Are these practices typical in your department??

TakeTwoAspirin, MSN, RN, APRN · Dec 26, 2012

Sounds very much like you're in a surgery center rather than a main OR. Although none of this is good, I have seen similar things in surgery centers (of course, not ones I would want to continue to work in). Some of these are clearly wrong, and I wouldn't be bullied into any lack of standards when it comes to the sterile field, counts, etc. Best advice I can give you is to raise your concerns with the agency, and get out of this situation.

SkipBeat · Jan 1, 2013

A surgery center would not have a critical care unit to pick patients up from. Sound like you work in a facility with a weak nursing voice and bad management. There should be a policy that clearly specifies when to do a full instrument count, and there really should not be an argument if anyone wants to do a full count for any reason. Sound like you need to fly as soon as your contract is up.

Editorial Team / Admin · Jan 1, 2013

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[TD=class: msgtxt] What are your thoughts regarding the following?
-Circulator being responsible for locking up anesthesia carts at the end of shift/ turning over for anesthesia provider between cases

Somebody has to do it. The OR environment should be a team environment. Does the circulator do this facilitate the anesthesia provider interviewing the next patient and obtaining informed consent for anesthesia? Is it included in the expressed duties of the circulator? What is management's rationale? Are supplies that the RN uses kept in the cart? (We keep our prescription pads locked in the anesthesia cart so that they are locked up per regulations but in the room for easy availability.)

-Circulator & surgical tech picking up patients from units for surgery (sometimes leaving sterile set up unattended)

Totally against AORN standards. The preoperative unit should be responsible for picking up patients from other units, with the exception of critical care patients who are not appropriate for the preoperative unit. In that case, one person should remain in the room to ensure sterility of the setup.

-Anesthesiologist refusing to assist with transporting intubated patients from critical care to OR

Depends on facility policy. Anesthesia doesn't help with transporting patients for tests as that is the responsibility of the respiratory therapist; the same may apply to transporting patients to the OR. Not really team playing, but that may be the way the facility wants to use their staff. Personally, I would rather the anesthesia provider help transport as they are familiar with the anesthesia machine and how to properly get the patient hooked up to everything.

-Lack of nursing assistant or operating room assistant to help with positioning, holding extremity for prep, transferring from patient bed to OR bed

Is it a lack of assistants being hired or that they cannot be found? If it's the former, then you need to rely on teamwork to do such activities safely- some places simply choose not to have such staff in order to save money. If it's the latter, it needs reported to the supervisor and dealt with through disciplinary channels.

-Having to stay over 1-2 hrs after shift is over to complete procedure (because there is no relief)

Are call assignments made and inadequate? If so and it's a routine occurrence, then call staff may need to be beefed up. If it's just once in a great while and management did their best to address the situation, then I don't mind. What is the reason for the procedure going late- surgeon late, cases not scheduled appropriately, reasons like this should be reported to management and addressed.

-Lack of sponge counter bags

Some places use them, some don't. I know that if I have a procedure where I only expect a few sponges to be used, I don't bother with the sponge counter bags. If I've got two raytec off the field at the end of the procedure, I can easily count them while they're draped over the edge of the kick bucket. Now, if I have more than 10, yes, I want those sponge counter bags.

-Having to debate with staff about counting instruments on abdominal procedures

Always follow the facility policy. Print it out and point out the specific part of the policy to the scrub if necessary- but remember that not all abdominal procedures actually involve going into the abdominal cavity and, depending on facility policy, may not require an instrument count- we also don't do a post-procedure instrument count on abdominal laparoscopic cases, just preop in case we have to convert to an open procedure.

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Editorial Team / Admin · Jan 1, 2013

What are your thoughts regarding the following?
-Circulator being responsible for locking up anesthesia carts at the end of shift/ turning over for anesthesia provider between cases

Somebody has to do it. The OR environment should be a team environment. Does the circulator do this to facilitate the anesthesia provider interviewing the next patient and obtaining informed consent for anesthesia? Is it included in the expressed duties of the circulator? What is management's rationale? Are supplies that the RN uses kept in the cart? (We keep our prescription pads locked in the anesthesia cart so that they are locked up per regulations but in the room for easy availability.)

-Circulator & surgical tech picking up patients from units for surgery (sometimes leaving sterile set up unattended)

Totally against AORN standards. The preoperative unit should be responsible for picking up patients from other units, with the exception of critical care patients who are not appropriate for the preoperative unit. In that case, one person should remain in the room to ensure sterility of the setup.

-Anesthesiologist refusing to assist with transporting intubated patients from critical care to OR

Depends on facility policy. Anesthesia doesn't help with transporting patients for tests as that is the responsibility of the respiratory therapist; the same may apply to transporting patients to the OR. Not really team playing, but that may be the way the facility wants to use their staff. Personally, I would rather the anesthesia provider help transport as they are familiar with the anesthesia machine and how to properly get the patient hooked up to everything.

-Lack of nursing assistant or operating room assistant to help with positioning, holding extremity for prep, transferring from patient bed to OR bed

Is it a lack of assistants being hired or that they cannot be found? If it's the former, then you need to rely on teamwork to do such activities safely- some places simply choose not to have such staff in order to save money. If it's the latter, it needs reported to the supervisor and dealt with through disciplinary channels.

-Having to stay over 1-2 hrs after shift is over to complete procedure (because there is no relief)

Are call assignments made and inadequate? If so and it's a routine occurrence, then call staff may need to be beefed up. If it's just once in a great while and management did their best to address the situation by finding volunteers to stay, then I don't mind. What is the reason for the procedure going late- surgeon late, cases not scheduled accurately, reasons like this should be reported to management and addressed.

-Lack of sponge counter bags

Some places use them, some don't. I know that if I have a procedure where I only expect a few sponges to be used, I don't bother with the sponge counter bags. If I've got two raytec off the field at the end of the procedure, I can easily count them while they're draped over the edge of the kick bucket. Now, if I have more than 10, yes, I want those sponge counter bags. Makes it much easier for accurate counts.

-Having to debate with staff about counting instruments on abdominal procedures

Always follow the facility policy. Print it out and point out the specific part of the policy to the scrub if necessary- but remember that not all abdominal procedures actually involve going into the abdominal cavity and, depending on facility policy, may not require an instrument count- we also don't do a post-procedure instrument count on abdominal laparoscopic cases, just preop in case we have to convert to an open procedure.

SRNA4U, BSN, DNP, RN, CRNA · Jan 28, 2013

In our facility, the anesthesiologist always goes to the icu to assist with transporting the pt to the OR.