Who checks your patient in?

[SandraFenway]

...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. ?

The person bringing the pt to the OR will a nurse's aide. This process change has only been announced, not implemented. I have NO idea how short stay is going to know if OR is truly ready for the pt (implants, room set up, instrumentation,.. all the things you mentioned). Administration has not shared this. They simply announced it in in the weekly email huddle. No discussion, no explanation.

If they are really going to do this and violate the WHO Implementation plan, then it's going to take a whole lotta phone calls and nail biting between the 2 departments. This is for everything from podiatry to open heart surgery, btw.

[beachgirl17]

Interesting.....sounds like a big shift. I can't imagine not going to speak to my patient beforehand - I can't tell you how many times I have checked my patient and realized that the consent is different than what was posted. Of course, then you have to make changes to prepare for the actual case. The OR would not have been ready, if I had not been there to speak to the patient beforehand.

Please keep us posted on what happens.

[FurBabyMom, MSN, RN]

I don't have any real advice. Our patients see the pre-op nurses and the OR nurses on the day of surgery. Our questions are pretty similar with a few differences, and like others have mentioned we document in two different places. We don't actually have to chart the pre-op interactions with the patient. I've had times an "old" consent gets pulled as "the" consent (similar but from an already performed procedure). I've had patients fess up about when they really ate or drank last... I've had patients mention allergies they mentioned to nobody else, etc. The only times we do not talk to patients before procedures are either for emergencies (those who are stable get interviewed if possible) or for ICU patients that are transported by anesthesia. I've had some close calls "fixed" by more people seeing the patient. I would personally write up each and every near miss in the occurrence reporting system if your facility has one.

[ComeTogether, LPN]

I only know what I've seen both as a patient and as a student when I got to tag along with my patient.

From what I've witnessed, a different nurse "checks the patient in" than the nurse who is with the patient in the OR. I don't know if this is what you mean.

From what I've seen, the scrub nurse receives the patient, verifies ID and procedure and the pt is anesthetized. Then, a time out is taken where the pt. is identified again, everyone present states their name and surgery begins.

I can see not interviewing the pt all over again in terms of health history, etc. but certainly Name, DOB, allergies, reason for surgery, etc.

[momathoner09, BSN, MSN, APRN]

I work in pre-op holding and we get both inpatients and outpatients/AM admissions ready. We check consents with orders with the schedule and report/fix any discrepancies. We order, repeat and draw any necessary labs and tests. Report any and all allergies. Order blood. Check patient identification. No we aren't "OR nurses," but our entire job exists to catch any errors and ensure that patient is ready to be pushed through those OR doors safely. We communicate very often with the OR coordinator, anesthesiologists, PAs for the surgeon and the surgeons themselves. We tell everyone everything twice.

The scrub, circulator & CRNA look at the chart and quickly speak with the patient before surgery but it is not intensive.

Now I will say that I wouldn't want a floor nurse doing this (if that's what you mean). Bc from what I've seen they don't know how to do it. It's harder some days to get an inpatient ready than someone who walks in off the street! I don't fault them Bc I know they are busy and have more patients obviously.

[Majestic Acacia]

I like to think of surgery as a game of telephone...I tell this to my patients all the time when they grumble about answering questions a million times...as a circulating nurse, it is my job to ensure that everything is in order before we go back to the room. Do I have: correct patient, correct procedure/side/ consent, is paperwork done? Etc...I don't care how awesome my preop department is, I am the last person receiving the message in the game of telephone. Many preop nurses do not know what each surgery entails, so I want to make sure everyone is on the same page before medicating that patient. I have caught a consent reading: Right total knee arthroscopy. Preop did their checks, they did the consent, it sounds good, but there is a very big difference in arthroscopy and arthroplasty. If I hadn't caught that, it would have been my licence on the line, no one would have backed me up.

OR circulator should be checking in the patients.

As for the comment on the scrub nurse- that is why you work with your surgical team- it is the circulators job to ensure that the patient has been properly interviewed, but I will say congrats on making sure you verify what you are doing before pt is asleep, I don't work with many techs that do that.

[acerbia]

We have preop RNs that check in the patient. When the pt arrives, the preop RN is the one that receives them. They start IVs, get a height/weight, toilet, give preop meds, abx, make sure an NP/PA or resident does the H&P, obtain surgical consent, allergies, NPO, medication hx, verify ID/MRN/DOB, correct surgery/site/side, draw labs, orders,

CRNA has their own interview: Verify ID/MRN/DOB, correct surgery/site/side, airway assessment, allergies, NPO, questions regarding anesthesia.

OR RN prepares OR and has their own interview: Verify ID/MRN/DOB, correct surgery/site/side, check signature on surgical and anesthesia consent, ask for metal/implants in body, any PMHx that would be relevant to the procedure or positioning.

OR RN and CRNA bring the pt to the room, and the rest seems pretty standard.