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.

[chulada77, ADN, BSN, MSN, APRN]

Stop- are you kidding?! YES it is essential to see the patient in pre op….safety safety safety. Your facility will not pass any type of inspection if you start cutting the big safety corners. I could give you 100 examples and reasons why but I ll stop here 

[Guest 1170770]

Yup I agree. I’m actually leaving the institution. 

[NurseCDT, MSN]

Yes it’s absolutely essential!! 

[NeuroORRN]

Anesthesia brings our patients to the room.  I rarely to never interview them in Pre-op.

[BarbaraNM, ASN, RN]

Not a chance I would go along with that. It is essential that we interview the patient in PreOp, carefully check consents and signatures, verify the surgeon’s marking on the operative site, reassure the patient and family. I have found a number of discrepancies that might have been a huge deal if not corrected. It is our policy that the OR RN and the Anesthesia provider bring the patient to the OR together. Turnover time is irrelevant if patient safety is ignored. 

[StacyAtheNurse, BSN, MSN, APRN, NP]

I believe it depends on what infrastructure is available in your hospital. In my hospital, it is not necessary to see the patient in the preop. In fact, it would probably take you 10 minutes to walk over there because it’s so far away (our OR is huge). We use Epic and iPhones/iPads. Everyone gets an alert once the patient is ready (electronic consent, premedication, surgeon marking, family info set up in computer, h&p etc) these are hard stops for preop.The patients file will not allow you to proceed without these things, neither can you notify the OR that the patient is OK to come back, and the only time we do skip this is in the case of emergency, in which the patient is straight to the OR anyway. The patient can be brought my the CRNA, PCT or RN. Usually the CRNA brings the patient (especially when blocks are required). When the patient is brought to the room, their id band is scanned. This puts in room time, anesthesia start time, name verification and starts the anesthesia chart. This is a hard stop. Anesthesia cannot proceed until this is done. The machine just literally won’t work. We do a pre-induction pause between anesthesia and the nurse. In places where the nurses go to preop to become buddy buddy with the patients I have never seen this done to the length we do it in my currently hospital. We verify name, dob, mrn, procedure, allergies and marking with the patient as an active participant (if able to communicate) if not, the resident takes the patients place. I check that off. That is a hard stop in my chart, and I cannot close my chart without completing it. After positioning, prep and draping, we do a 10 element time out. This is also a hard stop. The physician leads our time out, we are secondary and anesthesia is third (I’ve worked in hospitals where the nurse is going through the timeout and everyone is just talking, or mumbling or doing other stuff). We proceed with surgery. Everything that we do is instantly sent to PACU. They know when we are closing without us having to call (it’s literally just one button you press) your room is assigned to you and then you end the case. Because your PACU nurse is assigned to you at closing and has access to your chart as you are charting, it is not our practice to go over to PACU and give report, but I have seen some nurses do it. Don’t get upset if the PACU nurse asks if you think she can’t read. Then if you insist that you must say everything that SHOULD already be in the chart because you didn’t put it in the chart, you’ll be reminded that we are to chart in real time (and most of us do) it becomes a nuisance to keep the intraop record open because it limits the charting that PACU can do (two people cannot chart on the same encounter in the same department). 

Patients love our system. We send text messages to their family members, and regularly call them during cases for updates. They can contact us as well if they want to. Doctors love our system because it is efficient. I love our system because it is efficient and very technologically seamless, plus the ten minutes I wasted walking over to preop to talk to the patient or get report (all of which is on my side bar literally the entire time as it is entered into the system) is just an example of bad time management in my opinion, but my hospital has a large operating budget. We have nice gadgets, flashy tools, and it makes it easier for people to do their work. I can toss a warm blanket over my patients shoulders, smile and chit chat with them over to the bed, or sit with them outside by the window sill and stare at the river if they’re too nervous without having to delay my room to do so (at door time is room time). 
 

Being in other hospitals I can see why many nurses swear by the traditional way of doing it and if you don’t have the resources to do it how we do it then yeah, I get it. But me? I like to get my room ready, mark it as such and receive my patient all with the click of a mouse or the touch of my iPhone. 

[11Blader]

I would NEVER think of accepting a patient in the OR unless I had assessed them myself FIRST. I have more than once found: the wrong name bands on my patient, the wrong surgery on the consent, no blood consent signed, no marks on body vital to do time out AFTER patient is asleep, missing H&P=no clue what this patient's medical issues are, wrong, or missing allergies and allergy band. No blood band on, meaning blood not available for a case where we will likely need it.....the list goes on. Another fav- boxer shorts on a male patient who is having shoulder surgery. When we reposition them to sitting on the OR table for the surgery after intubation, those shorts are like a tourniquet on their junk. I could not make a 'Superstar" One year RN in pre-op understand that concept. She complained that I was 'upsetting the patient' with my explanation, so I was fired from my travle job....ROFL!