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Surgical Assistant Skills:
A. Demonstrate the ability to communicate the surgeon’s preferences and specific patient’s needs to surgical team including but not limited to suture needs, specialty supplies and instrumentation, and equipment.
- (1) Verifies all implants, supplies and special procedure equipment is available and functional. (i.e. microscope, tourniquet, etc.)
- (2) Facilitates a cooperative team atmosphere through professional communication.
- (3) Listens actively to surgeon, patient, and team to ensure safe patient-centered care.
- (4) Maintains awareness of patient monitoring and responds appropriately to potential complications.
B. Demonstrate the ability to apply advanced knowledge of normal and pathological surgical anatomy and physiology.
- (1) Describes the assessment and management of acute trauma.
- (2) Responds appropriately to emergency conditions.
C. Demonstrates Aseptic Skills:
- (1) Monitors the actions immediately surrounding the sterile field ensuring that the integrity is maintained and/or corrected appropriately.
- (2) Evaluates potential causes of surgical site infections, communicating concerns and possible corrective actions to prevent and/or treat potential contamination.
D. Acquires continuing education annually to maintain current competence and credential regarding specific skills and techniques including aseptic technique. Bases decisions on research-based evidence.
Preoperative Role:
A. Demonstrates the ability to provide preoperative skills such as assessing patient information, history, preoperative tests (i.e. EKG, EEG, EMG, lab values, diagnostic imaging), safety measures, biopsy results, positioning and draping.
- (1) Verifies patient identification, allergies, NPO status, procedure, surgical site, consent, history and physical on chart.
- (2) Inspects skin integrity for signs of infection, compromised perfusion or other signs of potential risk.
- (3) Ensures x-rays and applicable diagnostic exams are available for surgeon.
B. Specifics regarding positioning the patient:
- (1) Ensures placement of monitoring devices does not interfere with access or prep.
- (2) Ensures position of the patient provides the necessary exposure for the procedure, as well as the surgeon preference.
- (3) Demonstrates competency in all positioning techniques for the surgeries they are participating in. These competencies include, but are not limited to;
a. Prevention of nerve damage
b. Proper rotation of extremities
c. Prevention of circulatory or respiratory compromise.
d. Prevention of patient sliding on bed due to tilting or Trendelenburg.
e. Proper handling and placement of lines.
- (4) Demonstrates safe stabilized placement on the appropriate bed/table, with the appropriate operation, set up, safety measures, and utilization of all necessary equipment, stabilizers, padding, wrapping and/or attachments.
- (5) Maintains knowledge of new or upgraded positioning equipment, supplies and positioning techniques through continuing education.
C. Specifics regarding surgical skin prep:
- (1) Ensures safe placement of tourniquet, extremity padded correctly, safety precautions followed and the accuracy of the settings for tourniquet inflation.
- (2) Ensures skin prep will provide the necessary exposure for the surgical procedure, any possible drain sites and/or possible extension(s) of the operative incision, as well as surgeon preference:
- a. Facilitates clipping or trimming of hair in preop holding and only if necessary
- b. Demonstrates ability to perform a surgical skin prep selecting the
- correct prep for the situation (i.e chlorhexidine gluconate/alcohol prep, iodine povacrylex/alcohol prep, chlorahexidine gluconate, povidone-iodine (iodopovidone), etc.) and preparing the appropriate surgical prep site necessary.
- c. Demonstrates insertion of Foley catheter; prevents potential complications, as indicated.
D. Specifics regarding draping:
- (1) Streamlines the establishment of the sterile field.
- (2) Coordinates the draping procedure effectively correcting any breaks in aseptic technique.
- (3) Supports double gloving/changing outer gloves after establishment of the sterile and periodically (every 90 minutes) during case.
- (4) Secures lines and cords in a manner that prevents loss of integrity.
- (5) Evaluates and incorporates products to ensure effective barriers are established and maintained that prevent contamination during the entire procedure.
Intraoperative Care:
A. Demonstrates the ability to provide intraoperative skills such as visualization, trocar insertion, injection of local anesthetics, hemostasis, tissue handling, placement and securing of wound drains, and closure of body planes.
B. Utilizes the OR equipment pertinent to the surgical procedure. All actions shall facilitate the progress of the surgery, as well as anticipate the preference(s) of the surgeon. This shall include, but not be limited to:
- (1) Hemostatic equipment and supplies, including monopolar, bipolar, harmonic scalpel, ultrasonic, medications, sponges, etc. Includes appropriate safety precautions such as the placement of grounding pad, assists scrub and circulator with accuracy of counts when necessary, etc.
- (2) Knowledge of and use of any and all laparoscopic and robotic equipment necessary for a procedure, such as: Camera, light cord, inserting/removing trocars, graspers, scoops, sprayers, suction/irrigation systems, clamps, tenaculums, etc.
- (3) Knowledge of and use of any open procedure equipment necessary for procedures, including, tissue forceps, retractors, clamps, scissors, sponges, suction, irrigation, use of hemostatic agents, etc.
- (4) Any further applicable instrumentation or actions deemed necessary by the surgeon.
C. The surgical assistant should be proficient in all pertinent abilities required during a procedure. These shall follow any necessary and appropriate methods applicable to the procedure, as well as surgeon preference. These shall include, but not be limited to;
- (1) Clamping, cauterizing, suturing, inserting, injecting, manipulating, retracting, cutting, and ligating tissue as necessary
- (2) Any necessary involvement in hemostasis, including but not limited to the utilization of ties, vessel loops, clip appliers, digital pressure, packing, appropriate manipulation of sutures, etc.
- (3) Participation in volume replacement or autotransfusion techniques as necessary and appropriate.
- (4) Any further applicable instrumentation or actions deemed necessary by the surgeon.
D. The surgical assistant should be capable of working independently, or codependently with the surgeon, to finalize the surgery, according to the surgeon preference. These actions shall include, but are not limited to:
- (1) Participates in quality improvement process that include standardized approaches, checklist interventions such as the Michigan Keystone Surgery Project regarding surgical site infection to improve patient care and Time Out procedures to improve patient safety.
- (2) Initiates appropriate actions or instrumentation in collaboration with the surgeon.
- (3) Utilizes appropriate suturing techniques, according to surgeon preference, with closure of body planes and utilizing proper manipulation of suture. a. Using running, or interrupted suture techniques b. Including absorbable and non-absorbable sutures, staples, adhesives, strips, etc.
- (5) Demonstrates ability to secure drainage systems
- (6) Demonstrates ability to apply dressings, splints, casts and immobilizers/ stabilizers, according to surgeon preference.
- (7) Evaluates the patient for any possible damage from positioning. This shall include a skin assessment. Any abnormal condition should be reported to the surgeon, and appropriate treatment be carried out according to surgeon instruction
Postoperative Care
- A. Demonstrates the ability to provide postoperative skills in patient care such as dressing application, patient transfer and transport, transfer of care, and monitoring for immediate complications.
- B. Collaborates with others to provide continuity of care.