the status of the department and any information on patient, equipment, staffing or procedure changes
• Checks and makes assignments on the tentative schedule, notifying the Unit Director of any potential scheduling or staffing problems.