Internet use in the OR—is it safe?

AORN Journal,  Nov, 2004  by Suzanne C. Beyea

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APPROPRIATE USE

Use of the Internet and other communication devices can be essential to the provision of evidence-based care, especially when clinicians need the latest information to provide the highest standard of care. They can access online resources such as medical and nursing journals, documentation forms and reports, and other resources that are helpful in providing care.

Depending on the clinician's role and responsibilities, the need to access the Internet for professional reasons can vary greatly. What might start as patient-related use to look up a medication or access clinical information can lead to scheduling conferences, reading organizational e-mail, and ordering birthday gifts or planning travel. Part of the problem is that few guidelines and little data exist to help define when and how the Internet should be used in the OR and which clinicians should use it.

A NEED FOR GUIDELINES

The Federal Aviation Administration defines the need for a "sterile" cockpit at an altitude of 10,000 ft or less. This means that during takeoff and landing, all cockpit communications focus on the tasks at hand. When planes are at altitudes greater than 10,000 ft, pilots may engage in casual conversation or place the plane on auto-pilot. Even in these conditions, a "sterile" cockpit can be called for by any member of the flight crew if conditions warrant it.

In clinical situations, common sense and professional conduct should prevail, but managers should set standards of practice that clearly outline expectations. The use of communication devices should be limited to what is immediately required during the provision of care. For example, if an individual needs to access the Internet to support appropriate documentation, it is part of patient care, as is using the Internet to obtain a reference or a report of an x-ray.

As clinicians seek to improve patient safety in the OR, the need for reliable team members has never been more apparent. Team members need situational awareness to anticipate needs rather than react to events.

There is no such thing as downtime during a surgical procedure. The circulating nurse should be engaged in the surgical procedure constantly, regardless of its duration. Although there may be little physical activity required of the circulating nurse during certain portions of the procedure, he or she should be mentally engaged in every aspect of the procedure and the OR throughout the procedure.

Mentally removing oneself to surf the Internet, read a book, or perform any activity that is not related to the specific procedure diverts attention from the patient and the procedure. That time should be used to monitor activities during surgery and the needs of the patient and other members of the team. (1) The role of the circulating nurse is critical to the safety of the patient undergoing surgery, and ongoing monitoring and constant vigilance by the nurse supports the team's efforts to provide high-quality care.