[thlnc]

Just wanted some feedback on what is the standard of care for patients in the OR. Are belts commonly used to keep pt's from falling off table? If no belts, how is patient safety insured? Work at a small facility and had a patient fall off the table waking up. Not directly involved. Who has the ultimate responsibility for the patient while they are waking from anesthesia. We all know how small those tables are. Didn't fall during transfer, but apparently fell while waking up and no nurse was close enough to stop it. Thanks for any feedback
thlnc

[shodobe]

Just common sense to have a body strap on at all times and arm restraints. Circ should always be at the side of the patient while they immerge from anesthesia. If your facility fails to provide you with the necessary equipment to prevent patients from falling, then they are at fault just as much as anyone else. There should be no standard of care envolved, just the common sense as I stated above. It would be like not providing seat belts for your passengers and then getting into an accident. So who would be at fault? Mike

[suzanne4]

If a belt can't be used for some reason due to the procedure, it should always be in place during the wake-up time. No way around this. And the circulator needs to be directly at the bedside, not doing paperwork.

[MissJoRN]

Originally Posted by suzanne4

If a belt can't be used for some reason due to the procedure, it should always be in place during the wake-up time. No way around this. And the circulator needs to be directly at the bedside, not doing paperwork.

That wide flat belt makes a semi decent writing surface for last minute notes before the pt starts wiggling to much. Or pull up a prep table and write with one hand leaving the other two for anesth and the pt

[grimmy]

I have had some conversations with our anesthesia teams about "waking up" the pt before we have a chance to get them out of lateral recumbent positions because, while they are strapped in for the lat-recumb, we have to unstrap them to move them to supine for safe transfer. Similar issues come up for prone and lithotomy positions. I've noticed that some of our anesthesia residents like to wean off pts (or reverse them) a little too quick, and since I am ultimately responsible for the pt's safety, when I see the drapes coming down, I make sure the stretcher or bed is parked and close at hand, and I am on the other side of the OR table. We also have moving help available in the form of a PCT, surgeon or resident. I put them to work when necessary. Thankfully, most of our residents are helpful without my having ask, or throw them visual daggers while they are dictating, and I am having to struggle with a patient on my own.

[OnCall4Life]

The circulator should be standing next to the patient when they go to sleep and when they wake up. How many times have you seen a teen/child go off to sleep and wake up struggeling on the table?? Usually we have 2 techs in the room and one can stand on one side and I will stand on the other. But your right about anesthesia waking up the patient too early. It's hard to get patients out of stirrups when they are bucking and wiggling around. I saw one nurse get kicked across the room by a 17 year old male. Of course they didn't know what they were doing. But that is what happens when anesthesia slams on the breaks for some. We too have safety straps that are kept on the patient at all times. Even around their arms on the armboards. They can twist their lower half but it's hard for them to fall. You could try calling for someone extra to come into the room to help stand by the patient before you undrape them.

[MissJoRN]

Wow...our CRNAs and MDAs are all pretty good about that, we get a fair amt of time to toss out the drapes, and tape a dressing befoe the pt starts wiggling. Actually most of them have the slow easy revervsal down pat! We rarely have trouble. Sounds like that's especially to be appreciated since we don't have a surgical teaching program so no help from residents here.

[yoga crna]

I must defend your anesthesia professionals here. Every emergence from anesthesia must be tailored to the patient, the surgical procedure, the recovery plan and even the experience of the anesthetist.

For example, I wake up my asthmatic patients slowly, so the endo tube does not stimulate their reactive airway. My difficult intubations, full stomachs, airway problems, I let wake up on the tube, which may cause body movement. One of my plastic surgeons likes to tell the story of a patient who reacted with such force that they could hear all of the abdominoplasty sutures pop--they had to re-open and re-suture.

What is imperative is that the RN stay by the anesthetist's side when the patient is responding from anesthesia. I like the surgeons to be around, but the real help if from the RNs. The patients deserve the best.

Yoga CRNA