Q: Pre-operatively Applying Armbands for Blood

We are putting armbands on patients that have blood type and cross pre-operatively. Sometimes this may be 4 or 5 days before the scheduled surgery. We have some feedback from patients that they don’t feel comfortable wearing the armband that early before surgery. We all know the need for accurate patient identification when administering blood products, but I am wondering if there are any alternatives short of scheduling the pre-operative visit the day before surgery?

A: We do day before or day of.

A: If the patient prefers you can place the blood band around an ankle (a non-operative one if the planned surgery is orthopedic).

A: We schedule them early enough to come in the day of the procedure and have it done. This may result in them coming in very early, but it keeps them from wearing the bracelet or losing it.

A: Our cross match is only good for three days in our facility so we have them come in no sooner than the day before for type and cross.

A: We put them on our patients the day of admission. It is part of our pre-operative checklist that our outpatient nurses do. This is doubled checked by our OR nurse who is caring for the patient and doing her pre-operative assessment.

A: We do type and screen pre-op, then if needed day of surgery we do the cross match.

Q: Endoscopy

For those who have endoscopy in their service. Do you routinely perform pregnancy testing on patients that receive conscious sedation from the RN? We use versed and fentanyl.

A: We do.

A: We do pregnancy tests on all patients unless documented menopause for one year or hysterectomy.

A: We do as well.

A: We do allow the patient to decline a pregnancy test via documentation (hospital form) attesting their status.

A: Absolutely! We need to provide the information to the patient regarding the risks to the fetus of the medications to be administered.

Q: Getting Patients Ready

When getting patients ready in SDS, are the patients interviewed and changed into gowns prior to their family being present? Sometimes patients have information that they don’t want their families to know, and it is difficult to obtain this information if the family is at the bedside.

A: Yes.

A: This can be a very difficult situation and I try to let the patient know it is their decision if, and when, to have family with them. If I sense they are reluctant to have family in pre-op with them I am the bad guy and let family know they have to wait but will see their loved one before surgery. It is difficult to have a hard and fast rule that no family is allowed until the assessment is done.

Q: Avagard Surgical Scrub

Is anyone aware of any standard or regulation about putting Avagard Surgical Scrub pumps inside the actual operating room? Where do most facilities mount the pumps?

A: We have the Avagard located at the scrub sinks with the directions for use. Some staff members take short cuts when applying the waterless product.

A: We have ours mounted next to our scrub sinks.

A: We found that a good place to locate the pumps is by the scrub sinks and outside the OR entry door.

A: We use Surgicept instead of Avagard, and it is mounted outside each room by the scrub sinks.  It is also mounted in two of our ORs where total joints are performed. We needed approval from the fire marshall to add additional quantities of an alcohol solution into our total, but it isn’t really different than having alcohol gel in the room.  He was more concerned with our total volume.

A: We have it inside our robot rooms so the surgeons don’t have to leave when they return to the field from the console.

A: We have ours in our operating rooms.

A: Our Avagard dispensers are outside of the OR, next to the scrub sink.