Three Things to Consider When Receiving a Patient From an Inpatient Unit

When a surgical team workflow runs smoothly, nurses use their knowledge and skills to perform typical OR routines and procedures. However, nurses can experience “hiccups” or “bumps in the road” when they encounter scheduling complications or tasks that are more complex or time consuming. One example of a deviation from the regular OR routine or procedure is when the surgical patient is admitted to surgery from an inpatient unit within the facility rather than through the preoperative area. The following are three things to consider when your surgical patient is from the inpatient unit.

Expect the Unexpected

• The inpatient may have been admitted to the facility recently (eg, a few hours ago) or weeks before the procedure. The proposed surgery may have been scheduled weeks in advance or may be emergent. In addition, the patient may have been admitted for a different diagnosis than the proposed procedure. For example, an individual may be admitted for pancreatitis, and a few days later, may have a surgical diagnosis of appendicitis and require surgery.
• Weekend and after-hours surgical cases will also differ. Refer to your preceptor or supervisor regarding what the routine may be for these types of cases. You may be expected to get the patient from the unit along with the CRNA or other surgical staff members. The patient may be brought directly to the OR from the unit or may be brought to a patient room within the perioperative suite or to a “holding area” near the OR.
• Sometimes, accessing patient information is challenging because the data is located in a non-surgical portion of the electronic medical record (EMR). Ask your preceptor, nurse educator, or nurse informaticist about how to access data when you are on-call or working after hours. Examples of patient charts for after-hours cases may be available for reference. If not, take notes or ask for examples to ease the frustration of EMR charting.
• The consent form may not have been signed or witnessed. Make sure this is completed prior to transferring the patient to the OR. If the consent form has not been signed, ensure that this is completed by the patient or designated family member/guardian and includes the signature of the person witnessing the signature(s). If unsure, refer to the facility protocol or contact the department supervisor for further guidance.
• The patient may be wearing their own clothes and not a hospital gown or robe; or the patient may have jewelry, dentures, adaptive hearing devices, or extra personal items with them. The perioperative team will need to discuss if these extra items are needed in the OR or if they should be removed and placed in a secure area per facility protocol. Body areas with metal jewelry present a potential for burns if monopolar cautery is used during a procedure. Hearing aids may be lost in bedding or hair covers. Stones in rings may become chipped or dislodged. Rings have a potential for creating a tourniquet effect if the upper extremities become swollen. Be alert and aware of extra personal patient items.

Be Prepared for Unique Medical Devices and Patient Statuses

• In addition to multiple IV lines, the patient may have multiple IV pumps or infusion-regulated devices when transferred to the OR. The anesthesia professional will usually need assistance in identifying the location of each line and managing the IV infusion devices.
• The inpatient may arrive with a urinary catheter already in place. You will need to document that the patient arrived with an indwelling catheter and note the color, consistency, clarity, and amount of urine in the catheter bag. The surgeon may want the catheter removed before the patient leaves the OR. This action will need to be noted in the EMR and communicated in the hand-off report.
• Patients coming from the intensive care unit (ICU) may be brought directly to the OR sedated and intubated. Collaboration between the ICU nurse, anesthesia professional, and the OR staff members is a high priority during this transfer. During the pretransfer team huddle, discuss who will be transferring the patient from the inpatient unit to the OR, the time of the transfer, and any extra equipment that will be needed. If you have a question about the transfer, ask the anesthesia professional or the unit nurse who is currently taking care of the patient. If issues with unit-to-unit transfers occur with other staff members, bring your concerns to your manager or nurse council with suggestions of how this process could be improved.

Anticipate a Different Hand-off Report

• Inpatient-unit shift and hand-off reports may be conducted differently from OR hand-off reports. Be prepared to ask questions at the end of the hand-off report. You may want to ask if the patient has any family members or loved ones waiting and where these individuals will be waiting. Ask if the patient has any personal belongings—such as jewelry, dentures, hearing devices, or prosthetics—still in place. Ask the nurse where to locate emergency contact information for the family members or loved ones. This is important in the event that additional questions need to be answered or OR personnel need to provide critical updates. Your preceptor will be able to provide guidance on the types of questions to ask inpatient nurses.
• It may be helpful to have a checklist available to ensure the data and information received during the hand-off report are complete and accurate. A checklist may include the following:
  • NPO status
  • Most recent medications administered (ie, IV, oral, topical)
  • Is the patient on antibiotics? Last dose? Time of last dose?
  • Patient allergies
  • Will the family be waiting and does the family know where to wait?
  • Any patient belongings (eg, jewelry, piercings, dentures, glasses)

Surgical patient safety is a top priority for perioperative nurses. Knowing what to expect and being prepared for inpatient transfers will make the task feel less demanding and frustrating.