Clarifying Questions
Mr. A is scheduled for a right lower extremity debridement, but the e-consent is for a left lower extremity debridement. You call the OPR nurse to ask this clarifying question _________________.
Have you been able to clarify what procedure Mr. A is having today? because the consent does not match the surgery schedule
This is where you look to find out what nurse is assigned to your patient in OPR.
What is the printed Surgery Schedule next to the pyxis in OPR.
This is how Ross OR staff document that hand-off communication was given to ICU/OPR
A nursing note
Discussing this topic during scrub-to-scrub handoff ensures that the receiving scrub is aware of dosages and concentrations administered to the patient
What is Medications
What additional form should the circulator be notified of during preop handoff report if the patient is having a left AKA.
What is a Limb Disposition Form
In hand-off report, you were told the patient had no past surgical history, but you want to verify a safe location to place the electrocautery pad during surgery, so you ask this common perioperative question.
Do you have any metal anywhere in or on your body?
You go to OPR to interview your patient and get handoff report. This is the first thing you should do so the OPR nurse knows you are ready for report.
What is: let the OPR nurse know you are in OPR and ready for report
The Ross OPR Documentation Worksheet is not part of the medical record, but it contains all the critical information that should be communicated in a standardized hand-off report. It should be hard to miss this form, because it is this bright color.
Pink
Discussing this topic during scrub-to-scrub and circulator-to-circulator handoff helps ensure vital information about the patient gets analyzed by pathology/microbiology
What is Specimens
This status is important to discuss during any RN to RN handoff because it provides direction on how to respond if the patient codes
DNR status
You receive this SBAR report from OPR:
S - The patient is consented for a AAA
B- He is 55yo and is accompanied by his daughter. He has no past medical or surgical history, but has allergies to ceftriaxone and PCN.
What clarifying question do you have about these allergies?
What is the patients response to ceftriaxone and PCN?
If the OPR nurse is busy with their other patient when you first arrive, you can let them know you are available and do what next step?
What is: Interview the patient
It isn’t part of the medical record, but this paper form has been added to every sterile pack at OSU and can be used to make sure the scrub-to-scrub handoff is standardized.
What is the Surgical Tech to Surgical Tech Handoff CRM Tool
Discussing this topic during pre-op to circulator hand-off reduces the risk of perioperative infections by ensuring these medications achieve peak concentration just as the skin is cut.
What is Antibiotics
It is the responsibility of OPR to alert the anesthesia team about these cardiac implants preoperatively so that orders can be placed to evaluate battery life, lead integrity, and programmed settings
What are pacemakers/implanted defibrillators
A relief suture count has been performed prior to a lunch break. This clarifying question about suture from the receiving scrub person will help them anticipate the surgeon's next move.
What suture has the surgeon been using for this part of the procedure?
Waiting for these types of situations to resolve is helpful to ensure a smooth intraoperative hand-off.
What is: critical moments (going on-pump, coming off-pump, sternotomy, etc..)
In handoff report, the ICU nurse tells you that a telephone consent for EVAR was obtained from the patient’s adult son because the patient is incapacitated. You know the telephone consent process is different from the standard in-person consent and requires this additional signature.
A witness.
The witness signature indicates that another licensed staff member (usually an RN) spoke to the patient’s legal representative to confirm the surgeon obtained consent
Don't leave the patient before discussing this with the receiving staff member.. it is the R in SBAR
What is Recommendations
Discussing this topic during circulator to receiving RN handoff helps the receiving RN to be available for the patient's arrival
What is the Expected Time of Arrival
Mr. A is consented for a right lower extremity debridement & possible wound closure. He is POD 4 from a RLE fasciotomy.
When you get handoff, the OPR nurse says the right leg dressing has been left intact, and Dr. O did not mark the surgical site because it is an obvious wound, which does not require site marking per policy.
What clarifying question should you ask to confirm that site marking is not required?
Does Mr. A have any other open wounds or skin conditions? - if he does, his surgical site will need to be marked because it will no longer be obvious what area needs debridement
Your patient is in ICU. You’ve read in the H&P that she is intubated & unconscious. You decide that it would be best to get report from the ICU nurse by phone-- how do you obtain the correct nurse’s phone number?
Call the 4 Ross UCA (number is on our laminated phone lists in all the rooms. UCA can give you the nurses name and phone number or connect you directly).
The OPR nurse tells the circulator the patient still has their wedding ring on, and that the anesthesiologist and patient have both signed this form to document the patient has been educated about risks associated with wearing their ring during surgery.
What is the Refusal to Remove Body Piercing and/or other Jewelry for Anesthesia
These situations require scrub-to-scrub and circulator-to-circulator hand-off reports.
What is temporary or permanent relief from a surgical procedure (lunch break, change of shift)
Handoff communication about this important form ensures a patient's request to take home his/her aortic valve leaflets is carried out according to OSUMC guidelines.
What is the Special Release of Surgical Tissue to Patients Release of Liability and Assumption of Risk form