Theatres - Roles and responsibilities

• Carrying out all housekeeping duties, ensuring that the Perioperative environment is clean and tidy at all times and that duties assigned by the Line Manager are carried out to the required standard.
• Ensuring the kitchen and changing rooms are kept clean and tidy, report any defects or repairs that are required, monitoring of the food fridge temperatures and to assist with store duties as required.
• The upkeep of all housekeeping duties in the Ante rooms in the department.
• Using their own initiative to execute some duties and complete any non-routine tasks they think are necessary.

Band 2

Responsibilities:

• Participates in all aspects of theatre circulating duties and will act under the delegation and supervision of a senior member of staff at all times.
• Maintaining the cleanliness of theatre and ensuring all stock within their theatre is managed.
• Safely escorting or transporting patients to and from theatre and also in the safe positioning of patients for surgery.
• Helping with the setting up of theatre for surgery and will also learn to anticipate the requirements of the operating team and alert them of any changes.
• Maintaining accurate and up-to-date records and ensuring patient confidentiality is upheld to at all times.

Band 3

Responsibilities:

• Provide an advanced level of assistance within the theatre environment and will assist the Registered Practitioner in the induction and on-going development of new staff members and students.
• They must act under the delegation and supervision of the Registered Practitioner and will participate in all aspects of theatre circulating duties, anticipate the requirements of the operating team and alerting them of any changes.
• Help to ensure the theatre stock is managed and in the absence of the Theatre Stock Controller, they will carry out centralised ordering on a daily/ weekly basis.
• Help with the transportation of patients to theatre and are able to carry out the pre-operative checklist for patients with non-complex conditions and assist in the positioning of the patient for their surgery.
• Communicate important information within the multidisciplinary team maintaining effective communication at all times.

Band 4

• Provide advanced assistance in both the scrub and circulating roles within the perioperative environment.
• Recognise and understand their role boundaries and limitations and at all times must act under the delegation and supervision of a Registered Practitioner.
• Develop their roles by using evidence-based practice and strive to continuously improve their own knowledge and skills.
• Communicate important information within the multidisciplinary team and ensure any observed changes in the patient’s condition are effectively communicated both verbally and in writing.
• Carry out the pre-operative checklist for patients with non-complex conditions and undertake all associated paperwork and documentation relevant to the patient and their surgery.
• Participate in all aspects of theatre circulating duties, anticipate the requirements of the operating team and alert them of any changes.
• As a scrub practitioner, the APA will provide assistance to the surgical team, anticipate their needs and ensure that patient safety is maintained.
• They must be able to recognise and respond promptly to clinical emergencies, utilising skills learnt to assist where they can.
• Acting as a role model for new/ untrained staff and students, teaching them valuable skills and helping to guide them through the theatre setting.

Band 5

Responsibilities:

• For the continual assessment of the holistic patient’s care needs within the operating department
• Act at all times within the NMC/ HCPC codes of professional guidelines and strive to develop their role by using evidence based practice to continuously improve their own knowledge and skills.
• They may be required to take charge in the individual theatre setting and guide other team members to ensure the smooth running of the theatre operating list.
• In the absence of a direct Line Manager, they may have to assume responsibility for the management of the daily operational responsibilities of the department including work allocation, deployment and supervision of staff to ensure the smooth running of service.
• As a circulating practitioner they will provide assistance to the operating team, anticipating their requirements and alerting the team of any changes.
• Ensure that equipment is maintained and safe for use and that stock levels are managed effectively in their area, including all controlled drugs.
• As a scrub practitioner they will provide assistance to the surgical team, anticipating their needs ensuring patient safety is maintained (Also if appropriately trained registered staff may act as 1^st assistant). They must have in-depth knowledge of trays and specialised instrumentation for all procedures undertaken within theatre.
• Anticipate the requirements of the patients needs in Elective/ Emergency situations and have the knowledge and skills to act accordingly.
• Maintaining accurate patient records and to monitor standards of care within the defined policies, standards and protocols of the department and ensure these are adhered to.
• Undertake teaching and training of a range of staff including registered/ non-registered nursing staff, trainee Operating Department Practitioners, orientation junior doctors and paramedics.

Operating Department Practitioners or ODPs for short, have a wide and diverse range of skills across the 3 main areas of theatre, anaesthetics, scrub and recovery. ODPs are skilled in airway management and major incidents and can often be called to outlying areas of the hospital such as wards, ITU, SHDU and accident and emergency to assist with any critical care issues. 

Anaesthetics: The ODP plays a vital role in this area working closely with the anaesthetist. Anaesthesia is a highly skilled area requiring attention to detail, sound knowledge of anatomy and pharmacology, technical knowledge of anaesthetic machines, drug infusion devices, patient positioning, airway management - the list is endless. We have to be able to use initiative, prior planning and preparation, as well as being a forward thinker when difficulties or incidents occur. It can be very fast paced. When patients are in the anaesthetic room, they are at their most vulnerable as they are often filled with anxiety. At this point, we must be able to alleviate the patients’ fears by using learned techniques ranging from humour to comforting words. Every patient has individual needs and we learn very quickly how to adapt and deal with each situation as it arises. 

Scrub: This role also requires attention to detail and anticipation of surgeon and surgical needs. In this role,  you work closely with the surgeons and other theatre practitioners ensuring all surgical equipment, instruments, swabs, sutures are available and sterility has been maintained while we are operating. Organisation and knowledge of your instruments is paramount, particularly for surgery as what you start with, you must end with to ensure your final count is complete and accurate and patient safety has been maintained. Communication and teamwork is vital in the operating theatre. 

Recovery: This is quite a diverse area  for the ODP to work in, many skills are required in this department  from airway management to pain relief, post anaesthesia care is often most difficult as the patients have less awareness and compliance due to the anaesthesia they have received. As a recovery practitioner you must have the ability and competence to safely discharge the recovering patient back to a ward or for the more complicated patient perhaps to high dependency or intensive care unit. 

ODPs also teach student ODPs, student nurses and paramedics and also the new junior anaesthetists within the department - and can often be referred to as the junior anaesthetist’s safety blankets! 

Patients come to theatre at their most vulnerable so as an ODP, you must be able to put them at ease, give support and look after them while both conscious and unconscious. Theatre is a very fast paced critical care environment to work in, you need to be able to plan ahead, anticipate difficulties and respond to incidents when they occur. A theatre, like many critical care areas, requires staff 24 hours a day, 7 days a week, 365 days a year.  It's a commitment, however it is highly rewarding – you can instantly see the difference you make each day. 

Band 5

The recovery practitioner is involved in the immediate pre and post operative anaesthetic care of both adults and children in a busy theatre environment.

They have many extended roles and intensive nursing skills. Recovery involves the care of the unconscious patient and airway adjuncts, advanced pain management, invasive monitoring and management of post operative complications in a one to one nurse-patient environment.

Staff new to the department are expected to complete a 6 month orientation program with an allocated mentor to teach and develop all of the many skills required to become an independent practitioner.

Band 6

Responsibilities:

Surgical Care Practitioners are registered non-medical healthcare professionals who work as members of the surgical team

• Pre-operative care - taking a medical history and assessment of the patient prior to surgery and liaising with the theatre and surgical team informing them of any specific requirements individual patients may have.
• Surgical interventions can include, but are not limited to, prepping and draping the patient for surgery, inserting secondary laparoscopic ports under vision, operating the camera for laparoscopic cases, retracting, assisting in the maintenance of haemostasis, carrying out deep layer and superficial wound closure, inject local anaesthetic and perform minor operations independently.
• Postoperatively they assess the patients with the senior surgeons and are involved in the multidisciplinary meetings to discuss patients ongoing surgical care.

The role is to enhance the quality of the learning environment by identifying/coordinating the educational input/development activities in support of Registered Nurses, Operating Department Practitioners, Clinical Support Workers and other learners.
Lead and develop a range of clinical educational opportunities relevant to the Perioperative areas within NHS Fife.
Act as SVQ Lead for the Theatres, NHS Fife developing / delivering programmes relevant to the various awards to ensure successful completion.

Band 6

Responsibilities:

• Ensuring efficient and effective management of the operating theatre, with specific responsibilities for designated clinical specialities and to support the theatre manager in the ongoing operational management for the multidisciplinary team.
• Provide professional and clinical leadership to the multidisciplinary team and have a responsibility for co-ordinating the theatre suite ensuring that nursing knowledge and skills within the department and current and appropriate.
•  Demonstrate evidence of their continuing professional development in line with NMC/ HCPC CPD requirements and act as a role model at all times to promote and maintain defined standards of nursing care.
•  Implement and audit local protocols and policies within the department and ensure these are adhered to.
•  Manage the department and its staff on a daily basis, planning and organising workload, supervising nursing staff and ensuring the appropriate skill mix is maintained at all times
• Provide clinical advice on all aspects of perioperative nursing care and can lead, advise and teach the multidisciplinary team on the use of specialist instrumentation and equipment.
• Ensuring all equipment is maintained, safe for use and stock managed to ensure a high quality and cost effective service.
• Provide assistance as both circulating and scrub practitioners anticipate the trams needs and alerting them of any changes, ensuring patient safety is maintained and act as 1st assistant if appropriate.
• Efficient management of the theatre budget and effectively utilising allocated resources to provide a safe and efficient service. As part of this, they will ensure that departmental stock levels of pharmacy and stores are maintained and monitored, ensuring the economical use of all resources.
• Investigate and respond to any complaints and use the DATIX system to report, investigate and then taking appropriate action on clinical incidents.
• Educating and training all staff members, including pre/post registration students, and help motivate and develop the nursing team through utilising mentorship, clinical supervision, objective setting and appraisals through the completion of their PDPs which allows for staffs educational need to be met.

Band 7

Responsibilities:

• Ensuring efficient and effective management of the theatre suite on a daily basis, plan and organise workloads and has the specific responsibility for designated clinical specialities within these dimensions and manage and support a team of staff of variable numbers ranging from bands 2-6.
• Provide professional and clinical leadership to the multidisciplinary team and co-ordinate the theatre suite and all members of the multidisciplinary team, to ensure efficient use of theatre capacity and that the perioperative knowledge and skills within the department and current and appropriate
• Demonstrate evidence of their continuing professional development in line with NMC/ HCPC CPD requirements and act as a professional role model at all times to promote and maintain defined standards of perioperative care.
• Develop, implement and audit local protocols and policies within the department and ensure these are adhered to.
• Lead and ensure staff participation in audit and research as required
• Maintaining patient records according the NMC/ NHS Fife guidelines and local policy on records and record keeping.
• For the care of all patients, including all patients in the department.
• Act as team leaders and part of the theatre team practising clinical skills, providing expert clinical advice on all aspects of perioperative care and will lead, advise and teach the multidisciplinary team on the use of specialist instrumentation and equipment.
• Provide assistance as both circulating and scrub practitioners anticipate the trams needs and alerting them of any changes, ensuring patient safety is maintained and act as 1st assistant if appropriate.
• Efficient management of the theatre budget, effectively utilising allocated resources to provide a safe and efficient service and report any concerns to the budget holder
• Ensure that departmental stock levels of pharmacy and stores are maintained and monitored and manage the stock within their specific clinical area – setting, maintaining and monitoring stock levels.
• Support the theatre manager, the clinical nurse manager and directorate team in the organisational and strategic development of the operating department.
• Investigate and respond to any complaints and use the DATIX system to report, investigate and then taking appropriate action on clinical incidents.
• Lead, motivate and develop the nursing team, utilising mentorship, clinical supervision, objective setting and appraisals, enabling educational needs to be met.
• Contribute to and support the provision of clinical practice for pre/ post registration students to fulfil curriculum requirements.

Band 8a

Responsibilities:

• For the day to day operational issues within the operating department, including continuing responsibility for all non medical staff, over 3 sites and will ensure that the highest quality patient centred care is delivered.
• Provide professional leadership to nursing staff and ODPs and provide both professional and clinical advice regarding perioperative care to the Directorate Management Team and Clinical Director.
• Lead the assessment, development, implementation and evaluation of evidence based programmes of care.
• Lead, support and manage staff within the department and promote multidisciplinary team working and effective communication and working relationships with staff at all levels.
• Support the Charge Nurses to effectively carry out their role with how to manage sickness absence, in the direct supervision and provision of mentorship to nursing staff and the local resolution of complaints.
• Motivate and develop their team by utilising mentorship, objective setting, PDPs and appraisals, enabling the educational needs of the staff to be met.
• Continually promote a learning environment that supports innovation and encourages excellence.
• Has delegated budgetary responsibility and is responsible and accountable for monitoring the department budget for both the staffing establishment and supplies.
• Ensure that effective resource management strategies are in place.
• They are an authorised signatory for the department payroll and authorise overtime, bank or agency cover for all staff.
• Effective management of all theatre services, providing reports on theatre activity and managerial issues and taking the lead role in clinical risk management and the implementation of Health and Safety policies
• Develop effective networking and political awareness both within their division and other organisations out with.
• Participate in approved research projects and promote research based practice.