Patient Safety

Which of the following is a special consideration before the procedure for a burn patient?

• amount of light in the room

• temperature of room

• laminar air flow rates

• type of operating room bed

Answer explanation

Burn patients are at risk for developing hypothermia since they have lost skin and subcutaneous tissue that helps regulate body temperature. Laminar air flow rates will stay the same. The type of OR bed would only change if the procedure dictated the need for a different bed. The amount of light in the room would not change because it would have no effect on a burn patient.

Using gel pads during a surgical procedure helps to prevent

• pressure ulcers.

• excess bleeding

• gastric decompression.

• the need for a lift sheet under the patient.

Answer explanation

Gel pads reduce pressure ulcers. They are designed to minimize stress to pressure points and bony protrusions that can be susceptible to injury from a hard surface. Excessive bleeding can be controlled with pressure, or cautery. Gastric decompression can be relieved with medication, or will subside once the patient begins to become mobile again. The lift sheet will assist in moving a patient who is still under the effects of anesthesia.

Which of the following events should occur between the surgical technologist and her end of shift relief?  (Select the three (3) correct answers.)

• Perform another time out procedure

• Count sponges, sharps and instruments.

• Remove any empty suture packets from sterile field.

• Confirm the surgical procedure and progress of case.

• Relay pertinent information regarding sutures, specimens, solutions and medications.

Answer explanation

Another time out 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, sharps, 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 medications used on the field. Empty suture packets may remain on the sterile field.

A surgical technologist is being permanently relieved from a case at the end of the day.  Which of the following should the technologist communicate to her relief? (Select the three (3) correct answers.)

• that a side-to-side abdominal skin prep was performed on the patient for an abdominoplasty

• that initial and subsequent sharps and sponge counts are correct

• anticipated specimens

• amount of fluid replacement given by anesthesia during an exploratory laparotomy

• confirmation of fluids and medications on back table

Answer explanation

Any time there is a change in OR personnel, the sharps and sponges count must be correct before the first tech leaves. Any information about current specimens or anticipated specimen must be relayed to the incoming tech. The incoming tech should also be aware of any fluids and medications and how much has been used. Information about fluids given by anesthesia is usually not relayed to the surgical technologist.

During a preoperative count 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.

Answer explanation

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

The surgical technologist and the circulator are doing an initial count and are short one Raytec sponge. Which of the following should the technologist and circulator do?

• Make a note after the first count and continue with the case.

• Remove the sponges from the room and open a new pack.

• Call the OR supervisor for a count waiver on the sponge pack.

• Tell the surgeon about the count, document it in the chart, and proceed with the case.

Answer explanation

Since the incorrect number of sponges was found before the procedure has started, the pack must be removed from the room. Removing the package completely from the room prevents the risk of an incorrect count occurring later during the procedure.

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

• two

• three

• four

• five

Answer explanation

The minimum number of counts for an open procedure is three which includes the initial pre-op count, the first closing count, and then a final count when closing the skin. Only doing two counts would eliminate an important pre-op count or intra-op count. Any extra counts only become necessary if there is a change in personnel or if there is an incorrect count.

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.

• circulator and surgeon.

• incoming surgical technologist

Answer explanation

The surgical technologist that is relieving the current surgical technologist must be present for a count. 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.

Which of the following is the proper placement for the safety belt in the supine position?

• two inches distal to the knees

• two inches proximal to the knees

• around the abdomen

• across the knees

Answer explanation

It is best to place the safety belt across the patient’s legs 2 inches above the knees. Do not place over the knees to avoid damage to the knee joint or bony knee prominence. If the strap was placed across the abdomen, the legs would not be secured to the table. Placing the strap 2 inches below the knee would not provide enough of a safety measure to secure the patient’s midsection in the event of movement.

Sequential compression devices are placed on the patient preoperatively to prevent which of the following during surgery?

• hypertension

• pulmonary embolism

• pressure ulcers

• aneurysm

Answer explanation

Mechanically promotes venous return in extremities, prevents pooling, and reduces the risk of DVT development. Thrombosis can occur when legs are in a dependent position due to slow venous return