OBSTETRIC ANESTHESIA ORIENTATION CHECKLIST- WEEKDAY
CRNA Name_________________________________________
Orientation Date______________________________________
____ Operating Room and Emergency Equipment Setup
At the start of shift, it is expected that the CRNA will check out the ORs and make sure that each one is ready to go for a planned or urgent case that arrives. 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 down in 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, one pre-made syringe of ephedrine, phenylephrine, and syringes to pull up each drug. 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 patient must be charged to that patient. Please make sure you charge for the exact number of syringes used (especially ephedrine). Right now you will find or can type in patient name as "emergency tray" to pull drugs for the tray if needed. Again, please note that the pharmacy is not consistently seeing a double signature waste record for the CLE bag or in the OR for narcs. Please make sure all records are extremely legible and signed and dated.
____ Epidural Cart and Supplies
Locking all carts/cabinets at the end of cases (including epidural placement) and lock up the CLE bags on the pump; mandated by the 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, preferably from the patient’s input, allergies, and the procedure to be done. Please note the time-out time on the Anesthesia Record.
Debriefing after all code whites, other special circumstances: mandated by Rose administration
____ WHO Checklist:
WHO checklist initiative: participation in this as outlined by the Rose administration is mandatory.
____ Performance of C-Section with primary CRNA
See the patients prior to the procedure, complete the history and physical and obtain consent whenever possible.
___ 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 CAC doctor on the deck at the time. Please respond quickly when called upon for this reason.
____ Performance of Epidural/follow-up with primary CRNA:
Troubleshooting a non-functioning Epidural: Start with <10cc of 0.2% Ropivacaine with or without Fentanyl 50-100mcg after your evaluation of the patient. If the patient is not comfortable after your initial efforts, please call CAC MD directly in no more than 30 minutes from the first request to evaluate and certainly at any time prn.
____ Epidural Paperwork
____ C-Section Paperwork
____ Obstetric PACU
____ Patient Census Board
____ 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 CAC doctor and CRNA – the list should be divided. The CAC doctor will review the list and determine the division of labor. CAC might decide a particular patient should be seen by the doctor. CAC business cards will be handed to each patient at the post-op visit. Rounding will be accounted for in the rounding book at the nurses’ station. Please restrict your comments to “done” or “ok” or a brief comment about a complaint “itching” or comment “very satisfied” and your initials or mark it with a red dot. A red dot will signify that the CAC doctor 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, etc. A note in the chart is mandatory at the time of the post-op visit, dated and timed. Whatever comment you will write in the rounding book cannot be different from the chart note. The chart note should clearly state any issue or complaint. Complaints should be reported to the on call CAC doctor for further follow up. Restrict comments in the rounding book to pertinent remarks to facilitate rounding/follow-up. We are trying to track nausea/vomiting/itching through the rounding book – so those comments will be pertinent.
Orientation Performed by ______________________
Submit completed checklist to Clarissa Cotto
Scan to or fax to 303 344 1817.