sarath 1,362 Views
Joined Mar 11, '08.
Posts: 6 (33% Liked)
Our facility is small and is flexible enough to do these requests with enough advance notice. Certainly for emergent cases, there is no promises made.
So, I asked the boss about this and she said I should have told her when it happened, especially since this surgeon has done this a few times. It was not a very nice discussion. She said the issue should have been raised immediately and the patient should have been advised of the changes while in pre-op or as soon as he was brought to holding. The decision to procede or reschedule should have been his. She said that we as caregivers should not renig simply because the patient would never know and that we should always be up-front with our patients and advocate for them.
On any given day, there are some MDAs supervising and some who are not. In this case, the patient asked for this particular MDA only and his surgeon also wrote "Dr Q - only" on the surgery order form.
In the other case, there was no relief staff - we only had an hour block. To use your phrase, "someone flat out lied to the patient". Pretty much the same circumstance - the team make-up was specified on the surg order and was expressed clearly by the patient. This is what is so frustrating - it was the surgeon who brought an additional tech into the OR.
I like your advice. I will casually bring it up with the boss. She is very strict, but easy to talk to. Thanks!
We are an ASC, not a teaching hospital. Our consent form two pages and very specific, having blocks for both the attending's name and his/her assistant (SFA or other). The second page is for the MDA/CRNA, also with a block for the names of either MDA or CRNA, and here is where the issue arose in the one case.
Mr 'X' wanted a specific MDA he had been with on a case prior to this one. The schedule had been worked, and Dr 'Q' met with him in holding, but after he received his premeds, the MDA left him in the care of a CRNA. Again, the patient's outcome was great and he never knew about the switch.
What I am concerned with, in both cases, if how the patient ever finds out. In your response, you said they sued. How did they find out? Did someone tell them or did they access their records? Shouldn’t the boss know about this beforehand if it somehow surfaces?
There was nothing fraudulent concerning charting, but it was beyond telling them they wouldn't get a foley. One was promised a specific make-up of the surgical team and the other was promised a specific MDA. There was nothing that would have affected the patien'ts outcome, and they were none the wiser. I don't believe the boss would approve of this, so I will speak to her. I would rather not simply disregard something I know is wrong. Thanks for the advice.
I have recently moved to the OR. I am gaining confidence in my abilities and my team members. Though it has its ups and downs (my feet are killing me) I really like what I am doing. There is so much to learn and it is very exciting! On the down side, I have recently seen some things that I don't think are right.
Twice in the past couple of months, we have had patients that asked specifically for certain things in our ASC which were granted by both management and surgeon. However, once they had their premeds, those requests were ignored by staff and once by the surgeon.
I don't know if those were the only two incidents or if it happens more often. I am reluctant to ask colleagues since I am just getting to know these people. Since I was assigned to both cases, I attempted to advocate for the patient, but was reminded that "what the patient doesn't know won't hurt them" and that I should focus my attention elsewhere.
Should I bring this to the nurse manager's attention or disregard, focusing solely on the patient's outcome? Does this happen frequently and is typically in the best interest of the patient, or is it something that we shouldn't do? My belief is that if management/surgeon makes a promise to the patient AND it is medically appropriate, we should not disregard once the patient has been medicated. Am I wrong?
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