Open heart prep questions

[pcuRN100]

I work on a PCU/IMCU/stepdown with 3 or 4:1 ratios. We are responsible for an extensive chart prep and physical prep of pre open heart patients. They go directly from their inpatient bed to CVOR, and we administer a couple mg of Versed as they're leaving as an anxiolytic. We print and file all pre operative diagnostics in the hard chart and complete multiple paper checklists as well as the standards pre op checklist in our EMR. Then are responsible for clipping, completing CHG wipes x2, setting up blood tubing, placing prophylactic padded dressings, and more for the physical prep. It is very difficult to complete all these tasks when your other 2 or 3 patients are high acuity patients such as ETOH withdrawal, acute GIB needing multiple blood products, sepsis, active chest pain, etc, etc. 

 

My question is, what are practices for open heart preps at your hospitals? What does the chart prep and physical prep look like? Who does it? Do patients go to preop? I've found no literature supporting the way we do it at my facility and so I'm looking for feedback on how others do it! 

Thanks in advance!

[londonflo]

This brought back memories of my time working on a pre op and post op floor in the 70s. Our patients came in the night before choley's, colon resections, hernia repair, etc. The evening shift (which I worked) started getting the paper work together, started the checklist, made sure of the H & P, current lab, etc. It seems to me some of the burden on you could be started the afternoon or the night before. Couldn't supplies be retrieved and put in the room? Couldn't some reports be printed? Of course adding additional tasks to the evening shift may be troublesome as they are dealing with the same 

1 hour ago, pcuRN100 said:

high acuity patients such as ETOH withdrawal, acute GIB needing multiple blood products, sepsis, active chest pain, etc, etc. 

Just a thought....also, do all the preop activities require an RN to do them? 

[pcuRN100]

That's our problem... day shift is usually super busy and doesn't have time to start the process, so it all falls on night shift to complete. Unfortunately, for chart prep, the entire focus is on the paperwork... printing reports and labs that are in the EMR, making sure they're in the hard chart in the right places. The focus should really be on having the correct diagnostics complete and understanding WHY. 

Our CNAs do help with the physical prep such as clipping... but unfortunately we haven't been able to hire CNAs onto night shift in months, so it is not a reliable resource to be able to help or delegate tasks to. 

I'm trying to understand what advantage there is in keeping the patient on the unit to complete the work that preop does for every other patient in the hospital. They pick up all of our thoracic surgery patients such as lungs and pericardial windows by 0500 for a first case and complete the physical prep and chart checks there. I imagine it would go a lot smoother for a nurse in a 1:1 ratio to complete everything in 2 hours than a nurse on the floor with 3 other patients trying to fit everything in overnight between other tasks. It was one thing 10 years ago when our PCU took care of NSTEMIs, heart failure patients that were diuresing and chest pain rule outs that were waiting for stress tests or cardiac caths. Now our PCU is a true stepdown with very high acuity patients, and so it is pretty challenging for staff to manage all of the extra work of a open heart prep with the rest of their workload.

[MunoRN, RN]

Pre-op OHS on our PCU involves the CHG showers/baths except they no longer do the morning-of shower, that along with the clipping is done in pre-op (PACU).  The day before we make sure their pre-op imaging and labs are ordered and done.  There's some education as well.  

It's not really workable to send them through PACU after surgery but there usually isn't any reason why they shouldn't go through the regular pre-op process done in the dedicated pre-op area.

And definitely not setting up any tubing or meds for anesthesia.  You're other patients take priority over stuff like that.