Sedated patients in pre-op.

[Mr. & Mrs. RN]

I am an OR nurse, but I have been forced to pre-op many of my patients (I work off-hours). Management has asked that I send for in-house patients earlier as a result of poor turn-over time. However, I also have to set up my room which means I can't spend a whole lot of time in pre-op. There is NO ONE else in pre-op to help babysit when they have a patient to recover. This is fine if the patient is completely with it and has a family member present and a call light. My concern is for the sedated patients or those who are not A/O. What is your take on this? I feel like I am compromising my patient's safety, but I need a good argument to get my point across to management. What would you say to advocate for your patient?

Thanks in advance for any advice.

[GHGoonette, BSN, RN]

I always get SO furious with managers who fail to allocate staff to pre-op. No patients should be left alone to face their fears, especially if they are facing major surgery! As for premedicated patients, it's downright neglect!

You will have to speak to the manager about this; pre-op is all too frequently ignored in determining staffing needs, but it's one of our lines of defense against medico-legal incidents! And precisely who is going to take the blame if a sedated, confused patient decides he needs to get up to go to the loo, and promptly measures his length on the floor? All for the want of a junior nurse to attend to his needs?

Good luck, I hope you can convince the powers that be of the risks they are taking with your-and their!-patients.

[azhiker96, BSN, RN]

I'd suggest getting the most recent standards as published by ASPAN. Notify management of the standards and ask who you can give report to on the preop pt when you leave to prepare the OR. If they know the standards and don't staff appropriately, they'd better hope there is never an incident.

[PaKuRN]

Yes, ASPAN standards are a great reference for this. I do believe that it states one RN experienced in Pre Anesthesia assessment must admit the patient into the holding area. You can not jepordize your license for poor turn over times, that issue is bigger then you and ALL ORs deal with that, there is more in play then waiting on a patient. I suggest that Anesthesia take the responsiblity of monitoring the patiet pre-op while room is being opened. Or have supervisor stay with patient until you are ready to accept. I believe if a patient has an incident in holding you will be responsible, and I doubt the hospital will be behind you, they will claim you as negligent. You must go up the chain of command for resolution to this. Good Luck

[GHGoonette, BSN, RN]

We used to have a dedicated Pre-Op sister, but our current owners (our hospital was sold lock, stock and barrel some years ago to another company-the previous owners were a large health care conglomerate) do not acknowledge the need for pre-op monitoring. We Pacu sisters therefore trained the nurses to do the basic pre-op checks, and critical patients are brought into Pacu for monitoring. More than that we cannot do-we don't have the space. Fortunately our nurses have many years of experience behind them, and are trustworthy with the responsibility. I don't feel it is fair to our patients though, they are paying (or their insurance is) a lot of money for personalized care, but management is only interested in PROFIT!