OR Manager - March 2020 - 26

AMBULATORY
SURGERY CENTERS
Continued from page 25
Gallant got orders from the anesthesia
provider for two units of universal donor
blood housed in the building-a supply
for the cancer center that also serves
as a backup for the OR.
The surgeon called for a vascular assist.
Gallant ordered the blood, called
the postanesthesia care unit (PACU) coordinator,
and alerted the executive director
at the center and the North Shore
Medical Center (NSMC) OR, an affiliate
hospital in Salem. " I said, 'we're in trouble
over here and we may need instrumentation.'
The charge nurse said she
would pull kits and send them over. "
Ultimately, more than two units of
universal donor blood were needed
to stabilize the patient. Gallant's next
move was to call the NSMC blood bank,
which sent a crisis pack with four units
of universal donor blood and fresh frozen
plasma by courier.
Once the patient was stabilized,
the vascular surgeon needed a clamp,
and the only one available was a small
clamp from a fistula kit, so he used
that. Eventually, emergency medical
technicians rolled a stretcher into the
OR, and the anesthesiologist traveled
to NSMC with the patient for further
treatment. A few days later, the procedure
was performed without mishap.
" I thank my lucky stars for the experience
and the teamwork of our team
that day, " Gallant says.
Responding to Code Blue
Barbara J.
Holder,
BSN, RN,
CAPA, CAIP
Quick thinking in the OR
also saved the lives of
two patients at the Andrews
Institute ASC.
In one incident, a
woman in her early 60s
in the PACU had been
experiencing chest pain
and rhythm changes.
Suddenly, " before our
eyes, she suffered a
myocardial infarction, " recalls Barbara
J. Holder, BSN, RN, CAPA, CAIP, the
26
OR Manager | March 2020
Expect the unexpected
OR staff at Mass General/North Shore
Center for Outpatient Care (Mass General)
in Danvers, Massachusetts, have
faced additional challenges and unplanned
emergencies since the time of
the 2011 laparoscopic cholesystectomy
emergency that prompted them to be
better prepared for a surgical crisis.
Among them:
➤ bowel perforation during endoscopy
➤ ST segment changes on two patients
that sent both directly to the North
Shore Medical Center catheterization
lab (collaboration with onsite
cardiology was a key assist in these
cases)
➤ a vascular emergency in a distal bicep
reattachment orthopedic case that led
to another request for vascular surgery
to assist
➤ a laparoscopic cholecystectomy case
that had to be aborted because of
abnormal anatomy. The surgeon
center's QI/IC safety/regulatory officer.
The anesthesiologist on duty initiated
a Code Blue, and the team followed
Advanced Cardiovascular Life Support
protocols to revive the patient.
The patient was successfully treated
and transported to another facility. " She
was very thankful that she was under
our care when the event occurred, "
Holder says. Another time, a male patient
coded, and was revived and then
transported. Afterward, the surgeon met
with the staff and provided an update.
Follow-up is key, Holder emphasizes.
Staff at the Andrews Institute
ASC check in with patients throughout
their stay and again at home, sharing
feedback with anesthesia providers and
the nursing teams. The facility also conducts
daily huddles in every department
to review safety procedures related to
communications, medication availability,
and instrumentation, and to discuss
any other concerns about the patient.
couldn't differentiate the artery and
therefore could not move forward with
the procedure.
" There are things you'll never be able
to predict, " says Robin Gallant, MHA,
BSN, RN, director of surgical services at
Lawrence General Hospital in Lawrence,
Massachusetts, and former nurse manager,
day surgery, at Mass General. To
call for help, " it's not as simple as establishing
an official agreement with support
locations. You need to practice the
cascade of making the calls and make
sure that staff at both ends of the phone
understand the emergent nature of the
call and know the critical need for collaboration
and support, " she explains.
OR managers and directors are the key
coordinators for their nurses, their department,
and their system, Gallant says.
Since the 2011 surgical emergency, the
team has remained well trained for clear
communication and quick action.
Plan, Do, Study, Act
Following the laparoscopic cholecystectomy
incident at Mass General, a Plan,
Do, Study, Act exercise was conducted
to identify the discrepancies related to
this emergency and how to fix them.
Staff identified some key problems:
* The building had Code Red, Code
Blue, and disaster master plans.
However, other than transfer agreements
with local emergency services
and sister hospitals for admitting
physician orders, no other procedures
existed.
* OR staff had no emergency cart, vascular
clamps, or sufficient retractors
at their disposal.
* Reporting from the ASC's location to
the emergency department required
physician-to-physician handoff-but
freeing up a surgeon amid the crisis
to make this call proved to be
a challenge. " There was no way we
were going to get the surgeon away
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