Antibiotic Stop Times

Q: At some facilities it is required to document antibiotic start and stop times in order to receive payment. Does this include the OR? Is the OR exempt from this rule?

A: We document both times.

A: We document start times only.

A: You are required to document the start time (i.e. within 60 minutes of incision). You are not required to document the time it completed the infusion for pre-surgical abx. Often this is confused with the requirement to discontinue the abx after surgery within 24 hours.

A: We document our abx start time. However, it is an NDNQI indicator that at our facility is reviewed by Press Ganey, so I assume that it is part of the credentials for payment.

A: We just document the start time.


Music in the OR

Q: Does your facility allow music in the OR? Who gets to pick the music? What are the pros and cons of playing music during a procedure?

A: We have music in the OR. The team takes turns picking. A pro is that I think it helps with patient anxiety. A con is sometimes the music can mask other important sounds.

A: Every facility is different. At my current employer, music is very prevalent. It’s a “group decision” many days as
to what type. Most often someone uses their phone to stream Pandora or the like. In my previous life, we had docking stations and staff/physicians would use their phones to play their individual playlists.


Re-Gowning

Q: When a surgeon forgets to put on lead is it appropriate to let him back out of a gown go put on lead and come back into the same gown? Why do they think this is OK?

A: No.

A: No it is not OK. Isn’t the scrub person using their time more wisely than holding a gown for a forgetful surgeon?

A: If the surgeon hasn’t put his hands in past the elbow of the gown it is probably OK. The best option is to get a new gown

A: The best practice is to re-gown.


Cleaning Products in the OR Suite

Q: We have recently revised our contact isolation policy for the operating room which calls for stripping linens and disinfecting the patient cart/bed in the OR Suite after transfer to OR table. The cart is then returned to the common hallway for new linens to be applied. A question was raised whether it is acceptable to use disinfectant wipes (we use CaviWipes) in the OR suite if the case is already “open?” The only information I could find in 2017 AORN Guidelines pertains to aerosol use – which we already know is not allowed. I appreciate any insight or references anyone may have.

A: I’m not sure that “cleaning” or movement of linens should be completed in an “open” OR suite in any manner. Movement of the linens may cause changes in air flow and use of wipes in the suite could cause airborne contamination of sterile fields.

A: That is a great revision to an isolation policy. I do not think there would be an issue with doing this in the room. The product is wet which will trap any organisms that may be on the object. The only concern, and this is a stretch, is the additional movement in the OR while the patient is in there and the sterile field is open. Limited movement is a tool for decreasing risk for infection.


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