A Bad day in the OR...how would you have handled it?

Marie_LPN, RN, LPN, RN · May 5, 2006

Both the supervisor and the tech need fired before someone gets hurt AND dies as a result of their carelessness and stupidity.

Techs have no business closing a pt. That's illegal.

CrunchRN, ADN, RN · May 5, 2006

"I walk toward the room and the Dr. is scrubbed out...and the 2 techs were closing. The pt. had 3 trocars still in his belly. I couldn't believe it and it seemed so wrong to me."

Totally inappropriate. It needs to be taken to QA/RM. Even if you write it up and send it to them and don't sign it (if you are afraid of retaliation). You need to get it past the supervisor. I can't begin to fathom how inappropriate/illegal/unethical this is.

You know about it and you must do something. The potential for harm is incredible. This physician needs to be counseled by his peers.

I know it will be hard, but please take action. That feeling in your gut is right and you need to listen to it.

cwazycwissyRN, RN · May 5, 2006

maybe i need to vent or maybe i made to much out of the situation.
or maybe not enough
one time, a doc was on the phone and she started bovieing. we were doing a bowel case for cryin out loud!
pt advocate needed, tech working out of scope of practise
and, on one of her squeezes, she of course contaminated herself.
then, as i was pluggin in the camera, light cord ect....she went by me and again, contaminated herself. i again had to tell her. so what does she do??? she wants to cover it with a towel and towel clips. she contaminated the front of her gown.. i made her change it.
high risk for increased infection rate
then, the light source put a hole in the drape (she did this last week also). so, that was just the beginning.
hight risk for fire
well, it seemed to be working ok on my end. as long as it wasnt hooked up the the trocar, it worked. when they put it on the trocar, it stopped working. finally, it worked but, not without her tellin me to do certain things to the insulflator.

so, the tech tells me that they used some the week before. so, i went out to look. with no luck of course, when i asked her where they were kept, she had no idea but just knew we had them. after almost 10 minutes of looking, i find out that we don't have them and we were trialing them last week!
:angryfire what time did the 0730 case finally really get started...prolonged anesthisia time.......higher risk for pt.
so, i come back in the room and for the 2nd time, the light is right on the drape again.
again high risk for fire
i walk toward the room and the dr. is scrubbed out...and the 2 techs were closing. the pt. had 3 trocars still in his belly. i couldn't believe it and it seemed so wrong to me.
in most states illegal..out of scope of practice
[color=deepskyblue]i feel bad for you and your situation. it is difficult to address these issues without management supporting you.
and to top it off, my supervisor told me i needed to get the book "don't sweat the small stuff". what do i do????

[color=deepskyblue]maybe the supervisor needs to do a little reading herself, on accountablility and legal issues in the or.

[color=deepskyblue]i would be tempted to put this all in writing...yes right it up. that way you can prove that you have reported the situations that are occuring and you will be certain that management is aware of them. they can not act on heresay. state the facts, leave out oppionions and let management deal with it. a very important part of our job is to be a pt. advocate. our patients can not see, talk, or hear what is going on. we are their ears, their eyes, and their mouths. :icon_hug:

good luck, sounds like you are a great nurse!!!

Marie_LPN, RN, LPN, RN · May 5, 2006

Not to mention that surgeon. I can't believe he/she would be stupid enough to do that to their pt.

Marie_LPN, RN, LPN, RN · May 5, 2006

And as always, while everyone should pull their weight to get ready for a case, if i'm the one setting it up, i better be the one that makes sure that i have everything i possibly need in that room, and if it doesn't need opened, then it SHOULD be available to be grabbed and opened quickly instead of sending the pt.'s advocate out in the hall to find something that i should have had in the room to start with.

Marie_LPN, RN, LPN, RN · May 5, 2006

Another thing to think of is that you know this is going on. If someone else finds out this is going on and does something about it, think of the consequences of KNOWING these things are happening, and you didn't do anything about it. You could actually wind up in the same boiling pot.

Bummer01 · May 5, 2006

You have to do something, that puts you in the bad light just as it does the ST and surgeon. On all the laparoscopic procedures I have worked on, the surgeon always suture the trocar sites... What did they do??? Staple it or mastisol it??? And the breaks of sterile technique are simply mindblowing!!!

Marie_LPN, RN, LPN, RN · May 5, 2006

Kinda makes you wonder what breaks in technique aren't spotted, or are ignored, and the infection rate.

Nursingal · May 9, 2006

Kinda makes you wonder what breaks in technique aren't spotted, or are ignored, and the infection rate.

Well, I suppose the good thing is that we don't have a really high infection rate. It's pretty amazing what the body can go through. However, I do try and really watch the techs to see what is going on. I hate to make it an RN vs. Tech issue but, if I don't trust them....I have to watch them. I just wish we had more back up than we do. I'm thinking it may be time for me to move onto a new town and job. Not for sure but...guess it's one thing I'm thinkin of. Thanks for all your words.

:crying2:

surgerynomore · May 13, 2006

Maybe I need to vent or maybe I made to much out of the situation but if someone could give me honest insight as to what I could/should have done, I'd appreciate it.
We use surg. tech's at our hospital. Some are very very good at their jobs and some THINK they are very very good. This tech is one of them that feels she is just as knowledgeable as the nurses. Constantly trying to do our job and I feel over stepping her bounds. Not just with the nurses but the docs as well. One time, a doc was on the phone and she started bovieing. We were doing a bowel case for cryin out loud!
So today, I was with this tech...we start our cases at 7:30. We were doing a lap nissen and at 7:30, she decided to go and smoke. Well, I went and got the pt. and brought them into the room. No doubt, that made her angry and quit a bit behind. So....what happened? She was movin so crazy and fast, not lookin at what she was doing. Trying to squeeze by unsterile people and things. And, on one of her squeezes, she of course contaminated herself. So, I had her change. I told her she needed to slow down a bit. Then, as I was pluggin in the camera, light cord ect....she went by me and again, contaminated herself. I again had to tell her. So what does she do??? She wants to cover it with a towel and towel clips. She contaminated the front of her gown.. I made her change it. Then, the light source put a hole in the drape (she did this last week also). So, that was just the beginning. When they were getting ready to start the case, the dr. was insulflating the belly w/ a verres needle. Well, it just wasn't working right and so they were having me trouble shoot the insulflator. Well, it seemed to be working ok on my end. As long as it wasnt hooked up the the trocar, it worked. When they put it on the trocar, it stopped working. Finally, it worked but, not without her tellin me to do certain things to the insulflator. The Doc finally decided that maybe the trocars weren't long enough. (this is a brand new doc and we ordered a bunch of stuff in for him.) So, The tech tells me that they used some the week before. So, I went out to look. With no luck of course, When I asked her where they were kept, she had no idea but just knew we had them. After almost 10 minutes of looking, I find out that we don't have them and we were trialing them last week! (Which brings us to another problem of the techs constantly sending us out of the room for items and being unable to find them because the item wasnt put in the proper place.) So, I come back in the room and for the 2nd time, the light is right on the drape again.
I felt really uneasy about the case....So, being the "professional" I am...I switched rooms with another RN. I know that that was probably chicken **** of me but, I really didn't feel good about things. After the case, I was going in to give the nurse a break and clean up the room. I walk toward the room and the Dr. is scrubbed out...and the 2 techs were closing. The pt. had 3 trocars still in his belly. I couldn't believe it and it seemed so wrong to me.
Where does our responsibities begin and end? And, how do we get back in control? I could go on and on with the problems and can guarentee that when I was a tech, I certainly wasn't allowed to act that way. I'm at a loss. And to top it off, my supervisor told me I needed to get the book "don't sweat the small stuff". What do I do????

I'm a CST and have been for 20 years. If you are not a CST/FA, RNFA, I would not work in that hospital that allows the scrub to use your license for their work. Remember, it is your license!!!

surgerynomore · May 13, 2006

I'm a CST for the past 20 years. If the scrub is not a RN, CST/FA or RNFA, I would not allow the scurb to use my nursing license, your license is on that chart, not the scrub. You have much more to lose. Then again it falls on the DR. He must really trust that scrub!

surgerynomore