Communication & Reporting

Communication & Reporting

NCCT Review

Multiple Choice

Which of the following retractors should the surgical technologist have available during an exploratory laparotomy procedure

• Richardson

• Bookwalter

• Gelpi

• Weitlaner

​Rationale

The book Walter is used for large abdominal wounds to provide adequate exposure and retraction. The Richardson is a held retractor used to attract wound edges. The weitlaner is a retaining retractor that holds wound edges open. The gelpi retractor provides superficial wound exposure.

Multiple Choice

What should be done immediately if a count is incorrect

• Inform the surgeon

• Pause the surgical procedure

• Call for x-ray

• Keep on counting other items and come back to it

​Rationale

When a count is incorrect, the very first thing you should do is inform the surgeon and x-ray should be called after a thorough search of the field, and the room has been conducted

Multiple Choice

Which of the following events requires the surgical technologist to deviate from the surgeons preference card?

• Excessive bleeding

• Infected wound

• amputation

• Cardiac arrest

​Rationale

If a patient has an infected wound, the treatment protocol will vary from standard protocol. The case may require a different selection of suture equipment or irrigating solution. The surgeons preferred methods of controlling bleeding can be listed on the preference card and amputation would be scheduled procedure and habits preference treatment for cardiac arrest is not dependent upon a preference card. The same sequence is used for cardiac arrest, regardless of the procedure.

Multiple Choice

the surgeon asks that multiple suture and hernia mesh that were not on the preference card to be opened during the repair of a large umbilical hernia. The surgical technologist should recognize that.

• Items the preference are only to be changed by the surgeon or unit clerk.

• Sterile supplies associates stocked the hernia mesh are responsible for adding hernia mesh to the preference card

• Preference card changes are unnecessary. Both hernia mesh and suture are case dependent.

• Suture may be case dependent, but the hernia mesh is integral to the procedure and should be added to the preference card

​Rationale

Preference cards only need changed by the team case coordinator. The hernia mesh should be added to the preference card so it will be available in the room if the surgeon chooses to use it.

Multiple Choice

The facility is out of Mastisol, which of the following should the surgical technologist pull as an alternative

• Dermabond

• Tisseel

• Benzoin

• Hydrocel

​Rationale

Benzoin and Mastisol are both used to help keep skin closure tapes in place derma bond is a liquid skin adhesive to help close wounds hydrogel is a wound care product used to provide moisture to dry wounds abrasions or radiation wounds. Tisseel is a fibrin sealant containing thrombin used as a hemostatic agent

Multiple Choice

Which of the following is the minimum number of times a surgical instrument count should be performed for an open appendectomy case

• One

• Two

• Three

• Four

​Rationale

The minimum number of counts for an open procedure is three which include the initial preop count the first closing count, and the final count when closing the skin. Only doing two counts would eliminate important preop count, or intraop count. Any extra counts only necessary if there's a change in personnel or if there's an incorrect count

Multiple Choice

During a preoperative count to the number of sponges in a package is incorrect. Which of the following actions should the surgical technologist and circulating nurse take

• Discard the package and open a new one

• Document the shortage and continue the count

• Inform the surgeon immediately

• Open a new package and continue the count

​Rationale

If the count that is performed prior to the case has started is incorrect the packaged can be discarded and taken out of the room, starting a case with an incorrect package, even if documented can lead to miscount later in the case, the surgeon does not need to be informed of an incorrect count during the preoperative phase

Reorder

Reorder the followingPlace the following options below in the recommended closing count order for sponges and sharps

• Surgical field

• Mayo

• Back table

• Basin

1

2

3

4

• 1
• 2
• 3
• 4

​Rationale

Establish the same routine for counting, which should be first on the operating field second anything that is on the mayo third the back table and fourth anything in the basin

Multiple Select

Which of the following events should occur between the surgical tech and the end of shift relief (select all that apply)

• Perform another timeout procedure

• The count of sponges, sharps and instruments

• Remove any empty suture packets from the sterile field

• Confirm the surgical procedure and progress of case

• Relay pertinent information regarding sutures, specimens solutions, and medication's

​Rationale

Another timeout procedure would not be necessary because the patient did not change so that information would stay the same. The incoming surgical technologist must know the correct sponge sharp and instrument counts. The incoming surgical technologist must also know the specifics of the case how it is progressing whether any specimens have been taken and confirm the labeled solutions and medication's, used on the field suture packets may remain on the sterile field

Multiple Choice

When being relieved at the end of a shift, the surgical technologist should perform the surgical count with the

• incoming surgical technologist

• Circulator and surgeon

• Incoming surgical technologist and the circulator

• incoming surgical technologist, circulator, and surgeon

​Rationale

The surgical technologist that is relieving, the current surgical technologist must be present for account. This ensures that all items are counted for before the surgical technologist leaves the case the surgeon does not need to stop the procedure to participate in the count at shift change

Multiple Choice

During the surgical timeout, the nurse reads from the consent that a right uretoroscopy will be done. The anesthesiologist confirms, and the search tech also confirms and announces the right side is marked however, the surgeon says a left uretoroscopy will be performed. Which of the following should be done regarding the situation

• Rely on the surgeon as he will be performing the procedure

• Rely on the nurse as the nurse is reading directly from the consent

• Proceeded with the nurse annotating in the chart that surgical site is in question

• The procedure until the surgical site is verified

​Rationale

Until all surgical personnel agree on the correct operative site, the procedure cannot proceed. The circulating nurse may need to check the consent again or the doctor may be incorrect in his thoughts on the procedure never proceeded until the correct site is verified to avoid any wrong site surgeries

Multiple Choice

Which of the following hospital departments should receive details of the incident after a sentinel event

• Quality assurance

• Quality control

• Risk management

• Human resources

​Rationale

Risk management is responsible for monitoring risks and errors as well as implementing a plan to prevent errors from occurring again. Human resources is responsible from employee records, quality control, and assurance is referring to making sure package products are safe to use.

Multiple Choice

The nurse initiates a surgical timeout with the surgeon, not present and states the wrong patient identifiers which of the following is the best action for surgical technologist to take

• ask the nurse to repeat the time out once the position is in the room

• Report this sentinel event through the facility, compliance hotline

• perform the time out with the correct patient identifiers

• Allow the nurse to complete the time out

​Rationale

All surgical personnel that is participating in the procedure must be present during the time out ation among all the surgical team is essential once the surgeon is present. The circulating nurse can then repeat the time out with the correct patient identifiers incorrectly, timed out is not considered an event because no injury or death to the patient occurred.

Multiple Choice

Which of the following is considered a sentinel event

• An incorrect count, retained instrument

• Patient elopement

• Unsigned consent forms

• Damage to a patient's hearing aid

​Rationale

A sentinel event is an unexpected event that results in death or serious injury and incorrect count resulting in a retained surgical item is considered a sentinel event. Patient elopement is when the patient leaves the care of the hospital prior to their scheduled discharge and unsigned consent form can be corrected prior to the procedure start damage to patient. Property only requires an incident report to be filled out.

Multiple Choice

Which is a reportable incident in a surgery setting

• performing surgery on the correct area

• Performing surgery on the correct patient

• Performing the wrong surgery on the patient

• Performing a surgery using sterile technique

​Rationale

Performing surgery on the correct area and correct patient is exactly what is supposed to happen when using the proper sterile technique that is a great surgical conscience when surgery is performed on the wrong patient this must be documented and reported immediately.

Multiple Select

To avoid the possibility of retaining a foreign object in the patient, which of the following are the correct times to initiate a surgical count. Select all that apply.

• Prior to skin incision

• When changing positions of patient

• When closing the periosteum

• When closing the fascia layer

• when a change in staff occurs

​Rationale

The first initial count is done preoperatively. The second count is intraoperative upon closure of a cavity, and then lastly prior to closure of the skin. anytime there is a change in surgical technologist or circulator positions account must happen in order to ensure the count is correct at the time of staff change. The periosteum is the outer covering of bone.

Multiple Select

Which of the following events would require an incident report? Select all that apply.

• The Bovie pencil was activated on the sterile drape; a small hole is noted in the

• gross bile spill noted when the gallbladder is removed laparoscopically

• patient consented for removal of cancerous lesion from forehead, and the surgeon also removes a suspicious mole from the patient's right cheek

• the surgeon contaminates his glove during a procedure and refuses to change to patient respiratory status

• The wrong dressings were opened at the end of the case

​Rationale

An incident report is needed for anything involving falls, medication errors, loss of specimen, or intraoperative burns or any behavior that puts the patient at risk wrong dressings at the end of the case can be easily fixed, and reapplied Bible spillage is a known risk while performing a cholecystectomy and can be treated

Multiple Choice

Which of the following actions by the surgical technologist, supports the effective use of supplies in the operating room

• opening the same supplies used in similar previous cases

• Allowing the circulating nurse to make decisions about what supplies to open up

• Speaking to the surgeon directly about their needs for the case

• Opening extra supplies to ensure that the surgery goes smoothly with no lag time while waiting for supplies

​Rationale

Each patient may present unique needs. It is important to communicate with the surgeon about what they think is needed for each patient. Opening extra supplies increases the cost to the hospital, and the patient extra supplies opened may not necessarily be needed and would not be affective use of the supplies.