Common Nursing Issues in the Operating RoomCareer News August 2, 2013
Individuals need to scan only a few nursing magazines to discover that accidents and injuries within health care settings happen in the operating room (OR) more than any other location. The OR is a unique work environment and requires higher levels of teamwork and communication. The nature of the environment creates specific issues that may be under control in other units in the hospital.
The Sharp Issue
Teamwork is the focus in the OR. Everyone has a particular role and is expected to perform that role flawlessly. The physical room is often under low light, and space may be limited due to the number of people and machines. People walk in and out of the room bringing supplies and removing waste. People hurry to keep the patient under anesthesia for as little time as possible.
In the middle of all of this controlled chaos, people are using and passing around sharp instruments. One unexpected move by a team member and injuries happen. In spite of all of the experience and professionalism in the room, people get cut, poked and punctured. There have been many attempts to reduce these injuries through the engineering of safer equipment. But there is a balance between efficiency and safety, and efficiency generally wins.
The Runaway Patient
In a team environment, people work together to accomplish a common goal. Unfortunately, it can be confusing as to who should be watching out for the unexpected. Everything can be running smoothly. Someone close to the patient on the OR table turns around and suddenly the patient’s arm or leg flings out and knocks over a sterile tray. Or worse, the patient slips to the floor.
There are preventative measures taken to make sure this doesn’t happen. The critical moments are when the patient is being positioned before the restraints are in place, and when they have been removed before the patient is transferred. During these moments, just a half second of inattention is enough for an accident to happen.
Nurses in the OR are often the last person to check on a medication before it is handed to a physician to administer. Or, the nurse may be directed to give the medicine without further inspection. There are a series of checks and balances in place to make sure this doesn’t happen. But again, the nature of the operating room environment introduces additional conditions. In a time-sensitive situation, the wrong syringe on a tray of syringes could be picked up and given. The tubing from IV bags can be confused, and the wrong IV connected to the patient. Someone gives the wrong dose having misheard the surgeons’ request.
Most facilities institute a chain of command in the OR where a number of nurses will handle medications before giving it to the physician. This makes it less likely that a mistake can happen. Yet, they still occur.
There have been countless jokes made about this, and the Internet is full of amusing X-rays. It is a reality that things are sometimes left in a patient during a surgical procedure. The typical items are sponges and various tools. Because our bodies are so good at isolating foreign bodies, this may happen way more than is ever reported.
The solution would seem to be to count everything that comes into the work field and then count them as they leave. Here is where teamwork works, or breaks down. The surgeon calls for an extra sponge or retractor, and the primary nurse is busy with another task. Someone else fulfills the request and the count is thrown off. Sponges become soaked and blend into the field. The count may be right yet a sponge has been left behind.
An Infectious Environment
Probably, the biggest challenge facing nurses in the operating room environment is the risk of infection. There are many ways that a patient can develop a post-operative infection. Pre-op procedures create issues that go unobserved before the surgery such as nicks and scratches in an area that had been shaved. A nurse gives an injection and bounces the needle resulting in a “double stick.” Scrubbing and field preparation procedures are short cut because of time constraints.
Hospitals put many processes and procedures in place to reduce the risk of infection. Again, good team work is the key. Whenever someone sees a potential issue, they should report it to be investigated. It’s easier to correct the problem than treat a wounded infection in the patient later.
Nursing and Risk Management
Nurses must know a number of techniques to be effective in the operating room. On top of that, they must constantly be on guard for those unexpected issues. Hopefully, they can be corrected early, so they don’t become a more dangerous situation for the patient during and after surgery.