OK who else is dealing with Universal Protocol?

linda2097 · Dec 13, 2008

:banghead:I am having a hard time dealing with the new Universal Protocol...... marking of patient by the MD only......

As if hunting down the surgeon because there's no H&P wasn't a big enough pain in the butt. Somebody should force Joint Commision to circulate for a few months.

mooneyes65 · Dec 13, 2008

Currently we have so many changes occuring I am lost...and we expect JC to roll in anytime after Monday!!!

They (docs) have to sign, day, time the H&P...HP has to be updated or within 24hrs...THEN here is our time out...(this could be different come monday...lol)

"time out, this is jane doe, patient of dr. x. She is having a Lap. Chole/poss open or she is having left above knee amputation or whatever procedure is....THEN

1. Is she in correct position....(pause for answer from doc)

2. Do we have all our equipment...(pause for answer from scrub nurse)

3. Did she receive preop antibiotics, if so what time were they given...(wait for anesthesia to answer)...document the time given

4. Does she need DVT proph...(wait for doc)

5. Does she need a beta blocker...(wait for doc)....if doc says she already on them...we have to document that...look in chart to see ....

6. Does everyone agree? (everyone answers or gets reported)

Does anyone have issues with the doctors talking, starting, DEMANDING to hurry up...or want the time out done while things are being hooked up and pulled up to the field or just nodding in answer????? We have a few....

I yelled today at the neuro surgeon, "I NEED ANSWERS HERE"....lol

sbnursing · Dec 13, 2008

I am glad its not just me, I swear, I think I'm going crazy. Don't know how much more of this I can take. We had an MD mark ALL OVER a pt's face, he put a big arrow towards a mass he was going to remove, just being sarcastic. Things like that make me so mad. It's the patient that suffers. Time outs are not working like they are supposed to, people are disregarding it completely....don't know what to do!!

MsLeylaBar · Dec 14, 2008

Most of these things have been practiced by our OR for over 2-3 years now so I've come to accept it as part of every day work. We don't take our patients to the OR without consent or H&P or mark on laterality. There is also a form that needs to be signed by a surgeon. The surgeons know that it would just delay their case if they don't do that.

Not sure why these are big changes to your facility, it feels like we have been doing time-out for years now. Every surgeon, anesthesiologist and staff knows this must be done and we all stop and do it before each case starts.

I guess I would be frustrated too if others just disregard it. I do feel that doing these things will produce a safe patient outcome.

Sammy25 · Dec 17, 2008

No freakin kidding I thought we were the only ones with this problem.... it is sooooooo confusing it's like every day we come to work with new sets of rules!!! I mean I have no clue what the "correct" way of doing things are anymore it seems like things change every minute!!!!!! The thing that frustrates me the most is trying to get the SURGEONS to comply and dealing with them when they whine and complain and then refuse to do things...... then comes all the additional paperwork they throw at us to justify our every sniffle..... for example we have always done time outs but NOW we have to state things like

Patient name, date of birth, age

Type of antibiotic what time

Type of surgery, where, and if it was INITIALED.... not marked

Any beta blockers or anticoagulants

What position

If the prep is dry

if the correct x-rays are up or images

what type of implants.... if they are available as well as instruments

Blood products

Safety precautions/patient history

If the surgeons have any comments

Plus we have to do it while looking at the patient's arm band... as well as consent.... while at the same time making sure every eye is on you.... oy THEN we have to mark down the time we did the time out on the patients chart as WELL as fill out a whole lengthy sheet to put in the patients chart everything we said on the time out as well as who was there...... aaaaaaaaaaaaaaaaaaaaaaaaaahhhhhhhh!!!!!

brewerpaul · Dec 22, 2008

Omigawd... we're just so primitive...

Patient's name, procedure, laterality if that applies, and that's it.

You guys have the tail waggin' the dog!

cwazycwissyRN, RN · Dec 22, 2008

I am glad to see a name for all of this........universal protocol I am still trying to figure out why this is so tough for the surgeons.....we have been doing time outs, requiring consents and H and Ps for years.. just stepped up our baby sitting service a bit and I think the surgeons resent it. Hey doc, did you do your job today? do you want to get re-imburstments....(paid for your work today?) I will get my paycheck no matter what you do, the choice is yours, I am just reminding you. I told one of them that a get paid a pretty good fee to baby sit him. OK I said it laughing. At the time I was kinda having fun with the whole thing, now I just do not see why they have to be sooooo resistant to it. The time outs are growing to a 5 min. process. Most of it I can see purpose for. I just start yelling out stuff and people stop and look cause they know I have finally completely flipped my lid.......state all the facts and get on with it. JACHO was at our neiboring hospital and really cracked the whip on them about all of this......later chrissy

FlyOR · Dec 26, 2008

I am a new RN coming from an aviation background and while I understand the frustration of change and concern about time that the new protocols take, but I can tell you where they're coming from. Healthcare is taking a page from aviation with the use of checklists and verification systems. Before your pilots take off they complete checklists without deviation, because if something goes wrong, um, they die too. RNs don't usually have problems with the new protocols, as they're used to checking and re-checking anyway. As most of your experiences reflect, the trouble usually comes from the doctors, whose salary is based on speed and turnover. The good news is, eventually, new MDs will grow up with this training and it will just be a part of their surgical routine. Unfortunately, it has to progress through the veteran MDs who don't like change.

I have to say that even in my woeful lack of experience I often wonder when I see how healthcare works and the resistance to systems that trap errors. For instance, how come there isn't a black box for the OR? Imagine if you went into court and could show that the surgery was routine, all protocols were followed and the doctor was textbook. Wouldn't it serve? Like I said, woefully inexperienced here, but I am interested in how veteran OR RNs perceive these changes. I find them reassuring.

karnit · Jan 2, 2009

Where can I obtain a copy of the new protocol?

brewerpaul · Jan 2, 2009

Omigawd... we're just so primitive...
Patient's name, procedure, laterality if that applies, and that's it.
You guys have the tail waggin' the dog!

Our OR is starting to make noises about starting this stuff too :-(

Don't get me wrong, I'm all in favor of making sure the right patient gets the right operation. It's just that whenever bureaucrats get the germ of a good idea, they seem to carry it to ridiculous extremes. I've been in healthcare for over 30 years, mostly as a practicing podiatrist, and I've seen it again and again.

A syringe washes up on a beach in New Jersey and within no time at all there's a huge raft of new regulations regarding "hazardous medical waste" and whole new, huge, expensive and cumbersome industry is born, despite the fact that there is little credible evidence that anyone has ever been injured by this "hazardous" waste. The rules are often totally arbitrary too: if a hospital doesn't double red bag a single gauze square with some blood on it, they're liable for all sorts of large fines, but a private individual can throw bloody bandages out on the street and apart from a littering fine, there is no punishment.

Sorry, I'm just venting...

Yup, time outs are a wonderful idea, but let's not get ridiculous about it!

Editorial Team / Admin · Jan 2, 2009

We just went from a preincision time out of name of patient and procedure to now we do:

1. a mini time out prior to induction of anesthesia with name, DOB, procedure, and type of anesthesia

2. when the surgeon arrives and is scrubbed:

-name

-DOB

-allergies

-positioning

-procedure

-spiked solutions on the table (baci, hep saline)

-what antibiotics were given and when

-any implants available (if applicable)

The time out itself sometimes seems to take longer than the procedure, and sometimes till I get to the end of the list of antibiotics (because some of our docs order 3-4 antibiotics for one surgery) and the list of allergies, and half of us forgot what we started with!

We are also responsible for telling the preop nurse that yes, implants are available for the surgery.