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Rock Street, San Francisco

OR/PACU Experience
Regina Aldaco, SN
NWACC
I started my “OR” clinical rounds at North Hills Surgical Center. I started out in the preoperative phase of the OR. Here the nurse started IV’s and made sure consents were signed. The Patient I followed all the way through his procedure was having a left knee arthroscopy with medial meniscectomy. My first interaction with this patient was quite pleasant. After I was introduced as a Student Nurse he said “Great, I hope you enjoy your experience, the last student nurse I had was nice”. I believe this helped in his openness to me. Patient seems very relaxed and laid back, stating “I had my right knee done almost 6 months ago. The nurse took the laptop in with her as she discussed what was taking place and verifying that is what they knew. After she talked with patient and got him to verify the type of surgery the patient signed a consent on the laptop. He was asked about bruising or cuts and if he had removed all jewelry.
The surgeon would visit with the patient and verify and initial the surgery location. The circulating nurse then come in and discussed the different phases and what would take place in each phase and how long the procedure would take and let him know family would be updated if procedure took longer than expected. The patient seemed to be fully aware of the steps because he had just gone through this not long ago. The preoperative nurse • Assess patients prior to surgery • Ensure that operative and informed consents are signed and in order • Take and record vital statistics of patients to ensure readiness for surgical procedure • Initiate IVs and ensure that patients are informed about the procedure. My overall view of the preoperative phase was that it moved very fast but is a vital part of the OR.

The CRNA came in and gave a sedation in IV, while the patient was in BAY2, then he was wheeled back. He was very relaxed and was walked through moving over to the OR bed. They had the operating room set up for the procedure in hand to help prepare the surgeon. The OR was sterile and even the patient wore the blue cap to help in this process. All of this is to help aid in sterile-ness of the OR. I observed the circulating nurse call the time-out. This consisted with identification with the surgeon, anesthesia and the circulator as soon as the patient comes to the room. Before the surgery can begin the time out verifies the patients name and what procedure were doing. “The two most highly rated safety issues were preventing wrong site/procedure/patient surgery (69%) and preventing retained surgical items (61%)” ( Steelman, 2013).The nurse then checks to ensure the consent to make sure everything lines up then state that everything is correct out loud. Everyone in the room must stop and pay attention. This is done to ensure safety. The Circulator manages all the essential care inside the surgery room, assisting the team in maintaining and making a contented, harmless environment for the patient and observing the team from a wide perspective. They must ensure all surgical team members work together. I noticed that the circulating nurse can direct care and the activities in the patient’s best interest. In Intraoperative phase the team seemed to be very synchronized as if they read each other’s minds. The patient was treated with dignity and respect during the surgery.

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The surgery was complete, and the patient was wheeled to PACU. There I observed the CRNA give the nurse-to-nurse report, she was great and very detailed. I feel as if it aligned with the SBAR, she gave a very detailed description on the situation which included what they had done in surgery, the back ground was based on the patient prior to having surgery/ the need, the assessment was vitals and how he took the anesthesia, and the recommendation she thought would be useful in his recovery. I believe that all the information that was in hand-off was important in keeping the patient stable and safe. “A standardized reporting method enabled health care providers to address communication barriers and to maintain their focus on the patient during critical moments, thereby improving patient safety” (Johnson, 2013). The PACU nurse is responsible for assessing the patient’s condition by checking the vital signs, checking for any signs of pain, monitoring the respiratory system. They also have the responsibility to gather as much data about the patient and prepare a suitable care plan. The nurse will rouse the patient from anesthesia and to keep a close record of all the stats of the patient and inform the respective doctor in case of any complications or irregularities. I observed the nurse forming a post recovery scale of the patient and assessing for pain. She took vitals every 5 minutes and gradually took patient off the O2.
The discharge criteria were that the patient should be conscious and in a normal state of mind, vitals stable, Pain under manageable, nausea or vomiting is minimal, and temperature must be in normal range. The nurse kept record of all these conditions. The patient was then wheeled to Phase two of PACU or better known as recovery, there he said, “tell me everything I did crazy”. I assisted in getting him some ice water and vanilla pudding. The surgeon then come to visit him and give him details of the surgery. All the while the discharge nurse prepared his paper work and teaching material, then she went in gave him some pain medication for his ride home and read his discharge instructions and removed IV and informed him he could get dressed to go home. When patient was ready the nurse rolled him out to his awaiting ride.

Through my experience in the OR clinical rotation, I was able to go through all the phases with my patient. I feel as if all the phases are just as equally important as the next one. Watching the care team and providers working together to ensure the best care and safety for the patient was essential for the patient’s surgical experience. The care team is at a higher level of burn out due to being ” exposed to many potential hazards, including occupational traumatization, work stress, toxic and infectious agents, radiation, noise, anesthetic gases, working late into the night with a few people, working for extended periods in nonphysiologically positions, and disturbances in the workplace that threaten the security of staff” (Findik, 2015). So, it’s nice to see the OR running smooth. The patient was happy to see me in the phase two of PACU, he stated “How was your experience?”, I explained to him that it was good for me to see him through his whole experience. He seemed to be pleased that he could help me in my OR experience.

References
Findik, U. Y. (2015). Operating room nurses’ burnout and safety applications. International Journal of Caring Sciences, 8(3), 610-617. Retrieved from https://proxy01.nwacc.edu/login?url=https://search-proquest-com.proxy01.nwacc.edu/docview/1732805783?accountid=12916Johnson, F., Logsdon, P., Fournier, K., & Fisher, S. (2013). SWITCH for safety: Perioperative hand-off tools. AORN Journal, 98(5), 494-504; quiz 505-7. doi:http://dx.doi.org.proxy01.nwacc.edu:2048/10.1016/j.aorn.2013.08.016Steelman, V. M., Graling, P. R., & Perkhounkova, Y. (2013). Priority patient safety issues identified by perioperative nurses. AORN Journal, 97(4), 402-18. doi:http://dx.doi.org.proxy01.nwacc.edu:2048/10.1016/j.aorn.2012.06.016

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