While we can’t promise anyone that you’ll ever be “in charge of things” in your work environment, we did think it would be fun to ask our readers a similar question: If you could wave a magic wand and create the perfect operating room environment, what are some of the things that would be at the top of your wish list?
We received a number of enthusiastic responses that covered virtually every facet of or operations, including equipment, training, support, workflow, budgets and the overall operating room environment. “better communication and cooperation,” “updated, state-of-the-art equipment,” “competent or staff members” and “improved teamwork” consistently ranked at or near the top of respondents’ wish lists.
Providing High-Quality Patient Care
“If I could create the perfect or, my wish list would include updated equipment and instrumentation for my patients and excellent communication between all members of the perioperative team,” says Lynne Stewart, RN, CNOR, Manager, GYN, THORACIC and VASCULAR Services at UMass Memorial Medical Center’s Department of Surgery in Worcester, Mass. “These are the things that I believe enable us to provide the highest level of quality of care to our patients every day.”
“I would also like to have a little less drama in the or,” Stewart adds. “Too much drama can make for a long and difficult day.”
Tammy Ralls, RN, CNOR, the administrative director for Tower Surgical Services in Nashville, Tenn., expounds on Stewart’s wish for up-to-day equipment. “I would love to have the or suites aligned so that equipment does not have to move throughout the day—for example, to have dedicated spine suites, total joint suites, etc. our equipment is moved constantly throughout the day, which is exhausting on staff and rough on the equipment.”
“I’d like to work in the latest state-of-theart or with equipment that never goes down and that everyone knows how to operate,” adds Barb Alsager BSN, CNOR, CRCST, the resource clinical coordinator at Alegent Health Midlands Hospital in Papillion, N.E. “And to work with surgeons who come in on time and happily comply with all the new regulatory requirements—and with enough competent and happy staff who never hear the word productivity.”
For Lanie Dschaak RN, CNOR, the surgical services director at Cascade Valley Hospital and clinics in Arlington, Wash., “perfect communication between all team members when caring for a patient” would be at the top of her or wish list. “The perfect or would have teamwork between anesthesia, surgeons, nurses, aides and housekeeping, as well as interdepartmental teamwork with pre-op and PACU,” adds Pam Neiderer, RN, BSN, the director of surgical services for memorial Hospital and the Surgical center of York. “We are all here for the patient.”
“While communication is great, good listening skills are also high on my wish list,” says Karen Parker, RN, clinical supervisor SPD & or materials for Valley Hosp Med Center in Las Vegas, N.V. “It would also be fabulous to have no backorders of pharmaceuticals or supplies, adequate instrumentation for all, plenty of storage, and equipment that updates automatically and does not become obsolete.”
Staffing and OR Staff Training
If there was one consistent theme across all of the respondents’ comments, it was a wish for adequate staffing in the or across all shifts. “my wish list includes dedicated staffing for after-hours as well as weekends and holidays so our full-time staff covering the day shift would only be responsible for their shift,” ralls says.
“I’d like to have a call team that covers all the call,” adds Alsager, “and a case assistant to do the documentation.”
Tammie Steinard, RN, BS, BSN, ONC, the director of surgical services for Providence Hospital in Southfield, Mich., says she would like to have “two circulators for each case to handle all the new electronic record keeping demands. This is a huge challenge. And, of course, more full-time employees across the board and more capital dollars.”
We also received a number of comments from readers about their wishes for improved training for or staff. Diana reagen, RN-BC, BSN, CNOR, the perioperative educator for Onslow Memorial Hospital in Jacksonville, N.C., elaborates:
“I’d love to see just-in-time training modalities and competency evaluations for novices and advanced learners related to operating room equipment. Training time in the operating room is precious, and most learners are visual and kinetic.”
To meet the Joint commission’s expectations of training, reagen would like to see “24-7 competency evaluated through a touch-screen kiosk, selecting the equipment item, a podcast review of safety features/operational steps, and individual hospital criteria to meet the hands-on portion of the competency. The kiosk would provide a progress report per employee on completion of equipment competency. No more paper trail!”
Adoption of AORN’s Recommended Practices
For Ramona L. Conner, MSN, RN, CNOR, Manager, Standards and recommended Practices for the Association of Perioperative Registered Nurses (AORN), her wish list revolves around adoption by health care facilities of AORN’s new recommended Practices for medication Safety and Perioperative Healthcare Information Management, which will be published in the 2012 edition of the AORN Standards and recommended Practices.
“At the top of my wish list would be that every health care facility will adopt these processes as recommended,” Conner says. According to AORN, the medication Safety RPS are intended to provide guidance to perioperative RNs to develop, implement and evaluate safe medication management practices specific to the perioperative setting, while the Health care Information RPS provide guidance to assist perioperative nurses in documenting and managing patient care information within the perioperative practice setting.
“Medication errors can originate at any point in the medication use process and affect patients of all ages, and perioperative settings present additional challenges for safe medication practices,” conner says. “The aseptic transfer of medications onto the sterile field is a good example, because there are activities perioperative nurses perform that aren’t performed in other areas of the health care facility.”
In particular, AORN recommends that all health care facilities to move away from multi-dose and toward single-dose medication vials, syringes and needles. “Problems have arisen due to the use of multi-dose vials for multiple patients and outbreaks have occurred. In addition, we face ongoing challenges with regard to medication labeling. labels that are hard to read can easily be mistaken for other medicines—there are lots of opportunities for errors here.
“The perioperative RN should develop a nursing medication plan across all phases of care and in all perioperative settings,” conner adds.
On the health care information management side, conner’s wish is that “every health care facility will begin implementing and adopting electronic Health records (EHR) that are integrated with technology. This is an exciting frontier that’s opening up lots of wonderful new opportunities. In particular, I believe that adoption of EHR will lead to a reduction in never events like wrong-site surgeries, retained surgical items and medication errors.”