What is your OR Time OUT consist of??

Sammy25 · Dec 17, 2008

LMAO!!! Don't get me wrong.... I do like my manager however the whole place is going crazy nuts over this whole universal protocol thing and Joint Commission and it's getting most of us confused on what to do and what not to do... things are changing all the time.... I just think some things are going a little too overboard to make sure we are doing everything "perfectly".... like the whole new flashing policy we were discussing earlier ... :banghead:

Goerge1717 · Dec 17, 2008

The OR I worked in had the circulating nurse run the time out which consisted of stating the patient's name, reading word for word the procedure as written on the consent form the patient/legal guardian signed, verifying the correct side of the body the surgery will be on, stating the patient's allergies, stating if the patient received any pre-op antibiotics/or if they are currently receiving antibiotics, and stating what family members are waiting for them. The surgeon(s), surgical tech(s), surgical assistant(s), nurse(s), anesthesiologist(s), and really anyone in the operating room suite should all verbally agree that the stated information is accurate before incision is to begin. JCAHO standards are even starting to require that the time out includes whether or not implants will be going into the patient and even what surgical position the patient is in.

baygirl79 · Dec 19, 2008

In my OR, as soon as the patient enters the room I introduce the patient to whom ever is in at the time ask the patient to say out loud the procedure he is having done and the side. Our time out is very basic, consists of patient's name, procedure and side being done and allergies. We do a final check before the surgeon cuts.

I like the idea about hiding the knife............. :idea:

brewerpaul · Dec 19, 2008

I'M NOT WEARING A BRA TODAY!!!!!

Silence fell, and I said "Now that I have your attention, we have Mr Smith, who is having a right hernia repair....">

Love it! Maybe I'll try that. Of course, as a guy, I'd probably get more attention if I told them I WAS wearing a bra... :yeah:

$fracturenurse$ · Dec 21, 2008

OK, so I did a case with a surgeon on Friday. He just had been to the surgery department meeting. He walks in and tells me thathe is supposed to be doing the time outs. Not us. Head of surgery told him they have to do it and state what the patient is allergic too.

shodobe · Dec 21, 2008

OK, so I did a case with a surgeon on Friday. He just had been to the surgery department meeting. He walks in and tells me thathe is supposed to be doing the time outs. Not us. Head of surgery told him they have to do it and state what the patient is allergic too.

That is interesting. Never heard that one, must be unique to your facility. We just follow JACHO rules. It is hard enough to get them to mark the site let alone get THEM to do the time out? Good luck.

I have also hid the scapel!

GadgetRN71, ASN, RN · Dec 22, 2008

That is interesting. Never heard that one, must be unique to your facility. We just follow JACHO rules. It is hard enough to get them to mark the site let alone get THEM to do the time out? Good luck.
I have also hid the scapel!

Actually, the place I'm at now..the surgeon initiates the time out as well. I was used to doing it, because in my previous place, the circulator did it.(see my "bra" story on the previous page:smokin:) I went to do it in this place and the surgeon made it very clear that the docs had to do them.

Fortunately, the chief surgeon of my specialty has made it clear to the surgeons that time outs, IDs and marking of the site have to be done, no arguments. If not, they can get written up and disciplined.

mcknis · Jul 26, 2009

I am looking for another position to get involved in at my facility. We have a circ position open now so doing some investigating regarding circ'ing. I personally have experience with a bad 'time out.' Had my left eye operated on instead of the right! Yes, TIME OUT IS IMPORTANTE!!!!!

Heogog53 · Jul 27, 2009

We have two; one as the patient enters the room, before induction with attending, anesthesia, Circulator and tech all involved in the pre-induction time out----and most patients, if they aren't too groggy with anesthesia induction agents.....the patient is ID'ed by name, Birthdate, Med Rec, surgeon, site/type of surgery, allergeries, antibiotics ordered, position, blood in room, implants or special equipment needed?

Then prior to incision, we have another time out, again involving the entire OR team. This time we confirm surgery, side, antibiotics going in, prep is dry, position, and implants present.

At the end of the case, we are required to make sure that the posted CPT codes are the correct ones, how many specimens, and where our patient is going post op.

Now, we started this late last year, when JACHO said our time outs were not good enough. We put this script into place, audited outselves, changed what is put on the white boards in the room, etc.

About three weeks ago, two of us were getting ready as fast as we could for a liver transplant. We had hardly opened when the patient came into the room, lines went in very quickly and suddenly- everyone but the OR team was ready for incision. We said, we haven't counted, please wait to scrub. And the wonderful surgeon, bless him, waited for us to give him to go ahead, because he knew that if he was scrubbed, he'd be draping, etc, and that couldn't have worked at all well.

Then we did our second time out and got started; counted, pt identified properly, everything we needed there, etc.

KayceeCA · Jul 28, 2009

I think the time outs at my facility are a happy medium. We cover some pertinent info (pt. name, surgeon, procedure, side if applicable, allergies, antibiotics received) but not too much. We also state that the consent, schedule, H&P, orders and pt. interview all agree. My only pet peeve is that some surgeons do tend to want to carry on with their own conversations and not stop and listen to the time-out. My tactic so far has just been to keep repeating "time out" in a progressively louder voice until I have their attention. But I really like the "I'm not wearing a bra today" line, so I think I'm gonna steal it. :)

Heogog53 · Jul 28, 2009

When we were tasked with our new format of JACHO's mandate, it was made very plain to the attendings, residents, med students, OR staff, and anesthesia, that everyone was quiet and paying attention-or the time out didn't go forward. It's funny how quickly EVERYONE became compliant when reminded that if JACHO was unhappy with our time outs, that they could pull our credentials and shut us off, period. THAT made it through their thick heads!

And actually, it hasn't really changed anything as far as I can tell. I hope that the intended effect, which is to reduce wrong side, wrong person, etc, comes to pass. I really hope that those types of errors decrease substantially with this type of time out system.