OR for Peds

From Guide to YKHC Medical Practices

Patient Procedures in the OR

Occasionally we need to take a pediatric patient to the OR for I&D of a very large abcess, large laceration repair, multiple abscesses, sedated exam, extensive wound debridement etc. Frequently these can be done in the ER with procedural sedation or CRNA assistance. There are times deeper and longer sedation might be needed, a more controlled setting is required, when the ER is too busy/understaffed to use the ER or an inpatient needs sedation that we are not able to provide on the outpatient unit due to staffing and training.

Process for taking the patient to the OR for a procedure:

  • Contact the CRNA on call to discuss the case and what needs to be done with them. If they agree, then you
  • Call the OR nurse on call to figure out a time that works for the patient, the OR and the surgical staff
  • Document in a RAVEN note, from the same day, a patient history and exam and a statement that the patient is cleared to go to the OR for the procedure
  • Be sure the patient is NPO for the required length of time
  • Get a OR procedure consent is signed
  • Let the OR staff know what supplies are needed and make sure they are in the OR and ready for the procedure prior to starting.
  • Get in OR scrubs and gown and dress appropriately as you would for any OR case.
  • Remember to do a time out in the OR before starting the procedure
  • Complete the pre*op and post*op orders
  • Write an OR procedure note (there is a pre*completed one that you can modify is in RAVEN)
  • Place a charge order for the procedure.

Monday morning Dental Pre-op Exams

The pediatrician who is scheduled for inpatient duties on Monday must be prepared to come in around 7:30 a.m. to complete any scheduled dental pre-ops by 8 a.m. barring any other emergencies.

Procedure for Dental Pre-ops in OR suite

  • The OR staff will contact you on your cell phone at 7:30 a.m. to let you know there is a dental rehab patient that needs pre-op clearance
  • pediatrician needs to arrive early enough to complete the pre-op evaluation by 8 a.m. (in time to complete the exam before getting sign out from the Sunday call person at 8 a.m. and early enough to get the patient started in the OR shortly after 8 a.m.)
  • review the patient chart in RAVEN
  • examine the patient
  • complete a dental pre-op H&P using the pre-completed encounter created by peds
  • clear patient on for dental rehab on the H&P if appropriate or discuss the case with CRNA to make a collaborative decision about clearance or not.

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