Theatre Management

Role of OA as theatre manager

The OT manager must maintain various registers for different purposes.

  The purpose is to keep a written record of the operations performed per year. The following data is required:

• - Name of the patient
• - Medical record (case sheet) number
• - Date of operation
• - Age and sex of patient
• - Operation performed
• - Complications occurring during surgery
• - Name of surgeon

  Each surgeon is responsible for maintaining a record of operations they perform. Theatre manager also enters the details in a register. Entries to the record should be made daily, and summaries compiled regularly by the theatre manager.

There should be a separate register for the following

• - Weekly summary of operations performed by each surgeon
• - Monthly summary of the operations performed in each category using the following data:
• - Category
• - Number
• - Name of the surgeon
• - Complications
• - Patient’s name and medical record number

These details will provide a comparison to figures from previous years and can be used for research statistics and surgery audits. An operating register can be written in a book, or it can be in a computerised system.

1. Written record

Advantages

• - Simple
• - Easy to use
• - Reliable

Limitations

• - Does not hold much information
• - Sometimes illegible
• - Difficult to trace the information quickly
• - Bulky to store

2. Computer record

Advantages

• - Holds more information if a good data system is used
• - Annual, monthly and weekly statistics are easily obtained
• - Excellent for research and recalling information,
    e.g. lost patient numbers
• - Audit of surgical results.

Limitations

• - Expensive
• - Difficult to maintain
• - Initially needs a manual back-up, thus not time saving

Register and records

The theatre manager must carefully maintain

• Stock register
• Staff meeting register

Stock register

  All the materials needed for the theatre should be stored in the store room and the theatre manager should have control over it. A stock register is maintained and all entries must be registered. Stock cards should be maintained. The stock should have all the following details.

• - Name of the equipment/instrument
• - Serial numbers (necessary for hospital insurance policy)
• - Cost of item
• - Date of purchase
• - Manufacturer’s details
• - Spare parts required for its maintenance

Staff meeting register

Theatre staff meetings

These are held on a regular basis when the theatre is quiet. They allow the staff time to air their thoughts. The meetings also allow time to introduce and inform staff about changes that may be occurring. Staff meetings can be department based (that is just for theatre staff ) or with staff from other areas, e.g. clinic, ward, etc., It is advisable to hold these general meetings from time to time for the staff to review their work, contribute ideas, introduce new techniques and to suggest new policies. New staff should be introduced to all the staff members.The minutes of the meeting are to be recorded and maintained in the register.

Education

Class room teaching is necessary but it will remain theoretical unless it is applied and interpreted in actual assistance in the theatre. The theatre manager should be a good role model for the junior OAs. The manager should tell them how to handle difficult situations and ensure smooth running of the OT. The manager must illustrate the instructions with examples, answer questions and give assignments. Even at times of emergencies they have to control emotions and face them with positive attitude. The theatre manager is responsible to teach and maintain discipline among the theatre staff. The decorum of the theatre is to be maintained at all times.

Mentoring

A mentor is assigned to the new recruit. The mentor is an experienced and reliable member of the theatre who works and trains the new member, during the probationary period. The mentor’s teaching ability can also be assessed by the theatre manager.

Practical instruction

Practical training can be carried out initially by the mentor during the probationary period. The new recruit learns by watching and listening and gains more confidence by being with their mentor. Slowly they begin to take an active part in procedures. The experienced person should always be ready to offer support. This can take several operating sessions but has been found to be a very effective and safe way of teaching. The surgeon should be informed that a new colleague has joined them at the operating table.

Assessment

Assessment is useful for measuring staff progress and development. It is intended to assess the extent to which the employee’s performance meets the requirements of a particular position, and to establish goals for the future.

Staff appraisals

Staff appraisals are designed to encourage effective communication among the staff about their work and potential; to provide recognition for good performance; to establish how performance can be improved; and to identify potential and agree on areas where staff needs further training and development. This could be conducted annually and the results checked. The potential of staff members can be developed by annual appraisal.

In-service training

The theatre managers must ensure that staff is kept well informed on new ideas, new equipment and surgical techniques. It is the theatre manager’s responsibility to coordinate in-service training, encourage potential and further learning. The training programme must be based on the requirement of the staff. A custom-designed programme could be provided to the staff to sharpen their skills. New duties should be assigned to the staff only when knowledge base, skills and confidence are established. Each member of the operating team including the junior most OAs should be put through progressive training to bring them to a high level of efficiency. Training and education are ongoing disciplines for both the teachers and the learners. Reinforcement and encouragement is essential for successful continuing education.

New staff

When a new member is allocated to theatre they should be assigned a mentor, and learning objectives. The objectives should cover the basics of sterility, infection control and patient care in the theatre. These set a standard of work achievable in the probationary period.

Probationary period

This can vary in length, depending upon the workload, and the OA’s experience. Generally, three months will give the theatre manager a good idea of the new member’s standard of work and interest in theatre work. The theatre manager should be able to find the potentials of the new comers and give training according to their capacity.

Providing quality assurance

The department should always be striving for the highest level of product and service quality and patient satisfaction as well as the satisfaction of the staff of the hospital. The process requires the CSSD to achieve standards of practice that meet the expectations of their customers (patients and hospital staff ). It is important that CCSD staff be involved in developing a quality assurance protocol for the department so that the department can provide the best quality of products and services for its customers.

Monitoring :To ensure that instruments and supplies are sterile when used and the sterility of the operation theatre complex is maintained monitoring of the sterilisation process is essential.

Administrative monitoring

These consist of the written policies and procedures that are to be followed inside the operation theatre. It is necessary to stick to them strictly to ensure the sterility of the operation theatre as well as the sterile items. These policies should be constantly reviewed in case of any doubts. The person in charge should ensure the following of them. Policies and procedures can pertain to;

• - Cleaning of all reusable items.
• - Sterilisation methods for different types of items.
• - Packaging, loading and unloading of materials into the sterilisers.
• - Transferring of unsterile items to unsterile zone and sterile items to the sterile zone.
• - Maintenance of record for each cycle of sterilisation
• - Scrubbing procedures for the personnel.
• - Attire to be followed in the operation theatre.
• - Number of personnel in the operation theatre at any given time

Mechanical indicators (for sterilisers)

To ensure the sterilisation of the items is achieved, certain indicators are incorporated into the sterilisers by the manufacturers, such as:

• - Gauges, thermometers, timers, recorders, and/or other devices that monitor their functions.
• - Automatic controls and locking devices present in some sterilisers.
• - Alarm systems indicating improper closure of the doors or too much of loads or improper functioning of the sterilisers.

Test packs (Bowie-Dick test) should be run daily to monitor functions of each sterilizer, as appropriate. These can identify process errors in packing or loading

Chemical indicators

A chemical indicator on a package verifies exposure to a sterilisation process. An indicator should be clearly visible on the outside of every on-site sterilized package. This helps differentiate sterilized from unsterilised items. More importantly, it helps monitor physical conditions within the sterilizer to alert personnel if the process has been inadequate. An indicator may be placed inside a package in a position most likely to be difficult for the sterilant to penetrate. A chemical indicator can detect sterilizer malfunction or human error in packaging or loading the sterilizer. If a chemical reaction on the indicator does not show expected results, the item should not be used. Several types of chemical indicators such as tape, labels, and paper strips that change colour when exposed to one or more process parameters are available.

Biological indicators

Positive assurance that sterilisation conditions have been achieved can be obtained only through a biologic control test.

  A biological indicator consists of live spores that are resistant to the sterilising agent. They are available in the form of a self-contained system, in dry spore strips, discs in envelopes, sealed vials, ampoules of spores to be sterilised and a control that is not sterilised. Some incorporate a chemical indicator also. These are then taken to the microbiological laboratory for testing.

  The indicators should be used to test run new a steriliser or after major repairs. And after that the test should be repeated every month. It is important to maintain record of all the results. This will help in prevention of an outbreak or early detection of an outbreak.

  The aim of microbiological cultures is to monitor the quality of air. Too much reliance on such indicators is not advisable. It is better to strictly follow the protocols of cleaning. Microbiologically cultures can be carried in cases of out break of cluster infection.

Human resources

Quality should always be holistic. Therefore, emphasis on human resources and vigilance on policies and procedures and scrupulous monitoring is essential.

  Ideally every CSSD should have personnel trained in this subject. Alternatively, the hospital can devise its own training programme. The programme should be comprehensive and should include principles, significance and necessity of sterilisation, maintenance of sterile environment and asepsis and disinfection practices.

  The staff of CSSD should not be rotated, if possible. This instils a sense of responsibility in them and would ensure smooth work flow in the operation theatre complex.

  Well defined and clear job description is necessary to maintain the quality of services of this department

  Regular and productive staff meetings are the key to ensure good quality of service. The employees should be given a chance to voice their opinion and concerns and can also be updated on the policies. The infection rates are also to be monitored and communicated to all involved in the meetings.

   All these procedures all serve to minimize contamination and prevent accidents.

Summary

Theatre in any hospital plays a crucial role, especially in an eye hospital. The theatre manager has to shoulder a number of responsibilities and play their role effectively for the smooth running of the theatre. They have to maintain records and registers meticulously, so that whenever needed, appropriate reports can be generated. The manager is to conduct meetings regularly, not only to inform the OA about the happenings of the hospital but to have them contribute to the growth of the institution. These meetings help the trainees understand the culture of the institution. Waste management has to be handled effectively. Theatre has to be clean and tidy and be free from any type of infection.

Key points to remember

• - Theatre manager ensures a safe environment for the patients and staff
• - A high standard of cleanliness and sterility must be maintained
• - They must ensure that proper scrub technique is followed
• - They are responsible to observe and correct any shortcomings in the staff
• - New OA trainees are to be oriented and provided with a continuing education programme

Student exercise

Answer the following

1. What are the specific responsibilities of theatre manager.
2. List the five elements in theatre discipline.
3. List three records maintained in the operation theatre and their importance
4. Discuss the importance of theatre staff meetings.