Inpatient Pre-Operative Audit
Tool
Identifying and Resolving Issues with the
Inpatient Pre-Operative Process
By: Mary Muse, RN, BSN
Chair of Pre and Post-Operative Practice Committee
Role of the Pre-Op Nurse
• Verify pt Name/DOB/MRN on ID band
• Prepare OR Paperwork:
– SBAR & Blood Status Forms
– Label OR Flowsheet, charge form, etc.
• Check MD order;Hang Pre-Op Antibiotics
• Verify Allergies/Check for Red Allergy Band
• Check IV Site/Access
– Insert new PIV if existing is not working or less
than 18 guage
– Hang fluid (LR or .9NS) with blood tubing
• Verify consents are signed:
– Hospital,Surgical, and Anesthesia
Role of the Pre-Op Nurse cont..
•
Check Blood Status/Availability
–
•
•
•
Call Blood Bank/Check MD Order
Ensure operative site has been
marked/initialled by surgical team
***FINALIZE Pre-Op Checklist***
Make sure patient is informed:
–
Have surgery AND anesthesia come to see
patient & family? Answered questions?
Identify the Problem…
• Patients coming to the Pre-Op area NOT
properly prepared for surgery….
–
–
–
–
No Allergy Band, No Hospital consent
No Pre-Op Checklist Initiated,No IV Access
PCA pump connected to patient
Pts with belongings(dentures, contact lenses,
Jewelry,Cell phones, etc)
– Expired Blood Loc Codes/Type&Screen Order and
Pre-Op Labs not drawn
Purpose of Pre-Op Audit Tool
• Gather Information:
– Which errors are the most common?
– Which floors have the highest or lowest incidence
of error?
• Determine the need for re-education on the
floors/ICUs
• Provide information to help improve the
inpatient pre-op process
• Allow Pre-Op RNs a way to improve
professional practice
Pre-Op Audit Tool Data
Pre-Op Audit Tool: Errors by Nursing Unit
Cases with Errors
40
Total Cases
35
25
20
15
10
5
Nurs ing Unit
9W
PW
H
14
W
16
W
PW
H
U
PW
H
NI
C
U
SIC
16
W
16
E
15
W
15
E
14
W
14
E
13
W
13
E
12
W
12
E
11
W
11
E
10
SE
ED
O
U
10
SW
0
ED
Cases per Floor
30
Pre-Op Audit Tool Data
Pre-op Audit Tool Data
N o H os p C ons e nt
1 .6 %
B elongings
1 2 .8 %
N o A llergy B and
3 .5 %
N o P re - O p C hec k lis t
3 .5 %
proble ms
(s e e
P C A P ump
1 .6 %
I V A c c es s
1 .6 %
no problem
6 5 .0 %
T ype&S c reen
0 .8 %
N o Re d P late
6 .6 %
I s olation
0 .4 %
NPO
0 .4 %
P aperwork
0 .8 %
H C G T es t
0 .4 %
O ther
1 .2 %
What often happens as a
result of these pre-op errors?
• Pt surgery is cancelled!
• Pre-Op RN is rushed to get pt ready
– Pt safety may be compromised
– Leaves room for error
• OR cases are delayed
– Surgeon/Anesthesia dissatisfaction
– Pt dissatisfaction/frustration increases