Surgeons "go ahead" problem ? - page 3

So... here's the rub. You have an 8 am scheduled case. The patient is brought to the surgery holding area. The OR case is opened and counted. The anesthesiologist is ready. However, you haven't... Read More

  1. by   bifurcated
    there are some pretty strict guidlines from JACHO etc. that require that the "surgeon" be the person to mark their patients for correct site surgery protacol. That at least is a starting place.Check your hospital policies or organizational policies regarding this. Never a good idea to put someone to sleep without sighting your surgeon! Good luck
  2. by   passionate
    That's a good point. If the surgeon marks the pt. then the surgeon should be there for the RN to take the pt. to surgery. Become familiar with the Universal Protocol formerly known as the "time out". Regardless of policy I find that hospitals always, always want to know the bottom line with Jchco--great point.
  3. by   passionate
    Habitual offenders should be written up but make sure your mgr knows the problem so that it can be addressed in meetings at the management level. As nurses we try to advocate for the pt.--why is it that doctor's don't respect that? I have been accussed of being a problem. My problem is that I have been a pt. and know that I want a nurse who will stand up for me when I can't. I don't care if I have been a perioperative nurse forever. When I was a pt. I was a pt. period.
  4. by   mcmike55
    In our small rural hosptial, we wait till we see "the whites of his(her) eyes".
    Most of the time, the doc has to see them in holding to mark the site, answer last minute questions, update the H&P, etc.
    When we go to the room, we move right on to the start of anes., we don't "hold" a patient in the OR, the pt is charged from the time they enter the suite.
    Many times, our main general surgeons also are doing scopes in endoscopy, a couple of floors away. For the most, they are good about saying, while you are turning over, I'm going to go do a quick scope, I'll call you when I'm available.
    Sometimes their "quick scope" runs long, or includes a stop in ER, ICU, etc, so we don't move until we know.
    I've had a surgeon, many times call in saying that "I can see the hospital from here", my theory is that he has a picture of the hosptial on his dash board!!!
    I still don't move until I, or the front desk person has laid eyes on 'em!!

    Mike
  5. by   haras regnurps
    This is unfortunately a problem in alot of hospitals they will all handle the situation a little differently but, follow the hospitals policy and the national safety standards ( assuming of course that these 2 agree ) and your liscence and the safety of your patient will not be at risk.

    Knew of one hospital where there was a go- ahead policy if the surgeon called. well he did but was in a severe MVA after that call and the patient was under anesth. for 15 minutes and then awakened without the surgery being done.

    The time-out policy helps take care of some of this but not all.
    My hospital requires that the patient be marked by the surgeon before going back to the room. but we have a few that mark their patient and then disappear to go do rounds quite annoying to have to give a surgeon a personal invitation to come and do his own case.:angryfire
  6. by   crackerjack
    Our policy is that we will stick to the policy, change the policy to make things safer and demand surgeons learn to like the new policy then immediately buckle when the surgeon has a fit because he/she doesn't like it.:angryfire:angryfire:angryfire The policy changes about as frequently as I change underwear (and yes I change daily, at least). God help the poor soul who is off work for a few days and comes in to a totally new policy....trying to stick to the policy that was in place a few days before when he/she was there last. Why bother? For that matter, we have the same ever-changing policy on consents, H&P's, labs, or anything else 'required' pre-op. Let's just take people to surgery at whim, do whatever we want and expect them to be thankful and happy. No repercussions. Why bother with all that time consuming paperwork....:angryfire

    Can we tell that I'm a bit fed up with management having no balls? Oh, I know what happened, we did surgery on them at the whim of a surgeon without all that messy paperwork!!!
  7. by   haras regnurps
    no one
    no matter how "rushed" they are to meet a time limit or something
    should ever under any circumstances procede without the surgeon

    Where I trained the surgeon had to be present for induction or there was not an induction until he/she was present. sometimes the chief resident could sub for the surgeon but attending had to be in house or anesth. would not "go-ahead". nor should they. A general anesthetic is very dangerous as we all know and no patient should be under longer than nessecary. right?
    If your policy does not include marking the patient and a verbal time-out in the room I suggest that you send the national safety standards to your managers discreetly and actively work to change the policy in your institution because it is UNSAFE:angryfire:angryfire:angryfire:angryfire
  8. by   kiwi77
    I've been following this thread about surgeons giving the "go to the OR" order and how it's handled differently in each hospital but haven't seen this problem addressed yet. We're having issues with surgeons calling from their mobile phones, saying "go to the OR, I'm 10 minutes away." Their PA makes the incision and performs 30-45min of the surgery. The only MD's in the room were the anesthesiologist and the resident whom I think was a 1st year. The surgeon strolls into the OR to do the major part of the operation, however, was not around to supervise prior to that. In some cases there is no other MD in the OR as we use CRNA's and the only people at the OR table are a tech and PA.

    The pressure on the other circulators and me to go along with this is tremendous. My boss backed me up and told me to write up the surgeon----which I did. That has made me very unpopular with a few surgeons who know I wrote one of them up. On my nursing notes, I have to put the time in and out for every member of the team as well as what time the incision was made and the time of "time out". The difference between incision time and surgeon entering the OR was almost an hour.
    Is this isolated or happening everywhere? Where I work, no one calls the OR to notify that the doc is in the building so I have no proof that the surgeon isn't still on the interstate. The CRNA or anesthesiologist puts the patient to sleep, the patient is positioned,the PA and/or resident start the surgery.....none of the RN's I work with think this is a problem. My boss however does and is getting a lot of resistance from surgeons who say they were always immediately available, if not in the OR. In one case, one claimed to already have talked to the patient pre-op and was in the building although he had not because I was with the patient for 45 minutes and never saw him in the holding area. I just want to follow policy and not jeopardize patient safety or my license.
    I would like to know what other circulators are doing when faced with this.
  9. by   mikethern
    Quote from penningtonRN
    I would like to know what other circulators are doing when faced with this.
    If your O.R. has a policy that states that patients may be brought into a suite before the surgeon is present, then photocopy the policy. If it doesn't have a policy, you may want to ask your boss to make one. If a patient sues for receiving unnecessary anesthesia, guess who will be blamed? If you were following written policy, then you are probably legally covered.
  10. by   kiwi77
    Quote from mikethern
    If your O.R. has a policy that states that patients may be brought into a suite before the surgeon is present, then photocopy the policy. If it doesn't have a policy, you may want to ask your boss to make one. If a patient sues for receiving unnecessary anesthesia, guess who will be blamed? If you were following written policy, then you are probably legally covered.
    I have not seen a policy iabout this issue and it is being debated in the medical exec committee meetings at present. The biggest problem is surgeons who don't see their patients before induction and send their PA's in their place. The surgeon claims to be either in-house or just across the street, calls his PA on his mobile and all I have is one persons word against another's. We've had patients anesthetized for 30 min to an hour, needlessly waiting for the surgeon who was "10 min away" to finally show up and scrub in. All this is documented on the patient's chart so it can be tracked if there was anyone who wanted to see how often this was happening. We do electronic charting and the statistics are very easy to track by administration. I am going to ask to see what if any policy exists to cover myself in the event that a patient does sue.
  11. by   Chilly_hands
    Last year, our facility flooded on the ground floor. Surgery is on the main floor. Due to the problem, we used the holding area for storage and designated several of the pre-op rooms for holding. Now the anesthesiologist and the surgeons all meet the patient in the pre-op room and have them sign consents and also mark the patient if laterallity is a concern. Family is present.

    This has worked well due to the fact that most patients are nervous and can't remember what the doctors discuss with them. At least now the family usually remembers. Oh, and nervous patients will sign any form the doctor hands them without reading it, thinking that the doctor would never make a mistake, so it's been good all around. The doctors write the consent and state it to the patient and the patient then signs. The docs aren't really held up with questions from the family either. They've trained themselves to waltz in and ask if they are ready and "let's get the show on the road" and surprisingly, everyone saves all the questions for the nurses.
  12. by   mikethern
    Quote from Chilly_hands
    Now the anesthesiologist and the surgeons all meet the patient in the pre-op room and have them sign consents and also mark the patient if laterallity is a concern.
    The problem with waiting until the last minute to sign a consent is that the anesthesiologist might drug the patient before the consent is signed. Has this ever happened?
  13. by   Chilly_hands
    Never once has the patient been drugged before consents has been signed. Usually the Anes. Coordinator speaks to the patients first, then sometime later the surgeon comes in right before taking the patient to OR. The nurse working in the OR and the CRNA or whoever is administering anes. comes to take the patient to the OR. The patient is wide awake as they are taken to the OR or a dose of versed is given just as they unlock the brakes and start wheeling them away. It's worked so far and it really is nice having the family present, even if it means that us preop nurses have to deal with the surgeons and the anes.

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