Perioperative Nursing Care Assessment 2: Dubbo Base Hospital Analysis

This discussion board post analyzes perioperative nursing care, focusing on the responsibilities of nurses during surgical procedures and the importance of teamwork and adherence to protocols. The assignment uses the Dubbo Base Hospital case, where multiple cataract surgeries resulted in adverse outcomes due to the use of an inappropriate solution, as a central example. The post examines the roles of various healthcare professionals, emphasizing the need for thorough pre-operative assessments, careful medication checks, and clear communication to prevent errors and ensure patient safety. The discussion highlights the significance of developing and implementing hospital protocols, staff training, and the creation of multi-disciplinary teams to improve surgical outcomes and mitigate risks. It emphasizes that nurses play a critical role in all phases of the surgery and the importance of understanding patient vulnerabilities and managing expectations. The post concludes by summarizing the key elements of successful perioperative care and emphasizes the need for continuous improvement in surgical practices to avoid negligence and ensure patient well-being.

Online Discussion

Table of Contents
ASSESSMENT 2A..........................................................................................................................1
ASSESSMENT 2B..........................................................................................................................2

ASSESSMENT 2A
Cataract is related to opacity of crystalline lens that is present in the eye of an individual.
Extensive amount of it present in the lens reduces its access to light and ultimately leads to
condensed or no vision. There are various procedures available which are used for extraction of
cataract. The case states that Dubbo Base Hospital had high number of adverse outcomes from
the cataract surgeries that were performed on 8th February 1999 (Kain and et.al., 2014). The
commission was charged to find out the issue and reasons of these unsuccessful cataract
surgeries that took place in the hospital. 19 patients undergone surgery that day and out of them
12 were left with permanent damage in their corneas leading to perpetual visual impairment. It
was analysed that the actions took by health care practitioners to perform these operations were
inappropriate and brought them under scrutiny to check that what went wrong (Brown and et.al.,
2017).
The happening took place due a particular solution that was used during the surgery, that
is, “Eyestream”. A clear warning was stated on the bottle stating that the solution must not be
used when the doctor is conducting intra ocular surgery as it can result in adverse outcomes
(Nettina, Msn and Nettina, 2013).
The aforesaid situation is the clear case of negligence where appropriate surgical
procedures were not followed by the surgery team before conducting the operation. There were
various personnel who were involved in conducting these surgeries. These were,
Ophthalmologist, two surgical assistants, phaco emulsifier nurse, scout nurse, 2 instrument
nurses, Anaesthetist and one anaesthetist nurse. The main role in played by surgical technique
that has been used to remove the cataract. It is important that all the surgical instruments and
solutions used by the team are checked and all the warranty attentions have been well read so
that its adverse properties can be controlled (Brito Poveda, Clark and Galvão, 2013).
The case generates the requirement of issuing warrant attention. Hence, it becomes
important to analyse various aspect before opting for any surgery. It is the duty of hospital
management to issue the best protocol regarding the same. Hence, in that case, it becomes
important to state the protocols for acquisition of any material and substances required to be used
in operating room. Role of the function of pharmacy must also be defined wherein safety for the
harmful substances must be maintained and must not be issued without proper visualization of
the results. Moreover, it must be ensured that any new substance must not be introduced in the
1

surgery which has not been mentioned in the protocol earlier, unless and until the situation leads
to an emergency. It is also important to identify and report critical incidences to the operating
team members for better outcomes through the surgery. Even if any operation leads to adverse
outcome, it is the duty of hospital management to explain the cause and reason to the
unsuccessful surgical consequences (Horn and et.al., 2012).
ASSESSMENT 2B
Peri operative nursing care means managing patients at the time of surgery. It is related to
their physical examination, coordincation related to requirements and medications given to them.
Teamwork is an important aspect that is to be consider while indulging in peri operative
practices. He /She is responsible for closely working with the surgeons during operation and
hence equally responsible for any mistake that takes place during or after operation Journeaux,
2013 (. The essay discusses regarding various responsibilities that a nurse carries with respect to
the patient. In order to make the knowledge base concrete, practices that could have been
adopted by Dubbo base hospital will also be assessed in the essay.
Peri operative nursing care is related to circulating nurses who generally assist in managing
nursing care of the patients at the time of surgery. It helps in coordinate with the needs and
requirements of the team and plays an important role in dealing with the various aspects of
surgery. He / She is responsible for working closely with the surgeons, anaesthesiologists,
surgical technologists, nurse anaesthetist, etc. These types of nurses are also responsible for
delivering post-operative care to the patient as well (Galvin and Curley, 2012).
The case of Dubbo Base hospital has been chosen which is related to malfunction that took
place due to wrong use of solution in the eyes during a cataract surgery which ultimately led the
patients to total visual impairments. The case evidenced regarding negligence that was
performed from the part of nurse and health care professional involved in the surgery. It arose
the requirements of developing protocols for the hospital, where, it is important to analyse the
medicines and solutions that are to be used at the time of surgery so that its negative aspect can
be reduced to the minimum (Chieng and et.al., 2014). Moreover, it will also help in controlling
any adverse implication on the patient during or after surgery.
Peri operative nursing care is an important aspect as they play an importin role in passing
the solutions and instruments to the main health care professional who is performing surgery on
a particular patient. Hence, it can be stated that a major role is played by the nurse during peri
2

operative care. Understanding vulnerabilities of the patient, indulging in multi-dimensional
communication process, managing expectations of the patients and bridging the gap between
patient and doctor, are the main role played by the nurses during peri operative care. He / She is
also responsible in identifying various risks factors that can be present in the patient during or
after surgical experience (Lambertx and Carey, 2016). Considering the case of Dubbo Base
Hospital, nurses could have played an important role in going through the label of the solution
that was used at the time of surgery. Improved protocols and indulging nurses to it could have
helped in skipping the case of negligence.
Teamwork is an important aspect that is to be consider while indulging in peri operative
practices. It is a critical aspect in a surgical setting that helps in leading to a successful surgery.
Increasing the accountability and responsibility of various team members involved in the surgical
process can help in reducing the probability of having adverse results at the end of surgery.
Hence, the members must be prepared with the history, infections, case, allergies and other
important aspects of the patients so that the best treatment can be given to him / her in the end
(Blomberg and et.al., 2015). Having a planned surgery also helps in reducing the chances of
negligence. Moreover, the environment is planned in such a manner that it helps in increasing the
accountability and responsibility of each patient. It results in better outcomes and all the facilities
and resources are utilised in the most organized manner.
Based upon the cases of negligence and unsuccessful surgeries being noticed by the
commission, various practice s can be adopted that can ultimate help in achieving of goals in
such a manner that worse outcomes can be mitigated. Creation of service line teams in order to
develop action plans can help in supply of standardized and evidence-based practices (Lee, C. K.
and Lee, I. F. K., 2013). It also helps in maintaining the quality of services of metrics that
includes surgeons’ participations. It is also important to provide team building activities in such a
manner that “not my job” barrier can be break down. It will help in increased communication
activities and collaboration between the team members. Development of multi-disciplinary Peri
operative team can also come as a rescue, where, delays and issues in operations and surgery can
be assessed and root issue can be solved. Staff training and education, correcting process gaps
and implementation of corrective actions can help in solving out this issue. Adequate education
to the staff members can help in providing excellent quality peri operative nursing care to the
patient, unlike the case of Dubbo Base Hospital (Partridge and et.al., 2014).
3

The main thing that is important for peri operative surgery is preoperative history and
physical examination. It has higher dependence that what kind of operation will be conducted on
the patient. Instructions on medications being given to the patients are required to be checked by
the nurse and basic medical tests are required to be conducted on repetitive basis so that rise and
fall in the patient’s condition can be judged at the initial stage only. Supplies and eye drops that
are required to be used in cataract surgery must be checked and any allergic reactions that can be
present in the patient based on it can be judged in a manner that the best medical care can be
provided to the patient with appropriate medications (Adam, 2017). Identification of the issues is
important otherwise it puts the patient to high risk zone that can ultimately lead to poor results of
the surgery and anaesthesia outcomes. The surgical patient may become more vulnerable in the
existence of communication gaps and transition in care errors which can affect patient’s health.
Nurse is one position apart from the other care members involved, who takes part in
preadmission, intra operative and post-operative phases.
Pre operative assessment is considered to be a critical point based on which surgery
medications and procedure is decided. Failure of communication in the procedure can get
appropriate history of the patient can lead to have an unsuccessful treatment. Assessing the case
of Dubbo Base Hospital, patients were given eye solution without analysing impact that could
have had on their health. It led the patient to total or partial visual impairments. It was due to the
fact that the warning on the solution was not gone through by any of the team member. It
infected the eyes of patient, where cataract surgery led to total failure (Dougherty and Lister,
2015).
Hence, in such cases, it becomes important for the nurses to opt for better methods that
can help in avoiding such circumstances. Negligence in medical set up costs life of the individual
where it the only duty of the team, who are involved in the surgery, to take care of these
circumstances and follow the stated protocol with respect to pre operative and post operative
circumstances. Surgical patients are considered to at critical dimension of life, where transition
care is given as per their prevailing condition. Identification of risk factors become an important
aspect at this scenario which can affect their health due to undergone surgical experience. The
condition of the patient can change the overall trajectory of surgery. Hence, it becomes important
for the nurses to ensure that better practices related to pre operative and post operative duration
are adopted which ultimately leads to better output.
4

The complexity of surgical environment has been growing due to increased use of
technology during operative measures. It has increased the pressure on health care professionals
to ensure that cataract surgery they are opting for is ultimately a successful one. In such cases,
nurses have to make sure that the condition of patient is not dripping and all pre operative and
post operative measures are being adopted by them (Increase Your Knowledge of Perioperative
Best Practices, 2015). The scenario would have been different for Dubbo Base Hospital if all the
mentioned measures could have been adopted by the hospital management.
It can be concluded form the above essay that nurses play an equal important role in
reducing the impact of any mis happening that takes place during or after operation. It is the duty
of nurse to opt for pre operative and post operative measures so that it is ensured that the
condition of the patient is in stable state. Moreover, hospital management must adopt for
following protocols that are related to communication and surgery so that medication sand
surgical procedure can be assured to them. It is also important to provide team building activities
in such a manner that “not my job” barrier can be break down. It will help in increased
communication activities and collaboration between the team members. The surgical patient may
become more vulnerable in the existence of communication gaps and transition in care errors
which can affect patient’s health.
5

REFERENCES
Books and Journals
Adam, S., 2017. Critical care nursing: science and practice. Oxford University Press.
Blomberg, A. C. and et.al., 2015. Making the invisible visible–operating theatre nurses’
perceptions of caring in perioperative practice. Scandinavian journal of caring
sciences. 29(2). pp.361-368.
Brito Poveda, V., Clark, A. M. and Galvão, C. M., 2013. A systematic review on the
effectiveness of prewarming to prevent perioperative hypothermia. Journal of clinical
nursing. 22(7-8). pp.906-918.
Brown, D. and et.al., 2017. Lewis's Medical-Surgical Nursing: Assessment and Management of
Clinical Problems. Elsevier Health Sciences.
Chieng, Y. J. S. and et.al., 2014. Perioperative anxiety and postoperative pain in children and
adolescents undergoing elective surgical procedures: a quantitative systematic
review. Journal of advanced nursing. 70(2). pp.243-255.
Dougherty, L. and Lister, S. eds., 2015. The Royal Marsden manual of clinical nursing
procedures. John Wiley & Sons.
Galvin, P. A. and Curley, M. A., 2012. The Braden Q+ P: a pediatric perioperative pressure ulcer
risk assessment and intervention tool. AORN journal. 96(3). pp.261-270.
Horn, E .P. and et.al., 2012. The effect of short time periods of pre‐operative warming in the
prevention of peri‐operative hypothermia. Anaesthesia. 67(6). pp.612-617.
Journeaux, M., 2013. Peri-operative hypothermia: implications for practice. Nursing Standard
(through 2013). 27(45). p.33.
Kain, Z. N. and et.al., 2014. The perioperative surgical home as a future perioperative practice
model. Anesthesia & Analgesia. 118(5). pp.1126-1130.
Lambert, E. and Carey, S., 2016. Practice Guideline Recommendations on Perioperative
Fasting. Journal of Parenteral and Enteral Nutrition. 40(8). pp.1158-1165.
Lee, C. K. and Lee, I. F. K., 2013. Preoperative patient teaching: the practice and perceptions
among surgical ward nurses. Journal of clinical nursing. 22(17-18). pp.2551-2561.
Nettina, S. M., Msn, A. B. and Nettina, S. M., 2013. Lippincott manual of nursing practice.
Lippincott Williams & Wilkins.
6

Partridge, J. S. L. and et.al., 2014. The impact of pre‐operative comprehensive geriatric
assessment on postoperative outcomes in older patients undergoing scheduled surgery: a
systematic review. Anaesthesia. 69(s1). pp.8-16.
Online
Increase Your Knowledge of Perioperative Best Practices. 2015. [Online]. Available through <
http://infection-prevention-news.3m.com/increase-your-knowledge-of-perioperative-best-
practices/>
7