IntraOp Questions

Which IV might you see in the Intraop Lines/Drains section?

Any lines, drains, airways that were added in preop will be here. You can perform an assessment at any time by clicking on the quick buttons. (You can also add an LDA if necessary - usually anesthesia is responsible for this)

As you document Site Completion, what should you also document to ensure the patient's record accurately reflects what time the site was closed?

Case tracking event

Room setup started ten minutes ago. You realize that when you clicked the Setup Start button, it documented room setup at the current time. What is the fastest way to correct this documentation?

Click the Events button in the IntraOp sidebar

How do you document an Event at the current time VERSUS edit/documenting an event at a past time? (Not using the All Events)

Click the big Event Quick button to document event for current time; use the little Events quick button to document an event in the past

When there are multiple procedures being performed in a single case, how do you indicate which procedure you are documenting positioning for?

Click the button with the procedure name

You are documenting a Final Count. What question appears here that did no appear in the initial count?

Counts correct?

You are documenting a Final Count. What question appears here that did not appear in the Initial Count?

Counts correct?

T/F You must document which individual ESU is being used.

False

What different ways can you search for new supplies?

Full name, partial name, catalogue #, manufacturer #

You administer 3 mL of bupivicaine. Which incomplete field MUST you fill out before you complete this documentation?

Given by

If you are beginning to set up the OR for Ruby's case, how do you do this?

Go to ALL EVENTS button and add the correct date and time to the Setup start cells. Click accept. You have to use all events, you can't right-click from her chart. (Patient does not change color on status board FYI after you do this)

What do you have to do when you start the closing process?

Go to Counts, select closing and document who completed and verified counts. The make sure you make Procedure closing a case tracking event. Then go to Site completion section to document the closing of the surgical site(s).

If blood needs to be given, what is the first step?

Go to the More button on bottom left of screen, and click Blood Admin. This is the Blood Admin Navigator. You'll find consents, blood workflow quick tips and documentation tools. Then click Transfuse orders...and release.

What is important to remember when adding equipment and instruments?

Make sure you select the right selection (equipment, anesthesia equipment, or instrument) below the search field - otherwise you might not find what you are looking for

What should you click to indicate that you have sent a specimen to the lab for analysis?

Mark as Sent

You have started documenting a timeout, but need to close it when you have not yet finished. What should you click?

Pend it.

What does the Summary report show?

Procedure info, patient class, anesthesia, laterality, info on allergies, home meds, history, pre-op vitals and other info collected earlier from patient. You can also see what meds were administered to the patient during preop.

T/F Any time a specimen is sent to the lab, an order must accompany it.

TRUE! For multiple tissue specimens, only one order is needed. Make sure to name and list each specimen in the comments.

T/F You always have to enter your your password when verifying a chart.

TRUE. And this is because once the timeout is verified, it becomes read-only and cannot be edited. (To fix errors, add a comment or complete a second timeout)

What is the Handoff Report?

This is the very last section of Closing. Use this summary of preop and intraop documentation to review patient info with the PACU or postop nurse.

Which section do you confirm all of your specimens?

Timeout (debriefing)

T/F You can document a visitor in the room.

True. Add visitor (there is a button next to the search field in the Staff section) and free text their name.

Where do you find any IVs for your patient when they are in the room being prepped?

Under Lines/Drains section in the Intra-op navigator. All lines, drains, airways, tubes, wounds, incisions appear here. You will see any IV that was added in pre-op.

What happens if you can't find a supply the surgeon wants to use when you are searching for it?

Use the One Time Supply button for "supply on the fly". Enter necessary info.

If a doctor wants to use a different preference card fo a prodedure, what indicates the differences between the two cards?

Yellow highlight

What are Core Measures and do you have to complete this?

Yes, required for all patients. Way for you to indicate when a patient has a certain condition or meets certain criteria for clinical trial, etc.

How are implant trays different from implants?

You can use +/- buttons to change the number of an item in which the serial and lot #s are the same. Use the Add button to duplicate that item because the serial and lot #s are different. (Remember implants require more detailed info - lot/serial, tissue, date, location, etc)

How do you add another PRIMARY surgeon and/or service?

You have to use the Procedures section and add a panel if adding another PRIMARY doc. If you are just changing/switching the primary surgeon for the service, you have to add the new one BEFORE you can delete the old one. Additional procedures in the same servce can be added in the Add Procedure field. (You can add an assisting surgeon in the staff section). Remember a panel is defined as one primary surgeon and one service.

How does the system know which staff names to display on the Timeout form?

You previously documented the names in the Staff section

What do you document when the transfusion is complete?

You'd document a rate of O and calculate the total volume.

What do you type in the Manage orders field when trying to create and order to send a specimen to the lab?

"Spec to path" (aka specimen to pathology)

What fields are required when entering an implant?

Action (ex. implanted), Site (ex. abdomen), time, and Y or N if implant is a tissue. (serial #,lot # , and exp. date are optional yellow stops but you SHOULD enter thistrt). Implants require more detailed info than supplies.

What happens when you document on a site in the Site Completion section?

An incision LDA is automatically generated for the PACU nurse to document on

What button can you press to jump to each section in the comments field of the Lab order for a specimen? (If comment field contains Smart Text ***)

F2

T/F When documenting a timeout, you must document the answers to each question individually.

FALSE

T/F You MUST document which individual ESU is being used.

FALSE

The circulating nurse MUST use the MAR to document medication administration.

FALSE

When documenting a timeout, you must document the answer to each question individually.

FALSE

T/F You can administer blood from the Orders section.

FALSE. (You can order blood from the orders section though!) You might have to use the More button in the bottom left corner (below the navigators) and Click Blood Admin. This takes you to the Blood Admin Navigator where you start the process. (first have to release, then document in Blood flowsheet)

T/F You can document more than one pre-op skin condition at a time.

FALSE. Click new skin condition to document another pre-op skin condition (if they are largely the same you can click the copy icon and change the site). This is the same for Site Prep - you can only document one site at a time, but there are quick buttons.

T/F For equipment that can harm the patient, you don't have to document more equipment settings that other types of equipment.

FALSE. The equip/inst sections provides fields for each of the individual settings you must document for such equipment. Ex. With ESU you have to document a lot of info

T/F You canNOT edit an IV on a patient if it was giving to them in pre-op.

FALSE. You can click on the blue hyperlink and edit it with any intraoperative changes. I.e. if you changed the dressing, etc. **Remember that if the LDA was administered by the anesthesia staff, they will complete the documentation.

What is the purpose of the Macro button?

If you create one, it helps speed up documentation in the future. An intra-op macro will save your site preparation, site completion, pre-op skin, and post-op skin information. Any time you have a patient with this same procedure, the macro button will appear at the top of the navigator and you can pull in saved info automatically.

What do you do if you want to change a preference card?

If you want to permenantly change a preference card, you can send a request to one of the preference card builders. To do this, in the Intraop sidebar click on More actions and select Revise card. Send the email message to the builder at your facility. (You can also switch preference cards as well - the differences between the two cards will be highlighted in yellow. This might be appropriate if the provider changes)

Dr Hunter Timely is unable to perform Brianna's surgery today, so Dr Martin Stitch is going to be the primary surgeon. Where can you add Dr Stitch as primary surgeon and remove Dr Timely altogether from the procedure?

In the Procedures section

What could be happening if you are searching for equipment in Intraop and can't find it?

Make sure you are searching Equipment and NOT Anesthesia equipment or Instruments (these are all under Equip/Instr section)

Can you document more than one site prep at at time?

No, but you can copy and paste if the sites are similar.

Do you have to start from scratch when documenting site completion and post-op skin?

No, info pulls from the site prep and pre-op skin sections. You just make any necessary updates

Document wound class in the __________ section.

Procedures

What is the first thing you review when setting up the OR?

Review the Summary Report for the patient.

What do you need to do before you administer the blood?

Scan patient's armband and the blood barcode. (Anestheisa would most likely be documenting, but you can do this in blood flowsheets)

How do you search for a supply that is not already present on your list?

Search by name (or any variation of a name, including part of the supply name or nickname) or manufacturer number or catalog #. You manually change the numbers or use blue arrows.

What do you need to remember to do when you are checking the Procedures section of the patient's chart in Intraop?

Select a wound class! (use the speed buttons)

How are implant trays entered differently than implants?

Select the implants from the tray that you need. Use the + and - buttons to increase and decrease the number of each implant used. Click ADD if that iplant has a different serial/lot number for each individual implant. Use the fields to the right to document this info (lot #, model #, exp. date).

What should you select if your options are available as quick buttons when documenting site prep?

Show All Values

Document that Brianna's abdomen was scrubbed and painted with Betadine. In what section does this go?

Site Completion

What will a Macro save to help speed up the process for next time?

Site prep, site completion, pre-op skin, post-op skin. Helpful the next time you have a patient with this procedure.

What do you have to document before you can document Set Up complete? And do you want to do one before the other, if so, why?

Staff and counts. Staff - document nurse, scrub, docs, etc. Quick buttons are available for you to use. Put the proper time in for each member. In counts section, click initial. Your staff you entered earlier are now quick buttons.

What are SCIP and NHSN?

Surgical Care Improvement Project and National Healthcare Safety Network. You have to answer questions in the Core Measures section for each patient.

T/F You must add the new primary surgeon before you can remove the existing one.

TRUE

T/F Unlike other nurses, you do not have to use the MAR to administer meds in Intraop.

TRUE! Your meds are listed in Intra-op meds section already. From preference care or order. Not that you will see meds that were started in preop as well as the meds that anesthesia is administering. (A syringe icon means the med has been administered

T/F A dual signoff is required when administering blood

TRUE. Also be careful with the release button (don't release blood before you are prepared to administer it). After you go to the Blood Admin flowsheet and document the IV you are using in the rate cell, make sure to scan the patient and the blood barcode. Always document a rate. (Anesthesia would usually be documenting the blood admin - also don't forget about consents)

T/F Completing a surgical site in the Site Completion section automatically creates an incision/wound LDA that post-op nurses can view and document on.

TRUE. Make sure you Click on post-op skin, select the site, and complete the form.

T/F If your pre-op skin conditions are largely the same, you can click the copy icon and change the site

TRUE. The copy icon is a paper icon to the right of the skin condition. Make sure you document about the Operative site (Ex. warm,dry, intact)

T/F Patients who have more than one procedure will have more than one position form, even if that position is the same.

TRUE. The position if pulled from the preference card. You can make changes and document on the position by clicking on the blue hyperlink.

What is left after you verify?

The Handoff Report. Use this summary of pre-op and intra-op to review patient info with the PACU or post-op nurse.

What do you do if a procedure is delay or cancelled ?

There is a Delays button and Procedure Not Performed Button. In Delay, the type is always delay, and you can select a reason and add a comment. Document the appropriate length in minutes. When cancelling a procedure in Intraop, select Before Induction. (If it was cancelled in preop, the preop nurse would have cancelled and completed this already)

Why are there supplies already listed in the Supplies section when you first start the procedure?

They are automatically pulled from the preference card.

How do you document how many of a supply were used?

Type the number used in the Used field or you can Use the up and down arrows to increase or decrease the number in the Used field

What happens when you document site completion in your closing section?

Upon completion, an incision LDA is created automatically. You will see this if you click back on Lines/Drains section.

Is there a way to permanently change a preference card?

Yes. In the intra-op sidebar, click More actions. Select Revise card. This will email the build team. Enter the name of the preference card builder at your facility and then use the tabs to request a change.

How do you document Set Up complete?

You can use the IntraOp sidebar (on the right of the Intra-op navigator) and use the big events quick button -- if at current time. To edi or document an event in the past, use the All Events button and enter in time for Set up complete. (Once you do this, the quick button should change to In Room; you click In room to document the patient's arrival)

What do you do when the tranfusion is complete?

You document the flowsheet by Add column (if current time) and document a rate of 0. You would also enter the total volume infused. (FYI anesthesia might be doing this for you)