For quick, minor procedures, patients wear their street clothes
Put this sacred cow out to pasture, readers say
With same-day surgery programs being pushed to perform more procedures in less time, managers are on the lookout for practices that can shave precious minutes off lengths of stay. If those practices maintain quality care and make patients happy, that's even better. Now, some managers report that having patients wear their street clothes for minimally invasive procedures of less than two hours can save at least 20 to 30 minutes per procedure.
"We have found that this practice has saved an enormous amount of time in preparing our patients for surgery, since many of them are elderly and have difficulty undressing," says Jody Beale, RN, BSN, CNOR, director of surgical services at Richmond (VA) Eye and Ear Hospital.
Staff stumbled upon this idea when they realized they were having difficulty getting patients to the OR on time. Changing elderly patients into gowns is one of the most time-consuming parts of the surgical process, Beale says. And the lack of mobility among the elderly isn't the only reason, she points out. "They wear layers and layers of clothes."
The trend toward patients wearing street clothes in the OR is growing, says Suzanne Wassom, RN, BSN, MHA, CNOR, clinical director of surgery at Oakwood Hospital and Medical Center in Dearborn, MI. "I think they're more open-minded to is," says Wassom, who edits the newsletter for the Ambu latory Surgery Specialty Assembly with the Association of Operating Room Nurses (AORN) in Denver. Eight members recently reported to the assembly that they're allowing patients to wear street clothes in the OR.
AORN's Recommended Practice for Traffic Patterns in the Perioperative Practice Setting states: Patients entering the surgical suite should wear clean gowns, be covered with clean linens, and have their hair covered. (See AORN's suggestions on issues to consider, at left.)
Here's how it typically works: Patients come in fully clothed. Surgery staff put a gown over them. "So they go in their clothes, but they are covered," says Lynn Stapes, RN, MS, administrator of McKenzie Surgery Center in Eugene, OR.
The practice isn't limited to cataract procedures; it's also being used for other ophthalmology procedures such as retinal cases. In addition, same-day surgery programs are using the practice for botulinum toxin injections, ENT procedures such as myringotomy, and minor plastic surgery procedures. "We do it for any specialty we do that's limited to a minor body part and takes less than two hours," says Beale.
Pediatric procedures are particularly suited for this practice, sources say. "With children, it's such a frightening experience to come into facility," Stapes says. "If we can allow them to maintain any control of their experience, that's what we're trying to do."
Another advantage? The infection rate isn't affected. "We have had no absolutely increase, and we've been doing this for almost three years," says Beale. "We have a phenomenally low infection rate of .1%."
The practice is consistent with AORN guidelines, Stapes maintains. "AORN says you have to wear scrubs and cover patients in the OR, but that's what we do: We cover them with gowns." This practice is no different from that of surgeons who wear underwear and socks covered with scrubs, she maintains. Another bonus is that patients like the comfort of wearing their own clothes, sources say. Patients often feel exposed in gowns, Beale points out.
Consider using the practice for procedures lasting two hours or less, Beale suggests. This is particularly important if most of your patient population is very young or elderly, she says. "If it's longer than two hours, we have problems with patients wetting the bed."
Have your admitting nurse watch for patients who might have problems. For example, those with poor hygiene and unclean clothes need to change, says Karen DesJardin, RN, CNOR, clinical educator at Westfall Surgery Center in Rochester, NY. Also, if the nurses determine that patients have a problem with incontinence, and the surgery procedures won't be short ones, consider having these patients change out of their clothes, she suggests. Usually potential problems are indicated in the preoperative health assessment, she says. For example, patients may have had prostate problems, or the nurse might ask whether they have to go to the bathroom frequently. Patients wearing undergarments for protection and elderly patients who are being transferred from a nursing home also are red flags, DesJardin says.
Have a backup plan, Beale suggests, because some elderly patients might have accidents. Beale went to a discount store and bought inexpensive "warm-ups" in multiple sizes. If a patient has an accident, staff rinse their clothes and give them the warm-ups to wear home. To avoid embarrassing patients, employees don't ask them to return the clothes.
Ask patients to wear loose-fitting clothes and shirts with front buttons so monitors can be attached easily, Beale suggests.
Follow-up is important, DesJardin emphasizes. Perform a quality improvement (QI) survey and monitor infection rates so you can prove the move was positive, she says. Her facility performed a QI survey on patients having procedures on both eyes. For the first procedure, patients changed into gowns. For the second, they were allowed wear street clothes.
"The response was about 99% positive from patients," DesJardin says. "They felt much more at ease and less threatened because they didn't have to change. It was more comfortable for them, and it made it easier for them."
There's no reason you can't do it, Beale advises. "It doesn't affect your infection rate," she says, "so why not?"
[Editor's note: Is your facility asking staff to take home surgical scrubs and wash them? Please share your experience with other readers. Use the Reader Question/ Reader Idea form enclosed in this issue. Contact: Joy Daughtery Dickinson, P.O. Box 740056, Atlanta, GA 30374. Telephone: (912) 377-8044. Fax: (912) 377-9144. E-mail: [email protected].]
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