[surgeryrngirl]

I would love some feedback on how you handle these situations:

1. Being rushed between cases. Not having time to make sure everything is ready to go for the next case.

2. Do you ever go to the room before doing the count?

3. Do you count on cases where you are not entering a cavity?

4. Do you ever come back to the room after being sent to get yet another item..... to find that anesthesia has opened suture while you were gone?

5. Do you always do a "time out"?

I would love some feedback. Do all OR's have these problems?

Thanks,

Surgerygirl

[grahamcracker977]

Well, that's quite a list...
Yes to most of those questions...
I think it depends on your experience (years in the OR) and confidence...
There's always the "turnover" rush...when I worked at a major trauma center we had to scavenge for equipment like headlights, beanbags...people would steal from your room if you were not there...sabotage big time. I'm currently at a quickly expanding community hospital. Our turnovers are always 15 minutes or less, we have excellent ancillary staff (housekeeping,anesthesia techs) who care about what they do, and enough equipment so sabotage does not occur. So now, I'm not so stressed about the next case. If I were working days (not anymore), I would get to work early and get my cases situated (extra equipment, sets, suture, meds)...thus less stress during turnover.
Counting...try to do it before I bring a pt in. Not always possible due to that rush for turnover. We absolutely do a count before the surgeon gets the scalpel...same for our timeout. I don't care if it's a blase...this is john doe and we're doing a lap appy...it still works. You should always count for cavity cases...big cavities...like the belly/chest you should always do an instrument count. It also depends on the scrub nurse I'm working with. Some like to get set up and then break until the pt is ready. I'm cool with that because I'm not running like the proverbial chicken trying to deal with the pt, anesthesia...and now my scrub nurse. Others like to lounge around and scrub in at the last minute and then ask for various items they could have gotten if they had taken the time to prepare. I don't mind getting items but piss poor planning on your part does not make it my emergency.
Yes, I have anesthesia give suture when I'm out of the room. Usually they're kind enough to tell me or write it down on the grease board. If not, my scrub nurse is usually kind enough to let me know. They can be quite helpful if you're out of the room...they can also be a pain.
We always do a time out. That wasn't always the case but even before this was JACHO doctrine if it was an extremity/eye/hernia/etc I would always time out to verify site/procedure.
Again, there's always a rush to get the case started. Most anesthesia providers/charge nurses are cool and willing to give you an extra minute to catch your breath. Of course there are exceptions to the rule.

[HarleyNurse_Sue]

I must also say yes to all of those questions. I am a really new nurse(graduated a year ago) and have been in the OR since then. I do not work in a trauma hospital but when there are 65 cases scheduled for a day and most surgeons want to be done and in the office before 5pm days are very hectic. Counting and time out are hugely important things to do. Even though you feel that no one is listening to you, you at least know that you did your job. Just know that it is not just you and that you are not alone. Call for a count whenever you want, hold up the case to do a count because in the long run you are keeping yourself and the rest of the people in the room out of the courtroom.

[Rowan13]

I am a new nurse who is involved in a 16-week internship in the OR - my dream job. Sometimes I think the dream is really a nightmare. About Time Out: I find the best time to do this without causing an uproar by the surgeon (many hate time outs because they seem to think we don't think they know what they are doing) anyway the best time for me to do it is as I am securing his/her sterile gown. I am behind the surgeon and have him/her captive. It works every time.

Our hospital also requires that the surgeon mark the site to be worked on while the patient is in the holding room. A few surgeons either refuse to do it or act like a bunch of spoiled children when surgery is held up because they didn't do it. I'd like some insight from other nurses about how to best handle the surgeon brats out there. Is there a graceful way to get them to do this hospital-required act without stepping on toes?