Q: Strings Dangling in the Breeze

Often people step into an OR suite and have their mask on and only tied at the top with the strings hanging down. This can be X-ray, PACU, anesthesia, or someone just coming in to offer a break or get a status report on the progress of the case. How does one go about suggesting to another to tie their mask? Is it acceptable to have strings dangling in the breeze?

A: There are masks that have only one set of ties that prevent both this scenario and that of people having their masks hanging once the case is finished.

A: The circulator is ultimately responsible for the people who come in and out of the room and their attire. It’s about patient and staff safety. Those with masks inappropriately donned should be stopped at the door. Then inservice everyone!

A: Do you have a Surgical Attire P&P? It is everyone’s responsibility to promote worker/patient safety and provide a high level of cleanliness and hygiene within the periop environment (AORN recommended practices). See Recommendation VI.a.- “The mask should cover the mouth and nose and be secured in a manner to prevent venting.”

Q: Drinking in the OR

Is anyone allowing surgeons or staff to have bottled water in the semi-restricted areas?

A: No food or drink in patient areas – an OSHA Standard: Employees often ask why the hospital doesn’t allow food or drink in patient care areas. Here’s the answer-straight from OSHA. “The Bloodborne Pathogens standard section 1910.1030(d)(2)(ix) says, “eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.” According to a consultant from the Greeley Corp., convincing a surveyor that a patient care area doesn’t have a reasonable likelihood of an exposure is difficult.

The bottom line: Don’t allow employees to increase their personal risk, because the hospital runs the risk of an increased liability if an exposure occurs.

A: No.

A: We used to allow covered containers until the case started. Now it is no food or drink past the “red line.” •

Q: Explanted Hardware

Would anyone share their explanted hardware policy? How do you handle the return to patients? How do you prepare it? Does CS wash and sterilize the explants before returning them to the patient?

A: Our Sterile Processing Department washes and sterilizes the explant.
We provide it to the surgeon. He/She returns it to the patient at their office follow-up visit.

A: We never return anything taken out to the patient. It goes to lab for testing.

A: My hospital had to consider corporate compliance issues in regard to explants, as my hospital considers them the patient’s property, as he/she paid for them at the time of the surgery (see AORN Clinical Issues, February 2012, Vol 95, No 2, Page 294). However, if there is a recall, the explants is returned to the manufacturer after decontamination per the FDA.

A: We consider the patient’s explants (as well as other tissues) as their own property. I know this policy may open Pandora’s box but as long as we can have meaningful conversation about it – I’m supportive. You will find in our policy much more than has been requested thus far. Not only are explants covered, but also other tissues and materials including products of conception. Remember that while this works for us – I know it won’t fit everyone’s needs. I offer this only as a reference point for consideration and discussion.

A: Technically and legally any implants that are removed are the property of the patient and they are entitled to have them if requested. We send them to pathology and then they are disinfected before we release them to the patient. If the patient has a subpoena requesting that the implant(s) be turned over to their attorney, then we put them in a hard plastic specimen container and initiate a chain of evidence that stays with the implant.

Q: Fly in the OR

How is the best way to get a fly out of the OR?

A: Benzoin spray!

A: Turn off lights in the room and open OR door to lighted area – hallway/substerile room, etc. This usually works for me.

A: Shut off the lights and turn on the X-ray box.

A: Here’s a trick I just used a few weeks ago, put rubbing alcohol in a syringe and spray the fly. The alcohol will kill the fly instantly.

Q: No Ride Home

How often is it that patients come in for semi-minor procedures that they really need, however don’t have a ride home? It isn’t just that they don’t have a ride but sometimes patients are going home to an empty house. Is it acceptable to provide a ride home? Are there legal ramifications if you get in an accident and you are taking a patient home? Can the patient take a taxi? This is not an everyday occurrence, however it does seem to happen more and more frequently.

A: We require patients to be accompanied by a responsible adult anytime they receive sedation or anesthesia. The patient can take a taxi home as long as the adult goes with them. That is the standard of care. On rare occasions after a longer recovery period, our physicians will document that the patient is safe to travel home (not drive) without another adult with them, but that increases the physician’s liability if something should happen. We tell patients that their procedure will be cancelled if there is no one accompanying them.

A: If your policy says to discharge to a responsible adult then you need a responsible adult to give instructions to.

A: TJC standard 03.01.07 ep # 6 states “Patients who have received sedation or anesthesia as outpatients are discharged in the company of an individual who accepts responsibility for the patient.”

We are a city hospital and our patient population will frequently have this issue, so we require patients who cannot meet this criteria on the day of surgery to either reschedule or admit overnight in observation status post-op. Our outpatient d/c documentation includes the name of the responsible party. The transportation method is not the issue, it’s meeting the element of performance in # 6.