Analyze this situation -I'm POed

[cocothemonkey]

Circulating a cardiac case, standard CABG X 4 with a radial arm harvest on a younger gentleman. Surgeon is a spaz, throws little fits and is about the most impatient man i've ever met. But it's more comical than anything, almost like a cartoon character, he really doesn't bother me.

Well, the PA was done with the radial harvest and I went over to clean off his mayo stand and retrieve the countables. He had 3 empty suture packs but only two sutures. He's a high maintanance PA and comes into the room thinking he's one of the surgeons. I ask him how many sutures he was supposed to have. He said 3, that they're on the needleholders. I look again and can only find 2. He starts yelling that they're right there and that if I look i'll find them. Again I say you only have 2 here.

Now the surgeon gets into the middle of it and tells us to be quiet and that he doen't want to hear another word about it. I tell him that there's a missing suture. He doesn't care. So I let it go for a few minutes and then casually start looking around the floor where the PA is standing. Suture is stuck to the bottom of his foot. I say loudly here it is and pick it off his foot. No apology, no nothing. I'm mad and was mad the rest of the case.

Mad that the surgeon could care less that there was a missing suture. Mad that the PA insinuated that I was some sort of a moron and they thing was stuck to his foot the whole time. And mad that this moron left the case shortly thereafter and would have left me one needle short and could have tracked it into another case throwing their count off.

Thoughts? Am I being oversensitive and should I have just let it go?

[suzanne4, RN]

Document it. Simple as that. Dr. So-s0 informed of missing needle. PA -------- informed of missing needle off of his table used to close arm. Both were notified. And then there behavior can be included and given to your Director.

I had issues with a vascular surgeon one day.............wanted me to stop my count to change his CD. I told him that I was completing my count first, and he stopped working, and I continued my count.

"I want you to do that now."

And I am stating that you are missing two needles and I will be happy to stop, but I will not be back here when you need to open the patient again, and it will also be documented that you were informed.

The residents in the room froze, refused to assist him until everything was accounted for.

He did that a few more times, and was never working at that facility again.

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And if they refuse to look for a needle afterwards, when it can't be found; you can refuse to have the patient moved from the table until an x-ray is completed. That is AORN Standards, as well. X-ray to be done for missing object from the count, before the patient leaves the room.

[suzanne4, RN]

That usually will get their attention when the surgeon is in a hurry to get the next patient into the room. Will work, too. You can't bring in the next patient until the needle or whatever is found. And stick to it. Or it could be found later on and throw off your next count, and then you would need another x-ray on that patient as well.

Just stand your ground. You are there to protect the patient.

[grimmy, RN]

i agree - counts are critical items in pt safety, and cannot be fudged for any blowhard. the fact that the surgeon and pa are pompous morons is another story. obviously they've had great nurses around (like you) to make sure that they have never to had to open anyone up to retrieve an item, or gotten sued over an item left in the body. we don't want to have to go that far to teach them a lesson, of course, so let blowhards be blowhards, and document. i hope you have a supportive management that will stand beside you.

[Pam RN]

That just chaps my a%% that there is no respect for the patient, the surgical process or the job we need to do. Why do we need to threaten them to ensure our safety processes get done? Everything has to turn into an argument. But who's the first to complain? We know, the one's who tried to prevent us from doing the job in the first place.

[Marie_LPN, RN, LPN, RN]

Thoughts? Am I being oversensitive and should I have just let it go?

Incident report. He needs to learn how to give a ****.

[Charity, RN, APRN]

And if they refuse to look for a needle afterwards, when it can't be found; you can refuse to have the patient moved from the table until an x-ray is completed. That is AORN Standards, as well. X-ray to be done for missing object from the count, before the patient leaves the room.

Before the patient leaves the room...hmm... Then why is the PACU staff so often left to explain to the patient why these x-rays are being taken...

[Marie_LPN, RN, LPN, RN]

Our pts. are never to leave the OR suite or start waking up if a count is off, till the X-ray is taken. If they go to PACU, and an X-ray shows something left in, they'd have to go back in, which means starting all over again.

[suzanne4, RN]

Before the patient leaves the room...hmm... Then why is the PACU staff so often left to explain to the patient why these x-rays are being taken...

Per AORN Standards, no patient should be removed from the OR Suite until an x-ray is taken, if counts are not correct. If something is found, they go back to the OR to have it taken out. And have to go thru the entire process a second time, not a very good idea.

Your facility is not following standards.

[subee, MSN, CRNA]

Our pts. are never to leave the OR suite or start waking up if a count is off, till the X-ray is taken. If they go to PACU, and an X-ray shows something left in, they'd have to go back in, which means starting all over again.

In New York that becomes a state reportable incident. I didn't imagine that patients were being x-rayed outside of OR anywhere.