Fifteen Eighty Four

The operating department is strange; it is at once familiar to the public and those that work in the hospital and yet at the same time an unknown ritualistic world hidden behind locked doors, with its own culture, rules, and dress code. It’s unlike anywhere else in the hospital and therefore those that work in it require specialist knowledge and skills that allow them to flourish in their roles, providing care for vulnerable patients from anaesthesia, through their surgery, to recovery and their subsequent discharge. This new edition of the Fundamentals of Operating Department Practice sets out to do just this, guiding students, operating department practitioners, and nurses through the different facets of perioperative care—which describes the time around surgery.

The first edition of the Fundamentals of Operating Department Practice was published in 1999 and was a straightforward textbook for students and healthcare workers. Some 23 years have since elapsed, which have seen significant changes in education across the relevant professions, technology, law, clinical practice, and the evidence that underpins it. The aim of this new edition was to provide an evidence-based and holistic approach to perioperative care that will help a new generation of students, and perioperative practitioners to provide safe and informed care to an increasingly complex and aging population.

The book begins by outlining what exactly ‘care’ and ‘evidence-based practice’ are and uses them as the foundation that the book rests on. From here, the first section of the book continues to explain the more theoretical basis of perioperative care such as healthcare ethics, professional regulation, informed consent, legal expectations, operating department design, and health and safety legislation. Each topic is addressed without assuming any prior knowledge so that students are introduced to a readable yet comprehensive overview of the relevant issues before moving onto the more practical aspects of perioperative care. Rather than list the areas we address in the book, such as pharmacology, cardiovascular physiology, and patient positioning among others, below I outline a couple of the new and important topics often missing or deemed less important to perioperative education.

The second half of the book explores the clinical knowledge and skills required to be a competent perioperative practitioner, such as an in-depth discussion of the role and responsibilities of the surgical scrub practitioner. Part of the reason this edition needed to be more comprehensive than the first, is that there are now several topics that were not even on the radar 20 years ago. This would include the role of human factors and non-technical skills. We now know that the root causes of an adverse event or ‘never event’ is usually a failure in non-technical skills such as leadership and communication and that human factors are frequent contributors. This is why we now include a whole chapter exploring this area, so that students from the very outset of their education, understand the importance of developing non-technical knowledge and skills as well as technical competence.

Something we believe has not been given enough attention, is the—psychological and physical—impact that the death of a patient on the operating table can have. Despite our best attempts to provide optimum perioperative care, sometimes our patients die, and the impact this potentially traumatic event can have is frequently underestimated. This is why we thought it was important to explore the topic and how we can best support students and colleagues who have the misfortune of caring for a patient who dies undergoing anaesthesia or surgery. Despite being an under-researched area, this chapter aims to stimulate further discussion and encourage more research into evidence-based support strategies for those affected.

Our hope is that this new textbook will encourage and equip those considering a career in perioperative care as well as acting as a resource for educators and registered operating department practitioners and nurses.