Cancelle surgeries

Specialties Operating Room

Published

I wondered if this happens at your hospital. Almost daily, sometimes several times a day we (the PACU) have the responsibility of calling the floors for a pre-op inpatient who we hold in a "pre-op" bay. Well, I cannot tell you how many patients come down who have REALLY out of whack lab values (INR of 2.2, HB of 5.5 etc..) which NO one knows about. Then the aneshtesiologist screams "Cancelled" and they usually blame the floor nurse. It is ALWAYS the floors fault according to the docs and the OR nurses. Well, sometimes it IS their oversight, but I hold the surgeons and primary doc culpable for SOME of it. C'mon, the pts been in house for what, 5 days and no one has been checking the labs? This puts us in a situation of sending the poor patient back to the roo, and they have been NPO, and they are upset that surg is CX.

The other thing that happens is when surgeons don't weite orders for a consent, no one knows, but the surgery is on the schedule. Is there a person in your hospital that follows these things? We do call the night before when possible, to let the floor know about what time we will call for pt etc, but this is not our job nor does it seem to help!

anybody?

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It is our unit doctors responsibility to make sure the pt. is fit and well for theatre - ie reviewing ECGs, bloods etc , getting an anaesthetic consult if necessary. We check the consents the evening prior to surgery, then chase the docs in the morning if necessary. If someone is on the OT list and we have not been informed, we'll fast the patient, then try to figure out what's going on, doesn't happen very often.

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We don't have too big of a problem with our inpt's. It's the outpts that come in for pre-admission testing the day before their surgery and are still taking their plavix that get me. Then they get mad at the pre-op nurse and anesthesia for cx their surgery. Hello, shouldn't the surgeon thats going to cut them open be aware they are on plavix and take care of this more than a day before surgery. I had to cancel a lap choe last week for this reason and he was mad at me. He said "don't you know I'm going to Florida next week!" How would I know this and why should I care. I am more concerned with him bleeding to death but I guess he and I must have different priorities.

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Thanks guys.

The other thing that steams us is when we hear the schduled pt is not CLEARED by medicine or cardiology etc. It is a waste of OR staff too, as well as the cost of opening a room, blah blah...

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We had an incident where the patient was on the OR table and the MD happen to look at the CXR report which said patient had pneumonia. This was a patient that had been preoped as an outpatient, results had been called and faxed to the office, on admission to the hospital, the result was given to the Anesthesia person, and when the patient is on the table the Surgeon goes, we have to cancel this patient has pneumonia. Then they try and blame the nurses. We document every step we take when we get a bad result back. We document who we talk to, when we talk to them, where we faxed the results to and so on. When the surgeon tried to blame the preop nurse, she was able to say I talked to such and such at such and such time, and faxed the results to such and such number as requested by the office staff.

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Why is ANY of this the RN's responsibility???

1) "Write an order to get consent." Nope. Obtaining consent is not nursing scope of practice in any state I've been licensed in. You have to be able to do the procedure to be able to explain the risks/benefits of it. So that's for the residents or PAs to do.

2) I won't work on floors because you don't have time to know what is going on with all your patients. I think floor nurses are not encouraged to know more detail about their patients- if you aren't expected to know much about each one, you'll be comfortable taking more patients. I think all RNs should know that you can't go to surgery with an INR of 3 or an active pneumonia, but I doubt that they are told in report what the lab/xray results are. The last time I floated to M/S I knew nothing about my patients labs. I don't blame a floor RN who just got there for not knowing lab results on 8 patients.

3) Why wasn't a patient having a planned surgery told to stop taking their plavix/coumadin? The surgeon should have told the patient at their office visit. The anesthesiologist should have told the patient at preop testing. Day of surgery is too late.

It really seems to me that surgeons are trying to "just cut." The preop and postop management somehow isn't their job. Well, it isn't mine either. I refuse to take responsibility for things that need to be done before they get to the hospital (I don't work in the office and am not psychic) or for things that they KNOW need to be done and are out of my scope of practice. I witness consents and that's it. The doc gets them. He was taught that in med school and if he has the time to write an order to get a consent, he has time to get the consent.

I have no problem with nurses filling out preop checklists and making ONE phone call to anesthesia or the doc to say "XYZ is a problem/missing." But I am not the surgeon's mother or his secretary.

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Specializes in Telemetry, Case Management.

I have been a nurse for twenty years and have NEVER EVER had a doc to get the consent. I have always had to take the consent to the pt to get it signed.

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The Rn's here too have the responsibility of having the pt sign the consents (if ordered that is), but I have never thought this was right either. If they are DOING the procedure, they should have that form with them while they are explaining about it. Unfortunately, so many surgeons schedule surgery based on labs and and the PCP or ER doc's findings. They don't see the pt until perhaps 5 min before surgery. It amazes me that pts allow surgery without meeting the doctor (except in lif threatning situation...)

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Originally posted by KaroSnowQueen

I have been a nurse for twenty years and have NEVER EVER had a doc to get the consent. I have always had to take the consent to the pt to get it signed.

Karo-

Who fills out the consent form? Are you filling in the name of the procedure and the space that lists possible complications? I doubt the BON would allow an RN to determine what the patient has to sign for. Silly of the doc to have RNs fill it out- what if we don't write something on there and the doc gets sued because the patient "wasn't aware?"

If the doc fills the form out listing the procedure to be done and the possible complications of that procedure and reviewed all that with the patient, I would be comfortable giving the patient that form to sign. But if the doc does all that, he should just get it signed himself- he has to sign it too, after all.

Sharann-

Unless it's an emergency, I don't understand people who don't meet the surgeon preop. (And tell me why surgeons can't get the consents in their offices when they are meeting the patient?) I wouldn't. When my husband needed a surgery consult, we researched malpractice history and I spoke to docs I work with and nurses at that hospital who knew the doc before he chose one. Then we went to the office consulation together- would never have just called up and met her in preop holding. I needed surgery a few years ago- I fired the first surgeon because he was so condecending to me. I would never have felt comfortable with things based on his attitude alone- and if I hadn't met him first, I wouldn't have had much of a choice. Our healthcare system needs a lot of changes, but we do have SOME input in who does what to our bodies.

Why would anyone allow someone they've never laid eyes on to cut them open? How could it possibly be considered informed consent when the patient doesn't meet the doctor until they're naked and being wheeled into the room?

Argh. I don't do it. Have only had this be a problem at one hospital- and they had much bigger nursing problems than this. I don't work there anymore.

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