Who checks your patient in?

[SandraFenway]

Recently my friend's OR has started having the non OR nurses in admitting check in the patient for surgery. I mean check.in.the.patient. A non OR nurse will be looking at consent, ID, blood band, allergies, site marking: Universal Safety Checklist.

The OR nurse simply receives the patient as its pushed through the door and pray it's the right pt for the right surgery. The OR nurses are specifically told to not interview their patient!

My friend is going nuts thinking about this. It's hard enough to make sure everything is lined up for surgery, let alone have a patient you haven't checked in come through the doors. Implants, instrumentation... A non OR nurse doesn't know what we need. It's just a crazy, unsafe system.

Obviously her hospital administrators have no idea what a surgical nurse does and the efforts we go through to see that patient safely through surgery.

Yes, this is a physician led process (ya think?) but upper level nurse leaders are letting this go through. I don't think the OR director is permanent, he just doesn't care.

What does YOUR Operating room do? What does Joint Commission say? AORN? Who should be checking in that patient for surgery? What about SBAR? Have you had close calls if your facility has non operating room RNs check in the patient? My friend is looking for another job, btw. She's not interested in playing games with safety.

[Rose_Queen, BSN, MSN, RN]

I don't care how many other nurses have checked in my patient or verified consents- I'm still looking at the paperwork and asking my routine questions. The first thing the facility will do is throw the OR nurse under the bus when something goes wrong. My license is my livelihood- I'll do what it takes to keep it safe. AORN has a Patient Hand-Off/Over Tool Kit that may be helpful.

[springchick1, ADN, RN]

I scrub 95% of the time meaning I don't go interview the patient, check to make sure they have been marked by the surgeon etc. But when the patient is brought into the OR, I ask them name, procedure, who the surgeon is, and I have the circulator show me the consent. Your friend still has the opportunity to do everything she would normally do when picking up a patient.

[SandraFenway]

A surgical check in includes (not in order, not complete): checking the name, allergy and blood bands to the consent and H&P, check for tight rings and cut them off if the surgery warrants it (Admitting just tapes them), making sure the rep is in house and confirms that we have what we need on the vendor side, is the surgeon in house, checking the site marking to the consent, checking the H&P against the consent, verifying the consent with the patient, checking lab values, talking with anesth about their anesthetic plan, asking pt if they have any questions, introducing yourself to the family, does scrub have what they need, directing room arrangement. I disagree that asking name, procedure, surgeon and looking at the consent is normal. That is not a complete check in. My friend does NOT have the opportunity to do what she normally does.

My friend doesn't even have the opportunity to do what the facility requires - admitting RNs will be falsely charting when they tick box that required implants/ instruments are available. Admitting RNs have no idea what surgery is about, what instrumentation is needed. It's a hope and a prayer way of doing the first safety check for surgery.

(BTW, that pt you just interviewed in the room was pre-medicated). :-)

[SandraFenway]

I knew I could count on you, Rose Queen. I'll try to access the AORN hand-off tool and see if it addresses this directly.

[SandraFenway]

Hi, Can other circulators tell me who does the OR check in for your facility? Admitting RNs or operating room RNs? I'm talking about the first and second columns of AORN Comprehensive Surgical Checklist "Pre-procedure" and "Sign in". THANK YOU.

[Rose_Queen, BSN, MSN, RN]

first and second columns of AORN Comprehensive Surgical Checklist "Pre-procedure" and "Sign in". THANK YOU.

First column: both preop RN and OR RN, with the exception of the implants- that one is OR only.

Second column: circulating RN and anesthesia provider upon transfer of the patient to the OR bed. Patient participation if able.

[SandraFenway]

First column: both preop RN and OR RN, with the exception of the implants- that one is OR only.

Second column: circulating RN and anesthesia provider upon transfer of the patient to the OR bed. Patient participation if able.

That's interesting, Rose Queen. How do preop and periop both do one check in? Computer? 2 papers?

I did find a WHO document that specified that it is OR personnel that should be doing the safety checklist.

[springchick1, ADN, RN]

That's interesting, Rose Queen. How do preop and periop both do one check in? Computer? 2 papers?

I did find a WHO document that specified that it is OR personnel that should be doing the safety checklist.

We use the WHO checklist in our OR.

[Rose_Queen, BSN, MSN, RN]

That's interesting, Rose Queen. How do preop and periop both do one check in? Computer? 2 papers?

I did find a WHO document that specified that it is OR personnel that should be doing the safety checklist.

It's two different documentation areas in the record. Preop has their own section and I have mine.

[SandraFenway]

Hi, Allnurses, I found out that WHO has an Implementation Manual for the surgical safety checklist. You'll easily find the checklist itself, it's everywhere and is the basis for many facility's own version. Search now for WHO Implementation Manual pdf.

The WHO Implementation Manual teaches safety concepts behind the checklist. WHO emphasizes that a single peri operative person performs the check off. It could be a anesthesia care provider, for example. It doesn't matter, what matters is PERI OPERATIVE and single person follows through the checklist with that patient.

I think what has happened is that facilities scrambled to set up safety checklists, but didn't study the IMPLEMENTATION. There is a reason WHO emphasizes one single peri operative member perform the checklist: it's safer.

"Safe Surgery Saves Lives"

World Health Organization Implementation Manual of Surgical Safety Checklist

We all have the WHO safety initiative to thank for prompting this safety push. It's unfortunate that one of the primary safety components has been de-emphasized in the rush to institute checklists. It's easy to copy paste a checklist, obviously less convenient to read the manual and implement them properly.

I feel so fortunate, actually, that my facility implemented it correctly in the first place! Thank you, people of the committee that planned our checklist implementation - someone obviously did their homework. The Surgical Director who worked here at the time is long gone. I suspect it was her actions that gave us our proper implementation.

That's right, no surprise, there is no "friend". It's me, it's my hospital.

Recently an outside "efficiency expert" has come in and meets with the docs to Plot revenge on the nurses. It's called improving efficiency, but when they haven't any OR rank and file on their meetings, you know what it's really about. We get a one sentence bullet point email of this major change in our safety process (really) and we are supposed to Let it go. I'm sure this did not go to risk management, for example. The docs have no idea what we do, they just know we won't push their unmarked patient in the room, am I right people?

We have a temporary surgical director, a temporary surgical manager and a contract "efficiency expert" that are tinkering with our Surgical Safety process.

What could possibly go wrong?

For any nurses that are not following the WHO recommendations of a single peri operative team member doing the checklist, can you see the dangers in your facilities process? Each element that changes hands increases error risk.

[beachgirl17]

I agree with Rose Queen in that the checklist is completed by both pre op RN and OR RN. My question to you is - who is bringing the patient to the OR? Anesthesia or the circulator? If it is not the circulator, how are they sure the OR is ready to receive them, such as proper cleaning, equipment, implants, etc. ?