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By: Barbara Robinson
Published: 2/9/2008
No two of our orthopedic skin preps were the same. I know this because I observed the skin prep practices of our orthopedic surgery teams as part of a project to standardize our prepping practices. We'd scrub some patients before painting, but not all. Sometimes we'd wear gloves and use positioning devices and drapes, sometimes not. We'd use betadine on one patient, alcohol and iodine povacrylex on the next. Even who performed the prep varied, with the circulator, attending, scrub tech and fellow each taking a turn.
After gathering this data, I started looking for a fun way to present the not-so-standard practices that I saw in our hospital. I brought my video camera from home and wrote, produced and directed a short video. I enlisted surgical support staff as actors who portrayed a surgeon, patient and the circulator in the OR performing an orthopedic skin prep on a left arm. Using support staff in the video prevented finger pointing among the physicians, who might argue over which of them has the best skin prep methodology and who doesn't follow an established standard for prepping.
I showed my video to the chairman of the department of orthopedic surgery. To minimize resistance to change and encourage the use of a uniform skin prep method, he asked me to place information from the literature and evidence-based research next to the data from my study of our prepping practices. This made my presentation more persuasive. With evidence-based research, changing the way things are done in the OR becomes a no-brainer. Your payors also like it when they know you're using evidence-based practices.
After showing my video and data to the chairman, I got the results I'd hoped for. We were going to make another video, our own reality show. The orthopedic surgeons unanimously agreed to videotape a real patient being prepped (after securing proper consent) and then show the video to the entire orthopedic surgery team and perioperative staff. We'd later present the video to the OR nursing staff to clarify the need for clearer directions for the uniform orthopedic prep.
Our standard routine
Based on my research, here are the standards we now have for orthopedic skin preps:
One-two punch
The video was effective because we'd observed actual cases and we were able to show the range of skin prep techniques the orthopedic surgeon group was using. We also supported the video with data. By simply comparing our data side by side with evidence-based research and established AORN standards, we were able to launch a collaborative initiative with a vendor and the infection control department to standardize orthopedic surgical skin prep practices in our organization. As a result, we've eliminated confusion. Everyone in the OR understands the rationale behind our new skin prep routine and we are delivering evidence-based quality care. And the video created such a buzz that we're working on a sequel. Stay tuned.
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Over a two-week period, Barbara J. Robinson, MSN, RN, CNOR, observed the first orthopedic case of the day in her ORs and documented the skin prep practices. She found that patients were prepped in many different ways. Here are the results. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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