AORN Perioperative Efficiency Tool Kit 2016                          

Instructions for using the Perioperative Patient Throughput and Turnover worksheet The attached PowerPoint® document is a process mapping tool where the swim lanes define each team member’s lane for mapping tasks performed over the defined time period. The time increments at the top help define the amount of time each task requires and sequences tasks performed by multiple team members. The times may be longer or shorter depending on the complexity of the procedure and the physical layout of the facility. The swim lanes do not reflect a race but rather help synchronize each team member as the patient moves through the process. The first three slides provide an example to trigger discussion about the turnover process among team members. The blank slides can be edited to describe the roles at your facility and the tasks for your process flow. See instruction document on web site for more detail on how to use the worksheet.

Apply dressing and remove drapes Participate in debrief/confirm time to return to OR for next case Apply dressing and remove drapes Greet next patient in Preop area and mark surgical site Write postop orders and dictate postop note Participate in debrief/confirm time to return to OR for next case Assist with patient transfer and transport Apply dressing and remove drapes Extubate patient Assist with transfer of patient to bed Transport patient to PACU Give hand-over report to PACU Nurse Participate in debrief/confirm time to return to OR for next case Arrange Patient #2 transport Keep assigned team members in the OR informed of any changes to the schedule Participate in debrief/ designate time to return to OR with next patient based on facility standard Notify front desk when ready to send for Patient #2/call for turnover help/alert PACU that closure started/give approximate time of arrival to PACU Assist in patient transfer to patient bed Give hand-over report to PACU nurse Finalize patient documentation Assist with transfer to PACU Review Patient #2 chart Secure dressing Participate in debrief After count, begin instrument gathering/ organize instruments for processing by placing back in original containers to decrease the risk of loss and improve turnaround time for set assembly and sterilization Break down sterile field and put dirty instruments in trays according to policy/hand off any instruments that need to be sterilized for subsequent cases Assist with collection of trash and dirty linens Assist Surgeon with dressing/remove drapes Bring bed and transfer device into room Assist with collection of trash and dirty linens Move equipment to periphery/begin wipe down of equipment (foot pedals, cords, outer surfaces) Transport Patient #2 to Preop area if necessary/collect room cleaning supplies Participate in debrief Assist with patient transfer to bed Assist with termination of anesthesia Assist with transport to PACU Complete Patient #2 case cart Return unused, clean supplies Assist with patient transfer to bed Return equipment that is no longer needed Initiate DVT prophylaxis and prewarming protocols Complete preop preparation of Patient #2 Start IV and give medication as ordered Receive patient and hand-off information from RN circulator/receive hand-off information from anesthesia provider Place case cart and equipment for Patient #2 by room Assist Scrub Tech in breaking down sterile field Clean nurses desk and computer keyboard Verify case cart and equipment for next patient Assist with patient transfer to bed Remove unused medication

Mark surgical site for Patient #2 Communicate with Patient #1 family Out of room/return to OR at designated time discussed during debrief for Patient #1. PACU with Patient #1/write postop orders Out of room Return to OR Start invasive line, blocks etc/verify and document preoperative antibiotic/ communicate special needs to RN Circulator and Anesthesia Tech Transport Patient #2 to OR at designated time Greet Patient #2 in Preop area Notify team if more time is required Greet Patient #2/verify identity, site marked, and procedure with patient/review preop assessment and receive hand-off report from Preop Nurse/perform additional assessment if needed and provide patient teaching/check blood product availability/erase whiteboard from previous patient/write Patient #2 information on whiteboard Coordinate, assess and assist with progress of turnover/ review preference card/ensure equipment and supply readiness/ spread sterile supplies and begin opening Greet patient upon entering room and introduce other staff members in the room to the patient Final check for necessary equipment and supplies Complete initial count and document on whiteboard Breaks down sterile field/wipe down back tables, Mayo stands, and ring stands/places them in designated position to identify that they are clean/ transport case cart to decontamination area Validate Patient #2 case cart and bring into room/spread sterile supplies and begin opening Scrub, don gown and gloves Prepare sterile field Count with RN Circulator Wipe down lights, OR bed/mop floor/ remove trash and equipment Make bed Pick up Patient #3 Remove dirty equipment from anesthesia machine and cart/wipe off anesthesia cart and all cables with approved disinfectant Put new breathing circuit on anesthesia machine/ prepare any needed supplies or equipment for Patient #2 Assist Anesthesiologist with patient transport from Preop to OR Provide hand-over report to Anesthesia Provider and RN Circulator Begin preop of Patient #3/review and complete preop checklist/ contact MD or PA to resolve missing items or conflicts in orders/manage patient anxiety Coordinate sterilization of instruments for Patient #3 or later patients in the day Begin review of Patient #3 case cart, instruments, and supplies/pick suture and gloves for case cart Assemble positioning equipment for Patient #2 Bring new medication tray into room/set up prep tray/prepare medications Greet patient if RN Circulator is still involved in count Assist with opening sterile supplies/ dispense medications to field

Assist Scrub Tech with items needed to complete sterile setup Scrub and don surgical gown and gloves/wait appropriate time for skin prep to dry Perform briefing and surgical time out In room at designated time Assist and direct positioning/clip skin if needed Drape patient Make incision Scrub and don surgical gown and gloves Perform briefing and surgical time out In room\assist with transfer of patient to OR bed Assist with positioning Drape patient Assists with transfer of patient to OR bed/apply monitoring equipment Induction and intubation Assist with positioning and applying warming blanket/ assess patient alignment when positioning complete Perform briefing and surgical time out Line placement Assist with transfer of patient to OR bed/continue prewarming of patient/assist with applying monitoring equipment If Anesthesia Tech is not available, assist with intubation Assist with positioning and perform final assessment of patient alignment While skin prep is drying, perform briefing and time out Assist with draping and positioning back table/connect ESU, suction, and other equipment Insert Foley if required Perform skin prep Document time of incision Apply SCD Gown and glove surgeon and assistant While skin prep is drying, perform briefing and time out Complete sterile field set up Assist with draping patient Hand scalpel to surgeon Move stretcher/bed out of room to designated location Assist with transfer of patient to OR bed Assist surgical team as needed with supplies and equipment Assist with positioning Assist with prep if necessary Continually monitor the room and be available to assist with running for items Assist with transfer of patient to OR bed/assist with applying monitoring equipment Assist with induction and intubation/ assist with line placement Cover for other technicians if they are busy in another room/ restock extra anesthesia carts and exchange with depleted carts/ restock depleted carts throughout the day to have them available for exchange Assist with positioning Deliver HLD or IUS items to room Continue to sterilize other instruments needed for subsequent cases/communicate with OR Aide for delivery of supplies not anticipated for procedure Preop assessment of subsequent patients Assist Scrub Tech with items needed to complete sterile setup Continually monitor room and be available to assist with running for items Prepare case cart supplies and equipment for Patient #3 Provide breaks and lunches as assigned