PCS16 Provide surgical instrumentation and items for the surgical team and maintain the sterile field

Overview

This standard covers providing surgical instrumentation and supplementary items to the surgical team and monitoring their use.  This involves passing surgical instrumentation and supplementary items across the sterile field and checking and counting surgical items with the Registered Practitioner, in line with organisational policies and procedures. You will be working in a ‘scrubbed’ role whilst undertaking these activities. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 1

Knowledge and Understanding

You will need to know and understand:

1. The current European and National legislation, national guidelines, organisational policies and protocols in accordance with Clinical/Corporate Governance which affect your work practice in relation to providing surgical instrumentation and items for the surgical team and maintaining the sterile field
2. Your responsibilities and accountability in relation to the current European and National legislation, national guidelines and local policies and protocols and Clinical/Corporate Governance
3. The duty to report any acts or omissions in care that could be detrimental to yourself, other individuals or your employer
4. The role of regulatory bodies in relation to medical and healthcare products and regulations relating to medial devices
5. The application of standard precautions to the handling, provision and monitoring of surgical instrumentation and supplementary items and the potential consequences of poor practice
6. The difference between scrubbed and circulating roles
7. The importance of working within your own sphere of competence and seeking advice when faced with situations outside your sphere of competence
8. The principles of asepsis in relation to the provision of surgical instrumentation and supplementary items and the maintenance of the sterile field and the potential consequence of poor practice
9. The sources, transmission routes and destruction of pathogenic organisms
10. The responsibilities of the scrubbed role in monitoring and maintaining sterile fields during clinical procedures
11. The nature and purpose of sterile fields and describe how they are established and maintained
12. How the sterile field contributes to infection control
13. The importance of adhering to correct methods for passing items to, and receiving them from, the sterile team and the circulating practitioner
14. How sterile fields may be compromised during procedures, and the action to take if this happens
15. The safe methods of disposing of all types of waste from the sterile field
16. The potential hazards associated with surgical instrumentation and supplementary items and how they can be avoided or minimised
17. The criteria and methods for judging the sterility of surgical instrumentation and supplementary items
18. The types, purpose and function of surgical instrumentation and supplementary items in common use in the clinical specialties relevant to your practice
19. The requirements for, and suitability of, surgical instrumentation and supplementary items for the clinical specialties relevant to your practice
20. The factors to consider in selecting surgical instrumentation and supplementary items for individual patients
21. The importance of adhering to manufacturers’ instructions regarding the preparation of surgical instrumentation and supplementary items for surgery
22. The importance of checking and confirming that surgical instrumentation and supplementary items are in a suitable condition prior to use
23. Procedures for identifying and reporting problems in surgical instrumentation and supplementary items
24. The action to take if problems are identified with surgical instrumentation and supplementary items which have been requested
25. The types of procedure carried out in the clinical specialties relevant to your practice
26. The surgical instruments and supplementary items required by the surgical team for common procedures carried out in the clinical specialties relevant to your practice
27. The ways in which the type of procedure and clinical specialty affects the instrumentation and supplementary items required by the surgical team
28. The principles, methods and techniques for monitoring surgical instrumentation and supplementary items for the surgical team
29. Methods of care and handling of surgical instrumentation and supplementary items during use
30. The specific times at which checks must be carried out on surgical instrumentation and supplementary items during use
31. The procedure(s) to be carried out if any item is identified as missing during use
32. The importance of following procedures for the tracking and traceability of surgical instrumentation and supplementary items during use
33. The potential hazards associated with the handling of surgical instrumentation and supplementary items and how they can be avoided or minimised
34. The potential consequences of poor practice in relation to the handling of surgical instrumentation and supplementary items
35. Ways in which the sterile field can be compromised during hand-over of items, and how this can be avoided
36. Methods of effective communication with members of the perioperative care team during operative procedures
37. The individual responsibilities of all clinical team members in relation to monitoring and accounting for surgical instrumentation and supplementary items use during clinical procedures
38. The specific lines of accountability within the surgical team
39. Where and how to record information on the number and location of surgical instruments and supplementary items for used in clinical procedures
40. The importance of recording all information clearly and precisely in the correct documentation
41. The importance of reporting all information to the registered practitioner
42. The importance of immediately reporting any issues which are outside your own sphere of competence without delay to the relevant member of staff

Performance Criteria

You must be able to do the following:

1. apply standard precautions for infection prevention and control and other relevant health and safety measures
2. ensure your, position, posture and movements do not compromise the sterile field or patient safety
3. communicate clearly and assertively with others, giving appropriate information, instruction and advice so that they do not compromise the sterile field
4. effectively monitor the activities of the surgical team and anticipate their requirements for surgical instrumentation and supplementary items
5. handle surgical instrumentation and supplementary items correctly and safely, ensuring the sterile field and patient safety is not compromised when handing them to the surgical team
6. promptly clarify any uncertainty over requirements with the appropriate member of the surgical team
7. where you identify a problem in relation to:
   1. an instrument or item
   2. the sterile field
   3. contamination of instruments (immediately report and take appropriate action)
8. provide the correct instrumentation and supplementary items to meet the surgical team’s needs according to the patient, the clinical specialty and procedure
9. count and record instruments, needles, swabs and supplementary items in conjunction with a registered practitioner as the second authorised checker during the case and prior to closure and completion, in accordance with organisational policies and procedures
10. clearly inform the surgical team of the instrumentation and supplementary item counts at appropriate stages of the procedure
11. dispose of and transfer used instrumentation and supplementary items to the non-sterile area for accounting and compliance with tracing requirements for medical devices in line with local policies
12. complete records accurately and legibly in accordance with national guidelines
13. carefully remove drapes from the patient, ensuring their dignity and safety, and dispose of drapes as appropriate

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB7 Interventions and treatments