THE ROLE OF THE SPECIALIST NURSE

IN PAEDIATRIC CATARACT SURGERY

Glenda Lucia Morales Bajar

Ophthalmology Clinical Nurse Specialist
University Hospital Coventry and Warwickshire NHS Trust, UK
 Learning outcomes for theatre nurses

1. Discuss the role and responsibilities of an Specialist Ophthalmic

Nurse (SON) in providing safe care
2. To become aware of Risk assessment and safety culture in
Theatre i.e. biometry measurements, IOL checks, WHO
checklist.
3. Maintain a safe and clean working environment
4. Communicate clearly – verbally and written and to maintain
therapeutic communication to patients.
5. Carrying out scrubbing role competently
6. Work within the confines of the law/ policies
7. Report any issues/concerns and document
8. Apply evidence based care and the 6 C’s.
Overview of nurses' role in the
operating theatre
 Prepare theatre environment for surgery
 Ensure availability of equipment / instruments
 Ensure equipment in safe working order
 Risk assessment environment e.g. temperature
 Reduction of risks & control of infection – maintain
asepsis and aseptic practice in operating theatre.
 Sound knowledge & skills (competency).
 Education & assessment of staff: on-going
 Effective communication - address patients’ concerns -
record keeping/ documentation
 Evidence based care including research / rationale
 Clinical Audit - standard monitoring
Priorities of SON:

 Improve safety
 Improve quality
 Improve efficiency
 Reduce waiting
 Cope with high demands
 Monthly audits
 Achieve financial stability
Patient journey in the operating
theatre

 Holding bay / patient sitting area

 Anaesthetic room
 Operating theatre
 Recovery room or
 Back to ward or Day Unit
Paediatric Ophthalmic theatre
set-up:

 All procedures performed under GA

 Always first on the operating list are the
youngest ones , IF NOT a dedicated
paediatric ophthalmic list
 Parent / carer and nurse in anaesthetic room
during induction
 Normally gas induction
Role of nurse during peri-operative
stage:
 Professional judgement & critical thinking
 Technical knowledge
To help:
 Plan, implement & evaluate patient care
 Monitor patient’s physical and emotional
wellbeing
 Informed consent
 Assess any risks
 Manage resources
Role of nurse during peri-operative
stage:
 Maintain sterile environment
 Promotes health to patient
- reduce patient’s anxiety
- constant re-assurance
- health promotion
 Sterile role – scrub nurse
 Unsterile role – Assist multi-disciplinary team during
surgical procedure
 Recovery of patient
Safety Precautions and Hazards

 Hazards: sharps e.g. Blades, needles, drugs, Laser

 General Safety Precautions:
 Theatre apparel
 Shoes non-slip, antistatic
 Safe disposal of sharps and waste
 Ventilation within ranges
 Scavenging – gasses
 Equipment maintenance
 PPE
 Seven Steps to Patient Safety
1. Build a safety culture – Team Briefing, WHO checklist (brief,
sign-in, time-out, sign-out), Trust/Departmental policy,
guidelines.
2. Lead and support your staff – education and training,
collaboration, effective clear communication, good leadership
3. Integrate your Risk Management activity – risk assessment:
staffing/skill-mix, surgical consent, operative marking
4. Promote reporting - DATIX
5. Involve and communicate with patients and the public – Duty of
Candour
6. Learn and share safety lessons - Governance
7. Implement solutions to prevent harm - protocols
SURGICAL NEVER EVENTS
 Development of NatSSIPs
 concept of “Never Events” – UK 2009 – list of 8 adverse patient safety
events serious, largely preventable patient safety incidents that
should not occur if the available preventative measures have been
implemented
 core surgical Never Events: wrong site surgery and retained instrument
post-operation
 2010 Never Events Framework extended the scope to include retained
swabs and throat packs; Mandatory introduction of the WHO Surgical
Safety Checklist.
 2012 - The Never Events policy framework added a third core surgical
Never Event (wrong implant/prosthesis) and redefined the retained
instrument event as “retained foreign object post-operation”.
SURGICAL NEVER EVENTS

 2013, NHS England’s Surgical Services Patient Safety Expert Group

commissioned a Surgical Never Events Taskforce
 The report, published in 2014, NatSSIPs/LocSSIPs
 Never events data: https://improvement.nhs.uk/resources/never-
events-data
 Incorrect intra-operative lens
implant (IOL)

Reported never Incorrect lens model, A-constant,

diopters
events in
ophthalmic
theatres Incorrect Gas concentration – SF6
20%; C3F8 12%

Incorrect marking
The introduction of the WHO Safer Surgery Checklist was a great
step forward in the delivery of safer care for patients undergoing
operations-
Biometry: What to look for ?
The smooth running of the theatre list:

 Teamwork - multidisciplinary
 Leadership – building and strengthen – skilled
 Patient centered care – concerns addressed
 Effective communication / verbal, written,
body language
 Happy staff (confident, good morale)
 Culture of learning / training
 Right skill mix
 Audit – measure quality and impact of care
 Compassion in Practice - DH
Nursing, Midwifery and Care Staff
Our Vision and Strategy

Commitment

Care
Courage

PATIENT

Compassion
Communication

Competence
Reference list:
 The association for Perioperative Practice (2013) Sharps: Guide to best practice for safe handling of surgical
sharps. Harrogate: AfPP.
 Care Quality commission (2016) The fundamental standards. Online available from:
www.cqc.org.uk/content/fundamental-standards. Assessed August 2018.
 Care Quality Commission (CQC) (2015) Regulation 20: Duty of Candour. Available at
http://www.cqc.org.uk/sites/default/files/20150327_duty_of_candour_guidance_final.pdf (Accessed: August
2018)
 Dampies L (2009) Ophthalmic theatre practice In Watkinson S (2009) Issues in ophthalmic practice: Current and
future challenges. Keswick, Cumbria: M&K Publishing.
 Department of Health (2001) Building a safer NHS for patients. Implementing an organisation with a memory. On-
line available from:
http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_
digitalassets/@dh/@en/documents/digitalasset/dh_4058094.pdf. Accessed 2019.
 Department of Health (2012) Compassion in Practice. Nursing, Midwifery and Care staff. Our Vision and Strategy.
On-line available from: www.commissioningboard.nhs.uk. Accessed 2019.
 National Reporting and Learning System (NRLS) (2003). Available at http://www.nrls.npsa.nhs.uk/report-a-
patient-safety-incident/about-reporting-patient-safety-incidents (Accessed: 28 February 2018).
 NHS Improvement (2015) National Safety Standards for Invasive Procedures (NatSSIPs). Available at
https://improvement.nhs.uk/resources/national-safety-standards-invasive-procedures (Accessed: 23 February
2018).
 NHS Improvement (2018) Never Events reported as occurring between April 2016 and 31 March 2017 – final update.
Available at https://improvement.nhs.uk/resources/never-events-data (Accessed: 28 February 2018).
 Rothrock J.C (2010) Alexander’s care of the patient in surgery. 14th edition. St Louise Missouri: Elsevier Mosby
 Safer Surgery in Ophthalmic Theatres. Powerpoint presentation of Raquel Villanueva (2019)
 Stollery R (2003) Ophthalmic Nursing. 2nd Edition. Oxford: Blackwell Science Ltd.
Thank you