Q. PHYSICIAN PREFERENCE CARDS

Currently circulators will place a foley catheter in a patient if the surgeon wants one. Some preference cards state that a foley is always used. Even in some of these circumstances, the surgeon will not want a foley placed for one reason or another due to the patients medical history (it is always a good idea to ask). Is it necessary to have a standing order for foley insertion on the pre-op orders? Currently pre-op orders for antibiotics are based on the patients weight and allergies. The meds given intra-op are not always known pre-op, so they are not on the pre-op orders. These are also on the preference cards, and verifying with the surgeon is a must.

A: Absolutely NOT!! These cards are meant strictly for the scrub and circulator as a guide of what the needs of the surgeon are in a particular case.

A: According to a recent TJC survey in the hospital that I was formerly employed; physician preference cards do not constitute a physician’s order. Physician’s orders must be signed/e-signed by the physician for each patient. We developed an “Intraoperative Order Set” with the most frequently requested medications and items. The circulator puts a patient label on the form, documents the date and times the meds were administered and/or the items were used and the physician signs it at the end of the case.

The survey team approved this form and process before the survey was completed.

A: You should talk with the Infection Control nurse at your facility. Foley catheter use has decreased in our surgery department because of the CAUTI (catheter acquired urinary tract infections) initiative. Foley catheters are not needed for every procedure, we always ask. Medicare will not pay for these infections that are acquired in the hospital. We also have specific guidelines for removal when they are inserted and they need to be documented on the chart with date and time of insertion.

Q. ENZYMATIC DETERGENT

Is everyone in Endo departments using an enzymatic detergent in the procedure room to start to clean scopes or just in the processing room?
A: Yes, we use it in the room to begin the process. We suction enzyme cleaner through the scope prior to taking it to the decontam room.

A: Yes, we do use in the procedure room.

A: Yes, our initial cleaning is with an enzymatic detergent in the procedure room.

A: I think SGNA recommends that cleaning be initiated in the procedure room. We flush our scopes and use enzymatic cleaner to wipe them down in
the procedure room. Then the scopes are put into a closed container to transport them to the decontam area.

A: We also use in procedure room.

Q. FIRST SCRUB OF THE DAY

What does your surgery department require for the first scrub of the day? We do a 3-minute scrub with a brush and clean the nails under water, then each additional hand hygiene is with 3M Avagard. This product is widely used in many facilities and meets the CDC, FDA and AORN criteria for surgical scrub selection. According to AORN, a standardized surgical hand scrub with a soap (antimicrobial agent) nonabrasive sponge and water does not have to be the first scrub of the day before an alcohol based surgical hand rub product is used unless it is recommended by the manufacturer’s instructions.

A: This is what we do as well. Additionally, if the surgeon leaves the unit to round or go to the ER or any other event in which he leaves surgery (staff as well), then a full scrub is again required just as the first scrub of the day.

A: We provide for scrub staff to use either method of surgical hand preparation, water based with brush on nails and sponge on hands and arms or Avagard per the manufacturer’s recommendations, which is to wash and clean under the nails for the first scrub of the day.

A: By policy, we require a surgical hand scrub with brush as the first scrub of the day.

A: We do as previously described. I feel the staff must have strict guidelines, for the first scrub of the day.