Update!
A Message from Jodie
Dear Team,
Changeisinevitable.Whetherit'snewtechnologies(anotherrobotlandingatMurdoch),newsoftware(Workday, OracleFusionandUKG‘comingsoon’),evolvingmarkettrends(theconstraintsbetweenprivatehealthcareand health funds) or infrastructure growth (finally fitting out our two shelled theatres) - our ability to adapt and thrive in the face of change defines our collective success.
In the next few months we will begin the fitting out of the shelled theatres, Theatres 18 and 19. This is phase 1 of anumber of redevelopment projects happeninginand aroundtheatres including theexpansion of DPUbeds, extension of the Ortho workroom, extension of equipment storage area in theatre, development of a dedicated implant storagespace, redevelopment on CSSD and Sterile store, and eventually the building of Orthonova.
Some of us have been here before and can appreciate the challenges that bringing a building site to a working perioperative area incurs, but as a team, our strength lies in our unity and willingness to support each other through transitions.
And unfortunately change is not just in the fitting out of our theatres. As I mentioned at the start, we are still navigating our way throughWorkday and OracleFusion, and will soon have UKG (Kronos) as ourrostering/pay system to learn.We need to be vigilant financial stewards in our use of equipment and consumables morethan ever, as the cost of products rise and the rebates from health funds decline in some instances. But we are all here to help each other, reach out if you need assistance or are feeling a little overwhelmed by all that is going on.
“Change is not just a phase; it's a constant in our journey towards excellence. By embracing change wholeheartedly, we not only future-proof our team but also set the stagefor innovation and sustained success.”
Jodie Attwater
FIT Testing
Is your FIT testing up to date? All theatre caregivers should be having annual testing to ensure optimal protection from respiratory hazards. To book an appointment please use the QR code or the code is available on CORA, please ensure you select the Murdoch code.
Recruitment
We are currently recruiting in all areas to cover current FTE gaps as well as looking to the new year when we have 2 more theatres open.
Theatre 18 and 19 update
Thefit out of these spaces arecurrently in planning stages. The theatres are being fitted out generically, however some additions being included to Theatre 18 specificfor Neurocases. In conjunction with this fit out, there will be a DPU expansion, Ortho room expansion and in the newyear CSSD redevelopment along with additional sterile storage and equipment storagefor theatre.Works will begin in the shelled theatres hopefully the end of Julywith a hand over predicted of December 2024.
Taking excess leave during low activity
You may have been approached by your Manager over the past couple of months if you have an excess leave balance. The next couple of weeks is an opportune time to take some of this leave, just ensure that you are taking it from the correct “pile of leave”. See your manager if you are unsure. If you do have excess leave, you can be directed to take this leave on days where we have additional staff as the first priority.
We need to all be good financial stewards particularly during periods of low activity as this in turn means lower income for the hospital – please do not be offended if you are asked toflex, and make the most of the chance torest and recuperate.
EOFY Budget Update
The end of another financial year and whilst the financial climate has been tight we have still managed to purchase over $1.1m of capital equipment including;
Additional instrumentsfor ENT Micro tray
2 TRUS probes
ECG machine
Ortho Powertools
10 NewStryker chairs
20 Newsets Xraygowns
3 x 0 degree Hopkins telescopes (ENT)
Lap instruments (Hemoloks, Clicklines)
Neuro drill attachments and MIS Hub
Neuro currettes and deckers
Steris bariatric stirrups
Zeiss Kinevo ENT/Plastics microscope
Steris Ortho traction attachment and General bariatric attachments
ClinicalUpdate!
The Da Vinci Xi System is designed to enablecomplex surgery using a minimally invasive approach. The surgical robot system iscurrently the most widely used advanced surgical platform system in the world. The system consists of a Surgeon Console, a PatientCart, and a Vision Cart and is used with an endoscope, da Vinci Xi EndoWrist® instruments, and accessories.
Main Components of the system:
Surgeon Console
The surgeon seated at the Surgeon Console, controls all movement of the instruments andendoscope by using two hand controls and a set of foot pedals.The surgeon views the endoscopic image on athreedimensional (3D) viewer, which provides a viewof patient anatomy and instrumentation, along with icons and other user interface features.
Patient Cart
The Patient Cart is positioned in the operating room and containsfour arms that are positioned with respect to the target patient's anatomy. The endoscope attaches to any arm and provides a high-resolution, 3D viewof the patient's anatomy. The boomis an adjustable, rotating supportstructurethat moves the arms into a position appropriate for the target anatomy and patient position. The column moves the boom up or down to adjust the height of the system.
Vision Cart
The Vision Cart includes the supporting electronic equipment such as the light source and video and image processing equipmentfor the endoscope and themain electronic and software processing units. The Vision Cart also has atouchscreen toview the endoscopic image and adjust system settings.
Thank you,
Mini Nelson Clinical Nurse Robotic surgery
MirenaRemovalSet
The set lives on the gynae shelf in CSSD.
The set consists of
• 6.5mm sheath
• Grasper
• White bung
The sheath in this set replaces the hysteroscopy sheath and allows for the grasper in this set to fit down the sheath and assist with the removal of the Mirena.
Periprostheticfracturesrefertoabreakinthebonesurroundinganimplantandcan occurduringhipreplacementsurgeryorfromafallortrauma.
IntraoperativeAcetabularfracturesusuallyoccurduringcomponentimpaction.
Someofthecontributingriskfactorsinclude:Underreaming,Ellipticalmodularcups, osteoporosisanddysplasia.
Thestabilityoftheimplantisevaluatedintraoperativelyandiffoundtobestable postoperativecarewouldincludeprotectedweightbearingfor8-12weeks.Ifthe fractureisunstablesometechniquestocorrectthisare:acetabularscrews,ORIFof acetabularfractureandrevisionofacetabularcomponent.
IntraoperativeFemoralfracturestypicallyoccurduringbonepreparation(broaching) andimplantinsertion.Whereaspostoperativefemoralfracturesareusuallycausedby lowenergytraumasuchasafall.
Somecontributingriskfactorsinclude:Technicalerrorssuchasdimensionmismatch, revisionsurgeryandosteoporosis.
Considerationisgiventothestabilityofprosthesis,locationoffractureandqualityof surroundingbonewhendecidingonthebesttreatmentforintraandpostoperative femoralfractures.
Sometreatmentoptionsarecerclagecables,longerstemprosthesis,trochanteric fixationwithwires,cablesorplate,internalfixationwithlockingplateandscrews.
KarenSheldonOrthopaedicCN
What are surgical suture accessory Pledgets (PTFE):
Also known as surgical pledgets (surgical felts) they are used as a support to suture tissue.
Pledgets which are known as PTFE mesh are surgical suture accessories that prevent the sutured tissue to be torn. The non-absorbable pledgets are sold in various sizes.
Surgical felts are generally used for patch and sutures by the surgeons as a support for fragile tissue.
In cardiothoracic surgery, including procedures involving the heart, lungs, and chest cavity, pledgets are commonly used to reinforce sutures and provide additional support.
Equipment needed for making pledgets:
Sutures (differing needle sizes dependant on surgeon request, must be double ended sutures)
1 : Suture Sizes (3/0, 4/0, 5/0, 6/0 double ended Prolene are popular choices)
Pieces of Teflon Felt(size dependant on surgeon request, at least 2 pieces required for each request.)
The image above is a representation of how to make the Teflon pledgets. The second Teflon piece should be on artery.
Further Information:
In vascular, we can also use pieces of vein for the same purpose as Teflon pledgets.
In the theatre department there is a box of Teflon felt in the mobile thoracic trolley (located on the third shelf).
Figure
Figure 2 : Teflon Felt sizes
Figure 3: A completed Teflon Felt Pledget
WHAT ARE CLINICAL DECISION TEAMS (CDT)?
Teams made up of clinical caregivers and Group Supply and Procurement caregivers to collectively make group wide recommendations on the purchase of clinical products.
We have had a General CDT since December 2022 with me, Jodie Attwater being the clinical representative for Murdoch and in which we have seen trials and some changes in;
Laparoscopic scissors
Laparoscopic pouches
Ports/trocars
Cholangiogram forceps
Lap L hooks
Our VMO’s have been engaged in all of these ventures to date, and the aim is to always achieve a balance between clinical benefit and cost. Rather than remove items, a traffic light system has been established – with green being the preferred products to achieve the desired financial benefits, orange as a 2nd tier and red to only be used where clinically indicated as these are the most expensive. In some instances up to 40% savings have been realised.
A newly established Anaesthetic CDT with Tony (and Aimee) representing Murdoch will be starting to trial Classic LMA’s and masks – watch this space.
The obvious benefit to all of us is that if we can make savings in our consumables by purchasing smarter - we are releasing budget in other areas including capital purchases and recruitment.
What can you do to help?
Please engage in the trials with your VMO’s, return the evaluation forms to the trial organiser, and update your preference cards when decisions have been made.
Some of our current GREEN SUPPLIERS
FAIRMONT LAPAROSCOPIC SCISSORS, J&J PORTS/TROCARS, ASCEND CHOLANGIOGRAM FORCEPS
Innovation in Orthopaedics
Thereisadvancementtoorthopaediccareinthesurgicaltechniques,implantsand treatmentsusedinsurgery.Technologyhasplayedakeyroleinthisadvancement.Wehave beenfamiliarwithrobotic-assistedsurgicalsystemsthathavebecomeincreasinglypopular overthepastfewyears,wealsohavebeenfortunatetouseimage(CT-scan)derived instrumentationthatispatientspecificduringjointreplacementsurgery.Thishasmeant morecontrol,precisionandimprovedaccuracyduringsurgery.
Minimallyinvasivesurgery(MIS)hasprovedfavourable,withsmallerincisionsandmorerapid recoverytimesforpatients.Thesetechniquesrequirespecialisedequipmentandimaging throughouttheproceduretoensureprecisionandminimalinterferencetosurrounding tissues.CurrentlyatSJOGMurdochthereareanumberoffootandanklesurgeonsusing MISforbunionectomysurgeryandCalcaneussurgery.
Asnurseswemusthaveanunderstandingofthisnewtechnologytohelpfacilitateasmooth andefficientoperatingroomexperience.Beingincludedinthesesurgeriesinourmultidisciplinaryteamskeepsuscurrentandgrowingwithnewtechnology!
HerearesomeimagesoftheArthrexCalcanealOsteotomyMISsystem
Naomi Chan
Hello Colleagues,
Recently I attended the 2024 EORNA conference in Valencia Spain, which ran over 3 days. It was a very worthwhile experience to attend this conference as the presenters were of high professional quality. Although there was many informative sessions some however, were more interesting than others.
The issues operating theatres are experiencing worldwide are very similar to the issues we experience here at Murdoch. That being staff shortages, patient safety, mobile phone usage in the department, infection control to name a few.
I have brought back some brochures for everyone’s perusal on some of the products that I feel would be beneficial to our department. One of these especially, being the Ultrasafe. This unit is a fully automated formalin dispensing system. Much safer for staff handling specimens and a more professional way of collecting and dispensing them.
Another product called Steripro is a product that is wheeled into theatre ‘post’ surgery and disinfects the theatre up to 99.9% in two minutes. A very interesting device that is being used European hospitals at present.
The Bluetooth system of tracking patients through the hospital process is being introduced. Patients are given wristbands during their stay and seems to be a widely proven beneficial way of tracking. More information on the internet on this introduction.
The usage of diathermy smoke evacuators is proving to be essential. One day exposure to surgical smoke is equivalent to smoking 27 to 30 unfiltered cigarettes. Perioperative nurses have twice the incidence of many respiratory problems as compared to the general population. Masks do not help.
The next EORNA Conference is in Dubrovnik Croatia in May 2026. I encourage interested nurses to attend this wonderful event.
Denise Sheed
Projects in Place
Fortnightly Finest is under way! We are having a lot of great feedback about this but would love you to look out for the poll on the theatre Facebook group to give us a better understanding of how it is being received.
Projects in Planning
• After hours meals for patients arriving/ returning to the ward after hours/ when catering has closed. Currently no meal options are provided to those patients leaving recovery after 8pm, or in birth suite. We are looking to pilot an afterhours food trial with St Mary’s Ward
• New stickers andCertificatesforPaediatricspatients. Stickers were previouslysuppliedby recovery caregivers,the currentcertificates needarevamp.Matilda has beenbusy working on somedesigns with marketing (strict criteria for formatting) and we hope to soon see those arrive in Paeds recovery
• Long term; We hope to propose a revamp for Paeds recovery, looking at a separate holding bay, New paint and decals, with floor decals to provide a patient “yellow brick road/ rainbow road” so patient and parents can visualise the pathways through the periop environment.
• We will implementing a feedback link for our department to provide ideas for consideration
• Consideration into the building plans for another toilet to be included in the redevelopment outside of theatres 5&7.
What We have learned
• Thrive planning,presentation, and implementation take a lot of TIME. Please know we are working hard behind the scenes.
Nominee
ReasonforNomination
NaomiChanNaomiisagreatteamplayerandanavidadvocatetoherpatient’sneeds.Herskillsandattitudemake heraninvaluablememberoftheteam.ItisalwaysacomforttoknowifIamworkinginateamwithher becausesheiseverreliableinanysituation.
FleurBoyesFleurhasafunandvibrantpersonalitythatlightsuptheroom.Shedeliversexceptionalcaretoher patientsandisatreasuredmemberofourteam.
JessMartinIappreciateJessasshealwayspresentsherselfasakindheartedandcaringcaregiver.Sheputs othersbeforeherselfandiswillingtogoaboveandbeyondforthepeopleshecaresabout.
PeterKnightBecausehealwayshasacheerfuldemeanour,extremelyhelpfulatalltimeswhenitcomestobattery modeoforthopaedicequipmentandconsumables,hehasapositiveattitude,andheisaresourcefor caregivers.
PeterKnightAlwayshelpfulandifhedoesn’tknowwillfindoutforyou.
AnnieWilsonAnnieisarayofsunshineandbrightenseveryone'sday,sheisalwayssohappyandkindandhelpful�� MontyEager,happy,helpful
JustineSheisalwayskindandalwayscaringandalwaysstrivestogoaboveandbeyondforeveryone
Ling Lingconsistentlydemonstratesthehighestlevelsofpatientfocusedgraciousandkindhealthcare.She ishardworking,trustworthyandlovelytobearoundandworkwith.Whensomeoneisawayitadds depthstohowmuchtheydothatisnotalwaysinitiallyapprecaited.ComebacksoonLing.Wemissyou.
LuisaHeinAmazingtoworkwith.
BecNAbeaconofpositivityalways,agemtobearoundandsuperhelpful.
Pema AtotalBosswithERCP’s.Smasheditoutoftheparkonherfirsttime.Backeditupwithasecond. Amazing!
MichaelKMichaelissuchagreatcoordinator-sosupportiveandALWAYSwillingtocomeinearlyorstayback latetohelpouttheteam!Latelyhe’sbeingdoingmassive12oreven14hourdaystohelpcoverwhenwe areshortstaffed!Nothingsevertoomuchtrouble❤
StephMOverhaulingthepathbooks.Thishasmadetheprocesssoeasy,insteadofapointofresistance. EverytimeIgettothatroom,I’mappreciative.
Leia Leiaalwaysgoesaboveandbeyondwhenlookingafterherpatientsandworkingwithhercolleagues. She’sarealteamplayerandamassiveassettoMurdoch.Sheissowelcomingandlovely.
PrinceThomasPrinceisakindandhelpfulnurseinPACU.Heconsistentlyoffershelptoothersandworkshard. MellisaPlattMel,youareabeatifulsoulandgenuinlysupportivetoeveryone.Iamsoluckytomeetyouinmycareer journey.
LisaP Alwaysapleasuretoworkwith.Canhavefunandgetworkdonewellasateam.Sheislikeamum.
GingerGingerisprofessionalandcaringtonotonlyherpatients,buteveryoneinthetheatre.Shegoesabove andbeyondherexpectationsandhelpsscrub/scoutnurseswherevershecanevenwhenwedon’task forhelp.Sheissohelpfulandaninvaluablemembertoourteam.Ican’tpraiseherandherlevelof professionalismandstandardofworkenough!
AntanieAntanieisalwayssmiling,askingwhetheranyoneneedshelp.Heishardworkingandputsasmileon everyone’sfacetoo!
Nominee
ReasonforNomination
Renata Shealwaysgivesahelpinghandwhenneeded,isajoytoworkwithandhassomuchknowledge andpassion.Sheprovideseducationandhasagreatwillingnesstoteach.
MichaelKMichaelgoesaboveandbeyondforthestaffatMurdochheakindcaringindividualandlovesto lendahelpingheadwhenrequiredheistruelydeservingofcaregiverofthefortnight.
LuisaH Thankyouforbeingsokindandmakingmefeelseen.Youaresocalm.Youareamazingtowork with.
Frame Framehasagenuineconcernandrespectforpatientsandcolleagues,hethinksoutsidethebox andtakesinitiativetoensuregreatoutcomesforall.Heisdedicated,reliableandkind.Thankyou forallthatyoudoFrame!
