, , , U

(1. Department of Ophthalmology, The First Affiliated hospital of Dali University, Dali, Yunnan, 671000; 2. Department of General Surgery, Dali Bai Autonomous Prefecture People’s Hospital, Dali, Yunnan, 671000)

Introduction

With the development of medical techniques, the ophthalmological operations are also experiencing continuous innovations and creative improvements. These progresses make ophthalmological operations specialized in a more detailed way and set a higher demand on the nursing safety of operating room (OR). In order to match high frequency and short duration of eye surgery and guarantee the safety of ophthalmological operations, an eye surgery preparation room (ESPR), also called eye preoperative holding area, is specially established. It is used for double-check of patients and surgery preparation before operations, in the department of ophthalmology of the First Affiliated Hospital of Dali University.

MaterialsandMethods

Materials

As a province-level key department, we have separated surgical operating theater with four surgery rooms majoring for cataract and glaucoma vitrectomy, retinal detachment, conjunctivorhinostomy, laser vision correction and so on. In order to shorten the connecting time of operations, accelerate the turnover of operations and guarantee the nursing safety, we have built an ESPR which acts as a waiting space for patients from ward to OR, as well as a preparation room for doctors and nurses to coordinate nursing managements before and after operations, to assist to prepare surgical details and to supply the medical care to the patients before operations[1]. In average, there are 15 patients waiting for consecutive operations in the ESPR every day. The surgical equipment should be prepared in ESPR, including rescue carriage, ECG monitor, oxygenator, speaker, cart, wheeled chair and surgical instruments. All necessary surgical equipments should be easily accessible and in place. There should be a nurse who is responsible for the arrangement, check and turnover of all patients.

Methods

Procedure: The nurses in OR take the first patient into ESPR and collaborate with circulating nurses as well as surgeons on duty to double check and deliver the patient to OR after the ESPR nurse prepares all necessary surgical equipment. Then, consecutive operations are arranged in order of priority, from internal ocular operations to external ones and from sterile operations to unsterile ones. Those surgeries with short operating time such as cataract and myopia surgeries can be arranged in the order of age, and the nurses on duty are supposed to deliver 2 or 3 patients to ESPR.

Check: After the patients enter the ESPR, the ESPR nurse should check their names, ages, bed numbers, hospital admission numbers, surgery diagnosis, ophthalmic surgical marker, and surgery preparations based on their electronic surgery notices, medical reports, case history and wristbands. If consent forms and other legal documents were not previously completed, they will need to be signed. If errors were figured out, they will be registered and fed back to the responsible persons who are on duty. The ESPR nurses should review the results of blood tests as well as patients' medications and allergies, check the headdress or other materials which may affect surgery, and cover the patients' head with operating cap.

Preoperationpreparation: When patients come to ESPR, the nurses will rinse and clean patients' conjunctival sac. The anesthesiologists usually come to ESPR and have a talk with patients about the anesthetics and procedures for anesthesia. The ophthalmologic operations are usually performed under superficial or topical anesthesia. The superficial anesthesia or retrobulbar anesthesia should be carried out for patients awaiting surgeries.

Mentalnursing: As a kind of stimulus, the surgery will result in patients' psychological distress and conduce to negative induced emotions including anxiety, trepidation, fear and so on[2]. The ESPR nurses may utilize background music to relax patients for coming operations and also instruct patients how to collaborate with surgeon during operations.

Results

The waiting time of patients before surgery decreased from 1-1.5 hours to current 20 minutes after the ESPR was established and engaged in the ophthalmological operations. The turnover time of connective operations reduced to less than 5 minutes from previous 10-30 minutes. The application ESPR effectively shorten the turnover time of ophthalmological operations, improve the usage rates of OR, guarantee the safety of patients, and enhances the doctors’ satisfaction of cooperation and coordination in OR[3].

Discussion

The key of nursing management is nursing safety, which is a marker of nursing quality[4]. Before the application of ESPR, patients for the consecutive operations used to wait outside of OR under the observation of circulating nurses. The patients of eye surgeries are usually pretreated with mydriatics or myotics, which transiently do damage to vision, or superficial anesthetics, which transiently lead to perceptual disturbance. Meanwhile, the circulating nurses not only take care of the waiting patients but also enter OR for assisting operations. Thus, there exist some nursing risks in the nursing management without ESPR. The establishment and application of ESPR supplies a waiting area for coming consecutive operations. The ESPR nurses specifically take care of patients before operations and double check 13 items: names, bed numbers, genders, ages, hospital admission numbers, surgery diagnosis, operating sites, surgery names, allergy and medication history, preparation before operations, results of eye test, and reports of blood test. All these events build the first platform for safety check of patients. In addition, these waiting patients in ESPR are specifically under the observation and care of the ESPR nurses, who can protect the patients from accidental injuries and deal with the adverse reactions induced by medications before operations.

Eye surgeries are remarkable for their short time in operations and interval between operations. A large amount of eye surgeries are able to be performed in one unit of time, usually accompanied by superficial anesthesia[5]. In addition, the distances between wards and OR and the differences of operating time also lead to delay transfer of patients, low turnover rate of consecutive operations and the augmented waiting rates of operating ophthalmologists. For example, most of patients with cataract are usually transferred to the outside of OR in order to avoid delay turnover of consecutive operations during cataract surgeries, which are short-time operations and usually able to be performed on a large scale in one unit time. After the application of ESPR, the ESPR nurses can arrange the transfer of patients effectively to avoid the backlog of patients in OR, according to the operating details in OR and the number of patients in ESPR. Additionally, ESPR nurses can prepare surgical facilities and instruments in details as well as double check patient's documents and IDs, in order to exclude the unexpected errors. Moreover, ESPR nurses can collaborate with anesthesiologists to perform topical anesthesia before the patients enter OR, which can efficiently reduce the occupying rate of operating table. All these events in ESPR significantly improve the efficiency of ophthalmological operations.

The success of ophthalmological operations depends not only on the excellent skills of ophthalmologists but also the operations on pupil condition of patients before surgeries, which plays a vital role in the ophthalmological operations[6]. The ESPR nurses can reasonably arrange the transfer of patient, notify OR and wash conjunctival sac for coming operations to avoid the unexpected abortion of operation due to transient deployment of ophthalmologists. In addition, the ESPR nurses can instantaneously execute mydriasis or myosis and collaborate with anesthesiologists to perform anesthesia according to the requirements of OR, which can effectively avoid failure or expiration of anesthesia. All these events in ESPR match the speedy rhyme of eye surgeries.

Patients usually think surgery as a terrible experience. Their negative emotions including anxiety, fear, loneliness, dysphoria and so on, will arise in a high level[7]. In addition, patients undergoing eye surgeries are becoming more sensitive to unfamiliar environments and the anticipation of surgery. Thus, the ESPR nurses should assess the preoperative patients completely, take good individual personal care, and have an effective communication to relax patients. This preoperative preparation is aimed to let patients feel to be cared and respected, in order to collaborate with medical personal for the coming operations. Moreover, the ESPR nurses can prepare and play some music to release patients' anxiety and fear. Meanwhile, health education, such as sharing information, can be carried out to increase patients' understanding of procedures. It is also required to practice patients to move eyeball and stare straightly, to let them positively participate in the operations.

In conclusion, the application of ESPR significantly is potentially effective to improve the preoperative preparation quality of nurses, build an effective nursing system around ophthalmological operations and reduce the turnover time of consecutive operations. For operating ophthalmologists, the application of ESPR shows significance in shortening their awaiting time in OR. For patients, staying in the ESPR can ameliorate their emotions. The establishment of ESPR realizes the service aim of patient-centered therapy to a maximum extent.

[1]DENG J M, ZHENG Q, ZHOU Y, et al. The effects of surgery preparation room on the consecutive operations of eye surgery[J]. Mod Diag Treat. 2013, 24(15): 3590-3591.

[2]LI Q, ZHANG J. The studies on the application of the background music in eradicating patients' anxietious emotions in operating room[J]. Proc Clin Med. 2006, 15(6): 465.

[3]SUN A, LIU Y. The improvement of pre-surgery preparation precedure in craniotomy[J]. Chinese J Med . 2015, 4: 105-107.

[4]LUO Y, WANG F. The nursing safety of consecutive surgical operations[J]. Henan J Surg, 2007, 13(2): 124-125.

[5]XIAO H, PAN J, TANG H. The challenges and strategies of the nursing managers in the operating rooms[J]. Chinese J Mod Nurs. 2008, 14(26): 2803-2804.

[6]LIN P, ZENG Y P, WANG Y, et al. Discussion of the effect of Mydrin-p for mydriasis before phacoemulsification for cataract[J]. Nurs J Chinese PLA, 2003, 20(1): 324-325.

[7]FITZGERALD P J, GIUSTINO T F, SEEMANN J R, et al. Noradrenergic blockade stabilizes prefrontal activity and enables fear extinction under stress[J]. Proc Natl Acad Sci U S A, 2015, 112(28): 3729-3737.