scrubs leaving the room before the patient

[tariet]

I have a question to ask. When does the scrub usually leave the OR room? I have noticed lately that the scrub tech's I work with have begun to leave the OR before the patient has left the room. I was always taught that the scrub is the last person on the OR team to leave the room. Anesthesia has begun to "dismiss" them so that they can get a break before the next case, etc... I would love to hear everyones input on this.

Thanks

[otiscokat]

The standard is for the scrub to stay in the room until the pt. leaves. I will sometimes be at the door and take my case cart out as the pt. is moving towards the door. I often give the lunch breaks and our scrubs don't start their breaks until I am in the room. If we have new nurses orientating with the circulater then some scrubs will leave. I think it is a case of having one person the help with pt. problems and one person the run get things as needed. Talk with your manager and check your policy. Often things that seem routine need to be reinforced at unit meetings, without naming names. Anesthesia may have to be reminded the scurbs leaving is againest policy. If the anesthesia provider is new they may not know your policies, even though it should be a standard

[GadgetRN71, ASN, RN]

In my OR, there is no policy for this. We have had scrubs leave the room before the patient has left and it's not a big deal. I do one specific specialty(Ortho) so the possibility that we have to go back in is almost nonexistent. Circulators obviously stay with the patient at all times. Our techs always help us move the patient too.

And it can vary. If we have an unstable patient, then they don't leave.We have an excellent group of staff and we try to do the best for that patient. But, I think there is some wiggle room here. I have no problem with a tech taking their case cart out and catching a quick break if the patient is stable.

[ewattsjt]

At my facility it is a big deal. The scrub is supposed to assist in the transfer of the patient. The patient always is the first priority.

[ewattsjt]

Just playing devil’s advocate---what constitutes a stable patient after surgery. We all know and have seen patients crash in the blink of an eye. How defendable can the tech be if their patient crashes while they were on an unrelieved break? How defendable is the RN who sends the tech or allows it? The team is supposed to respond during a crash, everyone having their jobs that may be as little as grabbing a crash cart (but a big part) or calling out of the room for help while the others administer CPR.

How big could a wrongful death be against the team? As I have posted before, the tech can and sometimes is made an example but in law suites, they tend to go after the docs and nurses more because they tend to have more $$$ and a license to loose.

We have a vascular doc that does not have the techs to stay sterile or maintain the backtable in carotids. His reason is that he always does testing that takes about 45 min. and he wants a new setup if he has to go back. If I scrub with him on one of these, I maintain the field. Part of being able to defend in court is if it is reasonable practice (is it done that way in other areas (sometimes regionally and sometimes nationally). I know that the standard is to maintain the field so I do it to protect the team and every time the doc acts like I am a crazy man because I refuse.

My point is that if something happens can you defend it in a court? If you don’t think you can, then you need to rethink what you are doing.

[GadgetRN71, ASN, RN]

I think it matters too if the facility is a teaching hospital . We have residents in the room, CRNAs, anesthesiologists, SRNAs. If the patient is unstable from the get go, all of these people stick around.

And like I said before, yes there are certain sugeries where you shouldn't pull down the table, ie carotids, T&As etc. But, in Ortho, even if the patient goes unstable suddenly, it certainly won't be for something we need to go back in for. If the patient codes, all the tech can do is compressions, can't document or push meds. They can run for stuff, but like I said before, we have plenty of people to do that. It's moot anyway, because we have great techs -they wouldn't leave in a situation like that. But, in my hospital,in my specialty, they are allowed to leave the room once the patient is moved on to the stretcher in most cases.

Think of it this way, we do plenty of cases where there is no tech at all such as closed reductions, spica cast applications and in the general OR, EGDs, ERCPs Cysto, lithotripsies.In my state, the circulator must stay with the patient at all times, not the tech.

[Scrubby]

As a scrub nurse if there is enough nursing staff in the room while the patient is being extubated then it's ok for us leave. We have to take the used scrub trolley to unload our trays, throw out rubbish etc (we have to do everything ourselves) and this takes time. If we wait around while the patient is being woken up this means the turnover time will be delayed and that's the last thing we need if we want to finish on time.

If there is not enough staff in the room when the patient is being woken up then the scrub stays.

[fracturenurse]

I think it depends on the case...Our scrubs stick around and help move the patient. We have enough staff though that if we are flip flopping to another room there will be someone who already set it up for them. They do keep there back table sterile for vascular, T & A's and such. It drives me batty when you don't have enough people to move a patient because your scrub took off to get lunch. We aren't a teaching facility though.

[mcmike55]

Looks like it really varies from OR to OR.

In ours, the tech often stays until the pt is gone. They typically are finishing up putting the inst. away and picking up trash.

If we need to get a head start on re-running a set of inst, the tech will usually go out ASAP, many times, before the pt is out of the OR.

With big vascular cases, the tech stays in the room, maintaining a sterile field until we are out and gone, and all is well.

In our small rural hospital, it also depends on the time of day, or week day vs weekend.

Mike

[Bearzrul]

While it is considered patient abandonment for the circulator to leave the room, the techs have the same standard - they should not leave before the patient. With the shortages in OR personnel, I have also notice this trend and they/we need to be reminded that we are all there for the patient. Anesthesia does not have the authority to dismiss the tech or any one else in the OR that is not a member of their department. It is a long day scrubbed in (I just came home from an 8 hour case I was scrubbed from the start to the finish and at no time was there any chance to have been relieved due to the critical nature of the case, nor would I have left), I can certainly understand the need to find a drink and/or empty a bladder, but not at the risk to a patient.

[jdg0719]

If its a simple case, like a CTR or Breast Bx, the scrub tech can leave the room if the patient (that is) is looking stable. If its a big case then they should remain in the room with at least the sterile feild remaining intact. In theory the scrub should always ask anesthesia if they can tear down the sterile feild. If extra help is needed for moving the patient, etc; the scrub should be in the room assisting wherever they are needed.