Policy and Procedure Question

[premiern33]

Hello everyone. I work in a very busy orthopedic outpatient OR center and I just wanted to know what is the general policy for having the instruments in the room before the patient comes in.

Our manager many times wants the patient in the room before the instruments come out for the autoclave bc she feels that by the time the instruments are ready the patient will be ready and positioned.

However the techs dont feel that this is right and get very upset if we (the nurses) bring in the patient without the instruments being in the room.

So, in order to clear up the misconception I was hoping someone could tell me which is the correct way and if there is any literature or policy that I can prove it to either my manager or collegeaus.

Also, what is the policy for the time allowed to have the case opened? We are not sure if it is one hour or two. There are times when we run into this situation when the doc doesn't show up on time or a case gets complicated and we throw the packs away since we arent sure if they are still considered sterile or not.

Thanks

[Scrubby]

We have the instrument trays in the room before the case starts. I'm not aware of any AORN OR ACORN standards which say that you can't do this before the case. It wouldn't work at my HCF having them in later because you want all the trays opened before the patient falls asleep, so the scrub is actually ready by the time the surgeon wants to start. We sometimes scrub in before the patient enters the theatre as well, which to my knowledge is accerptable. To be honest here i'm struggling to understand the logic .... having the instruments ready before the patient is asleep and positioned gives the scrub nurse adequate time to count all instruments, set up their trolleys and have all the sterile extras opened. If we didn't do it this way then the extra time to do these things AFTER the patient is asleep would mean that the patient would be under a general anaesthetic much longer.

When we do some ortho cases up to twenty trays can be opened. It would be hard on the scout nurses to help with the positioning, placing diathermy pads on patient, doing paperwork as well as having to rush 20 trays into the theatre simply because management didn't like it.

[ewattsjt]

I am not aware of a rule outside of facility policy that states it in black and white either way.

I can say that I would want the instruments first because of many reasons. One of which is that there is always the possibility of the load not meeting the requirements to indicate sterility (autoclave screws up). Now you have a patient anesthetized and no instruments to do the procedure with, so what do you do? You now have the patient (unnecessarily) gassed and are charging them for OR time while you wait for another cycle. I could go on and on with the scenario of not having instruments, equipment etc… in the room first.

[mcmike55]

I think we are all thinking along the same line.

I also, don't know of any AORN recommendation about setting up instruments in relation to when the pt is brought into the OR.

I would think this is an individual institution policy.

I also agree that not having the instruments open (and set up) before the pt is put to sleep is a risky venture. Look at all the possible problems, incomplete sterilization, missing/brokens instruments, etc, all of which could mean cancelling of the case.

I would not want to be the one to explain to a pt in the recovery area, and family, why we put the pt to sleep, THEN cancelled the case.

I just think the risk vastly outweighs the benefits.

Now, I must say that is coming from a hospital based RN, not one who deals with the problems of running a free standing surgical center. I've not walked in your shoes, so hate to pass judgement, but..........

Where I work, especially for total joint cases, our techs scrub in early, and set up everything, making sure all the "pieces parts" are there and everything works.

Then the pt is brought in.

There's my

Mike

PS as far as how long to set up ahead of time, I think you'll find several old threads on that. AORN may have something on that as well, I can't remember.

Our rule of thumb is just before the case, however if we need to postpone for a little bit (for an EKG, etc) as long as the room is protected from traffic you are good. I believe it's good, with someone watching it, for as long as your longest normal cases. Think of it. If you say you must break it down after 3 hours, but you have a 4 hour surgical case in progress, do you stop and break it all down and redrape right in the middle?

Mike

[justjenny]

Where I work, especially for total joint cases, our techs scrub in early, and set up everything, making sure all the "pieces parts" are there and everything works.

Then the pt is brought in.

Our rule of thumb is just before the case, however if we need to postpone for a little bit (for an EKG, etc) as long as the room is protected from traffic you are good. I believe it's good, with someone watching it, for as long as your longest normal cases. Think of it. If you say you must break it down after 3 hours, but you have a 4 hour surgical case in progress, do you stop and break it all down and redrape right in the middle?

Mike

Agree with above post

Keep in mind that I am brand new to this, but I was taught that you open the packs and your scrub tech scrubs in and sets up just before the pt is brought in (counts are done, etc)

Your packs can stay open and are considered sterile as long as the field is constantly MONITORED. Just limiting traffic and/or "taping" the doors is not acceptable - the field must be actually monitored by someone with the rationale that a sterile field not watched cannot be guaranteed to be sterile..if something contaminated it who would know? A fly could find its way into the room....think about it.

Also, long cases are considered sterile...even if they are 10 hours or longer...so why couldn't a monitored field sit for 10 or more hours?? The reality is that it is not practical to tie up a person and room for a long time just waiting.

Jenny