Four Tips for Organization During Complex Surgical Cases

One challenge perioperative nurses experience is remaining organized during a surgical case. This becomes more difficult when multiple procedures are performed, involving more instrumentation, supplies, equipment, and people, and even repositioning of the patient. Frustration can occur when these cases devolve into chaos, such as having the wrong equipment, incorrect counts, or error messages on electronic devices. To reduce frustration, it is essential to identify ways to stay organized during every surgical case. This article provides four tips to help with organization.

Tip 1

If possible, prepare for the case the day before, including reading and reviewing the preference card, asking questions about the case (from your preceptor, charge nurse, or service lead coordinator), and investigating if extra supplies and items will be needed. The preference card will be one of the best resources for a surgical case, as long as the information is updated and correct. Some preference cards have an automatic “update” feature and will have a time and date stamp to denote when the preference card was last updated. Some facilities may use a reusable paper preference card in a protective covering. When there is a permanent change to the surgeon’s preference, the nurse documents on the preference card the date and the requested change. You may need to ask your preceptor or charge nurse where to locate the date of the last preference card update.

Tip 2

For complex or multiple procedures, it may help to do an interprofessional simulation in the OR the day before the surgery. (Of note: informal simulation processes may also be called a mock scenario or walk-through.) This process goes through procedural steps of, the needs for, and each person’s role in the surgery. Simulations allow discussion on each step of the surgical process from admission to discharge with the available interprofessional team members, such as the surgeon(s), anesthesia provider(s), surgical technologist(s), and other decision-makers. The simulation can help identify the availability of supplies and equipment and troubleshoot potential procedural emergencies that could occur (eg, preemptively ordering blood products). Patient-specific information pertinent to the procedure also is reviewed; for example, if a patient has a known skeletal contracture, this would be discussed and planned for during positioning, including regarding interventions to mitigate the risk of pressure injury.

The simulation would be done in the OR designated for the procedure, when available, with the equipment, supplies, and resources in their designated locations. The preceptor, charge nurse, or service lead coordinator would discuss the steps as they occur, starting when the patient arrives to the OR suite (Sidebar 1).

Sidebar 1. Steps in the OR to Include in a Simulation

1. Prepare the room and supplies, including reviewing the preference card, ensuring supplies from the preference card are available, opening sterile supplies, performing surgical counts, and ensuring equipment is on and functioning.
2. Admit and prepare the patient, including reviewing their chart and interviewing them.
3. Bring the patient to the OR suite with monitors attached.
4. Transfer the patient from the OR cart to the OR table.
5. Induce anesthesia.
6. Position the patient according to the preference card. Ensure padding and safety devices are secured and in place.
7. Prep and drape the patient.
8. Perform the timeout.
9. Start the procedure.*
10. End the case and transfer the patient.

*During this portion of the simulation, discuss possible scenarios that could necessitate obtaining  additional items and supplies and any potential patient risk factors that need to be addressed. If there is an expected long surgical duration, consider addressing personnel changes.

Tip 3

Keep different types of supplies in separate spaces. There are three types of items:

• Items that should be opened for the procedure (ie, open/needed items); these items will be located on the sterile field.
• Items that might be used, depending on the procedure for the specific patient (ie, hold/maybe items); these are located in the OR for accessibility, but not close to the sterile field, and may be contained (eg, covered in a plastic bin or clear bag), so that they can be returned to supply rooms if they are not opened.
• Items only used in emergencies specific to this procedure (ie, emergency items); these may be kept in a portable enclosed cart outside the room but readily available.

For example, needed items would be on a cart in the room, whereas maybe items would be on a cart right outside of the room. Each facility will have a process for outlining needed, maybe, and emergency items; ask your preceptor, charge nurse, or service line coordinator for this information.

Tip 4

Keep noise to a minimum.¹^, ² People, movement, and door openings in the OR can increase noise levels.¹^, ² Noise can be a source of distraction and may affect some individuals more than others.³ Distractions will divert attention from staying on task and organized. Multiple conversations can occur simultaneously, and, in time, the volume can continue to get louder. Do not hesitate to speak up and ask for the conversation volumes to be lower. You may need to direct this request to the individual(s). You can say, “Excuse me, Jon and Joan. I can see you are having a lively conversation right now. Would it be possible to lower the volume a bit?” or “Pardon me, Liu and Lilly, I appreciate you helping with this case; however, could we bring the conversation volume down? Please continue your conversation, but just a little lower.” It is a polite way of addressing conversational volume without cutting conversations off.

References

1. Guidelines for Perioperative Practice. AORN, Inc. Accessed October 31, 2024. aornguidelines.org
2. Position Statement on Managing Distractions and Noise During Perioperative Patient Care. AORN. Accessed October 31, 2024.
3. Nagaraj NK. Effect of auditory distraction on working memory, attention switching, and listening comprehension. Audiol Res. 2021;11(2):227-243.