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Surgery Center Orientation
A. Drugs
1. Narcotics
a. Remove narcotic from narcotic box
b. Match narcotic number with corresponding narcotic paper
c. Narcotic boxes with key located in cupboard
d. Versed is signed out here at the surgery center.
2. Muscle relaxants in refrigerator
B. Patient Flow
1. Admission / Discharge Area
a. Schedule taped to desk
1. Cubicle number located beside patient name
2. Initial of admitting nurse
b. Check charts
1. Charts checked by admitting nurse
a. Place note on front if something is missing
2. Anesthesia checks chart (second check)
a. Consents
1. OR
2. Anesthesia
a. Patient signature might need to be witnessed
b. H & P needs to within 7 dates
1. There may be a note on the front of the chart for surgeon to update.
c. Pediatric patients
1. State regulations for surgery center mandates that primary physician be
notified of pediatric patient having surgery at a surgery center.
2. Chart will have a consent form from pediatrician or primary care provider
to allow surgery at surgery center
a. If consent not present, surgeon may document that the primary care
provider was notified. The Admission – Discharge Area has a
stamp for this.
c. Antibiotics
1. Majority of IV antibiotics are administered by anesthesia to comply with the standard of
administering within one (1) hour of incision time.
2. Check physician’s orders for antibiotics
3. If antibiotic is ordered, the Admission – Discharge nurse will have antibiotic and supplies
needed to mix and hang in the patient cubicle.
a. Do not assume there is no antibiotic ordered if you do not see the supplies.
b. Anesthesia is still responsible for checking order.
c. Please try to use the PF and save the tubing.
d. Some surgeons repeat the antibiotic in PACU, so the tubing will be reused.
4. Charges for the antibiotics and supplies will be done by the Admission –Discharge.
5. Documentation
a. Document antibiotic on anesthetic record.
b. If none ordered, please note this in antibiotic record.
6. Vancomycin
a. There is two (2) hour window for this antibiotic.
b. The Admission – Discharge will usually hang on the first patient of the day.
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c. After this patient, the Admission – Discharge nurse will notify the OR Room /
CRNA that patient is to receive vancomycin.
1. The CRNA is responsible to then notify Admission – Discharge when to
hang the Vancomycin.
a. CRNA has better understanding of the patient flow.
2. OR
a. No patient goes to OR until surgeon is in facility (hospital policy)
b. Correlate times with OR.
1. Most common error is anesthesia end time prior to leaving OR
c. Time out prior to incision
3. Anesthesia Suction
1. If suction is left on the top of the suction will crack. Turn off when not in use and relieve the
pressure in the tubing.
4. PACU
a. Assist PACU with monitors and give report
b. Leave paper work intact with PACU staff
5. By Pass PACU
a. Report to Admission – Discharge Nurse
b. By Pass sticker to be completed.
c. Leave Top copy of anesthesia record and assessment with chart.
d. Remaining chart to PACU in basket on desk
1. Remaining copies of record and assessment and two purple charge sheets (meds and
supplies)
C. Charges
1. Supply Charge Sheet
a. Combo charges
1. Breakdown of anesthesia combo charges found in file holder on the back of each
anesthesia cart
2. Combo charges same as the main hospital
3. Charge for anything extra
b. Blocks
1. When block is main anesthetic (ie – axillary block for carpal tunnel)
a. One anesthetic record
b. Use the Brachial Plexus Block combo charge
1. This combo charge includes the stimuplex needle
c. Peripheral Nerve Block is only for BIER block
d. Remember to charge for medications used in block
1. Very important – only way to replace drugs
2. When block is for post op pain management (ie – interscalene, femoral)
a. Two anesthetic records
1. One record for the block
a. sign only if assisted with the block
b. be aware of your own times, do not overlap
2. One record for the case
a. Charge for the main anesthetic, most likely Basic General LMA or
Basic General ETT
b. Must charge separately for the stimuplex needle
1. Located under regional block category
c. Charge for block drugs
1. Ask MDA, if unsure what used.
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c. Missed Charges
1. Most common missed charges include:
a. When use Basic General LMA charge, if BAER hugger used, must be charged
separately.
b. Stimuplex Needle
c. Bard tubing with a Propofol infusion
d. Suction canister and tubing if anesthesia suction is used.
2. Medication Charges
a. Antibiotics started in Admission – Discharge are charged by Admission - Discharge.
1. Anesthesia charge only is you remove the antibiotic from our stock.
b. Charge for block drugs
1. Some MDAs will mix locals, please ask.
c. Charge for sedation drugs given in admission – discharge for blocks
1. Versed and Fentanyl
a. Occasionally Propofol
2. Located on Flow sheet maintained by admission – discharge or
3. Anesthesia record if CRNA assisted with block
D. Daily Responsibilities
1. Pharmacy
a. Pharmacy delivery daily around 1000.
b. Box located in Lab room.
c. Check meds with list found in box and stock cupboard
d. Return box to lab area
2. Supplies
a. Supplies are delivered two (2) times per day (around 1000 and 1400)
b. Anesthesia order is located in anesthesia supply room and equipment room
c. If a white order sheet with supply, initial and leave in equipment room.
d. Put supplies away
1. No outside boxes are to be in OR
a. Must unpack boxes on to cart
3. End of Day
a. CRNA is responsible for all equipment, drugs, and supplies for assigned room.
1. No anesthesia aides at surgery center.
b Restock carts and machines (drugs and supplies)
1. Drug quantities marked on drug slot.
2. Supply list in file on back of cart.
c. Restock anesthesia basket
d. Wipe off all anesthesia surfaces
e. Lock anesthesia cart
f. Check and change needle container if needed
g Garbage – double red bag and remove from room
h. Blades (Dirty)
1. Dirty blades must go to dirty utility room for cleaning.
a. No dirty blade in anesthesia workroom or supply room
b. Ask OR to place on table and take to dirty rooms with their instruments or
c. Take to dirty utility room (back hallway, across from room 4)
d. Place in basin in sink with water
d. Places will be put through steris machine and returned to workroom
i. OR schedule is to be placed in shredder box.
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1. Control Desk, Front Desk, Admission – Discharge Area
j. Narcotics
1. Check sheets with narcotics in box and return to main narcotic box
2. Narcotic count must be done at end of day
k. Lock medication cabinet at the end of the day
E. Malignant Hyperthermia Cart located in center core.
F. Difficult Airway cart located in center core.
G. Cellular phones
1. Located in each OR room at computer desk
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ADDENDUM TO ORIENTATION
1. Antibiotics
a. Please use partial fills and save them for the PACU. They ususally give a second dose.
1. Charge only for antibiotics you take out of Anesthesia cart. All other antibiotics are charged by the
Admission – Discharge unit.
2. End of the Day
a. Room
1. Restock cart, machine, and basket.
2. Turn off machine and monitors.
3. Turn off O2 from flow meter.
4. Lock cart
b. Check location of keys and then lock medication cupboard.
c. Narcotic count