During the Inova Dome Experience it was clear that all procedures and protocols were outlined prior to the surgery having begun, and the RN, MSN Darla was well prepared to give us an overview of the entire aortic valve replacement process. One of the most important safety measures I observed at Inova was the role each physician, nurse, and other staff member played in the surgery. Each individual knew what was expected of him or her and was held accountable for one task or another. Within the pre-op room, the age, sex, race and other important information were listed on the patient chart along with the details of where each individual would stand or sit throughout the procedure. A short but concise rundown of the steps to follow during the procedure was written out on the whiteboard along with abbreviations for special equipment to be used. During the procedure, Darla explained each person’s duty and highlighted the role of the nurse who was in charge of making sure all medical supplies were accounted for at the end of the surgery. This included a magnetic board that held all the needles used during the procedure, all the gauze used during the procedure, tubes, tissues, etc. Next, she discussed the role of the nurse anesthetist who would keep monitoring the patient’s alertness levels to decide whether the patient needed another dose of anesthesia. In addition, Darla explained how the RN-First Hand nurses were able to physically help the surgeon perform the surgery because they had received special training that allowed them to do so. Another nurse came in to administer the cleaning of the pig valve in saline and made sure all the equipment needed was used and carefully put back in place. The nurse by the doctors side was in charge of handing each piece of equipment to the doctor when needed, and Darla explained how the doctor was never require to say out loud what he