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OR/PAR cooperation for better patient care Often operating room nurses feel their job is completed when the patient’s dressing is in place. But, how many OR nurses follow through with complete patient care by providing information relevant to postanesthesia care to PAR nurses. Rapport between OR and PAR nurses could be enhanced and patient care and nursing practice could be improved by employing the following suggestions that may already be or can easily become part of each OR nurses’s routine. If all the PAR nurses are busy with patients when the patient is taken to the recovery room, the OR nurse should stay with her patient until a PAR nurse can take over. The OR nurse can take the vital signs, start oxygen, and have suction available. When a patient’s identification bracelet has been removed in the OR, the OR nurse should get a replacement before taking the patient to PAR or tape the old band on the patient rather than on the chart. Physiciansoften take charts to the surgeons’ lounge to write orders, and this Judith A Kroner, RN, is an operating room staff nurse at Centinela Hospital, Inglewood, Calif. She is a graduate of the Sewickley Valley Hospital School of Nursing, Sewickley, Pa.
leaves the PAR nurses with an unidentified patient. The OR nurse can give a verbal report to the PAR nurse who admits the patient stating the patient’s name; surgeon’s name; surgical procedureperformed; any unusual incidentsduring surgery, such as extreme blood loss, drains, catheters; and physical limitations or impairments resultingfrom surgery or which the patient had prior to surgery. When changing soiled linen, the OR nurse can remove excess iodophor prep solution or blood from the patient’s skin with clean water. By seeing to it that each patient goes to the postanesthesia room on a clean, protectedbed or guerney, the OR nurse saves time and work for PAR coworkers as well as protecting the patient. If necessary, the sheet should be protected and a peripad placed on the patient. The electrocautery ground plate, sandbags, folded sheets, tourniquets, or other devices used during surgery should be removed; these articles can cause undue discomfort as well as interfere with turning and leg exercises. Place urinary drainage bags, bile bags, closed suction drainage, and similar devices so they are easily seen by PAR nurses. If the patient is large, ask PAR nurses if they prefer to have the patient placed on his own bed before being taken to the recovery room. If so, arrange to have the bed brought to the OR before the end of
AORN Journal, February 1976,Vol23, No 2
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the procedure. This thoughtful measure can facilitate both nursing care by the PAR nurse and comfort for the patient. Before taking the patient to the PAR, the OR nurse should notify PAR nurses that equipment such as continuous TUR irrigation bottles, traction, bed cradles, respirators, I-Vacs, croup tents, or Isolettes will be needed. By placing the IV pole on the side of the guerney or bed where the IV is in place, the OR nurse reduces the chances of the tubing becoming tangled and accidently removed if the patient is restless during recovery. Although verbal communication between OR and PAR nurses regarding the needs of a patient is better than no communication, written information is even better. At Centinela Hospital, Inglewood,Calif, a checklist is being used on a trial basis. OR nurses are using the form to provide PAR nurses with information they need to plan and implement good nursing care for immediate postoperative surgical patients. Listed are special problems the patient had in the OR, patient‘s comments indicating anxiety or specific concerns, physical handicaps, position of the patient during surgery, the exact site of placement of the electrocautery ground plate, and postoperative considerations. Both OR and PAR nurses agree that this coHunication improvesnursing care because some information may be left out in verbal communicationparticularly if the OR nurse has to hurry back to start the next procedure. The PAR nurse can refer to the sheet rather than calling or going to the OR for more information or for information the OR nurse gave verbally but the PAR nurse forgot in the hustle and bustle of her own activities. Thoughtfulness on the part of every OR nurse in preparingher patientfor transfer to the postanesthesia room as well as use of a checklist to improve communication can improve efficiency and cooperation between OR and PAR nurses. This cooperation will enrich the complete patient care theory and result in the patient being the ultimate beneficiary.That is what we strive to achieve.
Judith A Kroner, RN Inglewood, Calif
182
Testing durability of prosthetic heart valves A laboratory method of testing the capability of heart valves to withstand fatigue has been developed at Washington University, St Louis. The accelerated fatigue heart tester spots wear defects in a fraction of the time that they would be observed in the human body. Richard E Clark, MD, FACS, associate professor of surgery, recommended to the Clinical Congress of the American College of Surgeons in San Francisco that prosthetic heart valves be subjected to testing for durability before they are put on clinical trial. In this way, valves with poor durability may be eliminated and clinical replacement of prosthetic valves will be prevented, he said. Despite the fact that this is a valuable tool, Dr Clark emphasized that it cannot replacein vivo testing. The fatigue tester developed at Washington University works by accelerating water flow through the valve at the rate of 2,000 cycles a minute. A computer-driven, time-lapse photographic system records where the initial wear begins and its growth with time. A single frame of film is exposed each hour and each frame is sequenced at 1/24th of the valve cycle. When the developed film is projected at 24 frames a cycle, one complete cycle per second is seen, representing 24 hours of testing. Dr Clark said results to date have demonstrated that the device “will fatigue clinically available heart valves in a rapid manner and that the type of fatigue obtained appears to correlate with that seen in clinical failures.” Dr Clark considers it “fortuitous” that tests have shown that one widely-used valve becomes worn in one sector at about a three-year time equivalent. A silicone leaflet valve tore along one of its attachments, a finding that corresponds to reports of clinical failures. On the other hand, a particular prosthesis using pyrolite carbon discs shows no significant fatigue for 10-year time equivalents.
AORN Journal, February 1976, Vol23, No 2
OR/PAR cooperation for better patient care Often operating room nurses feel their job is completed when the patient’s dressing is in place. But, how many OR nurses follow through with complete patient care by providing information relevant to postanesthesia care to PAR nurses. Rapport between OR and PAR nurses could be enhanced and patient care and nursing practice could be improved by employing the following suggestions that may already be or can easily become part of each OR nurses’s routine. If all the PAR nurses are busy with patients when the patient is taken to the recovery room, the OR nurse should stay with her patient until a PAR nurse can take over. The OR nurse can take the vital signs, start oxygen, and have suction available. When a patient’s identification bracelet has been removed in the OR, the OR nurse should get a replacement before taking the patient to PAR or tape the old band on the patient rather than on the chart. Physiciansoften take charts to the surgeons’ lounge to write orders, and this Judith A Kroner, RN, is an operating room staff nurse at Centinela Hospital, Inglewood, Calif. She is a graduate of the Sewickley Valley Hospital School of Nursing, Sewickley, Pa.
leaves the PAR nurses with an unidentified patient. The OR nurse can give a verbal report to the PAR nurse who admits the patient stating the patient’s name; surgeon’s name; surgical procedureperformed; any unusual incidentsduring surgery, such as extreme blood loss, drains, catheters; and physical limitations or impairments resultingfrom surgery or which the patient had prior to surgery. When changing soiled linen, the OR nurse can remove excess iodophor prep solution or blood from the patient’s skin with clean water. By seeing to it that each patient goes to the postanesthesia room on a clean, protectedbed or guerney, the OR nurse saves time and work for PAR coworkers as well as protecting the patient. If necessary, the sheet should be protected and a peripad placed on the patient. The electrocautery ground plate, sandbags, folded sheets, tourniquets, or other devices used during surgery should be removed; these articles can cause undue discomfort as well as interfere with turning and leg exercises. Place urinary drainage bags, bile bags, closed suction drainage, and similar devices so they are easily seen by PAR nurses. If the patient is large, ask PAR nurses if they prefer to have the patient placed on his own bed before being taken to the recovery room. If so, arrange to have the bed brought to the OR before the end of
AORN Journal, February 1976,Vol23, No 2
181
the procedure. This thoughtful measure can facilitate both nursing care by the PAR nurse and comfort for the patient. Before taking the patient to the PAR, the OR nurse should notify PAR nurses that equipment such as continuous TUR irrigation bottles, traction, bed cradles, respirators, I-Vacs, croup tents, or Isolettes will be needed. By placing the IV pole on the side of the guerney or bed where the IV is in place, the OR nurse reduces the chances of the tubing becoming tangled and accidently removed if the patient is restless during recovery. Although verbal communication between OR and PAR nurses regarding the needs of a patient is better than no communication, written information is even better. At Centinela Hospital, Inglewood,Calif, a checklist is being used on a trial basis. OR nurses are using the form to provide PAR nurses with information they need to plan and implement good nursing care for immediate postoperative surgical patients. Listed are special problems the patient had in the OR, patient‘s comments indicating anxiety or specific concerns, physical handicaps, position of the patient during surgery, the exact site of placement of the electrocautery ground plate, and postoperative considerations. Both OR and PAR nurses agree that this coHunication improvesnursing care because some information may be left out in verbal communicationparticularly if the OR nurse has to hurry back to start the next procedure. The PAR nurse can refer to the sheet rather than calling or going to the OR for more information or for information the OR nurse gave verbally but the PAR nurse forgot in the hustle and bustle of her own activities. Thoughtfulness on the part of every OR nurse in preparingher patientfor transfer to the postanesthesia room as well as use of a checklist to improve communication can improve efficiency and cooperation between OR and PAR nurses. This cooperation will enrich the complete patient care theory and result in the patient being the ultimate beneficiary.That is what we strive to achieve.
Judith A Kroner, RN Inglewood, Calif
182
Testing durability of prosthetic heart valves A laboratory method of testing the capability of heart valves to withstand fatigue has been developed at Washington University, St Louis. The accelerated fatigue heart tester spots wear defects in a fraction of the time that they would be observed in the human body. Richard E Clark, MD, FACS, associate professor of surgery, recommended to the Clinical Congress of the American College of Surgeons in San Francisco that prosthetic heart valves be subjected to testing for durability before they are put on clinical trial. In this way, valves with poor durability may be eliminated and clinical replacement of prosthetic valves will be prevented, he said. Despite the fact that this is a valuable tool, Dr Clark emphasized that it cannot replacein vivo testing. The fatigue tester developed at Washington University works by accelerating water flow through the valve at the rate of 2,000 cycles a minute. A computer-driven, time-lapse photographic system records where the initial wear begins and its growth with time. A single frame of film is exposed each hour and each frame is sequenced at 1/24th of the valve cycle. When the developed film is projected at 24 frames a cycle, one complete cycle per second is seen, representing 24 hours of testing. Dr Clark said results to date have demonstrated that the device “will fatigue clinically available heart valves in a rapid manner and that the type of fatigue obtained appears to correlate with that seen in clinical failures.” Dr Clark considers it “fortuitous” that tests have shown that one widely-used valve becomes worn in one sector at about a three-year time equivalent. A silicone leaflet valve tore along one of its attachments, a finding that corresponds to reports of clinical failures. On the other hand, a particular prosthesis using pyrolite carbon discs shows no significant fatigue for 10-year time equivalents.
AORN Journal, February 1976, Vol23, No 2
