Common Question

Nursing Staff & Anesthesia

Technicians in DPU
o Receiving patients (identification, pre-procedural checklist).
o Daily checking of anesthesia machine operating room
(anesthesia machine, medications, air-conditioning requirements,
crash cart).
o Time out procedure.
o Intra-procedure sedation monitoring.
o Recovery process from sedation/anesthesia.
o Discharge home from recovery.
o Effectiveness of point of care testing.
o Periodic preventive maintenance for medical equipment.
o Medication management: preparation and administration.
o What to do in case of cardiopulmonary arrest.
o What to do in case of fire.
?Q: What is the proper patient identification process
 According to Patient Identification & Surgical Safety
Policy: Any treatment, intervention and/or any services
being rendered to any patient at SMC must be
preceded by using “Two patient identifiers” (MRN,
Patients verbalization of Full Name and ID Number)
?Q: When do you use the identification of patient
:the identification of patient is used when
Administering medications
Taking blood samples
Providing treatment or procedure
Q: what is the content of preoperative checklist performed
in DPU?
CONSENTS -ID BAND –VITAL SIGNE, ALLERGY

See the policy SMC-MP-DPU-005. Admission and Receiving Patients

in OR

Q: What is the daily process checking of anesthesia machine

in operating room?
Q: What is the daily process checking of medication in DPU?

Q: What is the daily process checking of air condition in OR?

?Q: How is the time out procedure performed in DPU

Time out: (immediately before skin incision the surgeon,
anesthesiologist and circulating nurse will perform and
document a time out procedure)
Definition: A verbal time out or pause must be done in the
location where the procedure is to be performed,
immediately before the start of the case by the entire
procedure/surgical team.
The time out requires confirmation of:
 Confirm all team members have
introduced themselves by name and role.
 Surgeon, anesthetist and nurse verbally
confirm correct patient, correct
procedure, correct side/site, and correct
patient position. If the patient is not
sedated, it is helpful for him or her to
confirm the same as well.
 Surgeon reviews: what are the critical or
unexpected steps, operative duration,
anticipated blood loss?
 Anesthesia team reviews: are there any
patient-specific concerns?
 The scrub nurse or technologist who sets
out the equipment for the case should
verbally confirm that sterilization was
 performed and a sterility indicator has
verified successful sterilization.
 Has antibiotic prophylaxis been given
within the last 60 minutes?
 Is essential imaging displayed?
Q: What do you monitor during intra-procedural sedation?
See the policy SMC-MP-DPU-010. Monitoring of Patients in
OR and PACU
Q: What do you monitor during recovery from
sedation/anesthesia?
See the policy SMC-MP-DPU-010. Monitoring of Patients in
OR and PACU
Q: What is the criteria of discharge home from recovery?
From PACU to patient room
See the policy SMC-MP-DPU-016. Home Readiness after Day
Case Surgery or Procedure
Q: What is the definition of point-of-care testing (POCT)?
Tests designed to be used at or near the site where the
patient is located, that do not require permanent dedicated
space, and that are performed outside the physical facilities
of the clinical laboratories
Q: What do you know about the effectiveness of pointe of
care testing?
- Quality control for the devices (glucometers): we have
quality control sheet for each glucometer in ER
- Best practice before perform the test by using alcohol
swab, gloves, Lancet, gauze

Q: What to do in case of cardiopulmonary arrest?

 The management of the cardiac/respiratory arrest is defined by the
following actions:
First responder:
 Verifies the absence of cardiac pump or respiration, call for
help and initiates CPR.
 Continues the CPR after placing the victim supine (wedge
under the right hip for left uterine displacement in
pregnant females)
When help arrives, the second responder is responsible for:
 Activating the code blue via paging system stating the details
(code blue adult/pediatric, floor number, room number,
clearly repeat for three times);

Q: What is the process of crash cart management in SMC?

- Daily checking and documentation of the crash cart
contents should be done by assigned qualified staff.
- Crash cart must be kept locked at all times (integrity of
locks to be checked and documented during the
routine daily check)
- A staff nurse will be assigned and is responsible for
checking the crash cart every shift, including all
external contents, (e.g., oxygen cylinders’ levels,
defibrillator, functioning suction) then documenting
the inspection
 Q: What are the prerequisites for safe drug administration?
 All qualified licensed nurses authorized to administer the medications
according to their job description with correct certification EXCEPT:
High Alert Medications should be administered by qualified,
trained nurse in High Alert Medication administration using
independent Double check approach and 2 initials of both
nurses must be documented in MAR of patient.
Concentrated electrolytes should be administered by highly qualified and
trained nurses in administration of concentrated electrolytes using
independent Double check approach and 2 initials of both nurses must be
documented in MAR of patient

Roles & Responsibilities of Nurses

 Accepting orders from prescribers with ordering authority for

medications that are within the prescriber’s scope of practice
(Prescribers privileging List) and transcript the order on Medication
Administration Records
 Accepting a medication order that is complete and includes the order
date, client name, medication name, dosage, route, frequency,
duration, and prescriber’s name, signature and stamp.
 Make triangle check before any dose administration to any patient to
verify matching of medication ordered by physician to this correct
patient is same that issued.

 Follow the standard medication administration time Guideline used

in SHOAA Medical Complex for Scheduling dosing times for a
medication taking into consideration the effect of food intake on
medication absorption, contraindicated foods, possible drug
interactions, required interventions (for example taking vital signs)
and client choice or preference.

a. medication name
b. infusion time
c. nurse qualification
d. patient care unit.
Q: What are the items of verification of medications before
administration?

a. Verification of dispensed medication

i. Right patient
ii. Right medicine
iii. Right dose
iv. Right frequency
v. Right route
vi. Right time

b. verification against the medication administration record

c. verifying the expiry date
d. visual inspection
i. Discoloration
ii. Particulate
iii. Other clue of loss of integrity or stability

Q: What are the types of medication errors?

All medication errors will be grouped and classified as
follows:
Prescribing error (Medical staff)
Transcribing (Medical staff, Nursing Staff)
Dispensing errors (Pharmacist)
Administration errors (Nursing staff)
Monitoring Error. (ALL Healthcare providers)
Other: Any medication error that does not fall into one of
above predefined categories.
Q: What is the aim of reporting medication errors?
a. To learn from our mistakes
b. To enhance medication safety through prevention of
recurrence of medication errors

Q: What is the time frame for filling medication error form?

IMEDIATELY

Q: Should the treating physician be informed about

medication error happen to the patient under his/her care?

It is a must

Q: How can we enhance the culture of medication safety?

Healthcare professionals are provided with feedback on
reported medication errors, near misses, and hazardous
situations.
Q: What to do in case of fire?
RACE –PASS

Staff should know:

- The nearest extinguish / Evacuation Map
- The emergency exists
- Assembly points in SMC
Q / What is the Process for staff sharps injury?

The employee should adhere to the following steps

immediately post exposure:
A. First Aid
follow these steps:
i. Percutaneous injuries
1. Wash the wound well under running water with soap
for 15 minutes, do not scrub the wound while you’re
washing it.
2. Encourage bleeding but avoid applying pressure. Do
not suck.
3. Apply a waterproof sterile dressing to the wound.
ii. Mucocutaneous and non-intact skin exposures.
1. Flush splashes to the nose, mouth, or non-intact skin
with water.
2. Irrigate eyes with clean or sterile water or saline. If
available, use eye wash station and/or emergency
shower.
3. If body fluids splash into your mouth, do not swallow.
Rinse out several times with cold water.
4. Flush site for 10-15 minutes.
B. Reporting the Injury
a. The employee should report the incident to your
immediate manager or supervisor and complete the
Form-IPC-022-A. Accidental Exposure to Blood and Body
Fluids Reporting Form and an Occurrence Variance
Report (OVR) form.
 b. The report should include but not limited to the
following:
i. The date and time of the incident
ii. The location where the incident occurred
iii. The department where the employee works
iv. The source patient Medical Record Number
(MRN), if known
v. The details of the event resulting to injury or
exposure.

3). The Form-IPC-022-A is composed of Three (3) phases.

The first two phases should be accomplished by the exposed
employee (the physician in phase 2 will evaluate the
exposure and should give an initial medical
recommendation on the accidental exposure).
4). After completing the First two phases - the form should
be handed over or to be submitted to the Infection
Prevention and Control Practitioner or Employee Health
Clinic Nurse for investigation, management, and follow-up.