Q: TATTOOS:

Is it OK to put a bovie pad on a tattoo?

A: Tattooing practice is adopted worldwide and represents an important socio-cultural phenomenon, but the injection into the skin of coloring agents as metals might pose a risk for allergies and other skin inflammations as well as for systemic diseases. In this context, 56 inks for tattooing purchased from 4 different supply companies were analyzed for metal concentration. The relative contribution of metals to the tattoo inks was highly variable between brands and colors, even with pigments with the same base color. AORN does not recommend placing the cautery pad over a tattoo because of the possibility these metallic dyes may be present and can cause a burn to the patient. AORN does have a link on their website that has a short video on the placement.

A: As a clarification – although often used interchangeably, cautery and electrosurgery are distinctly different modalities and as such, cautery does not require the use of a return electrode (bovie pad).

COMPUTER CHARTING:

Sometimes the computer charting is so pre-programed that many limitations exist. If you currently use McKesson Paragon CCS for PACU charting, please share how you go about charting meds. Many times, even if a medication is not given early, the nurse is prompted to provide an early dose reason. The nurse then has to do additional charting to explain inaccurate charting.

A: We use Meditech.

A: As of yet we do not computer chart in the OR but the rest of the hospital does using the system CPSI. Does anyone else use this system? How user friendly is it to use in the OR?

A: We are using Meditech at the moment.

A: We also use Meditech.

A: We use CPSI hospitalwide, including in the OR. Like any other system, it is not perfect but we are using it quite successfully.

A: We use Meditech but a different system for anesthesia.

NIGHT SHIFT COVERAGE:

Does anyone staff the 11 p.m.-7 a.m. shift with only a surgical technician? Their duties are to get rooms ready for the next day, stock, do quality checks and call in the rest of the team.

A: We staff our night shift with one RN, who performs those duties and more. Her role is very valuable, particularly in assessing and triaging potential scheduling issues that may need to be resolved before the day shift charge RN comes in.

A: We do. They are actually very busy at night. They have to recheck all the cases that have been picked, get the ambulatory ready for the next day, stock preference cards and they assist as needed throughout the building as sitters, runners, etc.

A: We staff with a OR RN and a surg tech. These positions were added about 5-6 years ago as a retention strategy as we were losing staff due to the amount of call required. In addition to doing cases, they pick cases for next day, set rooms up, review expiration dates, etc. It has been challenging to continue to find valued work for them. Given our night shift volume, the additional duties are important for staffing this shift.

A: That is the same reason we added night coverage – to retain staff.

A: It is a huge satisfier to our RNs not to cover first call during the week.

SHOULD I WAIT?

Often times surgeons and anestheologist order tests and then want to proceed to the OR without the results of the test, because it is taking too long for the results. Why order the test if you are not willing to wait for the results? If this occurs, should the patient be charged for the test? Where is the best place to chart that the surgeon preceded without waiting on results? It is one thing to proceed in an emergency situation, it is another when it is a scheduled case.

A: I think we all have encountered this a few times in our careers and I agree it is ridiculous to order a test when you’re not willing to wait for the results when it isn’t a emergency situation. Why run the test then? When this situation arises we document it in the Intraoperative Report (under notes) that a certain test was performed on patient but surgeon/anesthesia refused to wait for results. My philosophy is that it is always good to cover our butts as circulating nurses.

A: Our policy states all ordered tests and procedures will be on the chart before being brought to the OR. This actually went to the surgery committee and fortunately I had administration backing for this. It is for patient safety and as you stated, “Why would the test be ordered if not needed?”

CHEWING GUM:

A question has come up on gum chewing in the OR suite. We all know there are days when we just can’t control a tickle in our throat and have had a cough drop still in our mouth as we roll the patient to the OR suite. I’m asking about chewing gum or any other food or drink in the OR suites. I’m interested in hearing what others are doing.

A: We don’t consider gum a food and allow it.

A: Absolutely no food or drink beyond the designated break area. If gum or a cough drop becomes a “distraction,” then it falls under our “distractions” policy (phones, radio, chatter, snapping gum, etc.) and is disallowed.

A: Chewing gum is appropriate as long as it does not disrupt cases. No food or drinks allowed. These are kept in the lounge.

A: We do not allow it.

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