Transcript Perioperative Patient Throughput and Turnover Worksheet

AORN Perioperative Efficiency Tool Kit
2016
Instructions for using the Perioperative Patient Throughput and
Turnover worksheet
The attached PowerPoint® document is a process mapping tool where the
swim lanes define each team member’s lane for mapping tasks performed
over the defined time period. The time increments at the top help define the
amount of time each task requires and sequences tasks performed by
multiple team members. The times may be longer or shorter depending on
the complexity of the procedure and the physical layout of the facility.
The swim lanes do not reflect a race but rather help synchronize each team
member as the patient moves through the process. The first three slides
provide an example to trigger discussion about the turnover process among
team members. The blank slides can be edited to describe the roles at your
facility and the tasks for your process flow. See instruction document on web
site for more detail on how to use the worksheet.
Participate in
debrief/confirm
time to return to
OR for next case
Apply dressing and remove drapes
Write postop orders and dictate postop note
Participate in
debrief/confirm time
to return to OR for
next case
Apply dressing and remove drapes
Assist with patient
transfer and
transport
Arrange Patient #2 transport
Participate in debrief/
designate time to return
to OR with next patient
based on facility standard
Participate in
debrief
Transport patient
to PACU
Give hand-over report to PACU Nurse
Keep assigned team members in the OR informed of any changes to the schedule
Notify front desk when ready to send for Patient #2/call for turnover
help/alert PACU that closure started/give approximate time of arrival to
PACU
After count, begin instrument
gathering/ organize instruments for
processing by placing back in original
containers to decrease the risk of loss
and improve turnaround time for set
assembly and sterilization
Assist with transfer
of patient to bed
Extubate patient
Participate in debrief/confirm time to return to OR for next case
Greet next patient in Preop area
and mark surgical site
Assist Surgeon with dressing/remove drapes
Transport Patient #2 to Preop area if necessary/collect room cleaning supplies
Participate in
debrief
Complete Patient #2 case cart
Complete preop preparation of Patient #2
Secure dressing
Assist in patient
transfer to patient
bed
Break down sterile field and put dirty instruments in trays
according to policy/hand off any instruments that need to be
sterilized for subsequent cases
Bring bed and
transfer device into
room
Assist with termination of anesthesia
Return unused, clean supplies
Initiate DVT
prophylaxis and
prewarming protocols
Finalize patient
documentation
Assist with transfer
to PACU
Assist with
collection of trash
and dirty linens
Assist with
collection of trash
and dirty linens
Move equipment to periphery/begin wipe down
of equipment (foot pedals, cords, outer surfaces)
Assist with patient
transfer to bed
Assist with transport to PACU
Assist with patient
transfer to bed
Return equipment that is no longer needed
Start IV and give medication as ordered
Receive patient and hand-off information from
RN circulator/receive hand-off information
from anesthesia provider
Verify case cart and equipment for next patient
Place case cart and
equipment for
Patient #2 by room
Assist Scrub Tech in
breaking down
sterile field
Assist with patient
transfer to bed
Remove unused
medication
Clean nurses desk
and computer
keyboard
Give hand-over
report to PACU
nurse
Review Patient #2
chart
Mark surgical site for Patient #2
Communicate with Patient #1 family
Out of room/return to OR at designated time
discussed during debrief for Patient #1.
Greet Patient #2 in Preop area
Return to OR
Out of room
PACU with Patient #1/write postop orders
Start invasive line, blocks etc/verify and
document preoperative antibiotic/
communicate special needs to RN Circulator
and Anesthesia Tech
Greet Patient #2/verify identity, site marked, and procedure with
patient/review preop assessment and receive hand-off report from
Preop Nurse/perform additional assessment if needed and provide
patient teaching/check blood product availability/erase whiteboard
from previous patient/write Patient #2 information on whiteboard
Coordinate, assess and assist
with progress of turnover/
review preference card/ensure
equipment and supply
readiness/ spread sterile
supplies and begin opening
Breaks down sterile field/wipe down back tables,
Mayo stands, and ring stands/places them in
designated position to identify that they are clean/
transport case cart to decontamination area
Validate Patient #2 case
cart and bring into
room/spread sterile
supplies and begin opening
Wipe down lights, OR bed/mop floor/
remove trash and equipment
Make bed
Remove dirty equipment from anesthesia
machine and cart/wipe off anesthesia cart and
all cables with approved disinfectant
Put new breathing circuit
on anesthesia machine/
prepare any needed
supplies or equipment for
Patient #2
Notify team if more
time is required
Final check for necessary equipment and
supplies
Scrub, don gown
and gloves
Prepare sterile field
Transport Patient #2
to OR at designated
time
Complete initial count and
document on whiteboard
Count with RN
Circulator
Pick up Patient #3
Assist Anesthesiologist with patient transport
from Preop to OR
Provide hand-over report to Anesthesia
Provider and RN Circulator
Assemble positioning equipment for Patient #2
Bring new medication tray into room/set up
prep tray/prepare medications
Greet patient upon
entering room and
introduce other staff
members in the room
to the patient
Begin preop of Patient #3/review and complete preop checklist/
contact MD or PA to resolve missing items or conflicts in orders/manage patient anxiety
Coordinate sterilization of instruments for
Patient #3 or later patients in the day
Begin review of Patient #3 case cart,
instruments, and supplies/pick suture and
gloves for case cart
Assist with opening sterile supplies/
dispense medications to field
Greet patient if RN
Circulator is still
involved in count
In room at designated time
Assist and direct positioning/clip
skin if needed
In room\assist with transfer of patient to OR bed
Assist with positioning
Induction and intubation
Assist with transfer of patient
to OR bed/continue
prewarming of patient/assist
with applying monitoring
equipment
If Anesthesia Tech is not available, assist with intubation
Line placement
Apply SCD
Assist with transfer of
patient to OR bed/assist
with applying monitoring
equipment
Scrub and
don surgical
gown and
gloves
Perform
briefing
and
surgical
time out
Assist with positioning and
perform final assessment of
patient alignment
Insert Foley if required
While skin
prep is
drying,
perform
briefing and
time out
Perform skin prep
Gown and
glove
surgeon and
assistant
Assist surgical team as
needed with supplies and
equipment
Assist with induction and intubation/
assist with line placement
Deliver HLD or IUS items to room
Drape
patient
Make incision
Drape patient
Perform
briefing
and
surgical
time out
Complete sterile field set up
Move
stretcher/bed
out of room to
designated
location
Perform
briefing
and
surgical
time out
Assist with positioning and
applying warming blanket/
assess patient alignment
when positioning complete
Assists with transfer of
patient to OR bed/apply
monitoring equipment
Assist with transfer of
patient to OR bed
Scrub and don
surgical gown and
gloves/wait
appropriate time
for skin prep to
dry
Assist with positioning
Assist with positioning
Assist with prep if necessary
While skin
prep is
drying,
perform
briefing and
time out
Assist with draping and
positioning back
table/connect ESU, suction,
and other equipment
Document
time of
incision
Assist with draping
patient
Hand scalpel
to surgeon
Continually monitor the room and be available to assist with
running for items
Cover for other technicians if they are busy in another room/
restock extra anesthesia carts and exchange with depleted carts/
restock depleted carts throughout the day to have them available for exchange
Continue to sterilize other instruments needed for subsequent cases/communicate with OR Aide for delivery of supplies not anticipated for procedure
Preop assessment of
subsequent patients
Assist Scrub Tech with items needed to
complete sterile setup
Continually monitor room and be available to
assist with running for items
Prepare case cart supplies and equipment for
Patient #3
Provide breaks and lunches as assigned