Pre-Procedure Verification
The facility where I work (unfortunately) transitioned over to using Cerner for documentation, and there is a pre-procedure verification section which indicates that those involved in the patients care need to do a briefing over the plan. Until just recently, I thought it was redundant, especially for those everyday cases. Last week, I had a pediatric patient that was scheduled for “Bilateral myringotomy with tube insertion, laryngoscopy, and bronchoscopy”. A myringotomy does not require the patient to be intubated, anesthesia masks down the patient since the procedure is performed so quickly, doing this they wake up fairly quickly and easily. Prior to going to get the patient, I asked the doctor if he was going to do the laryngoscopy and bronchoscopy between masking (as they too only take a short time, unless biopsies, etc. are needed). He replied with he’d take a look after doing the adenoids. I literally replied “Adenoids….?” We discovered that the patient was improperly scheduled, therefore the anesthesia plan was wrong, the equipment I needed in the room was wrong, medications I needed in the room was wrong, and the surgical tech’s set up was incomplete. Luckily, since I had reached out about the surgeons plan, we were able to catch it before the patient was in the OR and had the chance to get properly set up.
If this would not have been caught prior to the patient being brought back to the OR, the circulator would be responsible (in some cases, otherwise the surgeon) for going to the parents, family, or caregiver to get an updated consent signed by the parents, etc. This is not ideal, but there are also times when the surgeon discovers he/she should be doing something additional and unless it was talked about with the patient beforehand, a new consent is typically needed.
Asking your questions about a procedure ahead of time is always your best bet. There are times where this will save you a lot of running back and forth, but there are also times where the surgeon doesn’t think about everything they will need for a procedure. This happened that same day actually. We were getting ready to do a ‘revision meatoplasty of the ear” and the surgical tech asked the surgeon if she needed a soft tissue set up or if he needed a drill, nerve monitoring, etc. He said it’s all soft tissue, so just a ‘basic’ ear set up. Well- that wasn’t the case, not at the fault of the surgeon. He realized once he got into the patients ear that the previous surgery (by another surgeon) left the anatomy a little strange and he did end up needing the drill and the nerve monitoring- getting the drill was easy. However, adding the nerve monitoring- not so much. The patient needed have the surgical site covered with ioban, then the draped removed, the nerve monitoring electrodes placed (thank goodness we have a NIM machine and do not use a third party), then the patient was to be re-draped. This is what was best for the patient in order to ensure the best outcome. This did add a significant amount of time to the procedure, but it was needed.
Long story short, always ask your questions ahead of time. It may not always be beneficial,, but there are times where it will save you.
