Safe Positioning of the Patient for Surgical Intervention.

Abstract

Northwestern University Feinberg School of Medicine, Chicago, Illinois. carinezeeni@gmail.comSafe Positioning of the Patient for Surgical Intervention. By Serge Molliex, M.D., and Jacques Ripart, M.D. Paris, France, La Prévention Médicale, 2009. DVD format (90 minutes, 17 chapters). Price: 30€ (electronic download) or US$45 by check.The safety and well-being of the surgical patient lies in the hands of the perioperative team from the moment the patient enters the operating room. Proper positioning for the surgical procedure is an essential step that is often underemphasized, even trivialized, yet improper positioning may lead to serious injuries. These relatively rare complications are generally preventable but, unfortunately, continue to occur regularly. The Safe Positioning of the Patient for Surgical Intervention , published by La Prévention Médicale, aims to educate healthcare professionals in proper positioning techniques to prevent these injuries.The 90-min-long DVD is divided into four major sections, each containing multiple chapters that can be accessed directly from the main menu. The first section consists of a short introduction to familiarize the audience with the particularities of the operating room. The second section details multiple operating positions, including, but not limited to, the supine, prone, lateral, lithotomy, and sitting positions. Special considerations, such as particularities of laparoscopic surgery or the difficulties relating to positioning obese patients, are detailed in the third section. Lastly, all possible complications related to positioning, classified by organ system, constitute the fourth section.The strengths of this educational DVD lie in its thoroughness and use of multiple visual formats to convey its important messages. Indeed, the DVD presents a mix of real life cases that were filmed (e.g. , showing the audience how to transition a patient under general anesthesia from a supine to a prone position), in addition to demonstrating positioning on an awake model and using superimposed animation to better explain pathophysiology and show details less evident to the naked eye (e.g. , the exact pathway of a nerve). The message is reinforced by showing how wrong positioning can occur, explaining the consequences of such a position on the relevant organs, and demonstrating the maneuvers necessary to correct the problem. Concluding the DVD is a 10 point checklist that should be conducted immediately after each final surgical position has been reached. This checklist constitutes an extremely useful and practical tool for any healthcare professional involved in surgical work and provides an easy take home (or should we say to the operating room?) message.One of the negative aspects of the DVD is the occurrence of a number of spelling and pronunciation errors throughout the feature, which was originally dubbed in French. These errors, however, do not detract from the overall quality of the work. Furthermore, the film's producer has assured us that every effort is being made to correct at least the version available for download. It is also worth mentioning that the DVD is not compatible with a traditional DVD player but is designed to be played on a CD-ROM drive.Suggestions for the next edition would include adding sections regarding park bench positions and positioning on Jackson tables, a section regarding positioning of pediatric patients, and showing the audience the value of the use of prone-view devices for patients undergoing surgery in the prone position.In conclusion, I would strongly recommend the purchase of this DVD, specifically to anesthesia program directors and educators, nursing directors, and patient safety advocates. This educational tool would likely be of most value to novice anesthesia residents as well as nursing and surgical staff directly involved in patient care in the operating rooms. It would also be a good review tool for those who are out of practice. Prevention remains the best instrument at our disposal to reduce the burden of position-related injuries. Every healthcare professional involved in patient positioning should be aware of their existence and make every effort to actively prevent them. This DVD will help reach that goal.A picture is worth a thousand words.Northwestern University Feinberg School of Medicine, Chicago, Illinois. carinezeeni@gmail.com