Scott-Triggers-Gap-Analysis V2 092816
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TopicAnswer with a yes/no, or best estimate for the percentages)Add any comments or questions here
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Assessment (Environment)YesNoNA
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Population
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% over 62
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% Pediatric
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Number of cases in a year
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How many beds in the hospital
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Do you have Ambulatory surgery?
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When the patients surgery is complete where do they recover
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% Post anesthesia Care Unit to home
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% Post anesthesia care unit to other unit (surgery)
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% At home
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Other
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Procedure types
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Cardiac
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ENT
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General Surgery
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Neurosurgery
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OB GYN
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Orthopedic
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Plastics
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Urology
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Vascular
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Thoracic
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Other
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Length of Surgery
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% under 2 hrs <120 minutes
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% under 3 hrs but over 120 minutes
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% under 4 hrs but over 180 minutes
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% over 4 hrs
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Type of surgical position used
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% Supine
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% lateral ( R or L)
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% Trendelenburg
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% Lithotomy
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% Sitting
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% Prone
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If Prone do you use a Jackson table?
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If Prone do you use Wilson Frame?
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Do you use a sitting or beach chair position?
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Other positions
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Product specification/selection Equipment
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# of functional OR suites
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Do you have a hybrid OR?
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What is the brand of the OR tables?
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How old are the OR tables?
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Is there a replacement plan?
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OR TABLE PAD ASSESSMENT
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What is the brand of the OR table pads?
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What is the height of the OR table pad?
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2 in
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3 in
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4 in
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Do you use a high specification support surface? (non powered)
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Do you use a high specification support surface? (powered)
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Do you use a standard OR table surface (2 in elastic foam with laminate cover)
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What is the patient weight limit for the support surface you use?
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Do you have patients out side that range of weight?
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Assess the quality of the OR table pads below
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NEW (within 2 years) High Specification
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NEW (within 2 years) but NOT High Specification
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Need replacement, tears, sagging over 2 years old)
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Do you have a replacement schedule for table pads?
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Positioning devices
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Do you offload the heels during surgery?
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What do you use to offload the heels:
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Heel offloading devices
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Gel pads
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Pillows
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Other? Please state
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Do you pad the heels during surgery
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Do you use Stirrups? If yes what type?
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a. Candy Cane
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b. Crutch type
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c. Boot type? "Yellow Fin, White fin, other"
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Are these devices in good working order?
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Are these devices readily available for staff implementation based on the case load? Always, sometimes, never
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Do you use foam positioning devices
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Do you use gel positioning devices
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Do you use IV bags for positioning>
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Do you use pillows for positioning
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What other positioning devices do you use? List all
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Heel pads (gel or foam)
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Elbow pads ( gel or foam
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Axillary rolls
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Prone positioning device
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Occipital/head devices
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Shoulder devices
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Arm boards
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Trendelenburg positioners
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Trend Guard or similar
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Shoulder braces
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Safety straps
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Other
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Do you use safety devices such as safety straps, or restraints during surgery?
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Are these devices padded?
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