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Just Another Day in the OR

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    November 29, 2017

    At my facility, we have customized our preference cards within Microsoft Word. This makes them easier to read, add notes, and update rather than the typical programs that are meant for managing inventory primarily and are used for preference cards on the side. That said, there is only one computer and only a few people have passwords to access the computer. This means finding time to update a card when someone isn’t using the computer and finding someone with a password to let you into the program. Another downside is that when a pack changes we have to manually go through every card and update them based on the changes made to the pack. All of these changes are time-consuming and additional work on top of everything else going on in my job. Our version of preference cards are an improvement on some other options I have used, but they are not perfect.

    Blogger Miranda of Love, Blood and Scrubs takes Explorer on a whirlwind tour of a typical day as a Surgical Technician in the operating room.

    In Just Another Day in the OR, Miranda emphasizes the importance of communication and teamwork before and during procedures - between techs, nurses, and surgeons - and talks about the impact of having up-to-date and correct surgeon preference cards.

    Preparing For The OR

    I manage to crawl out of bed in the wee hours of the morning, put myself together, and head out to work. I am a Certified Surgical Technologist. I clock in, change into my scrubs, cap, and OR shoes, and cross the red line. I verify which OR I will be scrubbing in for the day and head off to find my case supplies. At my facility, we pull soft supplies for cases the day before and pull instruments for cases the morning of. I look over surgeon-specific preference cards for each procedure to find the necessary instruments and pull as much as I can for the day. Next, I grab enough of my preferred gloves to get through the day, and push my covered cart to where the implants are kept. I pull a variety of implants and specialty items based on the day’s cases and the preferences of each surgeon. Now I’m ready to begin my day.

    I start by sorting my supplies for my first case. I go down the list on the preference card to verify I have all that I will need for the case. This, of course, is only effective if my preference card is correct and up-to-date. Fortunately, about 85% of our cards are accurate which makes life a little easier. We are lucky, though; this might not be the case at all surgical centers or hospitals. Once I’m confident that I have all that I will need, I grab my mask and open all necessary supplies onto my sterile field. My next task is to scrub up at the sink before the setup of my first case. I carefully gown and glove myself then do a little sterile dance with my circulator… usually to one of our favorite tunes.

    To keep myself organized and speedy, I always set up the same way: sharps zone on the left corner and instruments at the top center of my table. I roll my towel and organize all my instruments. This set-up is a basic one I learned in school, modified by tips I have picked up along the way. My mental check-list is marked off as I set up my mayo with the necessary instruments to begin the case. I do this from memory aided by a tool I dub my second "brain".

    My “brain” is a personal notebook of doctor preferences, things that are not included on their preference cards, that keeps me on track as I set up. Without this, my day would quickly turn into chaos. I’ll do a little counting with my circulator, confirm any medications that I will have on my field, and label them accordingly. Now the waiting game begins for the obligatory three minute dry time of the prep. Finally, it’s time for the draping, which I typically do alone. On occasion, I may have some help if it is a particularly difficult case, but I mostly get it done solo. Light handle covers go on, cords go off, and the Doc walks in. It’s go time!

    "My 'brain' is a personal notebook of doctor preferences, things that are not included on their preference cards, that keeps me on track as I set up."

    The OR Struggle Is Real

    In a perfect world, all aspects of my morning would run smoothly. My cases would be picked perfectly, the instruments I need would be sterile and ready-to-go, and my preference cards would be 100% accurate and up-to-date. But my world is NOT perfect. My case cart is missing the surgeon’s gloves, all my dressings, and my C-arm drape. No problem, I take the extra time to pull what is missing and get back to my routine. After a quick one-on-one with my notebook “brain”, I realize my preference card is outdated, and the instrument set I need is still being processed. That could cause a delay in the case, but I keep going, making the best of the situation. This type of delay, due to inaccurate information, seems to pop up at least once a week. However, I work with an awesome team that works together to keep delays at bay.

    "I realize my preference card is outdated, and the instrument set I need is still being processed."

    One of the hardest parts of being a surgical tech has to do with preference cards. Keeping preference cards consistently updated and accurate is a huge challenge for our facility, like many others, especially if the surgeon likes to change things up from week to week. This is why I keep my "brain" handy. There are some downsides to this, however. For example, this information is not easily accessible by anyone other than myself. Thus, most techs keep their own notebook and, when possible, copy notes from others to add to their “brain”. Also, once I’m scrubbed in, I cannot access my notes as they are not sterile. During the surgery itself,  I’m working from memory, which I do well in most cases, but if I’m working with a surgeon I’m not too familiar with, it can slow things down a bit.

    "Once I’m scrubbed in, I cannot access my notes as they are not sterile."

    Although every facility will do things differently, from who picks the cases to who is in charge of preference cards, good operating room workflow always comes down to good communication. “Good communication” can mean everything from accurate updates to preference cards to the sharing of personal notes, tips and tricks for any given case. This communication is important not only in our day-to-day, but also when a new employee joins the team. Be it a nurse or tech, these new employees need to be trained on the specific preferences of our surgeons - oftentimes that responsibility lands on the more seasoned techs and nurses already here. I’ve seen all of us step up and be great resources for sharing notes and helping them learn the preferences of the surgeons. Communication and the resulting teamwork is a requirement for any OR - not just with preference cards.

    "Good operating room workflow always comes down to good communication."

    In my experience as a Surgical Technologist and, specifically, with all of the avenues for communication and ongoing surgical preference updates that we use, I find myself saying, “There has to be a better way.” How can I communicate to my fellow techs and nurses the information I know even faster? How can we stay on top of ever changing surgeon preferences in a reasonable way? How do I streamline the information that we have? I don’t know these answers today, but am interested to see how we can continue to improve our communications in the future.

    "How can we stay on top of ever changing surgeon preferences in a reasonable way?"

    Although it is very difficult, my job as a Surgical Technologist is one of the most rewarding aspects of my life. At the end of the day, when I’m headed home or to meet my bestie for happy hour, I smile knowing that for me, every day is just another day in the OR.

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