The Circulating Zones
The Operating Room Circulating Zones
Learn the standardized and systematic way to set-up an Operating Room from a Circulating Nursing Prospective.
A Simple Idea.
The creation of The Operation Room Circulating Zones came from wanting to teach new Circulating Nurses a systematic and a standardized process on how to set-up a operating room for any surgical case. A varying process is added due to the type of surgical case they will set-up for. These two educational techniques helps the new Circulating Nurse stay "focus" and helps the mind to stay involved in the overall learning process.
As educators and preceptors, we teach our Circulating Nurses everything from donning gloves, the proper way to open sterile supplies, to the proper way to prep a patient. Each of these processes has a standard and organized way to accomplish the task within a written standard, but we don't teach them a standard way to set-up a operating room. This varies from nurse to nurse. Until now.
During a simple drive home, the concept came to me. Break up the surgical suite into particular "Zones" or sections. Have the Circulating Nurse focus on one "Zone" or section at a time, then transition into the next "Zone" until complete room set up. That's it. Simple idea.
Circulating Zones Introduction
An opportunity was observed for improvement within the operating room. This "new" educational process is for the intra-operative set-up of the operating room before the patient comes in. This process is for the circulating nurses. Particularly, the new graduate nurse population.
It was observed that these nurses were overwhelmed and flustered in setting-up the operating room without a standardized, systematic process. They would move from one side of the room to another, just to go back to the same side of the room to set-up. This wasted movements I have called: "The Busy Bee Affect." Like bee's moving from flower to flower, just to go back to the same flower. Why don't we have a standardized process for our new operating room nurses to follow?
For these new operating room nurses, their unstandardized process way of learning could potentially lead the new operating room nurse to miss important items or devices necessary for preparing for their surgical case. It also puts undue pressure on them by not having a clear direction and points to hit in systematic order to follow.
To standardize and improve this process, both for the nursing professional practice and the safety and efficiency of the operating room setting for patient care, an innovative approach to standardizing the operating room nurse preparation was developed, "The Operating Room Circulating Zones." (T.O.R.C.Z.).
Now, let's take a look at this Circulating Nurse educational process....
"The Circulating Zone Technique"
The Circulating Zone Process.
The Circulating Zone Process is a potential key tool that could be used by Operating Room Educators and Operating Room nurse preceptors in teaching new surgical nurses the "standardized and systematic" educational process of setting up the surgical suite. It eliminates the unorganized and wasted movements within the operating room. It is important (case dependent) for the new Circulating Nurse to try to keep the same items in the same "Zones" or sections. Because this is a case dependent set-up, the combinations of a standardized, systematic set-up plus the varying of equipment and supplies per particular case helps to learn faster per research.
By doing this, the Circulating Nurse will not look at the operating room the same. Once learned, they will view the operating room in each unique "section" or "Zone" and not as much as an overwhelming huge room filled with equipment, lights and other supplies in which they have to organized in a set amount of time. The operating room will become less overwelming and their speed in which to set up the room should improve. Let's take a look.
As you enter the Operating Room you find Zone One (Z1), this is the space where your surgical bed resides (from the floor up to the surgical lights) (see diagram). The first and most important thing you must do is to just nudge your bed. Rationale? This relates to patient safety. You are making sure the bed is locked prior to patient transfer. Other things that should be completed in (Z1) are:
Surgical lights are functional and in proper position for your case.
Bed in proper position for posted case.
Bed straps are on.
Positioning devices on bed for specific case; (i.e. beanbag, insufflation devices, etc.)
Place patient arm board on bed opposite door side entry. The other arm board, place near the door so you can place on the bed once the patient is transferred over (both padded and covered).
Headpiece equip: Foam donut, gel rolls or donut, prone square donut, etc.
Bed base (possible storage area), if needed place folded sheets, additional positioning devices, double arm boards, axillary roll, and or patient warming machines on floor, warming blanket turned on patient bed.
The foot end of the bed you can place: patient deep vein thrombosis (DVT) sleeves, heel pad protectors, bovie pads, or lower body patient warming blanket. Vice versa at head of bed place upper body patient warming blanket.
Hang suction for top/bottom for sterile field connection later during case.
Floor space at foot of bed you can place: patient warming machine.
DVT machine: either at the head/foot of bed.
Anesthesia lines and space. Here you have a chance to make sure that Anesthesia lines are free and the bed is positioned not to crowd them. This gives our Anesthesia team members space at top. Teamwork.
That’s it!! Who said this was going be hard. Now, you have completed (Z1), it is now ok to move on to the next zone within the OR setting which is Zone Two (Z2).
Zone Two (Z2) (see diagram), a “WORKING ZONE”. This zone is found just left of the OR bed (see diagram). In this section you may find some of your surgical equipment. In this zone you will:
Check to make sure suctioning containers are in place and functioning well with suction tubing. Hang the suction tubing along your bedrail where you will connect the suction from the sterile field. Additionally, make sure your suctioning containers are appropriate size for your case.
Surgical headlight box in place and functioning.
Make sure the suction containers are facing and are visible for anesthesia personnel, in that they will need to see fluid levels for estimated blood loss (EBL).
Possible secondary machines are in place i.e. cautery machine, smoke evacuators, and vessel sealing machines. Any other surgical equipment that aids the surgeon can be placed in this zone. That’s why it is called the “WORKING ZONE”.
In (Z3), this is called your “Circulator Zone” (CZ). In this zone, is where the nurse would place those items that assist the new circulating nurse personally in taking care of the surgical patient. For this zone use a prep table to place all the desired items. Some of the things found in (Z3) are as listed below:
Head and Neck Table – EUA table: laryngoscopes, blue light cord, grey light cord and light clip Biopsy Forceps : small and large straight biting and small and large Up biting. Suction Tips : velvet with smooth tip. Accessories: White teeth guard, Telfa, 18 guage needle, specimen cups, non sterile gloves and have specimen sheet and labels ready.
GYN-EUA table: KY-Gel/gloves/plastic bag/speculum/razor/tape/blue chucks
Neuro- EUA Table: Antibiotic ointment/telfa/4X4’s/cover roll/iodine 2 step/razor/tape/marker/Pins
General Circulator table: Surgical prep kit, razor, tape, foley, electrocautery pad, DVT sleeves, extra foam padding’s, pillows, warming blanket, folded sheets, blue chucks, etc.
In this zone, make it your own, personalize it. But, remember to keep the same items you like the same though-out all zones, including this one.
Zone Four (Z4) (see diagram) is another suggested equipment zone. In this zone like (Z2), it pretty much mirrors (Z2). Here is another “WORKING ZONE”. Here you will find:
Second surgical headlight box is present and functioning.
Additional surgical equipment: Possible secondary machines are in place i.e. cautery machine, smoke evacuators, and vessel sealing machines. Any other surgical equipment that aids the surgeon can be placed in this zone.
In Zone Five (Z5) (see diagram), this would be your “Viewing Zone”(VZ). In this zone, you often find items such as your visual aids such as: Bronchoscope towers, cystoscope towers, laparoscopic towers, etc. That’s it!! How do you feel? You have just completed ALL circulating zones and now your room is ready for patient entry as far as a Operating Room Circulating Nurse standpoint.
Let’s see what that Optional Zone is, Zone Six (Z6) (see diagram).
Here is (Z6). In this zone, it’s optional for the new circulating nurse to log onto their central computer and bring up their patient record and any helpful x-rays or patient history for their particular case. This has it pros and cons. The pros are that you are able to review any History and Physical information, review the surgical plan and even see films of the surgical site. The cons, is if you are not observant of the computer where they have logged on, another staff member may be able to review another patient info on their sign-on screen. So, this is why this (Z6) is Optional.
The Circulating Zones Initial Design
This is the initial "Circulation Zone" design. In this, the Circulating Nurse would transition from the beginning "Zone 1" systematic to his/her last zone, "Zone 6".
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