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Improving communication between the OR and the intensive care unit
AORN J O U R N A L
AUGUST 1988, VOL. 48, NO 2
Practical Inno vations Improving communication between the OR and the intensive care unit
H
ow often have OR nurses taken a surgical patient from the OR to the intensive care unit (ICU) without knowing which room to put him or her in? In the health care industry, communication is the key to providing excellent patient care and practicing effective cost-saving measures. It would be a good idea if the OR nurses and the ICU nurses discuss ways to solve common problems such as knowing where to take the patient or how to avoid duplication of products. Problem: Where do I take the patient? The procedure is finally over. The cardiac surgeon tells you, “Let’s go!” You grab the OR bed, head out of the OR, and are halfway down the hallway to the ICU when you realize that you do not know where to take the patient. No one has called the ICU, so when you arrive, nobody is around. Finally, somebody shows up to take the report and locates the room. Solution: Communication board. Imagine how much easier it would be if a sign was posted in the employee access hallway between the OR and the ICU telling you where to go and to whom to report. The sign would have a message such as, “open heart patient to room 216 (patient name) (ICU nurse name)” and an arrow pointing you in the direction you need to go. After you enter the ICU, the ICU nurse will be standing by room 216 waving you straight ahead. You give the nurse the report on the patient and go back to the OR for the next case. Problem: Duplication of products. Have you ever arrived in the ICU with the patient and found the nurse preparing a Foley bag, a norepinephrine drip, and a central venous 188
pressure manometer when the patient already has those attached? And, lying on the bedside table is an nasogastric tube ready to be inserted-and the patient already has one. In the past, duplication of products did not seem as crucial. Now with cost-containment measures, diagnosis related groups, and the nursing shortage, such duplication is disturbing. Solution.- Communication form. The OR nurses complete a form that tells the ICU nurses all about the patient such as whether a nasogastric tube has been inserted, if there are pacemaker wires, and whether a norepinephrine drip is needed. The report is sent to the ICU about 15 to 30 minutes before the patient arrives. The report tells the ICU nurses that they do not have to set up another nasogastric tube or prepare a norepinephrine drip and that a pacemaker battery pack is not needed. This saves the ICU staff time, saves the patient money, and saves the hospital from unnecessary product duplication. (“See OR/ ICU Preliminary Report.”) Lack of communication can be a source of waste, duplication, and conflict. By communicating with each other, both the OR and ICU nurses can provide quality patient care. KAYROSENTHAL, RN
Kay Rosenthal, RN, MS, C C M , CVNS, is a critical care clinical specialist at the AMI Presbyterian Aurora Hospital, Aurora, Colo. She received her bachelor of science degree in nursing from Creighton University, Omaha,and her muster of science degree in nursing from the University of Colorado, Denver.
AORN JOURNAL
AUGUST 1988, VOL. 48, NO 2
OR/ICU Preliminary Report Date Time Surgeon Admission diagnosis Lines: peripheral IV (open or heparin plug) no/yes
arterial central venous pressure left artrial pressure pulmonary artery catheter Tubes: chest mediastinal chest drainage system other endotracheal ventilator settings t-piece nasogastric drains
no/yes no/yes no/yes no/yes no/yes no/yes no/yes no/yes no/yes no/yes no/yes
Procedure Anesthesiologist Allergies
site site site site site site site site
type site type site type site type
no/yes Foley no/yes pacemaker wires no/yes intra-aortic balloon pump Problems in OR: describe no/yes clotting describe no/yes long pump run describe no/yes pressure describe rhythm no/w Blood/blood components available (# units each) whole blood red blood cells plasma platelets more blood/components ordered no/yes pump blood available no/yes Drugs given in OR. Drugs to have ready in ICU: Form completed by: Patient stamp:
189
AUGUST 1988, VOL. 48, NO 2
Practical Inno vations Improving communication between the OR and the intensive care unit
H
ow often have OR nurses taken a surgical patient from the OR to the intensive care unit (ICU) without knowing which room to put him or her in? In the health care industry, communication is the key to providing excellent patient care and practicing effective cost-saving measures. It would be a good idea if the OR nurses and the ICU nurses discuss ways to solve common problems such as knowing where to take the patient or how to avoid duplication of products. Problem: Where do I take the patient? The procedure is finally over. The cardiac surgeon tells you, “Let’s go!” You grab the OR bed, head out of the OR, and are halfway down the hallway to the ICU when you realize that you do not know where to take the patient. No one has called the ICU, so when you arrive, nobody is around. Finally, somebody shows up to take the report and locates the room. Solution: Communication board. Imagine how much easier it would be if a sign was posted in the employee access hallway between the OR and the ICU telling you where to go and to whom to report. The sign would have a message such as, “open heart patient to room 216 (patient name) (ICU nurse name)” and an arrow pointing you in the direction you need to go. After you enter the ICU, the ICU nurse will be standing by room 216 waving you straight ahead. You give the nurse the report on the patient and go back to the OR for the next case. Problem: Duplication of products. Have you ever arrived in the ICU with the patient and found the nurse preparing a Foley bag, a norepinephrine drip, and a central venous 188
pressure manometer when the patient already has those attached? And, lying on the bedside table is an nasogastric tube ready to be inserted-and the patient already has one. In the past, duplication of products did not seem as crucial. Now with cost-containment measures, diagnosis related groups, and the nursing shortage, such duplication is disturbing. Solution.- Communication form. The OR nurses complete a form that tells the ICU nurses all about the patient such as whether a nasogastric tube has been inserted, if there are pacemaker wires, and whether a norepinephrine drip is needed. The report is sent to the ICU about 15 to 30 minutes before the patient arrives. The report tells the ICU nurses that they do not have to set up another nasogastric tube or prepare a norepinephrine drip and that a pacemaker battery pack is not needed. This saves the ICU staff time, saves the patient money, and saves the hospital from unnecessary product duplication. (“See OR/ ICU Preliminary Report.”) Lack of communication can be a source of waste, duplication, and conflict. By communicating with each other, both the OR and ICU nurses can provide quality patient care. KAYROSENTHAL, RN
Kay Rosenthal, RN, MS, C C M , CVNS, is a critical care clinical specialist at the AMI Presbyterian Aurora Hospital, Aurora, Colo. She received her bachelor of science degree in nursing from Creighton University, Omaha,and her muster of science degree in nursing from the University of Colorado, Denver.
AORN JOURNAL
AUGUST 1988, VOL. 48, NO 2
OR/ICU Preliminary Report Date Time Surgeon Admission diagnosis Lines: peripheral IV (open or heparin plug) no/yes
arterial central venous pressure left artrial pressure pulmonary artery catheter Tubes: chest mediastinal chest drainage system other endotracheal ventilator settings t-piece nasogastric drains
no/yes no/yes no/yes no/yes no/yes no/yes no/yes no/yes no/yes no/yes no/yes
Procedure Anesthesiologist Allergies
site site site site site site site site
type site type site type site type
no/yes Foley no/yes pacemaker wires no/yes intra-aortic balloon pump Problems in OR: describe no/yes clotting describe no/yes long pump run describe no/yes pressure describe rhythm no/w Blood/blood components available (# units each) whole blood red blood cells plasma platelets more blood/components ordered no/yes pump blood available no/yes Drugs given in OR. Drugs to have ready in ICU: Form completed by: Patient stamp:
189