HHO2007Leadership and Management in the Perioperative Environment Assignment Brief1There are FIVE Learning Outcomes.
1. Critically evaluate the implementation of national and local health policy and evidence-based practice within the multidisciplinary perioperative environment.
2. Demonstrate a critical understanding of factors that influence professional perioperative practice.
3. Critically discuss strategies for the effective leadership and management of perioperative environments.
4. Demonstrate the ability to apply decision making and problem-solving skills within complex and dynamic acute care settings
5. Demonstrate the ability to deliver a presentation submitted in an electronic format for online assessment.
You must meet all FIVE Learning Outcomes for a pass grade to be awarded. You must choose a clinical incident to analyse. You may choose from the scenario that we have created for you however you may also choose a clinical incident that you have witnessed/participated in from your practice placement. Please note: you should not identify any individuals or the organisation in anyway. If you decide to choose an incident you have witnessed ,then you must contact the module leader to discuss your assignment plan.
You will evaluate what you observe/experience in the scenarios against local/national policy and guidance to identify where you are following best practice and where improvements may lie. If you decide to use a reflective model this fits into the Evaluation section of the Gibbs model or the So what? Section of the Borton model.
Your analysis should concentrate on identifying root causes for the incident. From this analysis you will identify opportunities for change that will enhance the quality of patient care and optimise patient safety.
You should explore a number of options before identifying which ONE of these will potentially have the greatest impact in terms of patient safety. You will then consider this ONE change in the context of change management explaining how you will identify any barriers to change and your strategy for overcoming these barriers. You should consider this in the context of organisational culture within your trust/hospital. What would you do differently if you were team leader? Again, do not identify your organisation in any way. This is best expressed as an action plan which would fits into the Action Plan section of the Gibbs model or the Now what? Section of the Borton model. To grade highly in this assignment, you will utilise a change model and/or change tools within this action plan to explain HOW you would implement this change.
You started work at 0800 this morning. On arrival you checked the allocation board and you
were allocated to scrub in theatre 2. Theatres 1 and 2 are orthopaedic theatres and you were
in there yesterday preparing set lists and checking stock. You went to theatre 2 and started
getting the theatre ready with Jeff the Senior Operating Department Practitioner and Mary
the Health care Assistant. Between you, you prepped in good time and Jeff checked the drugs
with Semia who was the ODP on Anaesthetics. With the patient sent for you join the team for
a quick drink before Team Brief.
Just as you sit down with an (extra strong) coffee, Phyllis comes over. Phyllis is the Coordinator
for the day. Phyllis is a formidable woman with the broadest Yorkshire accent this side of
Halifax. She has also been a Theatre Sister for twenty-three years and is not afraid to tell you.
You do not mess with Phyllis. Phyllis informs you that there is a delay with your first patient
as the anaesthetist is unhappy with some blood results. She asks you to go into theatre 5 to
help until your list can start as they have a busy list. You say yes. You do not mess with Phyllis.
Phyllis thanks you and says to finish your coffee first.
Having had your drink, you make your way up the corridor to theatre 5. A quick look at the
board has told you that it is general surgery today and if it’s busy then it will a job lot of hernias
to get through before lunchtime. You enter cautiously through the scrub area as the patient
is already in the anaesthetic room. There is loud music playing. It sounds like an eighties mix.
You give a shiver. Is it you or is it cold in here? No-one else appears to be bothered; mind you,
they are all wearing gowns and gloves. You make a mental note to check the room
temperature once things have settled down. Two of the surgical team are in the process of
scrubbing and you seek out Denise who is running the list. You don’t really know Denise as
you have not worked in general since the first year of your training and she is quite new to
the department. Eventually you realise that she is scrubbed up and is preparing her set with
a Health Care Assistant. You introduce yourself to Denise and she introduces Asif, the Health
Care Assistant. Denise seems quite flustered and unhappy with her set. She appears to be
having difficulty locating some of the items on the Instrument list. Asif is holding the
instrument list in one hand and pointing at her set with the other. You make a mental note to
ask him to put a mask on before he goes near your set if he gets that close.
The anaesthetic room door opens at that point and a head appears. “Can we come in now?”
says a voice which you presume to belong to the ODP on anaesthetics. Another stranger?
Who are these people? There is a mumbled response from Denise and the ODP proceeds to
open the doors and start disconnecting the monitor block for the transfer to theatre. You
fetch the Patslide in readiness. You want to ask Denise at the point what case you are doing
but it is clearly not a good time as she has her back to you and the instrument crisis appears
to be intensifying. The patient trolley appears and having retrieved Asif to assist you safely
transfer the patient across to the operating table on the count of the anaesthetist, Dr. Eusef.
You stay with the patient until the ODP has secured the patient with arm retainers and then
begin to apply Flowtron boots. The patient appears to be a woman in her mid-thirties of
African origin. “What are we doing?” you ask, and it turns out that this is the first patient of the day, a Ms Jane Armitage who has come for a left inguinal hernia repair. You quietly
congratulate yourself on the accuracy of your list prediction.
Denise appears to be still counting instruments, so you leave Ms. Armitage covered for now
and apply diathermy plate to her right thigh and position the diathermy machine close by.
Kylie Minogue is singing “I should be so lucky, lucky, lucky, lucky!” on the music system. The
ODP comes through from the anaesthetic room opening up an upper-body Bair Hugger
blanket so you help position it across the patient’s chest. The ODP wheels in a Bair Hugger
unit attached to a drip stand and places it at the head end and plugs it in. ‘I’ll turn it on when
we’re draped’ she informs you, walking away “Miss Dunn, likes the drapes on first”
She returns from the anaesthetic room holding the patient notes “Who’s doing the WHO?”
she asks, and you take the notes from her because you know you will not see them again if
you let Dr. Eusuf get hold of them. Taking the anaesthetic chart off the top and placing it on
the anaesthetic machine you rummage out the WHO checklist which is normally on top at this
point. “Have you still got the WHO?” you ask the ODP.
“It’s in there somewhere” she replies, “I had it a couple of minutes ago when I did the Sign-in
and it’s not in the anaesthetic room”. You dig a bit deeper and find the checklist, noting that
she hasn’t signed it yet. You make a note to ask her to sign it once everything has settled
down. You can see that the surgeons are scrubbed and ready to start but it’s not clear if Denise
is ready yet. There still appears to be some frantic activity over by the instruments. “Can we
start?” asks one of the surgeons, looking at you. “Everyone ready for Time-out?” you ask
loudly and clearly. You have learnt very early on that this is the time to be loud, clear and
positive. If you took a timid approach and things would get away from you very quickly.
Anaesthetist and ODP stop what they are doing and wait, and all is quiet except for the sound
of the blood pressure cuff inflating and some mutterings from Denise. “Denise? Are you
okay?” you ask her. There’s a pause, then “I’m ok! Just sorting this set out, Start the Timeout” She returns to her set.
You start the time-out, and everybody introduces themselves. The surgeon’s name is Ms.
Dunn and you discover the anaesthetic ODP is Tracey. She’s from the agency. The Time-out
goes without a hitch initially except that Ms Armitage does not appear to be wearing TED
stockings. The surgeon does not appear too concerned. Dr.Eusef raises a quizzical eyebrow
but says nothing. When asked about the instruments there is a pause as it appears Denise
hasn’t heard. Then she turns round and says that everything is alright. Asif looks a bit surprised
and quietly goes and places the instrument check list by the computer. Denise returns to her
instruments and starts counting swabs loudly, over the music (Billy Idol’s Rebel Yell) with Asif.
You sign the checklist and, having retrieved a couple of ID stickers, return the notes to Dr.
Eusef. The surgeons have gotten prep sponges from Denise to you fold back the sheet and lift
Ms. Armitage’s gown to expose the surgical site. You wait for the sponges and place the used
ones in the swab bin. There are two wet ones and one used for drying so you look over to
check Denise has enough and Asif is just opening another pack onto her tray. You wait for the
drapes tapes then, when the surgeon is happy, move the diathermy machine a little closer
and connect the return electrode. You set it for the usual settings for cutting and coagulation and leave it in standby for now. Asif is fiddling with the music and Ariana Grande’s ‘no tears
left to cry fills the room’. That’s more like it, proper good music at last!
Denise appears to still be struggling. She’s moving stuff around and Asif is still pointing.
“There’s five of those pointy ones” and you hear him whisper loudly “Are they Criles or
The surgeon is offering you the diathermy lead at that point so you attach it to the
Electrosurgery Unit and switch on. All seems well. The surgeon, with a curt nod to Dr. Eusef,
helps herself to 2 swabs and the kidney dish with the skin blade in it. She’s becoming
impatient “Diathermy!” she says, curtly and it is clear that Denise is struggling to keep up. She
thrusts the Diathermy forceps into the lead and passes them to Ms. Dunn, retrieving the skin
blade and swapping it for her inside knife in a hurry. “Dunhills!” says the surgeon and Denise
passes over two of the ‘Pointy-ones’. She does not look confident in her decision. The surgeon
looks at the instruments, looks at Denise and then proceeds with a shake of her head. You
retreat to the computer and check that the care pathway has been filled in and that the times
have been put into the computer. Gradually, things calm down and start to get back on track.
Denise appears to have enough swabs; the sutures look about right for a hernia and there is
In fact, things actually go really well. It doesn’t take Ms. Dunn long to dissect down and it
appears to be a straightforward mesh repair. She step away and leaves the junior surgeon to
sew up whilst Denise id doing a swab count. Denise appears to be making a bit of a meal of it
though. The count is not going well at all. As before, there is a flurry of activity and lots more
pointing from Asif. After 3 goes at it Denise states that “swabs and needles are correct!” and
asks you to check her instruments with her. She has had enough of Asif and his pointy finger.
You retrieve the instrument list and start the check as you have been shown how to by your
mentor from when you were a student. Shauna used to insist you read each instrument
individually “No shortcuts” she would say. You make a start “2 number 3 BP handles, 1
Number 4 BP handle, 5 Criles Artery Forceps, 5 Dunhill Artery Forceps…”
Denise starts rummaging through her set and then stops and stares at you. You pause… “Just
tell me how many in total” she says. “Okay”, this isn’t the way you were taught but she is a
qualified nurse… “15 Artery Forceps…?” She rummages further “15 Artery Forceps…” she
mutters “5 straight little ones, 5 curved and 5 longer”, you continue to read on in this way,
pausing only when the surgeon needs another suture from Denise and when he wants some
local anaesthetic for infiltration. There is an issue when Denise cannot find a Morris Box
retractor, but Denise says that was not there at the start. You record it as missing and sign
the checklist as complete Asif hasn’t complete the checklist for the pre-operative instrument
check, so you make another mental note to ask him. He is already busying himself with
retrieving the drapes as Denise wants to apply a dressing to Ms Armitage’s wound and the
surgeon is in a hurry to get on.
“Final Swab count!” Denise declares; and you begin to count again. “10 small
swabs…1…2…3…4…5…here…1…2…3…4…and…” she says, retrieving a swab the surgeon has discarded on her trolley, “5 medium swabs…1…2…3…4…and…oh…?” She looks at the surgeon
who is retrieving the notes from Dr. Eusef. “Have you still got a medium swab?” she asks. “We
didn’t use any mediums?” he says, his head buried in the patient notes. “Oh…!” says Denise
“We’ve got a swab missing – let’s check again…” The check starts again, and you see that
there are only 5 small swabs and 5 medium swabs written on the swab board. You point this
out to Denise, but she insists “I have 3 red tags” and there are more than 10 swabs on her
trolley and the medium swab remains unaccounted for.
Dr Eusef wants to transfer Ms. Armitage to the trolley…