The 11 Rules of Operating Room Etiquette for staff and patients
Dec 5th, 2007 by Terry
The Operating Room is a whole other universe, and all the usual rules that apply in the outside world tend to fall away in here. That is not to say that the OR is a bad place; quite the opposite, it is a very orderly and territorial environment. It lost its circadian rhythms just moments after its inception, and everyday life depends on the cooperation and interfacing of many different people and departments to help the OR schedule reach its completion for the day. Only to begin all over again tomorrow. So, what follows is a guide to how life is conducted and the rules of etiquette that people live by behind the big double doors with the sign that reads: RESTRICTED TO OR PERSONNEL ONLY
For staff:
- Sleeping patients have the right of way. Stretcher traffic in hallways dictates that the anesthetized patient should always go first.
- IVs are inserted in the non-dominant arm, when possible.
- Patients are never moved or repositioned without the anesthesia provider giving the count: Ready - 1, 2, 3!
- Every member of the OR care team is also a member of the contamination police. If you observe a break in sterility, it is your responsibility to announce this to every one in the room. ASAP
- When the sponge or needle count is off, it becomes EVERYONE’s responsibility to fervently look for the missing object.
- The surgeon is the captain of the ship. He/she brought the patient to us, and will manage the patient postoperatively, too, and after discharge. If the surgeon wants the room cold, it will be cold. If he/she wants music during surgery, toons will be procured.
- “Be nice to the people you meet on the way up, cuz you’re going to meet the same people on the way down.” We are all important and vital, and no operation can happen without everyone working together. This includes, but is not limited to, the surgeon, anesthesia, the nurses, OR techs, orderlies, management, lab, and maintenance. It takes a village . . .
- As the anesthesia lightens and the patient awakens at the end of the case, all music and extraneous conversations and NOISE come to an end, to enhance a smooth and quiet wakeup and transition for the patient.
- In the OR, you get rewarded for working efficiently and in a timely manner by getting the add-on cases.
- If you are cold, long sleeve shirts from home are unacceptable to wear under your scrub top in the OR, but warm-up jackets from home are fine.
- Women must make sure that every strand of their hair is covered under an OR bonnet, but men can wear OR caps where the scalp hair around their ears and back of their head is exposed.
For patients:
- Showering, cleaning out your navel, and brushing your teeth are GOOD THINGS to do before any OR procedure.
- Leaving all jewelry (including tongue rings), polished nails, and makeup at home is always the right policy.
- Passing gas after a colonoscopy is ALWAYS DESIRABLE and doesn’t really count as real flatus.
- Pulling out your own IV is frowned upon; pulling out someone else’s IV will not help you win friends in the OR environment.
- Knowing what medications you take makes everyone’s life easier, and making a list of them is a prudent idea.
- If you are having same day surgery and you don’t have a ride home, don’t bother coming.
- Nothing to eat or drink after midnight includes lozenges, juice, candy, gum, and coffee with or without cream.
- Asking questions about your impending procedure is healthy for you and helpful for us to know your knowledge deficits. If you don’t want to know, that’s okay too.
- If you know where your best vein is, we will probably find it. The vein they usually find for taking blood may not be the best vein for threading a longer IV, please remember that.
- You may think you’re immune to the stuff, but we’ve never met a human being yet who we have not been able to “knock out.” Some take more, some take less, but everyone goes to sleep with our drugs if we want them to.
- Try to be a good historian. We are very interested in your allergies, if you have any: to drugs, to food, to dye. If you dawdle in recreational substances (alcohol, street drugs, scripts), we will not report you, but we need to know. The medications we give you will interact with what’s already in your bloodstream. For your personal safety, be honest with us. It’s all confidential. That’s the law.
“it is a very orderly and territorial environment.”
Great phrase! This was a great post, thank you. I just did my write up of my OR experience…I don’t think I belong in there but it was an eye opener, for sure.
On #7, gum counts as something PO? Is this because of increased saliva? Or because of accidental swallowing of the gum?
Love your blog!
Gum increases your saliva, but it also stimulates gastric juices, thus filling your stomach with more contents.
Thanks for your comments and for reading my blog.
Love your post!
Tounge rings! Hah I swear that I asked a patient 3 times if he had any percings. Then was he’s being put on the trolly to go to theatre he whispers that he has a nipple bar.
Arrgh! And guess who had to take it out because he couldn’t move his arm.
Love the blog.
WardBunny
Great post and I do hope you can give your list for professionals to all new OR employees!
Onehealthpro
Medico-leagally, the “Captain of the Ship” stuff died decades ago.
Anything in the mouth including gum stimulates the production of stomach acid which can lead to aspiration during anesthesia.
If the surgeon wants the room cold he should take his clothes off in a 65 degree room and have surgical prep poured on him/her and lay there for two hours. Hypothermia interfers with the bodies response to medication, slows recovery from anesthesia, increases infection rates, and increases oxygen demand when patients shiver.
Great post!! I really like that both sides are covered here–it’s nice to see the health care provider angle, b/c as a patient it is always a bit weird to think that all of this is happening to and around your body and you have no clue! Knowing that it is okay to ask questions, no matter how silly they may seem as we ask them, is so important.
Such good timing for me, having just seen a patient go through a spinal fusion/laminectomy. (I didn’t ask about the iPod, but it wouldn’t surprise me! Apparently he was wearing “very cool” blue glasses, according to the patient, who is doing very well, btw!)
Jerry, you are so on the money with your observations. I am a patient advocate, and personally, I CANNOT stand to have the room cold. But I do feel for those who wear the surgical gowns and work under the hot lights, you know? I can keep my patients warm with forced air warming devices like Bair Hugger, and I can keep myself warm with my fleeced warm-up jacket, or just a blanket wrapped around me. But those who are operating cannot take off their gowns if they get too warm, can they? It’s a compromise that those of us working in the OR all must make, and it is how we get along.
Laurie, glad to hear the good news!
Fascinating to learn about both sides of the OR equation. A question (please pardon my ignorance) — while the patient is under anesthesia, does the OR staff feel free to make joking or critical comments either about the patient or about their outcome concerns? Or is there a belief that on some physio-mystical level the patient can perceive, so comments should be reassuring? Just wondering…..
Barbara, thanks for asking. Nastiness towards patients, before or after they are asleep, is not well-tolerated, and, at our institution, usually gets reported. All of us (at one time or another) have been or may very well be on the “patient” side of the stretcher. The jury is out as to what patients can hear while “under the influence,” but there are many studies that have examined, for instance, the effects on patients of listening to soothing music through headphones during their anesthesia.
Most of the chatter in the OR is much more mundane - what was on TV last night, the latest sports results, political banter, idle gossip. And, surprisingly, there is also conversation pertaining to the surgery, too!
[…] Swimming in a file, these batfish appears to adhere to certain etiquette. Talking about etiquette, Counting Sheep wrote a nice article on the 11 rules of the Operating Room! […]