Discharge Instructions

When discharging patients from the hospital after same-day surgery, a set of discharge instructions is sent home with the patient. Is it acceptable to have the patient (not a minor) sign the discharge instruction paperwork if they are alert and able to?

A: Not unless they have only had a local anesthetic. We have the person who is with them sign the paperwork and advise our patients not to sign any paperwork for 24 hours.

A: I agree completely!

A: We review the discharge instructions with the patient before surgery (at the same time they sign consents) and have them sign at that time. They also get a copy at the time of discharge.
OR Distractions Policy

I am in the process of developing an OR Distraction Policy. The purpose of having such a policy in place would ensure that the primary focus of all providers and care team members remains on patient care and focuses on communication of patient care. Does anyone currently have a policy in place that they would be willing to share? How does your organization deal with/address anesthesiologists, nursing team members, other members of the care team Facebooking, surfing the web, texting, etc. in the OR? Is it allowed?

A: Absolutely not! I have zero tolerance – automatic corrective action.

A: I would also love to see the same type of policy. Our safe surgery committee is trying to develop something and we want to use the model from Council on Surgical and Perioperative Safety (CSPS) to encompass all electronic distractions.

A: Would love to hear what other organizations are doing. This is such a huge issue. Very difficult to enforce with nursing when surgeons and anesthesia providers do it.

A: We keep it simple – no cellphones in the OR! Any of that is completely unacceptable. If they are on call or awaiting an “urgent” text, etc. They can leave their phone with support staff outside of the OR and the staff can communicate any messages. We found anesthesia to be the worst offenders so we made our policy very simple and universal.

A: Absolutely zero tolerance!

First Assist

What are your minimal requirements to allow a surgeon to bring along his own first assistant?

A: Must be credentialed as either medical staff or allied health.

A: Our surgeons must have the staff member cleared through the credentialing department.

A: We would require that person to either be an employee of ours or a contracted provider. We would have them complete an application. I would verify their education and certification. They must have proof of immunizations (as required by the state). We would do a background check and HIPAA form. We require a liability waiver form (for non-employee – stating if they slip and fall in OR, they won’t sue us, etc. – same form I use for sales reps or other visitors to the OR) and malpractice insurance (with us as a certificate holder) if applicable. I can get this for the PA or CFA, both typically hold that. I’ve had surgeons want to bring a first assist and they use that term loosely – it could mean a P.A., it could mean a CFA or it could be their favorite surgical tech. I have had several times over the years where doctors just “show up” with an assistant of sorts and I can’t allow just anyone into the OR without this information. They usually get angry (stating that they’ve known this person or worked with them for years). Now, unfortunately, we can cite the example of Joan Rivers’ doctor as a prime example of why we can’t just let anyone into the OR. We are a Joint Commission accredited facility.

A: They must be credentialed through Med Staff.

A: If they are not employees of the organization, all licensed assistants would be credentialed through the medical staff office.