Patient movement

Safety procedures

A fully filled in request slip should be given to the theatre porters giving a clear indication of the name of the patient and the ward. The patient should be transferred from the bed to the trolley and safety rails raised; the patient is to be made comfortable and warm, during this procedure (it is important to ensure that the patient’s dignity is preserved and that the patient’s body is not unduly exposed) curtains should be drawn and doors closed where appropriate.

Before leaving the ward it is important to ensure that:

  the correct patient has been sent for, in accordance with the written operating list;

  the consent form is completed by the appropriate doctor (it is desirable that the surgeon performing the operation or senior member of the team has obtained the consent and this is preferably done in the out-patients’ department before elective surgery);

  the site and side, e.g. right or left breast or right or left foot, has been marked where appropriate, preferably by the operating surgeon;

  the patient has been seen by the operating surgeon;

  any intraoperative investigations, such as X-rays or frozen section histology, have been booked;

  the full notes and X-rays are available and are transported with the patient;

  the wrist identification tag has been checked;

  the patient leaves the ward accompanied by an escort and the porter.

Transfer of the patient from reception to the anaesthetic room

Safe transfer from the bed to the trolley will have involved the patient either moving themselves or being transferred using a slide; the following points should be checked:

  worn canvasses, which may split, should be discarded;

  the patient should not be lifted but slid on a special sliding board which is correctly placed using handles on the canvas. Correct posture should be adopted by staff to avoid back strain;

  the position of the patient’s head in relation to the canvas should be checked;

  the use of transferable trolley tops overcomes many of these problems.

With regard to the trolley the patient should be placed correctly so that the head end can be rapidly tipped into the Trendenlenburg position in an emergency. The patient should be positioned so that there is no pressure against the rails; intravenous lines and infusions should be correctly attached to the trolley and the patient’s covers should be in place. The notes and X-ray should be stacked under the trolley.

An appropriate lifting and handling policy can virtually eliminate back strain amongst staff if properly designed protocols are followed. Back injury is expensive and debilitating. It is avoidable.

The reception area

This is an important area which must be designed to receive the incoming and existing patients on trolleys together with an office where there are telephones and where the recep­tionist can check in and record the patient’s details, often with computer-recording facilities which permit reliable data collection for audit purposes.

Important safety aspects include:

  an appropriately trained reception clerk;

  the insistence of written lists at all times which cannot be changed by crossing out but must be rewritten;

  correct operative description;

       identification of the side to be operated on, i.e. right or left;

  the appropriate forms for sending for patients must contain specific details (never send for the ‘next patient’).

At reception. The patient should be greeted, the trolleys locked together and, wherever possible, lifting by canvas is avoided by the use of the sliding modules which are both smooth and comfortable. Preliminary identification of the patient and the checklist should include:

  name, including the name on the wrist band;

the operation to be undertaken;

the consultant in charge;

the time at which the last meal and/or drink was taken;

the presence of a valid consent form, the notes and X-rays.

A more extensive checklist is then carried out by the anaesthetic nurse in the anaesthetic room.

The anaesthetic room

On arrival at the anaesthetic room the patient is greeted, and once again a further full checklist and protocol must be undertaken, including:

  the presence of false teeth;

the presence of a prothesis, especially with metal components;

  the wearing of any jewellery;

  allergies to drugs, plasters, dressings or disinfectants. These should all be checked. Allergies must be marked on the front of the notes, on the drug chart and on the anaesthetic form;

the care plan is checked, the patient is watched, observed and engaged in appropriate conversation. Prior to the induction of the anaesthetic, the gowns are loosened in privacy, the patient is otherwise kept well covered;

       electrocardiogram (ECG) electrodes are applied;

the diathermy indifferent electrode is applied correctly;

  the induction of the anaesthetic is carried out by the anaesthetist, assisted by the designated anaesthetic nurse or assistant. The operation site is appropriately exposed. The covers and drapes are removed and installed in a warmer;

  all drugs given are recorded;

  all drugs are kept locked;

  the patient is transferred into the operating room with all lines well secured and with the appropriate documents. Ensure protection of the patient against trauma.

Special points. Special points to note are:

the full check must have been carried out;

  the patient is observed at all times, particularly during induction and transfer of the patient from the anaesthetic room to the operating theatre. Cross matched blood, if required, is available and the correct units are in the storage fridge;

the limbs are safeguarded, especially if paralysed;

nerves are protected from pressure;

eyes are protected, the lids must be closed on induction to avoid inversion of the eyelashes and to protect the cornea against abrasions, drying and foreign bodies.

Tourniquets. Pneumatic cuffs and tourniquets are usually applied in the anaesthetic room; they should be regularly checked by an engineer:

the pressure and time should be recorded by the nurse or operating theatre assistant;

the tourniquet width and position must be checked by the operating surgeon;

Esmarch rubber bandages used must be applied with care to avoid burns;

•‘disinfectant’ must not be allowed to run under the Esmarch bandage or tourniquet;

the use of more sophisticated equipment must be carefully supervised, and its design understood by the surgeon.