Improving Patient Experience

Every place I have worked always interviews patients outside of the OR suite unless it is a true emergency.

During my interview I try to keep it unrushed and as informative as possible. Meaning, I try to explain what the patient should expect upon entering the OR (move over to the OR bed, get hooked up to monitors, safety strap, oxygen mask/NC, medicine through the IV, drift off to sleep, etc.). I also ensure that we will keep them warm, comfortable, and safe before, during, and after the procedure.

I let the patients and families ask questions. As many as they need even if this means I enter the OR 5 minutes late. Of course, I keep my answers within my nursing scope and direct question to the surgeon or anesthesiologist as necessary.

If a patient has a special rosary, scapular, or other important token they wish to keep with them during surgery, I allow them to bring it with them but explain that after they fall asleep I will be removing it from them and safely labeling it and keeping it in the room. I confirm that this is ok with the patient and family as well.

As far as music, normally we turn off music as the patient enters the OR. Many patients may see music as being too unprofessional for surgery, often thanks to the media's portrayal of music during operating. On occasion, I have had the patient ask for music and it usually is not a problem to play some music for them while they are awake in the OR as long as anesthesia, the surgeon, and the OR team are ok with music during that time.

I also smile a lot and act very sure of myself and the surgical team. If all the above doesn't work, let's hope anesthesia has a pocket full of Versed!

If the surgery is going to take over about an hour, I tell the pt that I will call the family and let them know how they are doing. If maybe things aren't going so well, I will use my judgement as to whether to call. For peds pts, we always call and tell the parent when surgery has started. Most of the peds docs want us to call every hour for the longer surgeries.

I always warm the OR table by putting a warm blanket on the table and attaching the bair hugger blower to it. That way, the table is not so cold. Some people don't agree with this, saying that air is blowing over the sterile table. I disagree, and I hope that those people never have to climb onto a cold OR table!

I also never underestimate the power of hand holding. Any soft skin to skin contact usually seems comforting, like stroking a forehead.

Any concerns that they voice, I reassure them and mention that I have been doing this for 27 years. Most people accept that I know what is going on, and seem to relax. Any one who says, "I'm sorry I'm so nervous" or 'I'm sorry I have so many questions" I tell them that they have nothing to be sorry about, that they have every right to ask questions and being nervous is natural, and that there are lovely meds that will help them with that.

Anything that I can see to do to reassure a pt, I do it. Most pts appreciate any effort that you make.

At my hospital, OR nurses do not go out to meet/greet any patients before they enter the surgical suite. We are a "lean" hospital and this is what the group of know it alls decided to do. We get a over the phone report from the pre op nurse who supposedly did all the checking documenting, etc in pre op holding, but they miss stuff all the time and I need to go over all of it when the patient arrives. There is no time to really introduce ourselves either because as soon as they hit the OR we need to do a ID the patient time out (we do three in our facility). My hospital is much more concerned with what happens in pre op holding regarding patient satisfaction.

The music idea is not weird. We do it all the time, especially with the teenagers and nervous people. It's so easy now with music on our phones and tablets (they hook up to the surround sound). Make sure they are informed, cozy with warm blankets, and yes music can help.

I'm not a nurse - just a patient, but thought a patient's perspective on how to improve the patient's experience might be useful.

First - THANK YOU for caring about the patient experience and for trying to improve it.

Ask the patient what is stressful for them or what they are most worried about. Then do what you can to address THAT concern.

My experience after 9 surgeries is that medical personnel think that all patients are the same and that they are all worried about the same things. They assume that everyone is worried they will die "on the table" and that they will be in a lot of pain following the surgery. They always offer reassurance about those 2 things. Those 2 concerns are not even on my radar when I have surgery.

My big concerns:

1. That once I'm anesthetized they won't respect the decisions I have made, and they'll do whatever they want during surgery. (This actually happened to me once, so now I'm afraid to be sedated.)

2. They won't respect my privacy / values. They'll allow students to observe even though I have requested that they not, and they promised me they wouldn't. They will permit industry reps in the OR.

3. They'll allow residents to operate on me even though I have refused to be treated by residents and they promised me they would respect my decision.

Once someone asked, and I expressed my concern about privacy. That was communicated to the OR nurse by someone. When the OR nurse came to take me to the OR, she told me how she had even taped paper over the window in the door and hung a sign on the door. She said that she would make sure that only people providing my care were allowed in the room. I didn't expect anyone to do that, but I really, really appreciated it.

I had surgery a few times at my surgeon's own outpatient surgery center. They did one thing that I loved as a patient, but is probably impractical in a hospital. Prior to surgery each member of the OR team came out and introduced themselves to me and told me what role they would have in my surgery. Each person told me that they would take very good care of me. It was so comforting to know who was going to be there and what they would be doing.

At one hospital I went to the pre-op holding area had private rooms. You could have a family member with you while you were waiting, but they had to remain in your room. This was to protect the privacy of the other patients. I appreciated their concern about patient privacy.

At another hospital I went to the pre-op holding area had cubicles with a curtain across the open end. They also allowed family members, but they were allowed to sit in the hall outside the cubicle. I had some creepy stranger sitting in the hall starring at me in my cubicle. (They were also coughing their lungs up the whole time.) I got up and closed my curtain, but each time a caregiver came into my cubicle, they flung open the curtain. Then they would leave it open when they left. I will NEVER return to that hospital.

The point of that long story is someone else's family member doesn't need to even see your other patients. They don't need to be eavesdropping on the conversation between a patient and the caregiver. They don't need to be watching you start my IV. They don't need to be coughing their germs all over me.

And as SOP832 said patients really do APPRECIATE ANY EFFORT you make. At one hospital I went to they have one man who seems to start all the IVs in pre-op. As required by policy he initials and dates the IV when he starts it. He also always draws a little smiley face on it. It's a silly little thing to do, but I really appreciated his effort. When my mother was treated in the ER at that hospital I told my mother about that while the ER nurse was starting her IV. I was mainly talking to distract mom from the stick. When I told about the smiley face, the previously dour ER nurse looked up with a big smile and said "I know who you are talking about. He started my IV when I had surgery." His silly little smiley face even made a jaded ER nurse smile.

Once again, thank you for trying. Patients can tell who is concerned about both their physical and their psychological well-being, and we appreciate you.

The music idea is not weird. We do it all the time, especially with the teenagers and nervous people. It's so easy now with music on our phones and tablets (they hook up to the surround sound). Make sure they are informed, cozy with warm blankets, and yes music can help.

Just make sure the music that is playing is not some loud modern rock/rap crap with foul language. That happened to me once when I was wheeled in the OR. The circulating nurse told the young woman to turn it down-they should have turned if off.