Question for nurses here, especially OR ones

GadgetRN71, ASN, RN · Jul 21, 2007

I'm hoping someone can help me here. i'm sure you don't have to work in the OR to know it, i'm just a student but anyway,
if a patient who is heading to the OR refuses to remove their ring on their finger, do you as the nurse just
1) "note the presence of the ring in the nurses notes session of the chart" OR
2) "does the nurse explain to the patient that the hospital will not be responsible for the ring or her finger"
Thanks nurses.

The last place I worked had a jewelry waiver that the patients had to sign if they refused to take the ring off. It outlined the possible problems that could occur(risk of burns from the electrocautery, edema, risk of infection etc) and we had to explain this to them, they signed it and it went in the permanent chart. I think most OR's have something similar.

shodobe · Jul 21, 2007

Over the years I have had a personal policy for women or men to leave on their wedding rings, but only after they are explained the risks that come with leaving them on. Also, the liability lies with the patient and not the hospital. All other jewlery MUST come off, no excuses! Most patients will understand and the real problem lies with the nurses on the floors that allow this to happen. They do not want to fight with the patient over this issue and send the patients to us in the OR to deal with. Time consuming and just wrong on their part. Almost always after careful explanantion to the patient they will remove all rings, neckalaces, studs(ears, nose, eyebrow and yes even clitoral). The only problem with this now we become responsible for all of this hardware and must find a way to get rid of it. For example, just last week I had a patient down late one evening for a minor procedure. She was a rather large person and was in bed with her covers up over her body up to the neck. She pulled down the covers to show me the location of the surgery and lo and behold she was a walking jewlery store! She had at least 12 bracelets on, 6 necklaces and a ring on every finger! She had first told the nurses on the floor that she was not taking any of these off. After I talked with her she removed every item except one ring. The biggest problem was we had to call security and have everything logged and signed for BEFORE we could do the procedure. This delayed the surgery for 30 minutes. Nurses on the floors need to be more aggresive when it comes to this problem. I am in the process of writing a new policy for getting patients ready for the OR that will be followed to the letter of the policy! NO patient will brought down to surgery until all jewlery is removed or at least attempted to be removed. Our aides that go for patients will be trained for this, so hopefully it will take care of a very nasty problem. I just don't know why people come to the hospital with very expensive items only to have them "disappear". I also have never heard of a waiver for jewlery in all of my 30 years. I wouldn't want it because I don't even want to patients that option. Sorry, I'm "old school" and can be kind of a harda*s about these things.

suzanne4, RN · Jul 21, 2007

I agree with Mike 100% on this. No jewelry means just that. I will permit one wedding band and that is it. All piercings need to be removed, if needed a piece of string can be placed by the patient before they come to the OR. But getting a burn from the bovie in one of those areas that can have piercings is not a pretty picture.

I once had a patient come to the OR with more than 70 hairpins in place and she was having a AAA done where high cautery levels were going to be used. They were removed once she went to sleep. Just is not safe to do it otherwise.

GadgetRN71, ASN, RN · Jul 22, 2007

Well, obviously the ideal is to have them take everything off but every now and then you get a patient who absolutely refuses to take off jewelry..of course we explain to them if we need to cut this piece of jewelry off in an emergency, then so be it. It's also on the jewelry waiver. I'm surprised that more OR's don't have waivers..it's a legal document(per the hospitals attorneys) and it gets witnessed much like a consent. The wording absolves the hospital of all responsibility should something happen. Actually, I can count on one hand the amount of times I've had to use it-most people are pretty reasonable. And as far as offering them the option of the waiver...I only bring out the waiver after I've pretty much pressured them(nicely) to take off the ring or piercing-I don't mention it first thing. Suzanne, you're right, there are options to use so the hole doesn't close..I had my appendix out 7 years ago and managed to keep my tongue piercing in..it's a plastic type thing you put in place of the piercing-I think the brand name is called No See Ums. String can also work for other piercings.

suzanne4, RN · Jul 22, 2007

Plastic piercings and I have no issue with those. But large steel balls and that is what is going to come out. Especially if they need to be intubated, anesthesia will not leave it in. And unfortunately, that is what many patients come in with.

Also seeing issues now when the patient has contact lens in place, and does not tell anyone about them, and usually state that they have nothing in. Then they go to sleep, and wake up with a corneal abrasion. Patients need to take some responsibility for their care, and if they do not admit to something, then they should be held liable for it, not the one providing their care.

Proverbs 16:3 · Jul 22, 2007

So, if the patient refuses to take it off, do you tape the ring securely to their finger as a safety measure? I mean if the person persistently refuses, i don't think you can tell them the hospital is not responsible for their ring or finger because i think the hospital is responsible for the finger, maybe i'm wrong - i'm still learning

. So i'm what i'm wondering now is do you tape it if push comes to shove?

Thanks to all you pros out there for your wonderful contribution

elcue · Jul 22, 2007

jewelry in the or is one of the banes of my existence! our outpatient admitting (and inpatient unit) nurses are very casual about this. i do insist on removing it. in the cases of lols who have never had their wedding bands off in 60 years, i tell them about possible edema from fluid intake and implore them, "it would break my heart to have to cut it off your finger after all these years. how about if your husband/child, etc wears it for you while you're in surgery". usually that does the trick. in the case of religious medals they don't want to part with, i have bagged & labelled them & secured the little bag to their pillow; that has seemed to comfort pts.

if they still refuse, a quick nurse's note about your explanation to pt & their continued refusal to remove it is a good idea.

frankly, i have never understood what good it does to tape a ring, and if i'm concerned about edema, i prefer to be able to see the hand/finger.

regarding contacts, i always ask about them specifically. i had to dig contacts out of a comatose patient's eyes when i was working on the floors years ago, and will never forget it. she'd been with us for weeks and no one knew she was wearing them. i have recently noticed some anesthesiologists allowing pts to wear extended-wear contacts into the or.

in 23 years in the or i have never seen a jewelry waiver. maybe just another annoying piece of paper to deal with, but maybe not a bad idea! :idea: .linda

shodobe · Jul 22, 2007

The only thing that taping does is hold any settings in so they don't fall out and get lost. The poor patient I mentiomed in my previous post had EVERYTHING TAPED! It was miserable for the patient having to remove the tape before removing all of the jewlery. Every once in awhile I do have that patient that will absolutely refuse to take a ring or whatever off and you deal with this on a case by case basis. Luckily this only happens once in awhile. I guess jewelry waivers would be a good idea but only as last resort and not to be given as an option to patients. Most will sign and you'll be left explaining to them later about the burn they have because of their stubborness.

GadgetRN71, ASN, RN · Jul 22, 2007

Plastic piercings and I have no issue with those. But large steel balls and that is what is going to come out. Especially if they need to be intubated, anesthesia will not leave it in. And unfortunately, that is what many patients come in with.
Also seeing issues now when the patient has contact lens in place, and does not tell anyone about them, and usually state that they have nothing in. Then they go to sleep, and wake up with a corneal abrasion. Patients need to take some responsibility for their care, and if they do not admit to something, then they should be held liable for it, not the one providing their care.

I agree with shodobe that it is a pre-op education issue, and that patients need to be held accountable, as well as the nurses where we are receiving pts from. I have had fully dressed pts come up from the ER-we've all done incident reports that go nowhere. I've also seen the contact lens thing. It's frustrating.

passionate · Jul 22, 2007

Follow the policy of your hospital. We don't have one so I request they take off all metal jewelry. If a ring is too tight I help them with lotion, dental floss to remove or whatever. We have a ring cutter as well. It is amazing how that ring which never before budges is easily removed when the cutter is presented. This is a safety issue--metal is bad and burns do occur. A burn can lead to a spark which can lead to fire which causes death for not just my pt. but me. I love my patients but die for them? Hypothetical and dramaatic I know but..sigh............

Taping jewelry give you peace that the stone won't be damaged, etc. but bottom line, metal still touches the skin. Patients should be requested to leave all jewelry including watches at home. Our day surgery nurses are wonderful enforcing this at the time of the pre-op call. Stand up for this practice because you are standing up for the pt. If they choose to not comply then do get a waiver. I have even switched assignments. Dramatic--yes. Have I seen bad things happen when jewelry is left on? Yes, a religious medal was left on and taped to a pt. chest once and there was a burn and blistering under the tape. The tape?---maybe but still an incident report was filled out and the outcome indicated the nurse who worked up the pt. was responsible. :uhoh3:

Proverbs 16:3 · Jul 24, 2007

Thank you all very much. Hopefully, i'll be seeing some of you in the OR soon and hopefully we'll have a patient who would be willing to take their wedding band off:)