Consultant Anaesthetists,

Subang Jaya Medical Centre,

No. 1, Road SS 12/1A,

47500 Subang Jaya,

Selangor.

7 September, 1997.

 

Dr. Husain,

Chairman,

OT Sub-Committee,

Subang Jaya Medical Centre,

No. 1, Road SS 12/1A,

47500 Subang Jaya,

Selangor.

 

Dear Dr. Husain,

 

Re: SJMC Theatre Handbook

 

We refer to the above handbook which most of us received towards the end of June 1997. After going through it, we felt that there were certain parts of the handbook which could be better phrased or at times portions of which we could not agree with.

 

Unfortunately, this was at the time that the OT Sub-Committee was coming to the end of its term and a new sub-committee was in the process of being formed. Therefore, this letter could not be sent to anyone until now.

 

We therefore, submit to you our views and the suggested changes which we feel would make the handbook more appropriate.

 

 

 

 

Chan, Charlie                        Dalina                        Liew, Robert

 

 

 

Ngun Kok Wah                 Datuk Radhakrishnan              Samuel, Mary

 

 

 

Singh, Bachan                           Tan Poh Hua                                   Wong, Anne

 

 

c.c.

Mr. Kevin Potter,

Medical Director,

Subang Jaya Medical Centre.

OT Management

 

3.      The OT manager reserves the right to intervene or delay any scheduled case in order that a more urgent case may proceed after due consultation with the surgeons concerned.

4.      The OT manager also reserves the right to amend or modify an elective list in the interest of time or staffing constraints but always after due consultations with the surgeon concerned.

 

Comments

The anaesthetists should also be consulted in the above situations as this allows us to:-

1.      Assess the patient medically,

2.      Establish rapport with the patient,

3.      Discuss the anaesthetic plan with the patient,

4.      Order our pre-anaesthetic medication appropriately, both for this patient and other patients affected by the change, and

5.      Discuss with the surgeons the urgency of the case.

 

Suggestion

The end of each line should be amended to

... after due consultation with the surgeons and anaesthetists concerned.

 

 

Anaesthetic Coverage

 

4.      The rosters for emergency calls and for assigned operating lists are prepared by the OT manager in collaboration with the anaesthetists.

 

Comments

The anaesthetic roster is not normally prepared by the OT manager and we feel it is only appropriate that the anaesthetists themselves prepare the roster as they are in the best position to see how best to fit the individual anaesthetists into the various lists.

 

Suggestion

To change to read:-

The rosters for emergency calls and for assigned operating lists are prepared by the anaesthetists, after consultation with the OT Manager where necessary.

 

 

C.     SERVICE REGULATIONS

 

Elective Service

 

CI.  Patients undergoing elective procedures must be admitted to the hospital as follows:

 

AM list:            The night before - latest admission time 2000 hours

 

Comments

In the RULES & REGULATIONS OF THE MEDICAL STAFF OF SJMC which forms an integral part of our contract, clause 6 of the section on ADMISSION OF PATIENTS specifically states that “Patients scheduled for morning surgeries must be admitted prior to 6:00 PM the evening before” and this must be adhered to.

 

Suggestion

Amend relevant section to comply with the requirements of our contract and admit these patients before 18:00 hours.

 

 

D.    SERVICE CHARGES

 

D2. Support team for all OT procedures include

 

·        First assistant

·        Scrub assistant

·        Circulation/anaesthetic assistant

·        OT Technician

 

Comment

In the section on OT Setup, it is very clearly stated that there will be a separate anaesthetic assistant.

 

It is also stated in the Recommendations for Standards of Monitoring during Anaesthesia and Recovery issued by the Malaysian Society of Anaesthesiologists that “Skilled assistance for the anaesthesiologist must be available at all times during the conduct of the anaesthesia”

 

Our hospital should comply with these recommendations and ensure that each theatre has an anaesthetic assistant who is not responsible for any other duties and does not need to help out in non-anaesthetic duties except with the express permission of the anaesthetist.

 

This is especially pertinent now that our hospital is applying for certification under the ISO 9002 standards.

 

Suggestions

The line specifying the anaesthetic assistant should stand individually:-

·        Anaesthetic assistant

The specification of the other members of the team may be modified as necessary to reflect this change

 

 

E.     GENERAL RULES

 

            Consent

 

E5. For patients undergoing sterilisation procedures, consent is required from both the legal spouse and the patient.

 

Comment

A recent newsletter from the Medical Protection Society (MPS) has very clearly stated that not only is consent from the spouse unnecessary, but should the patient wish it, the spouse should not even be informed as this could be construed as a breach of patient confidentiality.

 

Suggestion

Change to read:-

E5. For patients undergoing sterilisation procedures, consent from the legal spouse is highly desirable but not a requirement.

 

 

F.     Anaesthetists Services

 

F2. The roster for emergency calls will be prepared by the anaesthetists in consultation with the OT Manager and distributed monthly.

 

F3. Where a case is delayed on an Open list and the assigned anaesthetist is consequently held up, the OT Manager is empowered to assign another anaesthetist to the case.

 

Comment

F2.       See section on Anaesthetic Coverage above.

F3.       OT Manager should always discuss these changes with the doctors concerned.

 

Suggestion

Amend to:-

F2. The roster for emergency calls will be prepared by the anaesthetists, in consultation with the OT Manager when necessary, and distributed monthly.

 

F3. Where a case is delayed on an Open list and the assigned anaesthetist is consequently held up, the OT Manager may assign another anaesthetist to the case after due consultation with the surgeons and anaesthetists concerned.

 

 

Appendix II

 

GENERAL SURGERY

 

I.        Rooms:

 

- Diathermy machine with circuits, bellows, ventilators, gas gauge, venturi point, soda line.

- Gas point x 2 each (oxygen, nitrous oxide, compress air & Turbine tools)

 

III.   Staffing

 

Up to 3 staff            Circulation x 1

Scrub nurses x 2

 

Comment

1.      A clerical error where the word “Anaesthetic” has inadvertently been replaced with  “Diathermy”.

2.      Shouldn’t vapourisers be included in the list of accessories provided with the anaesthetic machine.

3.      Medical air has not been included in the list of gas points provided

4.      Again no mention is made of the anaesthetic assistant.

 

Suggestion

Change to:-

- Anaesthetic machine with circuits, bellows, ventilators, gas gauge, venturi point, soda line and vapourisers.

- Gas point x 2 each (oxygen, nitrous oxide, medical air, compressed air & Turbine tools)

 

III.   Staffing

 

At least 4 staff                        Circulation x 1

            Scrub nurses x 2

            Anaesthetic x 1

 

Similar omissions are present in the sections for OPEN HEART SURGERY and NO FRILLS SURGERY and should be amended accordingly.