OUTLINE - Colorado Anesthesia Services



OUTLINE

I ORIENTATION

II JOB DESCRIPTION

III PAPERWORK

IV GCA CRITERIA

V MEMORANDUMS

VI APPENDICES

This booklet is a compilation of instructions and information supplied by GCA physicians and RMC administration. By compiling this booklet, Colorado Anesthesia Services, LLC, is only relaying information to its contractors, and has no input as to its contents.

I ORIENTATION

Welcome to the RMC OB deck. Prior to your scheduled Obstetric Anesthesia Orientation, you must contact the individuals below to obtain an ID badge, parking access and PYXIS training.

To schedule your ID Badge and parking access contact:

Linda Clancy

Rose Medical Center

4567 E 9th Ave

Denver, CO  80220

Ph (303) 320-2097

Fax (303) 320-2369

NOTE: You cannot work at Rose without your ID badge

To schedule your PYXIS training and password contact:

 

Jeff Stroup (x7353)

Rose Medical Center

Department of Pharmacy Services

4567 E 9th Avenue

Denver, Colorado   80220

Ph (303) 320-7353)

Pager (303) 266-8736 pager

Contact Clarissa Seda Cotto at (303) 250-4008 to schedule your OB deck orientation. You will be provided with the name and contact information of the CRNA that will orient you and the date of the orientation. You cannot start work before your orientation is completed. Orientation is session. Two checklists need to be filled out and signed by the orienting CRNA after completion of each session. Please fax the forms to Clarissa Seda Cotto at (303) 344-1817. Below are the checklists with detailed explanations of some points.

OBSTETRIC ANESTHESIA ORIENTATION CHECKLIST- WEEKDAY

CRNA Name_________________________________________

Orientation Date______________________________________

____ Operating Room and Emergency Equipment Setup

At the start of each shift, it is expected that the CRNA will check out the ORs and make sure that each one is ready to go for planned or urgent cases. This would include throwing away expired drugs, preparing numerous syringes for immediate use (but not labeled, which violates JHACO), and preparing the "emergency tray" which is located in the fourth drawer of the old anesthesia supply cart.

____ Routine and Emergency Drugs

The emergency tray should contain these items only: One vial each of Amidate, Succinylcholine, Propofol, Pitocin and syringes to draw up each drug. As well, there should be one pre-made syringe of ephedrine and phenylephrine. It is essential that at the end of every case, all drugs are reconciled. The emergency tray must be reset and the drugs used in the last case must be charged to that particular patient. Please make sure you charge for the exact number of syringes used (especially ephedrine). If needed, you can type in the patient name as "emergency tray" to pull drugs for the tray. Again, please note that the pharmacy requires a double signature waste record for the CLE bags, narcotics and Propofol. Please make sure all records are extremely legible, signed and dated.

____ Code White

It is essential to learn the Code White protocol.

____ Epidural Cart and Supplies

All carts and cabinets should be locked at the end of all cases, including epidural placements, and at all times when not attended. As well, the CLE bags on the pumps should be locked as this is mandated by Rose administration.

____ Epidural and Spinal Kits and Needles

____ Time Out and Debriefing

Time-outs must be done prior to each regional procedure: This includes the name and DOB of the patient, allergies, and the procedure to be done. Please note the time-out time on the Anesthesia Record.

Debriefing needs to occur after all “Code whites” and all other special circumstances as this is mandated by Rose administration.

____ WHO Checklist

WHO checklist initiative: Participation in this as outlined by the Rose administration is mandatory.

____ C-Section with primary CRNA

See the patient prior to the procedure, complete the history and physical and obtain consent whenever possible.

____ C-Section Paperwork

____ Epidural/follow-up with primary CRNA

Please call the GCA physician directly in no more than 30 minutes from the first request to evaluate, if the patient is still uncomfortable. Learn CLE pump set-up and troubleshooting.

____ Epidural Paperwork

____Procedure Line-up

If a line up of procedures occurs, you will be called and expected to help facilitate a quick turnover by setting up the CLE line, obtaining drugs, setting up the next patient, or various other ways as per the GCA physician on the deck at that time. Please respond quickly when called upon for this reason.

____ Obstetric PACU

____ Patient Census Board

____ Post Partum Rounding

Post partum rounding will be done by the next day’s shift on all patients discharged by Anesthesia prior to midnight the previous day. This list of patients to round on will be a joint responsibility of the GCA physician and the CRNA; the list should be divided. The GCA physician will review the list and determine the division of labor. GCA business cards will be handed to each patient at the post-operative visit. Rounding will be accounted for in the rounding book at the nurses’ station. Please restrict your comments to “done” or “very satisfied” or a brief comment about a complaint such as “itching”, with your initials beneath your comments. Please mark your comment with a red dot to signify that the GCA physician or the next shift needs to visit this patient, either because they were not in their room, or they had a complaint that needs further follow up. A note in the chart is mandatory at the time of the post-operative visit, and it needs to be dated and timed. Comments you write in the rounding book should be the same as those in the chart note. The chart note should clearly state any issue or complaint. Complaints should be

reported to the on call GCA physician for further follow up. Restrict comments in the rounding book to pertinent remarks in order to facilitate rounding/follow-up. GCA is tracking nausea/vomiting/itching through the rounding book, so these comments are pertinent.

Orientation Performed by ______________________

Submit completed checklist to Clarissa Cotto

Scan to coloradoanesthesiaservices@ or fax to (303) 344-1817.

OBSTETRIC ANESTHESIA ORIENTATION CHECKLIST- WEEKEND

CRNA Name_________________________________________

Orientation Date______________________________________

____ Operating Room and Emergency Equipment Setup

____ Routine and Emergency Drugs

____ Code White

____ Epidural Cart and Supplies

On the weekends, there is no anesthesia tech available. As the CRNAs are more frequently up on the deck than any one anesthesiologist, it is expected that the CRNAs restock the epidural anesthesia carts as they become depleted, mostly with epidural tray kits and tubing for the pumps. Become familiar with where anesthesia supplies are located, as the rooms need to be ready for a code white at all times. The compartment on the CLE cart where the patient stickers are placed should be looked at every time the CRNA is rounding on the epidurals (presumably every 2-4 hours). Due to the new computer charting program, many of the RNs do not know how or where to place the checkmarks for patients with epidurals. If you go to the screen and do not see that an epidural is running on a patient, do not assume that they do not have one. Please check the compartment on the CLE cart for patient stickers.

____ Epidural and Spinal Kits and Needles

____ Time Out and Debriefing

____ WHO Checklist

____ C-Section with primary CRNA

____ C-Section Paperwork

____ Epidural/follow-up with primary CRNA

____ Epidural Paperwork

____ Procedure Line-up

____ Obstetric PACU

____ Patient Census Board

____ Post Partum Rounding

Orientation Performed by ______________________

Submit completed checklist to Clarissa Cotto

Scan to coloradoanesthesiaservices@ or fax to (303) 344-1817.

II JOB DESCRIPTION

The CRNA is required to report to the OB deck at 6:30am for the day shift and at 6:30pm for the night shift. The following guideline for the daily routine is suggested:

1) At the start of each morning shift, please get a complete report from the CRNA regarding CLEs, complex patients, scheduled procedures, and any other matter that needs immediate attention. Make sure that the ORs are set up and make rounds on running epidurals. For scheduled C-sections, please see the patient prior to the procedure, complete the history and physical and obtain consent whenever possible.

Please touch base with the incoming anesthesiologist to establish expectations, plans for the shift, and divide the rounding responsibilities.

2) CLE troubleshooting parameters: Opinions vary on how to first approach this situation. A good history and understanding of what has previously transpired is essential. GCA physicians suggest that you first start with ................
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