Is seeing a pt in Preop really a must for OR nurses??

[Guest 1170770]

Hi and help!

I am a new educator in the operating room. Currently where I am there are only a handful of nurses that go to see their patients in preop, most of the time the room is still getting ready and counting as the patient rolls in (They do value quick turnover and on-time starts a little too much, hence why RNs are skipping seeing pts)

Where I practiced before the nurses took them patients back to the room, so it was never an issue, we just interviewed right before coming back. The Director is questioning if this practice of seeing a patient prior is necessary, as our anesthesia teams bring them back and in theory preop is supposed to do everything to prep the patient prior to surgery. 

Are there other facilities that don't go see their patients?  I am trying to find guidelines and justification for doing one or the other. AORN, from what I've read doesn't really address this. Any advice or feedback is gladly accepted!! Thanks.

[Rose_Queen, BSN, MSN, RN]

We get our own patients and there is a bedside report from preop nurse to OR nurse. It's another safety check as well- I've picked up on some things as circulator that preop and anesthesia missed.

[heather42r]

I always get my own patients. We have to verify name/DOB, the consent, allergies, etc...I would be very uncomfortable getting a patient without a trip to pre-op. I have had anesthesiologists try to take them first and I always ask for a minute. I do try to go talk to them as soon as I drop my patient off in PACU before they've had their block and/or sedation so they are a/o as much as possible depending on circumstance. Trauma? Different story. Get them back ASAP.

[Rose_Queen, BSN, MSN, RN]

Moved to OR forum for best responses since it’s more of a practice question. 

[RickyRescueRN, BSN, RN]

I cannot imagine not having those 5-10minutes to connect with my patient outside of the busy OR. In my mind that is the only chance I have to get to know my patient as well as to ensure that it is actually safe to bring the patient back. Consents are frequently wrong/ have errors or after speaking with the patient it is clear that they have little to no real understanding of their surgery (in which case they don't get taken back to the theatre) . For me the pre-op consult outside of the actual theatre is essential to patient safety and advocacy .Neglecting that would create the first opportunity for a safety mishap.In my mind, this constitutes Best Practice. 

[Jeckrn1, ADN, BSN]

I do not know what excuse the director from the OP will say when there is a wrong site surgery. 

I like to verify my patient to include their understanding of the surgery and what body part is being operated on before they receive their pre-op medications.  Since I am the one reading the consent form during the time-out I need to know that the patient has agreed to the surgery and surgical site.   My facility has the pre-op nurse sign off the site verification before the surgeons marks the patient.  All the pre-op nurse is signing is that there is a consent and they have been NPO etc.  During my interviews I have found issues with the consent that the pre-op nurse did not.  You can not rely on anesthesia to catch some mistakes, they are mainly focused on their part and not the whole picture.  At my facility anesthesia has to sign a sight verification after the OR nurse and before bringing the patient back to the OR including their consent.  The OR nurse is not responsible to ensure the the anesthesia consent is on the chart. I will not sign the sight verification until there is an anesthesia consent because the vast majority of consent issues at all the facilities I have worked at is there is no anesthesia consent.  The cause of this is because they think that if we have signed there is an anesthesia consent.  

 There is also some last minute patient/family teaching on what happens in the OR that can only be given by someone who has worked in the OR. This is a good time to greet the family members to give a face to the name of the person you might be calling with updates if its a long surgery.  This is also a good time to give the pediatric patients parents some assures that their child will be well taken care of.

 I am an service nurse for Oral Surgery and pre-op and post-op nurses have very little knowledge on the size of the plates and screws that are used and how after care differs from orthopedic plates and screws. 

[Allgood2016, LPN, LVN]

(Retired nurse - speaking as a "civilian")

To me, PRE-OP is as important as sugery.  Pre-op is prep time; getting to know if patient is ready; and knows what is going to be done, permit correct and signed, has the surgeon marked the site properly (ie-amputation), etc.

I myself actually had a wrong permit ready to be signed.  Was to have a salpingo-oophorectomy done; permit said hysterectomy.   When I refused to sign; and, stated wh; the nurse immediately got it corrected (I insisted on a new permit); and signed it.  The doctor and anesthesiologist wanted know the hold up; as soon as I got to surgery I told them.  I later found out that the unit secretary was the one who messed up.  

All I can add is thank heaven for the PRE-OP NURSE!

[Jeckrn1, ADN, BSN]

I agree pre op nurses have a strong roll to play. OR nurses are the last check if it slips by. 

my question is how did the surgeon not know until you got to surgery. He should have seen you in the pre op holding area to do a site verification and should have signed the new consent before you did. 

[Nscorpiored, BSN]

VERY!

At my hospital the CRNA/AA/PA brings the patient back to the OR but only after the OR nurse has seen, interviewed, signed off on the patient. Those few minutes have helped me determine what type of anesthesia they need/want, implants, allergies not accounted for, if they understand the procedure and is there even a consent/H&P update

It's imperative the OR nurse see their patient before coming back to the OR 

[affurman, BSN, RN]

If my director, who hopefully is/was an OR nurse, was questioning the reasons the circulator needed to see a patient in preop....I would RUN away from that place as fast as my legs could take me. 
There are safer ways to get TOTs lessened. 

[MereSanity]

Would you give a patient medication someone just handed to you? No? Would you want to check it yourself? I am a certified operating room nurse and I will not put my license or job on the line by placing my trust in doctors, anesthesiologists, nurses, and assistive personnel who may not abide by the Standards and Guidelines. I want to KNOW I am getting the right patient, right procedure, consents are signed, etc. Unwise, unsafe, cutting corners is just dumb. 

[redmango]

As a pre op nurse it’s very important for the OR nurse to do their part before OR. In my hospital we have to go over name DOB, MRN and consents and other forms.  This also makes the patient feel confident we are double Checking everything. Mistakes have happened before