The document discusses various registers and packs used in the operation theater. It describes registers for operating records, specimens, stocks, cancellations, condemned items, biomedical reports, deaths, and more. It also outlines packs for procedures like tonsillectomy, appendectomy, and incision and drainage. Maintaining accurate documentation in these various registers is important for patient care, statistical analysis, and legal requirements.
2. Registers and packed used in operation theatre
Operating register, specimen register,stock
register, cancellation register,condemn
register,biomedical report register,death
register,
Tonsillectomy pack, appendectomy pack and
I&D pack
3. INTRODUCTION
All the information and particulars of the patient which
appear on the operating slip are complete and in detail
and are recorded in the operating register:
The patients full names and surname ,Registration
number and age ,Ward in which the patient is admitted
Full description of the operation performed , Initials
and surname of anesthesiologist,
Type of anesthesia given ,Name of scrub nurse, as well
as the amount of specimens sent to the laboratory
Indicate whether the patient is male or female
Indicate whether the patient underwent major or minor
surgery,Duration of the operation.
4. Every operation done in the OT, whether under
general or local anesthesia, is recorded in the
operation register. The operating register is a
legal document, so are the operating slips, and
both are stored in the section for enquiry as
well as for statistical purposes for at least five
years.
5. RECORD MAINTENANCE IN OPERATION THEATER
Different registers are used in the OT, namely:
Operation registers
Daily register
Sterilization register
Temperature and humidity control register
Microbiology register
Water analysis and culture register
Instrument register
Central sterile supply department register(CSSD)
Linen stock register
Complaints register.
6. DAILY REGISTER
It is a detailed record regarding the infection control
activities of OT. It mentions the following:
Name of the concerned cleaning staff on duty.
Assessment of temperature control
Samples sent from the OT for microbiological tests
Biomedical waste management
The fumigation details of the OT with the name of
chemical reagent used is documented.
7. STERILIZATION REGISTERS
It mentions the following details:
The number of instrument sets that are sterilized along with the method of
sterilization. Specific indicators are placed on all the instrument boxes to
indicate the method of sterilization (plasma, ETO, Autoclave). A change in
color is noted in these indicators if proper sterilization has been done.
The total time taken for sterilization along with its starting and ending time
is also documented
The nursing staff responsible for sterilization is documented.
The various files for maintaining records are steam sterilization indicator
file, steam autoclave receiving and issued record, high speed autoclave
indicator
file, chemical integrator file, biological indicator file, Bowie Dick test file
and ethylene oxide things receiving and issued record, fumigation record
and autoclave maintenance record
8. TEMPERATURE AND HUMIDITY
CONTROL REGISTER
The temperature and humidity of the OT is
checked every 2 hours and documented. If any
deviation from the ideal temperature is noted
then immediate action is taken.
9. Microbiology register (specimen
register)
Samples are sent from every new batch of
ringer lactate and viscoelastic before it is used.
Samples are sent from various areas of the OT
every week for both fungal and bacterial
culture. Samples are also sent from the air
conditioning system ducts. The microbiology
report of these is attached in the register.
10. Specimen Register for biopsies
For efficient control over specimens, there is a book/ register in
which all specimens are recorded, with the same information as on
the label.
A space is made available for the signature of the person who
recorded the specimen into the book/ register, as well as the
signature of the person who received the specimen at the laboratory.
The specimen are clearly marked with the following information on
the label:
The name and surname of the patient , The registration number ,
The ward in which the patient is placed , The type of specimen ,
The name of the operation , The date and time when the specimen
was taken ,
The required laboratory test ,The name of the surgeon ,
At the end of the days operating schedule the nurse checks all
specimens with the entries in the book/ register.
11. WATER ANALYSIS AND CULTURE
REGISTER
Water samples for microbiological tests are
sent from various areas of the OT like scrub
room and sterilization room and a record of the
same is maintained.
12. INSTRUMENT REGISTER
It mentions the total number of instrument sets
that are used in a single day in the various
OTs. This helps in keeping a track of the OT
instruments to prevent loss of instruments.
13. BIOMEDICAL WASTE MANAGEMENT
REGISTER
This includes the record maintenance of proper
waste disposal from OT along with date and
time.
14. CENTRAL STERILE SUPPLY
DEPARTMENT REGISTER
It mentions the details of the quantity of linen
sent for sterilization and received after the
sterilization procedure is over.
15. LINEN STOCK REGISTER
It mentions in detail the linen type and quantity
that the OT has, like bed sheets, towels,
gowns, eye towels, trolley cover, etc.
16. COMPLAINTS REGISTER
All complaints for the OT are recorded in this
register and necessary action is taken
accordingly by the OT in-charge.
17. Death register
There is no separate death register for
OTs. Operation register is used to enter the
event of death with red ink. The main
objective of medical staff of OTs remains the
creation of a safe environment, conducive to
healing, and the protection of patient privacy
and integrity.
18. Poison drug Register
A variety of medicines are used in the theatre, especially for
the administering of anaesthesia. We maintain a strict control
of all the different medicines, as well as proper recording into
registers. Schedule 3 and 4 and Schedule 4 medicines are not
stored in the same poison cupboard, but in separate cupboards,
which are clearly marked Poison Schedule 5.
The poison cupboards are in a proper place and must be wall-
mounted ,The poison cupboards have a double lock and the
keys are kept by the nurse in charge, The keys are not be given
to any unauthorized person or left in drawers The poison drug
register is checked once a week by the nurse in-charge
/pharmacist of that section. This register is kept for at least five
years.
19. Condemn register
To maintain and regulate junk and spoiled
equipments from oT.
20. Tonsillectomy pack
The equipment required for tonsillectomy
depends on the technique used. Cold
tonsillectomy is performed using a Crowe-
Davis or McIvor mouth gag, Allis clamp, no.
12 scalpel, curved Metzenbaum scissors,
Fisher tonsil knife/dissector, Tyding snares,
adenoidectomy curettes, and a St. Clair-
Thompson adenoid forceps.
22. Appendectomy pack
The operation is performed with four permanent
instruments: grasping forceps, hook, scissors
and needle holders. A single needled 2-0 cotton
thread is used.
24. Incision and drainage pack
It is performed by treating the area with an
antiseptic, such as iodine-based solution, and
then making a small incision to puncture the
skin using a sterile instrument such as a sharp
needle or a pointed scalpel. This allows the pus
fluid to escape by draining out through the
incision.