Perioperative Nursing in NUH

There are three main roles for nurses in the Operating Theatre:

Perioperative Nurse

The perioperative nurse focuses solely on assisting the surgeon intraoperatively and ensuring that surgical procedures run smoothly. They work alongside surgeons, anaesthetists, perfusionists, embryologists and other medical personnel.

The day-to-day responsibilities of a perioperative nurse includes:

• Completing surgical documentation and charging.
  
• Assisting surgeons in operations by maintaining patient safety through ensuring sterility of the procedure and performing checks of surgical items used intraoperatively.
  
• Monitoring of patient's condition during surgery for Local Anaesthetic and Moderate Sedation cases.
  
• Providing nursing care in the OT to maintain a safe and comfortable environment.
  
• Ensuring surgical equipment and items are available for surgeries.
  

Anaesthetic Nurse

The anaesthetic nurse is trained to provide support to the patient and anaesthetist intraoperatively. 

The day-to-day responsibilities of an anaesthetic nurse includes:

• Preparing anaesthetic equipment.
  
• Monitoring the patient's condition perioperatively.
  
• Assisting the anaesthetist in managing the patient's airway.
  

Post Anaesthesia Care Unit (PACU) Nurse 

Post Anaesthesia Care Unit (PACU) nurses oversee care for patients who are waking up from anaesthesia. PACU nurses are responsible for ensuring the patient's condition remains stable post operatively by conducting regular observations of the patient.

The day-to-day responsibilities of a PACU nurse includes:

• Monitoring post-operative patients' state of recovery and consciousness from anaesthesia and giving updates to the surgical/anaesthetic team.
  
• Developing individualised care plans based on patient's condition.
  
• Administering and discharging patient in the PACU when appropriate.

Nurse led Initiatives @ NUH Operating Theatre includes:

Skin-to-skin Initiative

"Skin-to-skin" for elective caesarean surgery in OT has been initiated to ensure that NUH's standards of being a baby friendly hospital initiative (BFHI) is met. Traditionally, support is required from midwives in the OT in order to facilitate and maintain skin-to-skin contact between mothers and babies. Theatre nurses hold the role of receiving the neonate from the surgeon and assisting the neonatal physician in the initial care required. An essential part of improving the experience of caesarean section consists of avoiding separation of mother and child, which includes skin-to-skin contact immediately after birth in the OT.

Assistant Nurse Clinician Joyce Chai speaks on her experience in this new initiative which commenced in 2019.

"It has been a fulfilling journey thus far, coming out of my comfort zone and challenged with the certifications and situations of handling the care of neonates for elective caesarean sections.  Acting as an advocate and seeing the overjoyed smiles on the parents' faces when their baby is presented to them, brings me great job satisfaction."

PACU Nurse Controlled Analgesia

This initiative started off since 2012 whereby registered nurses are given the autonomy to initiate and deliver analgesia to post surgery patient who are experiencing pain. Having one anaesthetist in the PACU can be a challenge especially when he/she is attending to a patient, hence it takes time for the anaesthetist to be able to address the other patient's concerns. With this move, nurses are able to immediately address patients' pain by titrating analgesia to patient and with that, patient's pain is usually managed in a timely manner and they are also able to be discharged earlier to the ward to rest. This initiative has been quite well received by both anaesthetists and nurses as it benefits the patients. 

PACU Nurse-led Discharge

When a patient is ready for discharge in PACU, the anaesthetist may not always immediately be available to evaluate and discharge the patient. This leads to patient frustration as well as increased length of stay for the patient. Hence, the PACU Nurse-led discharge initiative was introduced in 2002 where nurses are given the autonomy to initiate and discharge post-surgery patient from PACU. 

PACU nurses are trained and certified to assess post-operative patient for discharge based on guidelines and criteria set. With that, majority of the patients are always being discharged by our PACU nurses, allowing the anaesthetist to monitor and manage more complex post-operative patients.