Case Six: A Night Shift Trauma

In practice

At three in the morning, an injured patient is brought to the operating room for surgery on a bleeding leg wound. Jamie, the scrub person, has been awake for many hours. Jamie sets up quickly but completely, checking each package and indicator, and counting aloud with the circulating nurse before the incision. The team cannot confirm all of the patient's history, so the anesthesia provider names the unknowns at the time out, including allergies. During the case, Jamie notices that the back of Jamie's own glove touched the edge of an unsterile light. Nobody else saw it. Jamie says so aloud and changes the glove, and the circulating nurse helps. Later, the surgeon uses the energy device near a drape soaked with alcohol-based prep that had not fully dried. Jamie points to the pooled prep and asks to wait until it has dried, and the surgeon agrees. At shift change, a relief scrub person arrives. Jamie gives a structured handoff at the field, covering the procedure's stage, the counts, the medications and solutions on the field, and the specimen, and the two count together before Jamie leaves. The handoff and the count follow facility policy, so the relief scrub person knows where every counted item is before Jamie goes.