PATIENT SAFETY IN THE OR
“Welcome to the OR!” is not the initial greeting you are likely to hear on your first day in the OR. “Whoa there!” is typically the first salutation you’ll receive if you get too close to the sterile field. More than likely you’ll think you are at a rodeo, not because we use stirrups but because things happen fast. Controlled chaos is among the terms used by those observing in the OR for the first time. One of the things as educator and circulator I emphasize while orienting new RNs, medical students, and OR first-timers is that our first concern is always patient safety.
Envision for a moment the OR from the patient’s perspective. The patient makes an appointment with their primary care provider (PCP) for either a routine physical or if something unusual is happening—pain, a lump, or an “unusual” feeling. Typically, they have an extended relationship with this provider where trust has already been established. The PCP then refers the patient to a surgeon with whom the patient meets once (that’s plenty of time to build an extensive relationship of trust, right?). Then, the next thing they know they are in the a.m. admission or same-day surgery (SDS) unit getting ready for surgery. The SDS RN then calls the OR RN for handoff communication. This is a safety briefing, ensuring that pertinent information is passed along to each caregiver. This is usually done in an SBAR (situation, background, assessment, recommendations) format. This gives us an organized format to deliver a brief and appropriately detailed report specific to the patient and allows the OR RN to plan for the specific needs of the patient.
Next, the patient is in route to the OR and they have had nothing to eat or drink since midnight. They’re nervous and hungry, which can translate into lightheadedness and dizziness. In addition, an IV has just been started before they were transferred to the OR. What does this equate to? Fall risk. All of our patients in the perioperative setting are at risk for falls. As our patients proceed to the OR, we talk to them in a preoperative holding area, and inevitably most need to go to the bathroom one more time—they will need an escort to the bathroom.
Bathroom duties handled, they are back on the gurney and headed to the OR suite. However, they stop first at the “red line” (Figure 15.1). “Red line,” you ask? That’s what designates the need for OR attire beyond the line. It’s one of our steps in keeping the patient safe.
Now for my soapbox. OR attire is there for a reason, so if you are an MD, med student, PA, NP, RN or anyone else, let’s be clear: OR attire is just that—attire for the operating room (Figure 15.2). If I wear my scrubs home, yes, I may look cool as I stop at the grocery store on the way home but I’ve just been in a bloody, contaminated OR. Then I am going home and throwing my scrubs in with my family’s laundry (that’s a pleasant thought). Then we take those “clean” scrubs and wear them from home where I have just been playing with my dog and proceed to the OR. Get it? Change your scrubs at the hospital. Patient safety starts with you.