Implant Verification and Availability for Certified Perioperative Nurse (CNOR)

Implant Verification and Availability

Guidelines:

• The perioperative nurse is responsible for verifying correct implants are available
• Nursing Process
• Comprehensive Surgical Checklist
• Surgeon Preference Card
• Knowledge of surgical procedure
• Knowledge of instruments, supplies, devices related to surgical procedure
• Surgical team communication (briefing/time-out)
• Verification of sterility or expiration date

Considerations:

• TJC Universal Protocol: National Patient Safety Goals *Prevent wrong site, wrong procedure, wrong person surgery
• 3 key steps:
  • Conducting a pre-procedure verification process
  • Marking the procedure site
  • Performing a time-out
• Pre-procedure verification process includes identifying the items that must be available for the procedure. This includes any required blood products, implants, devices, and special equipment.
• Also included on the comprehensive surgical checklist and is part of the nursing process with assessment and planning.

Nurse’s role:

• Utilize safety tools and processes, every patient, every time
  • This includes surgical checklist with universal protocol, briefing, time-out, debriefing.
• Pre-procedure verification process is vital to patient safety
  • Correct patient, correct procedure, correct implants and related equipment, devices, and supplies available, correct imaging displayed, relevant documentation (H&P, consent, preanesthesia assessment), etc.
• Verification of implant availability and sterility prior to procedure

Pitfalls:

• Must follow healthcare organization’s policies and procedures
  • Implant ordering, sterilization processing, storage, handling
  • HCIR presence in OR
  • Related equipment/devices/supplies
  • Documentation/log
• Follow manufacturer’s IFU
  • Expiration date/sterilization
  • Storage
  • Related equipment/devices/supplies
• Pre-procedure verification and team communication is essential

Examples:

• You are assigned to an OR doing back-to-back neurosurgery cases with the same surgeon using a craniotomy set and micro plating system and implants. A third urgent/emergent neurosurgery case with a different surgeon is added on to follow. You know that your facility only has 2 craniotomy and microplating system sets. As part of your pre-procedure verification process, what are some priority actions?
  • Verify that the instrumentation and implant set from the first case are being expedited for re-sterilization
  • Brief with surgeon on instrumentation required for add-on case
  • Communicate estimated time for instrumentation and implant availability
  • Coordinate with HCIR for refilling implant tray
  • Document!

Linchpins (Key Points):

• Use safety tools and checklists to prepare and plan
• Pre-procedure verification is vital to patient safety
• Team communication is a must
• Document, Document, Document