Q. Transporting patients to PACU

Do any of you transfer patients from the OR to the PACU in the patient’s bed? If so, what type of procedures and patients do you do this for?

A: We do this for all patients being admitted to the hospital. This way the patient only has to be transferred once, and it’s while they are still sleepy from anesthesia.

A: We use a chair-bed that goes from Pre-op to the OR and then PACU for eye patients and hand surgery patients.

A: We do, only for total joint replacements, hemiarthroplasty and shoulders.

A: We use stretcher chairs as well.

A: We put all inpatients back in their own bed plus any patients who are known admissions such as total joints and bariatric cases. It helps the nurses on the floor and especially decreases patient pain from transfers. We also start a lot of CPM treatment in the PACU, and those machines only fit well on a bed.

A: All inpatients are in Stryker beds (patient bed made to be transport bed). This includes CCU, MS and maternity patients. Patients from the ER come over on ER stretcher and we call for a bed to transport to the nursing unit after surgery. For any same-day surgery patient spending the night, we call for a MS bed.

A: We transfer in the patient bed for total joints, most fractures and major cases that are inpatients or admits.

 

Q: Surgical procedural checklists

A couple of years ago we adopted the WHO surgical procedural checklist complete with checkboxes to be filled when completed. The checklist remains with the chart as part of medical records. I recently attended a conference that stated checkboxes are not required and bullet points are preferred. It was also pointed out that the checklist does not have to be part of the medical record. Some organizations are using laminated posters in each of the ORs for the nurses to use for the checklist and only charting in the documentation that a time out and the checklist was competed per policy. I like this approach. Who else is using a laminated checklist on the wall in the OR only with accompanying documentation that it was done? It this preferable to the paper approach?

A: I feel that maintaining a paper checklist is necessary for several reasons:

1. It is intended to validate that all of the necessary double checks have been performed and are accountable for. I perform medical record QI audits for many of my clients and the safe surgery checklist is included. Valuable data related to documentation of time-outs, consent completion, etc., have been revealed as outliers, enabling corrective actions to be implemented to assure 100% compliance and, more importantly, identify any patient safety risks, the true purpose of the checklist.

2. Safe surgery checklist completion is mandatory and, beginning in July 2013, completion is required as a reportable Quality Measure. Without documentation, I have to wonder where the validating evidence would be supported.

A: We have a 4-foot-by-3-foot sign on the wall so that all members of the team can see it. It is based on the WHO checklist.

A: That is what we have done. It works well.

A: We also have a wall sign with the checklist on it. The nurse also documents in the electronic medical record.

A: Which conference did you attend and who stated checkboxes not required, and not a part of permanent record? Thanks!

A: OR Manager Conference October 24 in Las Vegas. The speaker was a former JC surveyor and she gave her email as JenCowel@PattonHC.com. I don’t think she would mind if I threw that out there for a resource and she might offer a reference.

A: If you get more information on the checkboxes for the WHO universal checklist, can you update us please? We check 59 boxes currently to meet this requirement.