Get your patient to surgery on time – some do’s and don’ts

Get your patient to surgery on time – some do’s and don’ts

stopwatchRushing to get your patient to the OR on time? Here are a few tips to help you plan ahead, compiled by OR nurse Cheryl Walker, RN, BSN, CNOR. “When our patients are totally prepared for their surgical experience, it prevents unnecessary anxieties and possible post operative complications,” she explains.

Consider using this reference sheet during handoff on pre-procedure patients or keeping a laminated copy at the nurses’ station. Read the content below or click here for a PDF version.

Do make sure patient has removed all clothing (including underwear) except for their hospital gown. Clothing can get in the way if chest compressions or other emergent procedures are required.

DO NOT give patient any food by mouth 6-8 hours before scheduled surgery. Medications by mouth can be given with sips of water. Tube feedings should be turned off 6 hours before scheduled surgery.

Do instruct patient to remove all jewelry and hair accessories. This includes earrings, watches, rings and piercings of any kind. Cautery devices used in surgery can cause burns to patients wearing metal objects. In the event a wedding ring cannot be removed, it should be taped to the patient’s finger.

DO NOT give patient clear fluids to drink 3- 4 hours before surgery. Patients should not chew gum or suck on candy prior to surgery – this stimulates the production of gastric juices in the stomach.

Do obtain an order to draw labs for hemoglobin and hematocrit.  A basic electrolyte panel would be needed if patient is on diuretics, diabetic medications, or beta blockers.

DO NOT bring patient to the surgical suite with personal items such as wallets, cell phones, pocket books, money, wigs or hair pieces. Valuables must be given to a family member or signed over to security.

Do obtain an order for a stat EKG if patient has a history of cardiac disease.

Do have a functioning 18 or 20 gauge peripheral IV.

Do have the patient sign a consent form indicating the procedure to be performed. The consent form should be witnessed by the nurse after the patient acknowledges understanding of the procedure. The signature of the patient, witness, and surgeon performing the operation should be dated and timed. If the patient is unable to sign because of an impaired mental status, unconsciousness or a physical disability, the next of kin or power of attorney can sign.  A telephone consent is obtained when the next kin, legal guardian or power of attorney is physically not able to sign. This type of consent requires two (2) witnesses who are listening as the surgeon explains the procedure or operation to be performed.

Do educate the patient on what you are doing. This will help lower their anxiety level.

4 comments

  1. Posted by Anne Patterson, at Reply

    Ultimately, informed consent is the sole responsiblility of the proceduralist performing the procedure. The doctor explains procedure (informed consent)to patient. An order is entered that will include the name of procedure, no abbreviations, exactly as it should appear on the consent form. This order is transcribed to a consent form. The nurse is “witnessing” the signature of the patient only, not the content. This is within the nurses’ scope of practice. If the patient has further questions the doctor will be contacted to clearify procedure.
    Perhaps legal consents and scope of practice are great topics for grand rounds.

    Anne Patterson, Margaret Saul & Terri Ridel

  2. Posted by KP Verow Mclaughlin, at Reply

    I and many of the RN’s I have encountered have some concerns/reservations about the encouragement to;

    “Do have the patient sign a consent form indicating the procedure to be performed. The consent form should be witnessed by the nurse after the patient acknowledges understanding of the procedure. The signature of the patient, witness, and surgeon performing the operation should be dated and timed.”

    There are many cases and seemingly a general sentiment hospital-wide, that presumes the RN’s can have the patient sign the consent form prior to pre-op. Physicians often write orders to that effect. Unless I am missing something, I am of the understanding that in fact the surgeon and only the surgeon can have the patient sign the consent. It is outside our scope to actually gain consent.

    It is very much our role to facilitate getting it completed and witnessing with our signature is appropriate.

    I would, and I believe quite a number of nurses in the hospital would as well, appreciate some clarity on this issue and how to deal with an MD order “obtain consent” or “have patient sign consent” for procedure.

    This leaves out the common practice of MD’s obtaining consent from a patient at the bedside and then coming out of the room to ask a nurse to sign as witness. Having not witnessed because I was not there it is a difficult position to be placed in.

    Thoughts anyone?

    • Posted by Cheryl Walker, RN, at Reply

      After obtaining an order for consent for surgery or procedure. It is the surgeon or proceduralist’s responsibility to explain the surgery or procedure to the patient. The nurse’s signature on the consent is witnessing the patient’s signature on the consent form.

  3. Posted by Beth Schmidt, at Reply

    Thanks for the tip sheet! Always looking for ways to be timely.
    Don’t forget antibiotics that need to be ordered & hanging before our pre-anesthesia checklist.

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