2025 FY Safety in HR/PACU (Certified/Tech)

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2025 Certifited/Tech

Safety in HR/PACU

Identify measures to maintain a safe environment in HR/PACU

Identify safety measures in preventing HAC

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07

Describe the correct procedure in prepping a patient with clippers & CHG

Describe the criteria for administering pregnancy tests

06

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Identify safety measures for prevention of pressure injuries

04

Demonstrate knowledge of abnormal vital sign values

03

Utilize the care partner checklist in preparing patients for surgery

02

Describe effective communication strategies

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OBJECTIVES

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• Make patients feel valued. When we give another person our undivided attention, it shows we value the person.

• Help patients feel in control. Good communication can help people see that they have a voice concerning their own lives.

• Help patients feel at ease. Patients commonly feel anxious about their health and what their future holds. This may cause the patient to come across as rude or aggressive. Having good communication with health care workers can reduce their anxiety and build their confidence.

Effective Communication can:

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Communication errors are the most common cause of medical errors and are essentially preventable

• patient safety

• quality of care

• patient outcomes

• patient satisfaction

• staff satisfaction

Poor communication can have a negative effect on:

Establish a rapport with the patient and their family

Show respect

Be responsive to the issues they raise

Allow them to voice their concerns

• Introduce yourself

• Maintain eye contact - it shows you care

• Actively listen - affirm the speaker

• Watch your body guestures

• Show empathy & be friendly

• Answer their questions

• Allow them to voice their concerns

• Be responsive to the issues they raise

Communicate with your patient

Handoff to the primary nurse actions you have completed at bedside with the patient

• Vital Signs (especially if VS are out of normal values)

• Any pressure injuries, abrasions, wounds or skin concerns

• What valuables and personal belongings you gave to family member and name of family member

• Clipping you performed on patient

• Surgical scrub you performed on patient

• Urine pregnancy testing results (if you did it)

• Any other significant information you feel the RN needs to know

Communication with your colleagues:

• Introduce yourself to the patient

• Identify patient by checking ID band with patient and chart

• Instruct patient on how to undress, put on gown, place belonging in bag, and put on yellow non-skid socks

• Assess skin if helping patient put on gown

• Check for dentures, contacts/glasses, and other valuables

• Verify who is receiving patient belongings

• Check patient's vital signs & place in chart or give to bedside RN

• Check with RN for orders to do urine pregnancy testing, clipping, skin preps, foley insertion, or SCD application

Checklist Items:

Care Partner Checklist:

Normal Vital Sign Values

Report all abnormal values to RN immediately

• Blood Pressure
• 120-130 mmHg systolic
• 70/80 mmHg diastolic
• Heart Rate
• 60-100 beats/minute
• Respirations
• 12-20 breaths/minute
• Temperature
• 36.0-38.0 degrees Celsius (96.8-100 degrees Fahrenheit)
• Oxygen Saturation
• 92% - 100%

Vital Signs:

Temperature Regulation:

Place Bair Paws gown on every patietn in HR and instruct patient on how to use the dial to regulate the temperature

• Normothermia is a crucial component of patient safety

• Goal temperature 36 to 38 degrees Celcius

• Core temperatures outside the normal range pose a risk in all patients undergoing surgery and have been associated with an increased risk of surgical complications, including:

• increased rate of surgical site infections

• increased surgical blood loss

• increased nausea & vomiting post surgery

• extended recovery times

Normothermia

• Assess bony prominences anytime you are assisting patient

• Assist RN in taking picture of all pressure injuries and uploading into patient chart

• If patient in HR/PACU greater than 2 hours, ensure patient is turned every 2 hours while waiting to go to surgery or waiting on inpatient room

• Place sacral Mepilex dressing on EVERY patient in HR

• Use heel mepilex on high risk patients and keep heels floated while in HR/PACU

Assist RN in Assessing Skin for Pressure Injury on Admission to HR & Admission to PACU44

Pressure Injury Prevention

Ensure proper placement - do not place too high!

Mepilex sacral dressing on every patient unless provider specifically asks for one NOT to be placed

Pressure Injury Prevention:

Obtain clean catch urine specimen - test takes 3 minutes to complete. Enter results into computer and document results on preop checklist (care partners may perform test & enter results in eStar afer completion of POCT training)

MUST HAVE AN ORDER FOR THE TEST!

Perform on female patients who have a uterus and who are:

• Post-menarche and pre-menopausal
• Between 12 and 50 years of age except for those who are menopausal
• menopause is defined by having not menstruated for 1 year
• Not otherwise know to be pregnant
• Have not undergone surgical sterilization (tubal ligation)
• Do not refuse pregnancy testing

Pregnancy Testing

Be sure to use vacuum attachment to prevent loose clippings from remaining on bed linens.

Hair removal should be completed before patient arrival in the OR.

• When prepping for cardiac procedures, remember to clean and clip from chin to toes. Pay close attention to the groin areas because when hey harvest grafts from the legs, this is a possible source of infection. All pubic hair (males or females) must be removed to decrease the chance of a surgical site infection

• In the cases where the surgeon will perform a "mini thoracotomy"(such as a mitral valve and tricuspid valve replacement) hair in the axilla region must be completely removed.

Site Prep- Hair Clipping

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2% CHG Cloth Skin Prep Instructions:

• Use first cloth to prepare the skin area indicated for a moist or dry site, making certain to keep the second cloth where it will not be contaminated. Use second cloth to prepare larger areas.

• Dry surgical sites (such as abdomen or arm): use one cloth to cleanse each 161 cm2 area (approx. 5X5 inches) of skin to be prepared. Vigorously scrub skin back and forth for 3 minutes, completely wetting treatment area, then discard. Allow area to dry for one(1) minute. Do not rinse.

• Moist surgical sites (such as inguinal fold): use one cloth to cleanse each 65 cm area (2X5 inches) of skin to be prepared. Vigorously scrub skin back and forth for 3 minutes completely wetting treatment area, then discard. Allow to air dry for one(1) minute. Do not rinse.

Site Prep - Site Scrub

Sequential Compression Device (SCD) sleeves

• Alternate leg pressurer

• Rythmically squeeze the legs simulating muscle contractions. This prevents pooling of blood in lower extremities

• Contraindicted in:
• lesions
• broken skin
• signs of poor circulation - cold, blue, pale skin
• edema (swelling)
• too small or too large for device

***Don't place sleeve over operative site***

Anti-Embolism Devices (SCDs):

• Must have an order for Foley - does your patient really need one for OR?
• Ensure sterile technique is maintained with insertion and use pre-packaged wipes in kit for cleansing of perineal area prior to insertion.
• Use StatLock for securing Foley to leg
• No dependent loops in tubing and hang bag on side of bed below the level of the bladder. Must be 6 inches above the floor.
• Do not lay drainge bag on the stretcher/bed when transferring to and from OR/patient room.
• Empty urine from bag before traveling with patient.
• Perineal care every 12 hours if patient stays in PACU.
• Discontinue as soon as possible - utilize the nurse driven Foley discontinuation protocol unless otherwise ordered (urology patients require a provider d/c order)

Does your patient need a foley?

CAUTI Prevention

• Yellow non-skid socks in place
• Yellow armband
• Sign on door if in private room
• Education to patient and family if at bedside (and documented in EPIC)
• Belongings in reach
• Assist to the bathroom
• Bed in locked position and siderails up

ALL Surgical Patients are considered "High Risk" for Falls once they receive:

• Pre-op sedation
• Epidural, spinal, or peripheral nerve blocks
• General anesthesia
• Moderate sedation

ALL Surgical patients are considered "High Risk" for Falls once they receive sedation!

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FALL Prevention:

Early Ambulation:

• Early ambulation decreases DVT and improves body function. To meet discharge criteria, patient may need to ambulate.
• organize environment - arrange chair near stretcher, position IV pole near chair, etc.

• lock brakes on stretcher & chair, position stretcher in lowest position, request help if needed.
• prepare by assisting into sitting position. Sit on edge of stretcher for a minute or longer and observe for signs of postural hypotension- dizziness, light-headedness, blurry vision, weaknes, confusion and/or nausea.
• ambulate with yellow non-skid socks on.do not leave patient alone to walk, toilet, or get dressed because of the danger of falling.

Ambulation

Clinical Area Survey Checks:

• Please keep your clinical area clean & orderly
• No food or drink at the bedside unless it is the patients (use designated drink stations on the unit)
• Do not use patient specific refrigerator or medicine refrigerator for staff food/drinks
• Name badges present and above waist on all staff
• Do not prop doors open & keep stairwells free of stored material
• Do not place anything in front of gas panels or fire protection equipment
• Hallways need to stay free of clutter/equipment all on one side
• Clean stored linen remains covered at all times or stored in a cabinet
• Sharps containers secure and below the fill line (replace if it becomes full)
• All meds/prescription pads/RX star paper are secured
• Patient is covered in rooms with open doors or curtains are pulled.
• Keep confidential patient information out of view

Environment of Care:

• Perioperative Services SOP - Patient Identification - Adult

• Perioperative Services SOP: Required Preoperative Documentation

References: