Moving patient's in the OR

HelenofOz · Mar 22, 2009

I work in recovery/PACU so shall give you an answer from our end.

Our pts are transported to OT on their own beds, the bed sits outside that theatre during the case, then the pt is transferred back onto their own bed directly from operating table. The method for transferring pt from table to bed is to use the sheet that is under the pt on the table and a pat slide. We remove that extra sheet from under the pt during their stay in recovery if they are staying as an inpatient, if they are a day surgery pt then no, as they will usually be out of bed within the hour.

I can remember working on the wards many years ago & pt's were taken to & from theatre on gurneys. Not so bad on the way there, but on the return to their room they had to move/be moved from (warm) gurney to (cold) bed and any analgesia that had been given suddenly seemed to stop working! And how often was there enough people available to help.

As to coding them on a bed or a stretcher, is it any different to coding them on a bed in ICU, or in their own room. You just do what you gotta do and hope you've got good help.

nw31705 · Mar 22, 2009

I do agree we do what we have to do, but i feel that depending on how much room you have in the OR bringing the beds down can be accomplished.Some days recovery have already sent for the beds and there is no room to even put the stretcher the patient came off of. We have a serious issue with space. Jacho says we have to have everything on one side of the hall but we barely have room to put things on both. Where i use to work it was against policies to bring a bed to th OR. If a patient came on a bed by the end of the case there was a stretcher outside the roomand that hopital has 19 rooms and it is pretty spacey. They said it was for safety reasons and that stretcher were easier to transport in the event that a true emergency did occur and the deparment had to be evacuated and it also saves space. I don't know about where you work but half of our beds don't even roll straight they have a mind of there own, and the beds we have can't even hardly fit through the doors you have to turn them side to side while you are steadily bumping the wall with the patient on it. It is realy a pain. Sorry I know it is much easier for PACU but all of the nurses in my OR hate it. I've been a patient in the OR 4 times for open abdominal surgery and I had to move to my bed where I had my procedures done and to tell you the truth I can't really remember it. Well it looks like ya'll have a good system I wish we could work out something better.

Editorial Team / Admin · Mar 23, 2009

If a patient is coming to surgery as an inpatient, I would almost rather have them in the bed than on a litter. The community I work in is not exactly one of the healthiest, and several of the patients are obese. Our litters are only rated for up to 350#. Plus, working on second shift we see a lot of ortho procedures. I don't know about you, but if I were in bed with a hip fx in traction, I sure as heck don't want the traction taken off and be moved to a litter to go to surgery.

That being said, we wrap a draw sheet around our rollers to move patients, unless they're peds and can be easily lifted. As to coding a patient in bed vs liter, the beds seem much more stable when doing compressions, and I would be more concerned about having enough help with the limited staff than what they're lying on.

nw31705 · Mar 23, 2009

That indeed is true staff short and it's not the bed that they are lying on that I have the issue with it's the green towel that is the problem.Yes I would rather place fractures and lumbar cases and such on a bed, but as you said yourself with the limited staff who's going to come take the green towel from under the buttocks of the 80 year patient whom we've just finished doing a debridement on her foot from under her butt so we want have to later debride that too. I'm sure you know and understand where I am coming from. I use to be a supervisor in a nursing home and we had this one patient that if you rubbed on her skin too hard it tore. Those are the kind of things that keep me up at night not the bed that they are lying on. That is the least of my concerns. As i am sure you do know medicaid and medicare is no longer paying for hospital acquired pressure sores. The person in the above response mentioned they remove the sheet in recovery, well that does not happen where I work. So therefore if they are transfered onto thier bed post-op with a green towel it stays until God knows when verses if they are put on a stretcher. I can rest at not knowing that when they were transpoted up stairs to the floor they had to move to their bed and that little green towel that they love so much was left behind and that's why you take a roller with you when you take a patient to the floor. I've been a floor tech before and had help with patient's coming from the floor I know how hard it can be, but there is a solution for everything, but #1 we should be concerned with the benefit of our patient's not with the bed or the stretcher. The big hole they might have in thier behind should be the main concern. Just the other day one of our nurses had to transport patient's for recovery because we are so short staffed and she asked me have you ever took a patient to the floor by yourself pushing a bed with an IV pole. She said she that she was going to have to take the patient back to surgery she hit so many walls. There are advantages and disadvantages to this. I could give you many many senarios were bringing a bed to the or for all inpatients can be a saftey issue. I'm still trying to figure out what we're going to do with all the beds before JACHO COMES SINCE ALL THE FIRE EXITS ARE BLOCKED EVERYDAY WITH BEDS.

Editorial Team / Admin · Mar 23, 2009

Is a green towel the only option you have? We have shelves with all types of linens in our subrooms, including draw sheets that are used for all patient transfers if the disposable lifter on the bed isn't clean and dry.

As for the beds in the hallway, are they requesting beds for every patient for the day and all of those beds are there at once? We have a spot outside of each OR designated for either a bed or a litter, and only the bed or litter for that particular case should be in the hall. If a patient comes in from outside the hospital for surgery and goes back in a litter, but will be going directly to the ICU, we get a bed for them. When the bed arrives the litter MUST be removed.

As for blocking the fire exits, perhaps an anonymous tip is in order?

nw31705 · Mar 23, 2009

That is a good idea. This place is just not open to change. I am doing an inservice tomorrow about this and hopefully it will give them some kind of insight i'm talking about the sheets.as for the beds, yes they do get them all because that's when the staff has time to get them and our neurologist want do surgery if we don't have beds out side the room for all their patient's even the ACD&F. They take up all the room. We are now storing beds in holding after the firdt cases start because of space. Also do ya'll have mop buckets outside the rooms also. The green towels are the option they chose because they are lazy. I don't use them I keep sheets in my room I hide them and I do not allow my patients to be moved with a green towel that's a NO NO.

lindaloo51 · Mar 24, 2009

It seems we all have the same problems. We have tried a lot of different things. (long rollers, short rollers, slide boards, plastic bags with a towel) The very best that we have found is something called air pals. It is an inflatable moving device that is put on the OR table before the patient comes in the room. It is covered with the usual linens. After the procedure, it is attached to a canister (looks like a vacum cleaner) which inflates the air mattress. It is then easy for only 2 people to move the patient from the OR table to the stretcher or bed. (I'm not sure of weight limit but easily over 400#) The patient is transported to PACU with air pal under them. They are taken out there when usually the patient can help roll themselves. It is then wiped down and returned to the OR. We have been using these for several months and they have worked better than anything else we have tried. Also, no more back injuries for staff.

Fun2, BSN, RN · Mar 24, 2009

We use a draw sheet wrapped around the roller at one facility, and a pillow case wrapped around the roller at the other facility.

If the patient is really little/light, we will just use the drawsheet, if it is still clean.

$fracturenurse$ · Mar 25, 2009

It seems we all have the same problems. We have tried a lot of different things. (long rollers, short rollers, slide boards, plastic bags with a towel) The very best that we have found is something called air pals. It is an inflatable moving device that is put on the OR table before the patient comes in the room. It is covered with the usual linens. After the procedure, it is attached to a canister (looks like a vacum cleaner) which inflates the air mattress. It is then easy for only 2 people to move the patient from the OR table to the stretcher or bed. (I'm not sure of weight limit but easily over 400#) The patient is transported to PACU with air pal under them. They are taken out there when usually the patient can help roll themselves. It is then wiped down and returned to the OR. We have been using these for several months and they have worked better than anything else we have tried. Also, no more back injuries for staff.

Yes, we have them too, hover matts. We used to use them a lot before Hurricane Ike, but he damaged a lot of our cannisters. They do work really well, it just seems like a lot of work. I am always like by the time I get this thing plugged in I would have the patient pulled over on the bed.

Having said that, I once saw a patient get cut on a roller because someone folded a pillowcase and pulled the patient in the same way you described is being done with green towel. I always, always use a draw sheet and if I see someone skimping I tell them about the lady who got a cut on her back, and that does it!

Good luck!