Sammy25

yeah I think we have almost adopted a "no-tolerance" to flashing.... that it is not for convenience but for an emergency. There have been times where cases have been delayed hours because turnover issues or there is a hole in the wrapper, ect. I just want to see if this is a universal issue or if other facilities have the same policy... they say it is a JCAHO standard, but it seems like from previous posts no one else is adopting this policy

Just curious as to your OR flashing policy... We cannot flash any kind of instrument or tray unless something we need is dropped during the case or is somehow unsterile and the patient is already in the room. We cannot flash for turnovers or before the patient is in the room whatsoever. This has kind of caused some frustration in our OR because sometimes we have multiple cases requiring the same instruments, and in some instances we only have one set that needs at least a couple hours to process, so cases can be delayed. Our facility states it is JACHO policy...

LMAO!!! Don't get me wrong.... I do like my manager however the whole place is going crazy nuts over this whole universal protocol thing and Joint Commission and it's getting most of us confused on what to do and what not to do... things are changing all the time.... I just think some things are going a little too overboard to make sure we are doing everything "perfectly".... like the whole new flashing policy we were discussing earlier ...

Nope this goes for any type of tray or instrument. In this case it was a reamer tray... no implants. we spoke with our manager and head surgeon and they both wouldn't allow a flash to be done.

Okay so I am a little confused about the whole "flashing" thing.... they tell us that is not recommended we flash instruments and that we do it only when we "need" to because of patient safety and preventing infection..... then why do we do it at all if it's "not safe?" We have a policy in the OR that if we open a tray that has been contaminated or has a hole in the wrapping BEFORE the patient is in the room that we either have to call for a new tray or if we don't have another one... the tray has to be sent back down to be cleaned and reprocessed (which takes over an hour) and the case has to be delayed. HOWEVER if the patient is IN the room the tray can be sent down to be cleaned and then flashed. I don't really get the meaning of it..... Recently we had a case where I was bringing the patient to the room and right as we were about to open the door they tell me to bring the patient back to admitting and had to delay the case because there was a hole in the wrapper of a tray we needed and when they called for another tray that one ALSO had a hole... so we had to call for a tray to be sent from another campus so we waited another forty minutes and when we got the tray that one ALSO had a hole in the wrapper so the patient had to wait another two hours before the case could start so we could process the tray because we had none left..... however if we had entered the room two minutes before we could have continued like usual and flashed..... aaaah! sorry if this was long and confusing.... Any input?

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!!!!!

Where I work... time outs lately have been a HUGE issue it's been crazy nuts!!!!!!! First the patient comes in the room and we ask them to identify themselves and what they are going to have done After the patient is draped and ready we have to make sure EVERYBODY is looking directly at me and the time out consists of Patient Name Date of birth and age Type of surgery and what side Is the site marked? What kind of antibiotic and if it was given If the patient received any beta blockers or anticoagulants What position the patient is in If the prep is dry Allergies Any safety measures taken depending on patient history Are the correct x-rays or images up Blood products (are they available) What kind of implants are being used and if they are available in the room Do we have all the correct instruments/trays Any questions/comments? On top of that we have to write down the time we did the time out on our OR record.... plus fill out another whole sheet checking off every aspect of the time out as mentioned above.... plus write who was in the room at the time

I work at a same day surgery facility.... however I don't know if we can be called that because half of our patients are inpatient...oy... and we are mostly an ortho hospital so we do lots of totals.... well anyway... we generally have a great team and we try to reduce turnover time as much as possible... so we try to keep it under ten minutes. Usually there is a team of people that stream in after the patient leaves to clean up and open the next case... so by the time I take the patient to the recovery room, I can go to admitting and get the next patient right away. Even for difficult ortho turnovers which we do A LOT... we can go from general surgery to a total hip within minutes. For ENT, we usually have two RN's in the room so when one nurse brings to recovery, the other gets the patient so turnovers are even under three minutes. The other day, day we finished 14 ENT procedures by 1400, one surgeon had six cases (4 total joints 2 scopes) done by 1600 by flipping two rooms, and one room had three total joints and one scope and finished by 1500, with start of the day at 0700.

Hee Hee that reminds me of a couple weeks ago when I was scrubbed in a revision total hip case where I started my period in the first half an hour of the case.... not fun... spent the whole time PRAYING and crossing my legs hee hee... plus I couldn't leave because it was a total case. Thankfully it wasn't that bad and nothing was showin through at the end (lasted about two hours). But the circulator seemed to know what was up and laughed as a ran cross legged out the door.

Yes, it is very important to prevent ANY type of alcohol based prep from pooling on the skin, under the patient, or under the drapes. It is also important to make sure that the alcohol based prep (prevail, duraprep, ect) is completely DRY before draping if using electrosurgery or cautery. Vapors from the undried prep underneath the drapes ... mixed with the spark from a cautery tip... plus high concentration of oxygen equals danger. At our facility it is mandatory that we add prep dry time to our time out.... as well as document the time the alcohol based prep was applied to the time it dried and drapes were applied.

Hey everybody! I am just curious to find out what you guys think is the most challenging and difficult area of OR nursing for you whether it is Neuro, Cardiac, Ortho, ect, ect, in regards to training, equipment, prep, instruments and whatnot. Thanx!:monkeydance:

I've seen lots of posts on this site about new OR nurses trying to cope with orientation. It seems like people who have worked in the OR their whole lives sometimes don't see the whole picture and expect fresh new grads to think and work like they have been their 20 years, and that really frustrates me! I know that doctors and nurses want things to go fast and proficiently without disruption in the room, but it takes a lot of time, and I mean A LOT of time for a circulator or scrub to get used to things, and that does not give any excuse for yelling, cursing, or even rolling their eyes at them, which I have seen way too much. I know it can be frustrating, but they are trying, and it just produces frustration, anger, and additional stress for everybody. As an RN, we don't have an "operating room" class in nursing school so when we come in we have to learn a whole new language. My suggestion is that when a new RN comes in, that you get to know them and help them out... and here is some other suggestions to help them learn and develop their skills...and to save time especially for those scrubbin in.. 1. When getting the room ready, explain things as you guys open. Tell them what kind of instruments you are currently opening and what they are used for. Point out and name items on the cart that they possibly need opened during the procedure so when asked for them they don't get confused and are searching around. 2. When asking for something, say their NAME and SPEAK CLEARLY, don't just muffle out words. Even though we are trying to tune in to you guys, voices can be muffled behind masks and we don't know if you are having a conversation or asking for something. Also, we might not understand names of instruments you are asking for and their names can be funny...like "tenotomy, or debakeys, or other weird names so be clear and articulate. 3. Also when asking for something, tell them where to find it and describe it. Tell them what it is and if it's on the cart, in the closet, in the core, or if you need to call down to instruments. When I was new there were many times when the scrub would muffle something I didn't understand and would roll their eyes at me when I asked them to repeat it...and then yell at me when I couldn't find it right away... and then roll their eyes again when I gave it to them.... yea please don't do that it makes us feel like "you know what" If you guys have any other suggestions please feel free to post them here! Sara Beth

Nice to hear that you got in.... I was very happy when I got my acceptance letter..... but I hope that you have a much better time in nursing school than I did... and let me tell ya I am soo glad I am done... good luck with the ENDLESS hours of CARE PLANNING...(dreadful, dreadful, aweful things), classes, studying, studying, and more studying, as well as the 8 - 12 hour clinicals!..I did two 16 hour clinicals as well during preceptorship. I think when I first started nursing school in full gear (after spring) the teachers actually told us in class to prepare for no social life in order to do well.... however..... it is well worth it in the end! The pride you get from finishing, and especially realizing that you have your degree AND that you passed those wonderful boards.... I can't explain the feeling!

It's exciting to hear about your interest and enthusiasm in the medical field. I would highly recommend also that you go through CNA training. Volunteering is also a great choice, but I hear your looking to gain some experience in working with patients, taking vitals, ect. Volunteers are not qualified to do many of those things, and being a CNA really lets you work with the team as a whole and you will learn a whole lot about patient care and assessment and how things are run. I also think that doctors who had experience working as CNA's make the absolute best doctors regarding the treatment of patients and bedside manner! Good luck to you in the future!

Yeah I definitly agree that there needs to be more information to the question..it looks like the STEM of a question, and not the whole...if that was the only information provided in the question. one would have to go through the general ABC's, and circulation is definitly a priority.... I agree for some clients a heartrate of 56 is normal... so if the patient is doing fine and not feeling weak, dizzy, ect and the pulse has been at a steady 56, then the weight gain needs to be reported. If the client's pulse dropped significantly to 56 in the last hour, then the HR needs to be reported stat.

As for the questions that were asked, they were mostly PRIORITIZATION, and I was concerned about that throughout because I thought maybe I just wasn't answering them right...they seemed to go on forever and ever! Other than that, only two were OB, very few medication questions, and I don't recall many questions on things like cardiovascular, respiratory, ABG analysis that I was hoping for because I am very competent in those areas! But..thanks for the reply and I will keep posted on the results... I will be on my toes for the next couple days!

I just took the NCLEX-RN this morning for the first time. I started really "prepping" for the test about a month ago..just going over some of the major material that I needed brushing up on from school and lots of practice questions. I aced all of the practice tests that I took, and wasn't too worried, however when I went today to take the test...it turned out to be so much different from the practice that I did. I am very worried it seems like after the first ten minutes I had no clue if I was answering the questions correctly or not! I have absolutely nooo clue if I passed or not! The computer shut off after about 130 questions...would that mean anything? Plus I finished in only an hour and a half... before anyone else in the room did... so I am really concerned. How did the test go for you guys? Were anyone of you in the same situation as me and passed? I am crossing my fingers!