OR_RN

We have our service coordinator pick up a blood slip with the patient info from the circulating RN in the room and our request form completed with the number of units of blood we want in the room. We can order several units and only request 2 RBCs to be brought down, but have other units prepared in blood bank for our patient in the event of an emergency. The service coordinator goes to the blood bank and picks up our coolers and brings them back to the OR for us. We had a few instances of wasted blood, so now we have timers on the coolers that go off 1 hour before they are to expire. The blood bank also keeps track of the coolers, so if the timer is running out of time, they will contact us. We always share the cooler information on a white board with expiration times and EBL, given units, what is left in the coolers, and what is available in the blood bank. We also discuss blood available and in the room in our intra op handoffs, timeouts, and debriefs with all members of the team (surgeon, anesthesia, etc.). The circulating RN and the service coordinator communicate about when the blood is no longer needed in the room and they return it to the blood bank. Our service coordinators have made this a top priority to bring back any unused blood as soon as the case is finished or when the RN asks them too. It's a team effort!

I think someone mentioned this before, but have you tried contacting the CST governing body? Not sure who that is in your state. You could anonymously ask for their policies for scope of practice so you have it in writing. Its really difficult to deal with people who let things slide to make their lives easier, but we ultimately are there for the patients, and don't work for the surgeons. At least at my hospital. There are going to be times we disagree and don't see eye-to-eye, but if you're doing it for the patient and their safety I would hope your management would back you up. Good luck and hopefully your co-workers see why you're concerned with this issue.

It would be like you performing surgery and no one asking why. There is a surgeon there for a reason - they have the training to do so and it is in their scope to perform the procedure after years of training. For a CST to perform surgery (suture, cut tissue) would be what I consider out of their scope, and it is absolutely our job as the RN to question this. I wouldn't think of you as being difficult at all for sticking up for patient safety. You're right that we are there for the patients and we are their spokesperson while they are under anesthesia. If we don't, who will?

I think that was an amendment, but I think this is the current bill passed. I could be reading it incorrectly, but it says "passed" https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201120120AB2561

I'm in California. As far as I know, they are the only people on the team working under the RN's direct supervision in the OR. I've attached the current California CST laws for you to look over. It specifies their scope of practice, but does not include suturing. It says they can cut and prepare suture, but to me that does not include the act of suturing. Try to Google "scrub tech laws" in your state to see if they outline their scope for you. I'm curious to see if this differs in other states. https://leginfo.legislature.ca.gov/faces/billCompareClient.xhtml?bill_id=201320140AB2062&showamends=false

I'm not sure what state you're practicing in, but this would be of concern to me as a circulating RN. The scrub tech works under the RN license in my state. If something were to happen it would be the RN license on the line for the scrub tech working out of their scope, not the MD. I would check with the board of registered nursing in your state and determine whose license they are working under - the RN or the MD?

Since this is a sensitive topic, I'd rather not share the exact specifics at this time.

Thank you for your reply. As this is an ongoing issue, I will keep you all updated as things progress. I am absolutely not willing to risk patient safety or my license.

Your pharmacy sounds amazing! Haha It's like pulling teeth to have them compound any medications for us. Thank you for your advice. I believe pharmacy is also responsible for this especially given the BRN states we are not allowed to do this under our scope of practice.

For the last few months we have had pre-compounded medications on back order and are now being asked to compound the medications ourselves with high risk meds, like Epi. According to the board of registered nursing in CA, nurses are not allowed to do this, but management is saying it is okay. Pharmacy is refusing to mix these meds for us. Has anyone experienced this, and what is your advice?

As an OR nurse, I can tell you that not all surgical masks are the same. I've had similar breathing issues recently and find the cheap blue ear-looped masks are the worst. There must be some chemical in the fibers too that we are reacting to. Our facility tried to change from one supplier to another cheaper supplier a few years ago and many nurses had allergic reactions and a few even had to go to the ER. Try a new brand of surgical mask if you can find one. I really like the HALYARD masks. I have purchased several pairs of the KN95s, which I find to be fairly comfortable, and then put a surgical mask over that. We are all doing the best we can. Stay safe!