Room Turnover
I’ve been to one facility where the nurse was in charge of changing out the Anesthesia machine tubing and setting up the A-Line if needed. At another facility, the nurses were not allowed to help with turnover and weren’t allowed in the room until housekeeping personnel were finished. I didn’t know this and tried to help clean. I was reported to the housekeeping union for “trying to take their job.”

A: Union hospitals are different. Talk to your manager and also look at your job description. Is there anything listed regarding “cleaning, etc?” You may be able to perform some “nursing” tasks that cross over to environmental.

A: In our OR, nurses and techs are strongly encouraged to participate in turnover. As the OR manager, I own the environment and the cleaning crew reports to me. I think everyone should participate when possible. It does show respect and it is teamwork.

A: All our staff participate in turnover.

Disposable Bouffant Hat
One recent study on head coverings (disposable bouffant or skullcap, cloth cap), identified that the commonly available disposable bouffant hat is the least effective barrier to transmission of particles. Does your facility still allow the use of a disposable bouffant hat?

A: That is all we use and we got rid of the skullcap. We allow cloth caps with the bouffant over it.

No IV in the OR?
We have a new orthopedic surgeon that insists we do not use an IV for some of the “simpler” procedures that are performed in the operating room. These are usually quick trigger finger releases or carpal tunnels. There is no sedation, just local. What experience do you have with these cases? How do you document them? We have a separate Circulating RN for the procedure and another RN for the patient. This is new to us. We have always had IV access before and are comfortable giving and monitoring patients with IV sedation. It is the “no IV” that is troubling us.

A: For all locals, we do not place an IV. Just like going to the dentist for a local for a filling, they do not place an IV before giving local.

A: I would consult with anesthesia to determine if this would meet their guidelines. I realize that anesthesia is not involved in the case as it is a straight local but they are ultimately responsible for emergency care if it were to arise in these patients. I have always had policies that stated all patients going to surgery would have IV access even if it were just a saline lock. I do not believe there is a hard and fast rule but I would definitely get anesthesia to sign off on the practice. If anesthesia is comfortable I would then document that in a policy or guideline just so everyone is on the same page.

A: We do not place an IV for a local procedure unless there is conscious sedation involved.

 


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