Prioritizing in the OR

CuttingEdgeRN · Nov 6, 2006

Starting, let's say, a laparoscopic gall bladder case:

Position patient, help with induction, prep.

THEN, (all at the same time!)

place bairhugger blanket

Tie up surgeon and asst.

ground patient

Turn on over head lights

hook up suction, bovie, position foot pedals, hook up gas, light source, camara, suction irrigator fluid.....

call family

In other words you have to prioritize exactly what needs to be done 1st and last, when everyone expects you to do all of these things at the same time! And that is just getting the cast started..... LOL

Janet E Groll · Nov 7, 2006

Prioritizing is really important. First off let me say I do not like to get caught with me pants down at the get go so, the first thing I do for myself is check my patient and their chart. Make sure the preop check list is complete, this one form has alot of info on it. Look for the anesthesia workup because this too will have a lot of condensed info ie: past medical history, abnormal labs, allergies, and such. then I look for my permits, surgical and blood. Then I look for the face sheet to match up the medical record number and the hospital number, and identifiable markers, to include name and birthdate. You would be surprised how often these do not match. Then I look at the history and physical to make sure I have all the information needed to help my patient( I had a case today where the anesthesiologist was about to do an epidural on my patient in the room and I took the attending aside to remind him that my patient had an active aspergilosis that would be introduced into the csf fluid via the catheter during the epidural. He thanked me for knowing this info and from stopping him from making a mistake) Know your Med Surg even if you have to read journals to keep abreast. And have a good repore with your surgical staff( your will be made strong in the operating room.) Next I look at the lab printout and the EKG. I also look for the preop order form, this tells you what kind of antibiotic the surgeon ordered, if a foley needs to be placed, pneumatic stockings and so forth. I then call the bloodbank as a check for me to find out if a sample has been sent off, then I confer with the anesthesiologist, based on the pt's H&H to see how many units he wants either set up or in the surgical suite. The surgical schedule will tell you the special equipment needed like Microscopes, mayfield headrest, steath for example if you are doing Neuro by chance. I like to arrive in my division about 15" early to gather supplies find out who I'm working with and pull any other supplies I may need like suture and drugs and have it all in the room. This sounds like a lot but if I pull what I need, and it turns out my coworker is alittle "lazy" I still spend less time out of the room gathering supplies that they figure I'll get for them anyway. Less traffic in and out of the rooms is better for my patient during surgery anyway. So then while I'm doing my patient check my coworker is opening all the supplies, and when I come into the room it falls into place, you do the best that you can tying up everyone, counting, helping anesthesia, putting the stockings on then the foley, positioning the patient with all agreeing on the proper position and padding( this includes the surgical staff, anesthesia, and nursing) you have to make sure you have done everything to prevent harm to that patient intraop. After positioning then you put the grounding pad on & prep the patient, tie up the surgeons, after they drape you hook up bovie, abc, suction and headlights. Call a time out prior to incision to make sure you have the correct patient and that all involved agree on the site, and procedure. Call for blood products and make sure everyone is taken care of, then you can start your paperwork. (a little clue- when you are gathering your info in holding or ACU, start writing on your paperwork, allergies, past medical problems, surgeons names and anesthesia names, nurses and tech's names. Makes for less you have to write if the case is a short one, where you run the whole time, and you just don't have time to do paperwork during the case.) Remember you are the manager of that room, limits ins and outs of the doors during the case, any distractions ie: talking and phones ringing, make sure you check all your equipment prior to use time so that you are not to blame if the equipment fails and there is a delay in the surgical start.

This sounds like alot of work but after a while you are proficient and surgeons ask for you in their rooms. Not to mention you can be proud and sleep at night knowing you did a good job for that patient. It really doesn't take that much time after you develop a pattern. Always remember--That which doesn't kill you makes you strong.( and they cannot kill you.) You will have fun and you forge close personal relationships with your coworkers, they all spend more time with you than their own families, esp.if you take a lot of call or work in a busy institution.

IsseyM · Nov 7, 2006

Hi everyone! Let me first say I am addicted to this site. I think all you OR nurses have great advice and a tremendous amount of knowledge.
I am starting my orientation in the OR soon and have a question. Everyone says that priortizing is a key element to being an OR nurse. Beside patient safety (which is always the priority), what other things are you prioritizing in the OR? Can you give examples based on how your day goes?
I can't wait to start this new experience. I am still a new nurse (graduated in May) and have been working Med/Surg since June, and unfortunately really dislike the floor. I have wanted to be in the OR for the longest time, so needless to say I am very excited. Thanks for any advice you can give.

First of all congrats on starting your orientation in the OR soon!!! Prioritizing is a very important skill for the OR nurse to have. Like you i'm also a new nurse, graduated in May & went straight into the OR. Its pretty scary but exciting at the same time. There is so much to learn and remember! It might help you to carry a little pocket memo to write your own personal notes. This has helped me a great deal in the OR. I usually have my blank moments. LOL. You got some great tips and examples from Cutting and Janet, thanks for posting this because i'm still in training and trying to learn as much as i can. Don't have advice as far as prioritizing goes, but i wanted to congrat. you and wish you much luck in the OR. Take care and keep us updated.

IsseyM.

shelbywu · Nov 7, 2006

Thanks for the awesome responses! This info will go a long way. It has also made me realize how much I really want to do this and I WILL make it work. It seems like there is so much to do, but at least it is for one patient at a time, not the 7 you usually get on a Med/Surg floor.

Thanks again!