EM and surgery

[deyo321]

Hey does anyone know if it is contra-indicated to wear an electronic monitoring bracelet in the OR? (The patient not the Surgeon). Thanks.

[listeningangel]

great question..not so easy to answer. I've had patients that were transferred to hospital , ended up in the OR with officers in the OR with shotguns as necessitated by security determined by law enforcement.

a patient with an ankle monitor is ordered by a court and that's the issue frrom the law enforcement side. from the medical side..

is the ankle monitor interfering with the surgery and could it cause the patient harm? (infection, the surgery hampered by the monitor, many other issues to consider). If the ankle monitor is interfering with the care the patient should be receiving in the OR, then what needs to be adjusted? The surgeon can evaluate whether the monitor is interfering with care the patient needs and law enforcement can obtain an emergency order from the court to remove the monitor during surgery. there are options..

[ImThatGuy, BSN, RN]

Speaking from the badge side of the fence, unless you're doing ankle surgery or some other procedure in the immediate area it's not coming off. Wipe betadine on it, put a bag over their foot, or whatever, but it's there for a reason.

[listeningangel]

no kidding, it's there for a reason. that's understood. however, compromising a person's health is a decision made by the physician's. Judges recognize that the law allows for these determinations to be made. it's a case-by-case determination. it has to be weighed and balanced within the law. it's not helpful to medical folks when law enforcement intimidates them and spreads fear about the safety of medical staff who work with people in custody.

Hey, the law is the law and it's about balance and good decision-making. No matter what the crime, believe it or not, medical staff get sued all the time for making bad decisions under intimidation from law enforcement who are with the prisoners. It's not law enforcement that they sue the majority of the time. So, generalized comments from the authority of the badge force medical staff to risk their licenses, that's unfair; there's alot more at risk than the immediate safety of everyone involved. These small and large decisions turn out to be very costly (taxpayer's money), when things go wrong.

If both sides do their job well, then the outcome is usually good, which is what I encourage. If both sides respect each other's function and expertise it's works out better for all involved. This kind of power struggle is really "bad for business". Most of the time, medical staff make good decisions and take safety and security very seriously and do what ever is possible to achieve both objectives.

Thanks for 'weighing in', it's an important discussion. Take care.

[ImThatGuy, BSN, RN]

I just said unless its ankle surgery or a procedure in the immediate area. That gives a lot of latitude to remove it as necessary. In that case, just move it to the other ankle.

[listeningangel]

sounds like a good option.

[deyo321]

well my thoughts were more concerning that it is transmitting a signal and is there any history of interferring with any medical electrical equip. She is getting the surgery it is just going to be with staff or with bracelet. Surgeon asked that it not be there, which means we tie up staff. Was wondering why he might have asked. Decision is made way above my pay grade just looking for knowledge. Thanks all.

[listeningangel]

Hey Deyo,

I would be concerned also, about the ankle monitor interfering with OR equipment. The technology varies and continually changes with the ankle monitors. Different facilities purchase different types of ankle monitors. It should not be incumbent upon surgical staff to determine if the ankle monitor would put OR equipment interference at risk or risk consequences to surgical staff.

Surgical staff should not be expected to take any risk at all. Law enforcement is not qualified to make that determination of interference, it is a mute issue. The surgeon can write an order that it is to be removed during the surgery and send the order to the Cheif Medical Officer of the correctional facility. Facilty medical and custody administration can work it out from there. Custody can determine if an officer needs to be in attendance with the prisoner at the hospital. It is highly unlikely that a court would override the surgeon's order if it was necessary to obtain a court order to remove the ankle monitor during surgery. Any prisoner with an ankle monitor is generally a low security risk to begin with. High security risk prisoners don't wear ankle monitors. Hope this helps.

[ImThatGuy, BSN, RN]

What are these signals going to interfere with?

[wtbcrna, MSN, DNP, CRNA]

I think the problem would be that electronic bracelet could be injured/destroyed or cause the patient harm when the electrocautery is used especially if it is unipolar vs. bipolar.