OR supervisors share problems, solutions June C Persson, RN
June C Persson, R N , a member of the AORN Editorial Committee, is OR supervisor at Boulder Community Hospital, Boulder, Colo. A graduate of Johns Hopkins Hospital School of Nursing, Baltimore, she received a n A A degree from the College o f Sun Mateo, S u n Muteo, Calif. She has a BS in nursing from Johns Hopkins University and a B A in history from Loretto Heights College, Denver.
244
Has an OR supervisor from another hospital in your community ever called to ask what you do for a particular problem or whether you have had any problems with a particular piece of equipment? How often have you heard, “How do you handle call time?” “We are in the midst of reviewing our sponge, needle, and instrument counts and are wondering how you do them?” “We are attempting to revise our OR record and . . . .” This interhospital communication between OR supervisors seems to go on constantly for everyone’s benefit. If you are a new member to the management team in your operating room, your head may be spinning from this new world of personnel interviews, staffing problems, orientation, inservice education, maintenance problems, housekeeping, and budget. Your nursing education may not have covered how to cope with these problems. How do these two situations relate? At an AORN of Denver workshop a couple of years ago, one of the local OR supervisors commented she had spent hours calling local hospital OR supervisors to find out how they handled a particular problem. Others agreed they did this frequently and also received many inquiries from the other OR management personnel. Donna Tate of Presbyterian Hospital ended her comments by stating, “What we need is a meeting of all the OR supervisors and other management personnel every so often t o share ideas, problems, and solutions so we don’t waste time calling with individual surveys .” I had just been appointed assistant OR manager a t St Anthony’s Hospital and was realizing how much there is t o learn about management. I thought selfishly, “What a great way to learn. I
A O R N Journal, February 1977, Vol 25, N o 2
could get it all from these experienced hands-all the little nitty gritty do’s and don’ts.’’ Within a month we organized and in March 1974, the Denver Area OR Supervisors Committee held its first regular meeting on OR records and charting. The loosely organized group decided t o hold informal discussions but a t the same time keep detailed minutes to share with all the members. The supervisors presented their hospital charts, starting with the host hospital. They told how the charts were used, any changes being considered, and why. Some questions were, What did they like in their chart? Who is doing sponge, needle, and instrument counts and how are they recorded? Some charts included use of the cautery and where the ground pad is placed. Some had space to record visitors in the room-student nurses, x-ray technicians, critical care nurses-information that is helpful for infection control. One OR recorded if the case was late and why. Some records were a single sheet and others two to three copies for the OR, the business office for charges, or medical records. Several side discussions developed from the main topic. The first one on counts started because one hospital was ready to implement instrument counts. What did the group do when there were too many sponges present? All responded that an x-ray should be taken. A record of this should be made on the OR chart or in the nurse’s notes indicating the results. Are basic Mayo stand and back table setups necessary? All felt these are essential for proper instrument counts. The question of keeping log books was raised. Several hospitals no longer keep them because they have computerized systems that record all cases done. This is acceptable to the Joint
Commission on Accreditation of Hospitals (JCAH) because the information is retrievable. Another discussion turned t o written communication between the operating room staff and floor personnel via the patient’s chart. Most operating rooms utilize an operative record for all intraoperative occurrences. Some supervisors felt that few unit personnel refer t o the OR chart for necessary information. Several OR departments are beginning to use the standard nurse’s notes in the patient’s chart for citing information such as medications given or special or. unusual occurrences. Because unit nurses use nurse’s notes, these departments feel the nurses have a better idea of what has happened with a patient in the OR. Using nurse’s notes gives the OR occurrences higher visibility with other hospital staff members. Another beneficial session covered orientation procedures for new registered nurses and technicians in the OR. The OR supervisor a t the host hospital for that meeting, Lutheran Medical Center, gave a detailed description of the method used by Lutheran’s inservice education coordinator. Orientation covers six weeks and is individualized. Several other hospitals also have inservice education instructors but most use on-the-job training coupled with the buddy system. Several present the new employee with a packet containing the OR floor plan, general rules and regulations, and some pertinent procedures such as sponge, needle, and instrument counts. Some departments have developed skills and knowledge checklists, progress notes, andlor experience records on all new employees. Copies of forms from institutions were shared with those present. This discussion resulted in the
AORN ?Journal,Fehru1r.y 1977, Vol 2ii, No 2
245
conclusion that inservice instructors rather than senior staff members need to orient new employees to scrubbing and circulating. When orientation is done by senior staff members, it does not always have results as prescribed by policy. Hospitals using the buddy system have had only fair results. Several departments have developed basic Mayo stand and back table setups that have proven helpful in orienting new employees and students. Basic instrument sets are also helpful. Adhering to basic setups in these areas had also proven beneficial when doing instrument counts. Since the initial sessions, the group has met almost monthly. Discussions have included topics on environmental service in the operating room, OR technicians, electrical equipment, evaluations, infection control and reporting, staffing problems, JCAH and OR requirements, AORN standards of practice, and inservice education. Occasionally, guest speakers or resource people have joined us. Meetings tend to last 1%to 2 hours. A tour of the host hospital OR follows the meeting and comments heard are: “Oh, so you use that. Why?” “Well, we use this because . . . .” “Have you ever had trouble with this?’’ “Don’t buy that, it’s nothing but trouble with constant repair.”. “Oh, lovely, I just ordered two.” The committee originally included representatives from the 20 Denver area hospitals and the two Boulder hospitals. This year, OR management personnel from Longmont and Loveland hospitals joined. In some hospitals OR administrators are called supervisors and in others, managers. Some have head nurses, inservice education coordinators, and team leaders. The organizational setups vary as to the case loads, but the problems are similar and the solutions varied. 246
An interesting sidelight has been the reaction of surgeons and anesthesiologists as they become aware of the group. Has the comment “Well, they don’t do it that way over at . , . .” ever bothered you? Or, “Mercy has it, why don’t you?” Now our response tends to be “Doctor, they have it that way at St Joseph’s because . . . .” The physicians are realizing we are getting together and sharing ideas, problems, and solutions and that we know the how and why of procedures at other hospitals in the area. Not only are inter and intradepartmental communications essential to running an effective and efficient operating room but interhospital communication can benefit individual departments. The exchange of information also serves as a learning situation for new administrative staff members. We are all professional colleagues, and by sharing and combining our knowledge, our staff members and patients will benefit. 0
AORN Journal, February 1977, V o l 2 5 , No 2
June C Persson, R N , a member of the AORN Editorial Committee, is OR supervisor at Boulder Community Hospital, Boulder, Colo. A graduate of Johns Hopkins Hospital School of Nursing, Baltimore, she received a n A A degree from the College o f Sun Mateo, S u n Muteo, Calif. She has a BS in nursing from Johns Hopkins University and a B A in history from Loretto Heights College, Denver.
244
Has an OR supervisor from another hospital in your community ever called to ask what you do for a particular problem or whether you have had any problems with a particular piece of equipment? How often have you heard, “How do you handle call time?” “We are in the midst of reviewing our sponge, needle, and instrument counts and are wondering how you do them?” “We are attempting to revise our OR record and . . . .” This interhospital communication between OR supervisors seems to go on constantly for everyone’s benefit. If you are a new member to the management team in your operating room, your head may be spinning from this new world of personnel interviews, staffing problems, orientation, inservice education, maintenance problems, housekeeping, and budget. Your nursing education may not have covered how to cope with these problems. How do these two situations relate? At an AORN of Denver workshop a couple of years ago, one of the local OR supervisors commented she had spent hours calling local hospital OR supervisors to find out how they handled a particular problem. Others agreed they did this frequently and also received many inquiries from the other OR management personnel. Donna Tate of Presbyterian Hospital ended her comments by stating, “What we need is a meeting of all the OR supervisors and other management personnel every so often t o share ideas, problems, and solutions so we don’t waste time calling with individual surveys .” I had just been appointed assistant OR manager a t St Anthony’s Hospital and was realizing how much there is t o learn about management. I thought selfishly, “What a great way to learn. I
A O R N Journal, February 1977, Vol 25, N o 2
could get it all from these experienced hands-all the little nitty gritty do’s and don’ts.’’ Within a month we organized and in March 1974, the Denver Area OR Supervisors Committee held its first regular meeting on OR records and charting. The loosely organized group decided t o hold informal discussions but a t the same time keep detailed minutes to share with all the members. The supervisors presented their hospital charts, starting with the host hospital. They told how the charts were used, any changes being considered, and why. Some questions were, What did they like in their chart? Who is doing sponge, needle, and instrument counts and how are they recorded? Some charts included use of the cautery and where the ground pad is placed. Some had space to record visitors in the room-student nurses, x-ray technicians, critical care nurses-information that is helpful for infection control. One OR recorded if the case was late and why. Some records were a single sheet and others two to three copies for the OR, the business office for charges, or medical records. Several side discussions developed from the main topic. The first one on counts started because one hospital was ready to implement instrument counts. What did the group do when there were too many sponges present? All responded that an x-ray should be taken. A record of this should be made on the OR chart or in the nurse’s notes indicating the results. Are basic Mayo stand and back table setups necessary? All felt these are essential for proper instrument counts. The question of keeping log books was raised. Several hospitals no longer keep them because they have computerized systems that record all cases done. This is acceptable to the Joint
Commission on Accreditation of Hospitals (JCAH) because the information is retrievable. Another discussion turned t o written communication between the operating room staff and floor personnel via the patient’s chart. Most operating rooms utilize an operative record for all intraoperative occurrences. Some supervisors felt that few unit personnel refer t o the OR chart for necessary information. Several OR departments are beginning to use the standard nurse’s notes in the patient’s chart for citing information such as medications given or special or. unusual occurrences. Because unit nurses use nurse’s notes, these departments feel the nurses have a better idea of what has happened with a patient in the OR. Using nurse’s notes gives the OR occurrences higher visibility with other hospital staff members. Another beneficial session covered orientation procedures for new registered nurses and technicians in the OR. The OR supervisor a t the host hospital for that meeting, Lutheran Medical Center, gave a detailed description of the method used by Lutheran’s inservice education coordinator. Orientation covers six weeks and is individualized. Several other hospitals also have inservice education instructors but most use on-the-job training coupled with the buddy system. Several present the new employee with a packet containing the OR floor plan, general rules and regulations, and some pertinent procedures such as sponge, needle, and instrument counts. Some departments have developed skills and knowledge checklists, progress notes, andlor experience records on all new employees. Copies of forms from institutions were shared with those present. This discussion resulted in the
AORN ?Journal,Fehru1r.y 1977, Vol 2ii, No 2
245
conclusion that inservice instructors rather than senior staff members need to orient new employees to scrubbing and circulating. When orientation is done by senior staff members, it does not always have results as prescribed by policy. Hospitals using the buddy system have had only fair results. Several departments have developed basic Mayo stand and back table setups that have proven helpful in orienting new employees and students. Basic instrument sets are also helpful. Adhering to basic setups in these areas had also proven beneficial when doing instrument counts. Since the initial sessions, the group has met almost monthly. Discussions have included topics on environmental service in the operating room, OR technicians, electrical equipment, evaluations, infection control and reporting, staffing problems, JCAH and OR requirements, AORN standards of practice, and inservice education. Occasionally, guest speakers or resource people have joined us. Meetings tend to last 1%to 2 hours. A tour of the host hospital OR follows the meeting and comments heard are: “Oh, so you use that. Why?” “Well, we use this because . . . .” “Have you ever had trouble with this?’’ “Don’t buy that, it’s nothing but trouble with constant repair.”. “Oh, lovely, I just ordered two.” The committee originally included representatives from the 20 Denver area hospitals and the two Boulder hospitals. This year, OR management personnel from Longmont and Loveland hospitals joined. In some hospitals OR administrators are called supervisors and in others, managers. Some have head nurses, inservice education coordinators, and team leaders. The organizational setups vary as to the case loads, but the problems are similar and the solutions varied. 246
An interesting sidelight has been the reaction of surgeons and anesthesiologists as they become aware of the group. Has the comment “Well, they don’t do it that way over at . , . .” ever bothered you? Or, “Mercy has it, why don’t you?” Now our response tends to be “Doctor, they have it that way at St Joseph’s because . . . .” The physicians are realizing we are getting together and sharing ideas, problems, and solutions and that we know the how and why of procedures at other hospitals in the area. Not only are inter and intradepartmental communications essential to running an effective and efficient operating room but interhospital communication can benefit individual departments. The exchange of information also serves as a learning situation for new administrative staff members. We are all professional colleagues, and by sharing and combining our knowledge, our staff members and patients will benefit. 0
AORN Journal, February 1977, V o l 2 5 , No 2
