WORKING IN THEATRES
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Timings and Hours
A normal working day is 8am to 6pm i.e. 10 hours. Theatre briefs are mostly 8.15am aiming for an 8.30am send. In elective orthopaedics and elective caesarean section lists we brief at 8am aiming for an 8.15am send.
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Lists
Bluespier is the theatre management IT system and is used to generate lists. Further details here. For convenient checking of your list, open a web browser, enter the URL bluespiermobile/ and enter your Windows login credentials. This generates a read-only version of Bluespier which is a far quicker way to access your patient details.
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Elective patients who have been through POAC will have a summary on Synopsis, the POAC IT system (accessed again using your Windows login credentials). Information on non-elective patients may be available on Careflow.
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There are some ‘odd’ lists which are too numerous to list here, but they include:
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‘Mobile IR’ – Wednesday PM and Thursday AM every week – a mixture of GA MRI scans and GA interventional radiology cases, all in gate 19
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Vertebroplasty – Tuesday PM weeks 1 & 3 in IR 3
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PCNL (percutaneous nephrolithotomy) – Monday PM and Wednesday AM every week
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Endoscopy (Wednesday AM weeks 2 & 4 in endoscopy (gate 13)
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DC cardioversions – vascular hybrid theatre every Wednesday AM
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Cryoablation (renal tumours) – in CT scanner gate 19 Wednesday AM week 1
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Finding your patients!
Most patients reside in Medirooms pre-op and will be recovered in the same room post-theatre. There are two zones (A & B) on Level 2, and three zones (A, B & C) on Level 3. There are whiteboards in the main corridor showing which Mediroom cluster is allocated to each theatre, and whiteboards in each cluster with a list of patients’ names under the Theatre number. They also state which Mediroom nurse is allocated to your theatre.
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Each cluster has separate trolleys with needles and syringes, cannulation equipment, blood tubes etc, an arrest and airway trolley. There are grab-bags for emergency intubation.
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Emergency Theatres
Theatre 1 (General/Burns) and 2 (Plastics Trauma)
8am plastics trauma meeting is in Carpenter Room (Level 2, Seminar Tower)
Theatre 1 sometimes has work other than plastics/burns, and theatre 2 sometimes has cases "colder" trauma which may not be discussed at the meeting (e.g. Wednesdays "fix n flap" orthoplastics cases)
Getting there: in the green/seminar tower, level 2​
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Theatre 3 (Ortho Trauma) and Theatre 4 (Ortho Trauma)
8am trauma meeting – most theatre staff attend this hybrid meeting from theatre 3
Alternatively, 8am in Cabot Room (Gate 14, Level 5).
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Getting there: At the green/north/main entrance end of the clinical corridor right at the end in the Cabot Room, gate 14.
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Attended by orthogeriatricians – they try and see the #NOFs before theatre. This helps a lot and they may ring you in theatre with patient details. Give them a chance to see them before you send (start with something else?).
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Theatre 5 - General Emergencies
Attend briefing at 8am outside Theatre 5.
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Theatre 6 - Neuro-emergencies
Attend 8am meeting in Guy Jordan seminar room on ICU.
Getting there: In ICU (2nd floor, pink end, Gate 37). Seminar room is next to the coffee room in ICU. Walk down clinical corridor on 2nd floor, past theatres and you will see ICU on your right recognisable by the slats on the windows adjacent and the signs saying Intensive Care.
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CDS Theatre 1 – Obs emergencies
Attend 8am handover meeting CDS coffee room, emergency theatre team brief follows after handover.
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Brunel Theatres
Theatres are arranged in pairs with a shared laying-up/prep room behind. There are no anaesthetic rooms. Fridges are in the prep rooms – code *12345# - but note that only one of the two theatres can open its door into the room at a time – there is potential for getting trapped either in the prep room or your theatre, while waiting for the other theatre’s door to close! As such, you should have a cache of muscle relaxants / other important fridge drugs in your theatre at all times.
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There are two mobile carts in each theatre – the larger one is primarily for your use and contains cannulae, needles, syringes and regional anaesthesia equipment. The narrower cart contains airway equipment and is manned primarily by the Anaesthetic Assistant.
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The airway cart has the same layout in all theatres, comprising:
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A standard array of facemasks, oral and nasal airways
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Classic LMAs and iGels sizes 3-5
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Standard and reinforced tracheal tubes sizes 6.0-8.0
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Macintosh laryngoscopes sizes 3 and 4
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A scalpel in the top drawer for CICO situations
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There are CMACs in each cluster of theatres, to which fibreoptic scopes may be attached if necessary.
There is a supply of smaller (paediatric) airway devices in theatre stores (ask your Anaesthetic Assistant) and a ‘one-lung anaesthesia’ box containing all necessary equipment.
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Anaesthetic machines are the same throughout the Trust: Datex-Ohmeda Aisys CS2. These are excellent machines but have some idiosyncrasies in their operation (e.g. 2-touch actions for starting FGF) so please ensure you are familiar with their operation before embarking on a case.
Drugs are in one of three steel cabinets adjacent to the theatre doors. The upper cabinet contains the majority of the drugs, organised from A-Z and with an inner locked cabinet for controlled drugs. The lower cabinet contains bulkier items (e.g. medications in plastic bottles, fluid bags, 50ml propofol vials etc). Local anaesthetics are in a drawer in the third, full-height steel cabinet on the right (the majority of which contains larger ancillary equipment e.g. breathing circuits).
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There is a pharmacy store on Level 2 and Level 3 within the theatre complex – usually your Anaesthetic Assistant will stock up from there, but it’s useful to acquaint yourself with its location and layout. There is a code to get the cabinet keys from their locker – your Anaesthetic Assistant can give you this.
The pharmacy store contains dantrolene and intralipid, plus a ‘cardiac drugs’ crate. Level 3 pharmacy store also contains a crate of drugs for managing phaeochromocytoma patients.
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Both Level 2 and Level 3 theatres have an equipment store which contain dedicate aisles of anaesthetic consumables. Again, it’s useful to be familiar with their location and layout.
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​Elective Operating
Typically, your Anaesthetic Assistant will fetch your patient from the Medirooms. Patient notes will be in the notes cabinet, if not in their Mediroom. A WHO sign-in needs to be done which involves you and the Anaesthetic Assistant. It can be done in theatre or in the Mediroom.
The theatres are relatively soundproof and shouts for help may prove futile. There are alarms in theatre and if you are not happy and want a third person in theatre for induction, ask for one and wait before embarking on the case.
Not having anaesthetic rooms requires a culture shift for theatre staff and surgeons, and they can be gently reminded of the importance of a quiet relaxed environment for your patient.
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Holding Area
The Medirooms also act as a useful place to “store” a patient from the ward prior to starting their case. It takes a variable amount of time to get a patient from the ward, so if you send for them to go to Medirooms it means you can start straightaway with minimal delay.
Out of hours or for emergencies, it is sometimes reasonable to send straight to theatre. There are paper slips in Medirooms and theatres that need to be completed and given to the porters. There are porters in each cluster of Medirooms. You can request an ECG in Medirooms if needed. If the patient is not fit or there is a problem, speak to a senior but it is acceptable to return the patient back to the ward.
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Recovery
Medirooms are also used for recovery, with the patient usually returning to the room from which they came.
Handover should involved a truncated medical history, details of surgery, relevant drugs and fluids given, plus ongoing plan regarding drugs and other therapies. It may be appropriate to detail physiology targets, but this is clearly not essential for all patients.
As patients are in individual rooms (rather than an open recovery ward), do not leave them if you have any concerns. On some days there may be relatively inexperienced Medirooms nurses and you may need to give additional handover or stay with the patient a little longer while they regain control of their airway etc.
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HDU/ICU Patients
All extubated patients go to the Medirooms for recovery before being transferred to HDU/ICU. The only exception to this is patients with noradrenaline running – Medirooms nurses are not able to manage this infusion (also adrenaline or any other high-risk vasoactives). Metaraminol infusions are acceptable in Medirooms. Patients on noradrenaline etc therefore need direct admission to ICU and you may need to stay for some of stage 1 recovery if the ICU nurse is not comfortable managing the airway. As a rule, all extubated patients being transferred to ICU must have control of their own airway and reasonable pain control.
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Bed Shortages
You may find Medirooms being used to nurse patients who have recovered from anaesthesia and should have returned to the ward or ICU/HDU. To be clear, once these patients are recovered from anaesthesia they are the responsibility of the surgical team or ICU. You may find you are called by the Medirooms nurses for ward jobs. If this occurs you should direct the nurse to the relevant parent team. Of course, please do help if the patient is in extremis, but do not get embroiled in doing surgical ward work. – this is neither desirable nor appropriate!
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Cotswold Theatres
There are two modern, modular theatres adjacent to CDS wherein gynae surgery is undertaken. These theatres have the same range of drugs and equipment as the Brunel theatres; however they each have an anaesthetic room.
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Patients are admitted to the gynae wards preoperatively and undergo stage 1 recovery in the recovery bay between the two operating theatres, before returning to the ward.
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Access to this theatre suite is via CDS.
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Blood
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Level 2 fridge has O-negative blood, as does ED and CDS. There is none on Level 3.
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2 samples sent at different times are required for ordering cross-matched blood from blood bank.
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Major haemorrhage is activated on 2222. Blood bank will be alerted. A porter, a general surgeon, theatre coordinator, 9030 and the 3rd on anaesthetist should be alerted.
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There is a Rotem/TEG in Level 2 theatres. There is also a gas machine in medirooms and ICU.
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BloodTrack is the system we use at NBT to take group and save samples and administer blood products. It is a fully electronic system. It is important that you complete the Blood Track training before going on call.
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There are 2 components via learn https://nbt.kallidus-suite.com/learn:
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BT1:(MaST) - Clinical Blood Transfusion Training (BT1) - for Medical Staff (Doctors etc.) only
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BloodTrack PDA Modules
Once you have completed your online modules, you will need a face-to-face assessment by one of our trainers: Dr Sarah Thomas (sarah.thomas2@nbt.nhs.uk) and Dr Mihaela Onofrei (mihaela.onofrei@nbt.nhs.uk)
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