-
I am interested in how much training is given to Junior doctors by perioperative nurses on core skills eg scrubbing, prepping, instrument and sharps handling. Do your Junior Doctors learn on the run, from university training, or do you have programs to teach them? Do you constantly monitor this group for breaches in aseptic technique? Do you identify many areas where a breach has occurred? Can you identify areas of greatest need for education? Who do you think should deliver these areas?
I am very keen to see how other perioperative nurses feel about this topic and how it impacts on their practice. I am from Queensland, Australia.
:-? -
Hi,
inthe UK it's a bit of bothy really! My local medschool has a perioperative modul for the med students but as an Operating Department Practitioner (ODP) we have little involvement in delivering the practice element. Usually the consultant asked them to scrub in an assumes that these skills have been taught somewhere!
Many years ago we did have an induction process for medical students, but the demands of service have put this to one side.
Hope this helps.
Leicester, UK....wet.........very wet.....
-
Thank you Leicester, does anyone else have a comment? From sunny Queensland but a cool 23 degrees centigrade - it is our Autumn nearly winter.
-
Also from uk... We occasionally teach them to scrub and teach instrumentation if they're interested and ask to be shown nothing formally structured though.
-
An update on my passion for training our future potential surgeons is that we have had a decrease in needle stick injuries within this group. I have been very excited that the incidence has been declining in the 2 years that the program has been running. All I want for Christmas is the number zero on this report!
-
Do you have any training/information on reducing needlestick injuries that you could share or direct us too ?
-
I briefly go through the theory with the safe zone and how to handle instruments. I then set up a mock scenario where they actually prep, drape, mark a wound, inject LA and cut out a lesion. I am their scrub nurse and they have to tell me what they want and why. We are also practicing the passing of instruments and sharps whilst performing the task. I go through the what not to do and pick up any problems at this point. I then get them to repeat the task using the correct technique. We keep going until they are happy and our movements are safe. They are also keen to learn as I identify the literature that says there is a high incidence of needle stick with the junior group. I am presenting at a conference in Perth and am in the process of researching if there is a difference between this group and a group who have not had conventional training. Hope this helps and watch this space!
:-h -
The skills of the junior doctors is slowly falling away as they are agin taught in a classroom and not given practical tips of theatre environment. As their role becomes more and more ward based as their more senior colleagues will not invite them to theatre, so they lose out on this valuable knowledge.
One junior doctor I worked with recently, around change around time in August, was asked to come to theatre in the middle of the night to assist the consultant as the registrar was busy in ITU and A&E. The junior arrived in scrubs but they were ill fitting and were also over the top of his normal clothes. He was politely asked to change properly. Then he entered the theatre without his hat and was shouted at by the consultant. I know his role in theatre was only going to be a glorified retractor but the experience of being there when the consultant cleared the SBObstruction would have been invaluable to him. The scrub technique was absolutely attrocious as he just seemed to wash his hands in the water and a small amount of scrub soap. But if the cycles were five minutes, then may I pick the winning lotto numbers four weeks in a row. By the time he had finished scrubbing and putting his gown and gloves on for the third time as he had desterilised to sets already, the consultant had finished the operation and was sewing up. The anaesthetist had started to wake the patient up and thankfully hadnt given the reversal as the consultant asked if the junior do stitch the skin. Well this proceedure of stitching the skkin took three times longer than the whole operation. The anesthetist had to give more relaxant and the wound had a bout four dogs ears in it. But as he had never been taught any surgical skills and the consultant had presumed he was competent in this task had rang the registrar and said that the junior was closing up and could he pop his head in later. The consultant had his head on his pillow at home when the operation had finished and was unaware of the juniors lack of skills. The registrar put his head round the dorr as the dressings were going on and asked if everything was ok. The anaesthetist went over for a word and asked him to come in and clear up the mess. If the junior had been fifteen minutes earlier or had the skills needed to scrub safely then he would have learnt something invaluable. If he had been five minutes longer the consultant would have closed the skin and the operation would have been done.
It is up to us all to teach the juniors, but unfortunately, either they are not around to teach or you get some of them that will not be taught by a nurse or ODP and it will go in one ear and out the other.
-
Hi Paul,
You have no idea how delighted I am to read your comments. I was starting to think it was only me who identified a problem with new doctors and you articulated this so well. It is true that my original main focus of aseptic technique was only part of the issue. As scrub nurses it is hard not to pounce when we see a breach in asepsis, but it is also difficult for these junior doctors to gain skills when they have probably been taught in medical school where at the time there is no relevance. With increasing time pressures on scrub staff my colleagues are also questioning if the medical staff should take responsibility for training their own staff while we train the nurses. The junior doctors often do not see the relevance or consequences in the techniques being taught as this is not explained under these time poor conditions. Training is also not standardized and often delivered by rushed or novice nurses who are the only ones spare to teach.
The PIP Med program has been working so well they are going to fund it for another year. On day one and two of employment (after an initial tour and scrub to theatres in orientation) two Junior doctors were called to theatre for remote call. One was for a laparoscopic appendix (after hours) and the other for a femoral popliteal bypass (registrar caught up in endoscopy). When I asked them and colleagues how they went, both were comfortable and had no issues. We cover camera work in orientation as we have identified a laparoscopic appendix is on the cards after hours. The first doctor was delighted that he knew what to do and said it felt pretty good as he knew how to pull back when an instrument was introduced, follow the instrument in, come closer for greater vision and keep the camera upright. The second doctor was able to get to theatre, scrub aseptically and get to the table in time to assist from the start and hold his own throughout the procedure. It is these stories that give me more enthusiasm to continue for our future. It also gives the doctors greater confidence at the start of their professional life and they are gaining skills that will not only help with a surgical rotation but throughout many specialties and general practice if that is their choice.
Please let me know if you have more stories and thank you for taking the time to write.
:-h -
In an update to previous discussions on Intern training in theatre I am delighted to report that our percutaneous exposure rate for the medical officer/intern/resident group has dropped by 83% since the commencement of our PIP Med program. The nursing staff have remained unchanged in reported injuries throughout this period.
=D>
Howdy, Stranger!
It looks like you're new here. If you want to get involved, click one of these buttons!
In this Discussion
- ag145 May 2012
- AMAllanson January 9
- oldskool October 2012
- Paul November 2012
- Theatresister May 2012