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he wasn't using a Bovie, the surgeon didn't understand why he had to wait for
the prep to dry. Our director stopped his meeting to talk to the surgeon. He
agreed he would wait the 3 minutes on his next case. The nurse felt supported
and empowered to do what's right.
New processes are hard to sustain. As the saying goes, what gets measured
gets done. Staff nurses perform monthly chart audits to verify we let the prep
dry before draping. About 6 months in, we observed prepping practices in 14
random cases and were happy to see our nurses applied the prep from the inci-
sion out to the periphery and wore sterile gloves to prep every time. Ongoing
education helps a new practice become a standard practice. You don't want staff
to think "Oh, this is the flavor of the day. They're going to teach this today and
something else tomorrow."
The next phase of our prepping project is to create a standardized prep chart
for our facility — a table that lists the suggested skin prep and an alternative for
each surgery we perform. We use alcohol-based chlorhexidine gluconate in
about 85% of our cases and betadine scrub-and-paint when we can't use CHG
(allergies, in open wounds or on any mucous membrane).
OSM
Ms. Glandorf (teresa.glandorf@bswhealth.org)
is the OR/endo clinical educator at Baylor Scott &
White Health in Round Rock, Texas.
