Another Team Player

“Everybody here has a voice…and you should listen!”

I make this point over and over when I help to implement a CPNB Program. I will go on to say that even if those putting the catheters in place are the best in the world, the outcome of the CPNB Program will still have more to do with the team around them. In my programs, this is a ‘Team Sport.’ I am happy to spotlight another ‘Team Player’ from Paris Regional Medical Center (PRMC) in Paris, Texas which is about 100 miles northeast of Dallas, Texas. This is Jasz Blake, CSFA who works in the O.R. at PRMC. Jasz came up with an idea that I’ve never considered, and I know it will not be the last time that I learn a new trick from someone on the team who does something besides actually performing the nerve blocks.

I got to meet Jasz (pronounced like ‘Jazz’) recently during our second On-Site visit to PRMC. I was in the break room speaking with some of the O.R. staff about their role in the maintenance and growth of the new CPNB Program and getting their perspective on some of the changes that were going to be taking place while we were there. I was talking about doing some common things to remind everyone about the presence of the CPNB catheter as they are getting used to the program so that they would keep from pulling it out accidentally. For example, many people will add some 4 x 4’s over the tegaderm in case the sticky side of the drape lines up over the CPNB dressing. That way, the 4 x 4’s are pulled away, and the dressing below is left untouched. Pulling out catheters is more common when a CPNB Program is young or when new CPNB’s are added. It seems to occur more frequently with interscalene and supraclavicular catheters, and it represents extra work and expense to replace the catheter (for those who are even comfortable to do so). It could also mean that several downstream mechanisms (like PACU bypass or an outpatient procedure) have just been thrown off course if the catheter can not be replaced. Even in the most experienced hands, ‘second attempts’ can add a layer of complexity and challenge which may compromise the ultimate quality of the nerve block or eliminate the opportunity to offer the procedure at all. If you have moved your open rotator cuff repairs to your surgery center, then this could be a big logistical problem…beyond the fact that the patient is now going to have worse pain control than anticipated!  

I saw the gears turning in his head as he considered the changes to his usual routine. Jasz may have felt confident enough to speak his mind or to offer suggestions even if I had not just said that the Anesthesia Department would listen to everyone’s suggestions…and that they are actively seeking ideas to improve the quality of the CPNB Program. The problem is that some may not be this confident, and they may have really good ideas. Jasz said that he could help others remember to be aware of the catheter by writing on the drapes with the blue felt pen right over where the catheter is placed. Brilliant!! It doesn’t cost anything, and it takes about 5 seconds to do it. The ‘prompt’ will be present throughout the procedure for the surgeon and others to see as well as when we get busy pulling off the drapes. I try to get the CRNA (or Anesthesiologist) to be as defensive about the catheter as we are with securing the airway, so having them remind someone on the other side of the drape to write out ‘CATHETER’ or a big asterisk should be a helpful ‘prompt for the prompt.’ 

Below, you can see where the drapes are being held by the surgeon, and in bold letters (with very nice handwriting, I might add) you can see that our reminder is clearly visible. Thanks for being part of the team, Jasz! And thanks to the Surgery Department and Anesthesia team for listening! To the Paris, Texas community and beyond: PRMC is continuing to improve patient care and setting a great example as they work together as a team!