What is expected of an OR Nurse?

[All4NursingRN]

Hi all!

So this morning I had a patient who needed prompt surgical intervention for an infected leg. Patient was a poorly controlled non compliant diabetic, admitted for drainage of lower leg abscess which turned out to be more extensive into fascia and needed a possible amputation. She arrived from the OR to my SICU due to possible septic shock/DKA, tachycardic and hypotensive. Went back to the OR about 6 hours after for the amputation.

She was on an insulin drip for her DKA and was well into receiving her 2nd unit of blood when OR suddenly called to bring her in. I transport her down the hall to OR holding area on cardiac monitor, with insulin and PRBC in progress and give a brief summary of the patient, her medical record, transfusion slips and rate/titration of her insulin drip.

The OR nurse goes ''oh we don't document transfusions because we don't have access to allscripts, only our OR EHR system 'SIS'' ''Usually they finish the blood''

I stood staring at her baffled, not really sure what she wanted me to do, but to me it almost read as her saying ''we don't take blood transfusions, we don't monitor or rather do any interventions here''

So then I tell her that the patient is on an insulin drip and tell her that I have been titrating it every hour per protocol and she just shakes her head no at me, looking lost. I ask if they are capable of titrating the medication and she says no we don't do that here.

So we stand there awkwardly and I say ''well I can't take her back to SICU, I was told the OR would be starting her case in an hour'' The nurse just shrugs it off and says ''its fine'' and I return to my unit and run this situation by my charge RN who says it's fine, I ask if there are any specific protocols and she said ''not really, they don't really do anything with the patients over there we only send the patient with critical meds like pressors'' But aren't a transfusion and insulin drip both critical? and even still do they titrate pressors in OR holding?

The entire situation made me feel strangely guilty somehow, but then I thought this patient still needs treatment up until and during her time of surgery. I can't stop blood and insulin just because OR holding doesn't deal with that? I truly don't mean to be rude but I feel as though I knowingly put the patient into incapable hands, at least that's how it came across. Would they know how to titrate the insulin? Was the RN really trying to tell me she couldn't monitor a patient of this kind? I really don't know..

I looked it up, our hospital does not have any policy regarding a situation of this kind except that the patient should be transported on a monitor with an RN or MD if need be.

I don't know much about what OR nurses are trained to handle, but I would think that they have some critical care training?

I honesty went home this am, worrying about the patient, if even intra op her blood sugar would be monitored because when I admitted her hours earlier, she came directly from the OR with her insulin bag empty, her glucose was very high, tachy in the 140s and I had to titrate her insulin up high to get the blood glucose down again.

I want to bring this up to my manager just for some clarity, I don't want to get anyone in trouble, but it seems like a grey area. What do you think?

[Rose_Queen, BSN, MSN, RN]

Any critical care patient who has any type of drip other than heparin running, is vented, or has invasive monitoring lines is treated as a direct admission. They will bypass our preop area. The ICU nurse brings the patient to the OR, where the circulator and the anesthesia provider take report and go straight to the OR. No waiting in preop holding for these patients. The OR nurses also don't document blood products- anesthesia does. However, they very rarely are able to finish the documentation in the computer system when it's started elsewhere because the various specialty modules don't communicate with the rest of the system. We still complete the paper documentation attached to the unit of whatever's transfusing.