Office-surgery advanced cardiac: life support; medication labeling; autologous bone banking; endoscopic equipment processing

AORN Journal, Nov, 2005 by Ramona Conner

QUESTION: I work in a plastic surgeons' office-based surgery center. At the completion of the day's procedures, nursing staff members, anesthesia care providers, and surgeons often leave approximately 30 minutes after the fast dressing is placed. Most of the patients receive propofol and often epidural Mocks. Recently, the professional staff members had left and the secretary/receptionist was the only person left in the facility with a patient who had undergone a five-hour abdominoplasty. As the patient was recovering, she was vomiting, and only the secretary was available to care for the patient. I feet that the patient was placed at risk. Should at least one advanced cardiac life support (ACLS)-trained professional staff member remain in the facility until the last patient is discharged safety?

ANSWER: Clinical staff members qualified in ACLS should remain in the facility until all patients have left the premises. Accrediting agency and professional association standards all either require or recommend the presence of ACLS-trained professional personnel in ambulatory and office-based surgery settings until all patients are discharged from the facility. Accreditation and professional standards vary slightly among organizations but are consistent regarding the presence of professional personnel to provide postoperative patient care.

* Accrediting bodies, such as the Centers for Medicare & Medicaid Services (CMS), require the presence of ACLS-trained personnel in the ambulatory surgery facility until all patients have left the building. The CMS states that "There must be a RN available for emergency treatment whenever there is a patient in the ASC (ambulatory surgery center)." (1)

* The Accreditation Association for Ambulatory Health Care accreditation standards require that

Personnel qualified in advanced resuscitative techniques (ie, ACLS [for adult patients] and when pediatric patients are served, PALS [pediatric advanced life support]) are present or immediately available until all patients operated on that day have been physically discharged. (2(p46))

* The Joint Commission for Accreditation of Healthcare Organizations (JCAHO) standards for office-based surgery require that

For patients who receive moderate or deep sedation or anesthesia, clinical staff members certified in advanced life support (ALS) are onsite until all such patients have been discharged from the setting. (3(pPC13.40.10))

* The American Association for Accreditation of Ambulatory Surgery Facilities requires that

A physician, certified RN anesthetist (CRNA), or RN with advanced cardiac life support certification or who is otherwise qualified in resuscitation is immediately available until all patients have met the criteria for discharge from the surgical facility. (4(p12))

Professional organization standards and guidelines also advise that ACLS-trained personnel should be present in the ambulatory surgery or office-based facility until patient discharge.

* AORN recommends that perioperative RNs providing postoperative patient care in ambulatory settings have ACLS and PALS training (ie, if pediatric care is provided). (5)

* The American Society of Perianesthesia Nurses recommends that all nurses who provide postanesthesia nursing care have ACLS and PALS training. (6)

* The American Society of Anesthesiologists states that "Personnel with training in advanced resuscitative techniques (eg, ACLS, PALS) should be immediately available until all patients are discharged home." (7)

* The American College of Surgeons states

At least one physician, who is credentialed or currently recognized as having successfully completed a course in advanced resuscitative techniques (ie, Advanced Trauma Life Support, ACLS, or PALS), must be present or immediately available with age- and size-appropriate resuscitative equipment until patients have met the criteria for discharge from the facility. In addition, other medical personnel with direct patient contact should, at a minimum, be trained in basic life support. (8)

Qualified health care personnel with ACLS or PALS training should be immediately available and remain on the premises until the last postoperative patient who has received moderate sedation or general anesthesia has been discharged from the facility. Patient safety should be safeguarded in all settings in which surgical and other invasive procedures are performed. Health care personnel with appropriate training in resuscitative techniques should be present to support the patient in the event of an emergency throughout the perioperative period.

QUESTION: The director of the pharmacy department at our facility believes that aseptos and bulb syringes used for irrigation on the sterile field should be labeled, just as we label other medication syringes. At this time, the OR policy is to only label the regular medication syringes on the sterile field; aseptos and bulb syringes are not labeled and are left in the sterile solution in the labeled basin. We have found that labels do not adhere easily to the syringes and become loose when wet. I am concerned about the potential problem of the labels falling off unnoticed into the wound. Should aseptos and bulb syringes be labeled?