chain of command

[mechunli2]

Is there a chain of command in the OR? I've always been under the impression that the circulator essentially runs the room. Basically we had an incident where the circulator saw that the sterile field was broken, but the ST said she didn't see it happen so disregarded the whole incident. Besides the obvious that the ST needs a talking to about the culture of safety I'm trying to find something to help remind/educate people and thought there was some sort of chain of command in the OR. Or is this just an unsaid thing?

[FurBabyMom, MSN, RN]

In my facility, I guess, if we *had* to define it, the circulator runs the room. This is up for discussion in some states as STs are lobbying state legislators to be "supervised" by the MD/surgeon as opposed to the RN/nursing staff. I can see why the STs think this would be advantageous, and why MDs might be okay with it...but I have some serious concerns about it practically although that's a different topic.

You can certainly discuss this specific situation with your manager - depending on the ST - that may be the best step. My advice would be to make it about the patient and not "whether something was done right" or "whether (so-and-so) did their job correctly". I try to treat my patients the way I want my family to be treated, so this seems intuitive to me.

With that said, we err on the side of caution, and if there is a question at all, we consider it (whatever *it* may be) contaminated, replace/re-do and move on. *This would have been the end of it for me - this is really not negotiable and I would have made it about the patient and their best interest while insisting the "situation" be corrected*.

When you say "chain of command", I think of something a little different and usually involving something *beyond* two staff members who likely have the same manager. Maybe it's the scope of our facility - but for us "chain of command" is used primarily for things beyond what you're describing.

[MinneNurse, BSN, RN]

In my OR there is no "chain of command" where the circulator "runs the room." We work as a team and we all have individual duties to meet the common goal. But no matter what your OR's culture is, when it comes to sterility any concerns made by anyone should always be addressed appropriately. Nobody should be able to disregard such incidents no matter who brings it up. I'm not sure of your facilities policies but I would reference AORN Guidelines if you are looking for some backup.