Intermed/Generations Surgery Center
Services at Generations Surgery Center: Orientation
| SECTION I:
|Section I: Administrative Information|
David Andrews, MD (741-8417)
Sharla Moretti-ASC Manager [firstname.lastname@example.org]
Susan Lefebvre-ASC clinical lead/OR circulator RN
Kaitlin Brent-ASC preop/PACU/OR circulator RN
Amy Frink-ASC preop/PACU RN
Cindy Curry-ASC per diem OR circulator/preop RN
Karyn Fisette-ASC OR circulator RN (will be starting soon)
Julia Gagne- ASC per diem pre op RN
Rebecca MacLeod- ASC per diem PACU/preop RN
Lauren Jones- ASC per diem preop RN
Jessica Brann- ASC CST
Gina McHugh-ASC CST
Paul French-ASC CST
Stacy Mahoney-ASC CST per diem
• Dr. Emil Gotschlich is the ASC Medical Director.
• The ASC currently operates Tuesday, Thursday, Friday
• Surgery start times are 0730 on all days except 0830 on Thursday to allow attendance of anesthesia conference. There are occasional special requests to start at 0700, usually to accommodate an add-on ERS.
• The current OR volume does
not generally necessitate a formal lunch break as most days finish up
by early afternoon.
• Parking: There is
a parking garage within the Intermed
building. Access to the garage is open, but a vehicle tag is required
and will be provided after credentialing is complete. You will need
your auto registration number with you when you complete the
application for the sticker with Jill Binford. Although you do not
need it to gain access to the garage, security occasionally monitors
who is parking where. Parking should be done on level 3 of the parking
garage in locations labeled Intermed Staff .
• Daily case schedule:
A daily case list is generally left
on the anesthesia supply cart (Blue Bell). Otherwise it is readily
available at the nursing station in the PACU area. All cases are
expected to receive anesthesia services.
Policies & Procedures
• Current documents include Pre-operative Guidelines and Pre-op Medication Protocols. These are available for review by asking Karen or Byrni.
anesthesiologist evaluations are required for ASA 3 patients and those
with BMIs greater than 40. If
the BMI is greater than 35 the nurse will
request a review of the chart to determine if the patient needs to come
in pre-operatively for an anesthesiologist evaluation prior to the date
of surgery. If the BMI is over 40, patients may only considered for the
ASC if their procedures are minimally invasive and of limited duration
(i.e., less than 1 hour and no laparoscopies), and if patients are
considered to be medically appropriate by the examining
anesthesiologist at the mandatory pre-operative evaluation.
• Diabetics on oral or insulin therapy are instructed to bring their personal Glucometer, as well as insulin, with them to Generations ASC. There is no glucose measurement device at the facility (due to quality control considerations). Patients understand that if they forget to bring this equipment, their surgery will be cancelled and rescheduled for another day.
• NEW A detailed List of Selection/Exclusion Criteria for InterMed Patients is outlined in this document (2013)
|Section II: Clinical Information|
Supplies & Equipment
• Anesthesia Cart: A GE Healthcare Aespire 7900 anesthesia machine with ventilator is in the OR with a Bluebell cart stocked with drugs and supplies. . Sevoflurane, desflurane, and nitrous oxide are the available inhalation anesthetic choices. An AMBU Bag is hung on the back of the machine.
• Suction: Suction is turned off in two locations after hours in the interest of preserving the suction pump. In addition to the patient suction, the scavenge manifold valve also needs to be turned off. The staff know about this and usually take care of this, but we should also check these functions on the machine before and after the day's cases. If the scavenge valve is not turned back on for a case, bag ventilation will work, but the ventilator will deliver ~10 cm of unrequested PEEP, the scavenge bag will be tensely inflated and waste gas will not be properly evacuated.
• Piped Gases/ back up
tanks: The tanks for the piped gas
system are also on the 10th floor. Central gas levels are verified with
one of the nursing staff once weekly on Tuesday. Backup E tanks are on
the anesthesia machine.
• Controlled Drugs:
Controlled drugs may be obtained by the
nursing staff either before or during the case. Versed is very rarely
indicated. Unused fentanyl should be
passed off to the PACU nurse. Muscle relaxants are kept in the
refrigerator in the anesthesia supply office.
• Patient Warming: The OR has Bair Hugger warming device and patient blower blankets are available. Most cases are less than an hour, in which case SCIP guidelines do not dictate active rewarming practice. Consistent with Spectrum practice, the blower is not used without a commercial warming blanket.
Typical Clinical Course and Anesthesia Implications
Common Practices / Suggested Anesthesia
All patients booked in the ASC
expect an anesthetic procedure. Spinal anesthetics are rarely used.
After the anesthesiologist is done speaking with the patient and
consent obtained, the circulating nurse should be informed, at which
time she will complete her process and escort the patient to the room.
|Questions, Problems||Direct to David Andrews MD or Sharla Moretti|