Just recently moved to a new state and new hospital. I've been in the OR for over 15 years and just have a few questions. They do quite a few things different in this hospital and it just seems wrong, so I'm looking for some input.
1. The nurse doesn't prep the patient. The doctor or the scrub does when they are scrubbed in. If they use betadine, they just paint it on and don't even do a scrub! If they use Chloraprep they don't follow the manufacturer instructions of going back in forth a the incision line and then going out. I have never seen this before and when I brought it up they thought I was crazy. Said they never have heard of the nurse prepping a patient?
2. Saw a nurse drop a peel pack of hemostats off of a case cart. She opened it up, when I mentioned it was contaminated because of strike thru she didn't understand that. Said they don't do that here? Is that not the case anymore, did I miss something?
3. When putting a patient in lithotomy, they don't move the head of the bed to the foot. They just put the stirrups on.
4. When tucking arms to the side, they tuck under the mattress. I was always taught to tuck under the patient because if you tuck under the mattress it can pull the arms back and compress nerves.
There are other things as well, but these are the things that I could immediately think of. I don't know anymore, I'm beginning to think it's me. Would love some input from everyone. I've only been working here a few days and hate to be "that" person but seriously????
Jan 26, '13
I am new to the OR but I can spot bad practice a mile away. I was told yesterday by the circulator I was working with that I should tuck my scrub shirt into my pants because of "skin sloughing" only to watch her prep a patient 10 minutes later with no gloves on! Um, doesn't skin slough off your hands too? In our ORs there is a main door with a smaller one next to it that latch together (to increase the doorway to allow beds in and out). In some rooms the doors need to be physically closed together in order to latch, otherwise the smaller one stays open...wide open. I am the only person who EVER shuts this door! People think there is nothing wrong with surgery happening in a room with a door wide enough to fit a person open...HELLO! People are just too damn lazy to open and close a door and people are so used to it being open they think nothing of it!
I have found the OR to be the land of control freaks who believe the way they do things is the ONLY way to do them. Period.
Since I am new I am not offering advice, but in my hospital the circulator preps the patient. Since I work in a teaching hospital, there are usually residents and/or PA's who scrub in with the attending...sometimes I have seen the residents or PAs prep. Never the scrub person though. I have seen preps run the gamut from just blobbing on betadine with a sponge stick, to widening circles of chloroprep with reaching over the patient. I was taught by my educator to scrub the incision area 20x and then expand my prep area, but I am always scrutinized by the circulator I am working with and usually told I go too slow, or don't need to get "too crazy."
In lithotomy the head of the bed is always moved to the foot. And I was told to tuck patient arms using the sheet under the body, not mattress.
I don't think "it's you." I think many people have just allowed bad practice to become second nature and nobody speaks up. And it is very discouraging to constantly be advised on these boards to just grin and bear whatever I see or am told to do, and then do it my way when I am on my own. Why am I not allowed to question what I see by the person teaching me? And isn't this where bad practice comes from? I mean, if you follow people around for 6-9 months who have bad practice, and you are constantly told to do it their way in their OR, then by the time you are independent you have adopted these bad habits into your practice and they become hard to change, and some of these things newbies may not even know are bad practice. Such a shame. And people wonder why HAIs and SSIs are on the rise instead of the decline...
Jan 26, '13
Thank you for your response. It doesn't matter how long you have been in the OR, we should all be as diligent as you! You are going to be just fine. Just keep your good standards up. I'm beginning to think I'm crazy. I guess I'm just going to continue to practice the same way I have always done and hope others will follow!!! And yes, the doors should be closed!! LOL!
Jan 26, '13
The only place I've seen doctors prep a patient after scrubbing in was over seas. Apparently, it's a common practice in some countries. I've never heard of anyone not putting the foot at the end of the bed for lithotomy. The only time I've seen patients tucked under the mattress is when also using a sleigh, that's the only way to prevent nerve compression when tucking under the mattress. Something I never thought I would ever see was a nurse bagging laps without gloves on. I had to report that one due to infection control issues, and because it was just plain disgusting.
Jan 27, '13
Thanks for your response. I'm feeling better now like I'm not completely crazy. Bagging laps without gloves? That is just the nastiest thing I have ever heard!
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