Safety
This is when a sterile field should be prepared to minimize its exposure to airborne and environmental contaminants.
What is as close as possible to the time of use?
Teaching Point:
AORN recommends preparing the sterile field as close as possible to the time of use. The goal is to minimize the time that sterile items and the field are exposed to the OR environment.
This safety process must occur immediately before the invasive procedure begins or the incision is made, with the immediate members of the procedure team actively participating.
A patient has signed consent but, immediately before entering the OR, says, “I've changed my mind.” This is the patient's right to do this.
What is withdraw or refuse consent?
Personnel wearing hospital-provided scrubs who leave the hospital building to visit another building on campus must either change into street clothes or wear this over their scrubs.
What is disposable Bunny Suit?
Policy 11180 (OR-Surgical Attire and Restrictions)
Our department standard for turnover minutes.
What is 25 minutes? (30 minutes for total joints)
Before opening any sterile package onto the field, you should first perform these checks, including package integrity and, when applicable, sterility indicators and expiration date.
What are inspecting the package and verifying its sterility-related indicators and expiration date?
Teaching Point:
AORN recommends inspecting sterile packaging for integrity before opening and verifying applicable sterility indicators and expiration information. If the package is compromised, the item should not be considered safe for use.
A patient has the right to understand the proposed procedure, including its risks, benefits, and alternatives, before authorizing care. If the planned procedure changes, the team should stop and address this before proceeding.
What is informed consent?
A patient's signature is present on the consent, but the patient tells the circulating nurse, “I don't understand what they're doing to me.” This is the appropriate next step.
What is STOP and notify the responsible practitioner so the patient's questions and understanding can be addressed before proceeding?
Beards and facial hair must be completely covered with a beard cover before entering this area of the Surgery Department.
What is restricted Area?
Policy 11180 (OR-Surgical Attire and Restrictions)
New workflow to ensure appropriate inventory tracking for use of supplies/implants/tissue in all cases.
What is scanning of all supplies into Epic?
According to AORN sterile-technique guidance, this is the number of patients for whom an opened sterile field should be used.
What is one patient?
Teaching Point:
AORN recommends that only one sterile field be open per patient. This helps prevent cross-contamination between patients and procedures.
A patient's core temperature drops below this threshold during the perioperative period. AORN identifies this condition as inadvertent perioperative hypothermia, which is associated with complications including increased blood loss, infection risk, and delayed wound healing.
What is 36°C (96.8°F)?
Teaching point: Active warming, including appropriate use of forced-air warming, is one strategy used to help maintain normothermia. Temperature management should be planned and monitored throughout the perioperative period.
The surgeon is ready to make the incision, but the circulating RN notices the consent says left knee while the schedule says right knee. What should happen?
What is STOP the procedure and resolve the discrepancy before proceeding?
During the Time-Out, you discover that the Verification of Consent is incorrect or incomplete. After escalating the issue to the Charge Nurse, this is the next step you should expect to take.
What is stop the line and obtain a correct verification of consent prior to starting surgery?
VOC Policy 11942: (Consents)
AORN's current Patient Temperature Management guideline expanded beyond simply preventing perioperative hypothermia. It now addresses this second potentially life-threatening temperature-related perioperative emergency associated with certain anesthetic agents.
What is Malignant Hyperthermia?
Teaching point: The updated AORN guideline addresses both inadvertent perioperative hypothermia and malignant hyperthermia, including assessment, monitoring, prevention, and management.
A scrubbed team member notices that an unsterile object has contacted the sterile field. The appropriate response is to immediately recognize, communicate, and address this event rather than silently continuing the procedure.
What is a break in sterile technique?
Teaching Point:
AORN emphasizes vigilance in monitoring the sterile field and communicating when a break in sterile technique occurs. Corrective action should be taken promptly to protect the patient.
If any member of the surgical team identifies a discrepancy involving the patient, procedure, consent, site, equipment, or other safety concern, the appropriate response is to do this before proceeding.
What is Stop the Line?
The patient is asleep, the site is prepped, and the surgeon realizes the consent doesn't include an additional elective procedure they now want to perform. What should the team do?
What is STOP the line and address informed consent and verification of informed consent before performing the additional procedure?
Site Markings: What do these criteria have in common:
Premature infant, Perineum, site determined by image guidance, GI procedures accessed through single natural orifice and bilateral procedures
What is exempt from site marking?
Policy 28278 Universal Protocol
This allows the team to easily identify patients who have orders for cardiac monitoring during transport.
What is the heart emoji on our tracking board?
During a surgical procedure, this hands-free practice places needles, blades, and other sharps in a designated area rather than passing them directly from one person's hand to another. AORN identifies this practice as an important strategy for reducing sharps injuries.
What is a Neutral Zone (Safe Zone)?
Teaching point: The neutral zone should be established and communicated with the surgical team, and sharps should be placed there with verbal notification. The goal is for only one team member to handle the sharp at a time.
A patient is in preop and the nurse begins asking questions in English, and the patient responds in a foreign language and appears to not understand the nurse. The nurse utilizes the interpreter ipad. This is an example of...
What is patient rights?
The consent, surgeon's note, booking, and H&P all identify the same procedure—but the patient states during the briefing that they thought they were having a different procedure. This is what the team must do.
What is STOP the procedure and resolve the patient's concern before proceeding?
When law enforcement is not immediately available to receive a specimen intended as forensic evidence, the Chain of Custody requires that the specimen be turned over to this department.
What is security?
Policy 11181 OR-specimen handling and disposition
There are two surgeons doing two separate surgeries on the same patient during the same case. This is what is required of each independent surgeon.
What is informed consent, verification of informed consent by each surgeon independently?