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Archive October 2020 XXI, No. 10

Behind Closed Doors: Change for the Better

The pandemic has forced us rethink and revamp surgical routines.

Paula Watkins

Paula Watkins, RN, CNOR

BIO

CHECKING IN
CHECKING IN The COVID-19 pandemic has forced facilities to alter how they prepare patients for surgery.

There's no question major changes have been made in the OR as a result of COVID-19. Of course, changes come with a lot of complaints. We perioperative nurses would rather work add-on bowel resection cases than alter how we go about our days. But deep down we know this much is true: We should have made changes to some aspects of surgery long before a pandemic forced our gloved hand.

We had become a bit complacent, hadn't we? Come on, don't you think surgery is better than other departments and specialties? That we don't have the same problems because our protocols are pretty close to perfect? But one of the few positives of this pandemic is that it has forced us to rethink our "That's the way we've always done it" and "If it's not broken why fix it?" attitudes. Here a few examples:

  • Social distancing. It's no longer acceptable to pack pre-op bays that are separated by tissue thin, threadbare curtains. These bare-minimum barriers are an ongoing problem when it comes to HIPAA compliance, but it's never addressed by those in charge of dinging us for protecting a patient's privacy. Right now, you can discuss the patient, their malady and the plan for surgery within easy earshot of nosy neighbors. That can be an issue in Smallville ASCs. "Hey, I know that voice. Hiya Marge — didn't know you were having problems with your parts."
  • On-time case starts. New distancing guidelines will also force you to revamp and improve how patients are processed for surgery to ensure waiting rooms don't become overcrowded. Maybe a dedicated staff member will greet patients, take their temperatures and direct them to assigned seats in the waiting area and open bays in pre-op. Perhaps you'll assign block times based on how quickly surgeons operate and which ones arrive on time with a good attitude and paperwork complete instead of doling out assignments based on seniority and case volumes. You ultimately need a clear policy in place that will prevent patients from spending two or three hours waiting around for their procedures to start. That's a good thing, for them and for you.
  • Faster turnaround times. Cleaning up after cases is going to take longer in the post-COVID-19 era, so get ready to talk turkey about dreaded turnover times. Being asked to swoop in and reset rooms faster than it takes a NASCAR pit crew to change four tires has always been difficult for those of us in the trenches actually doing the job. With new pandemic-based cleaning protocols added to the mix, expectations will be impossible to meet. Sure, we'll continue to wipe things down manually, but now we'll have to figure out how to reach corners and cover crevices with those fancy robots and fumigating machines. Moving forward, cleaning rooms between cases will require more brain power than elbow grease.

Even though it's been a tough year in the OR, one full of uncertainty and plenty of change, there's still no place I'd rather be. If you feel the same way, send me the things for which you're grateful, and I'll try to include them in next month's column. OSM

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