Everyday Struggles in the OR | Part One
After nearly 2 years in an OR leadership position, I decided to take a step back. I learned so much during this journey and I will be grateful for the opportunity to lead that team and I will remember them forever. I have a different prospecting on a lot of things after being a leader and I learned a lot about myself. Choosing to leave this role was bittersweet, but I do believe it was in my best interest (more on this later!). I returned to my ‘home’ hospital back at the (OR) bedside. While there was nothing that seemed to change, there was a lot that did.
Charting System Struggles in the OR
One of the major changes was that the hospital (unfortunately) switched from Epic to Cerner. Yes, you heard that FROM Epic TO Cerner. Talk about a downgrade!! Adjusting to this charting system has been a struggle on nearly every aspect. I’ve noticed some things missing, and I truly wonder how this charting system is ’approved’. For example, there is no place to document incisions. How will the care team document assessments of the incisions in PACU or on the floor? Of course, you can always verbally tell the next care team on handoff, but that feels like an ‘if you didn’t chart it, it didn’t happen’ situation. You can free text in skin assessment, but there isn’t even a ‘post-op skin assessment’ area. Maybe other areas have a better version and have updated their pain points? Rumor is, we will be going back to Epic within the next few years – phew!
Process Change Struggles in the OR | PTH Labs
Another change for me was intraoperative PTH labs for parathyroidectomy. This best practice, however, the previous surgeons who I had done parathyroids with did not order labs until postoperatively. So, here we are about 20 minutes into the procedure and the CNRA comes over to me (there’s a student intern still with the patient) and asks if I had done the PTH before, I immediately knew I missed something. I reviewed the preference card ahead of time and saw nothing there related to PTH, not that that says much, Cerner’s preference cards are a joke. So, we problem solved (or PS’d as my 4-year-old would say) and found some printed off instructions from an email that was hanging up in another OR.
So here I go following the instructions to get a label printed from PACU and called lab, etc. The instructions say specifically to tube the sample to lab, so I did. Made the phone call to let them know it was sent over with a STAT order. Went back to my room. Waited a bit, after about 20 minutes I asked the surgeon if it’s normal that this takes a while. He said it has been a little ridiculous how long it takes to get the results back lately. So, I wait another 20 minutes or so with no result still. I give lab a call. THEY NEVER GOT THE SAMPLE. What?? I called you and told you I just tubed it to you, and it didn’t come. Wouldn’t you have thought hmm... maybe I should call? Apparently not. So, we get another sample drawn and another nurse offered to walk it down for me and hand it to them directly. Okay, now we’re moving. But what happened to the specimen I sent? Labs tube station was full, and it sent it back. Another nurse went to use the tube station and sat the blood over to the side and moved on with her task. Should I have just walked in down in the first place, absolutely. But I followed the instructions and tubed it. You can bet I adjusted the instructions after this incident. Moral of this story - just walk your samples to the lab if you’re able to!
There will continue to be struggles on a daily basis, but if you stay flexible and open to adjusting your daily practice, you’ll adapt just fine! One of my biggest pet peeves is when I heard people say “But we’ve always done it this way”. That attitude right there is when you no longer move forward. If you’re struggling with a change that was presented, try to understand the why behind it. It may not help you LIKE the change anymore, but it may help you see the importance.
