Standing orders; automated endoscope reprocessors; documentation; central service department attire; counting ligaclips - Clinical Issues

AORN Journal,  Jan, 2004  by Ramona Conner

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Automated endoscope reprocessors that are designed to reuse the liquid disinfectant until it has reached its minimal recommended concentration generally have their own unique rates of disinfectant dilution. Factors that can contribute to dilution of the disinfectant in an automated reprocessor include, but are not limited to,

* failure to properly level the disinfector unit,

* contact between water droplets on the basin surface left behind from a previous rinsing phase and the disinfectant delivered to the disinfection basin, and

* flushing minimal volumes of residual disinfectant (ie, disinfectant that lines the walls of the internal reprocessor plumbing or is trapped in valves) that fail to return to the disinfectant reservoir down the drain during subsequent rinsing phases performed after disinfectant immersion.

These and other factors can lead to problems associated with disinfectant-concentration testing that is performed less often than recommended. Contact the manufacturer of the particular automated endoscope reprocessor for answers to questions regarding access to the disinfectant so that concentration testing can be performed. The reprocessor manufacturer should provide specific information for disinfectant-concentration testing of the specific reprocessor model being used. (4)

QUESTION: Recently, the computer system used for charting in our OR went down for the day. Our backup, paper record was available, but some staff members did not want to chart twice. Using the paper record required them to complete a paper record first and then enter the same information in the computer when it finally became available six to eight hours later. Rather than charting twice, they simply jotted down some notes and entered them into the computer chart at a later time. Should I be concerned about this, or is this an acceptable method of charting?

ANSWER: AORN does not recommend completing the intraoperative record several hours after the procedure. One primary purpose of the record is to communicate patient information to the next caregiver. Complete, accurate, and timely documentation is vital for safe patient care. It is not a good idea to keep notes and enter the information later. Intraoperative patient care should be documented immediately and should accompany the patient to the next area of care. Delay in completion of time intraoperative record could lead to unintentional omissions, inaccuracies, and loss of critical detail.

To ensure continuity of care, time intraoperative information should be immediately available to the next caregiver. To delay this written communication could result in poor patient care or even lead to a medical error. Although the circulating nurse should provide a verbal report when transferring the patient to the next caregiver in the postanesthesia care unit (PACU) or other patient care area, verbal reports are forgotten easily or misunderstood and cannot be referred to later to confirm information or refresh memory. The PACU nurse may need to refer to various details found only on the perioperative nurses' intraoperative record.