To tape or not to tape: How do you handle jewelry?

Policies vary as much as what patients wear

Asking a patient to remove a treasured wedding ring or body jewelry that defines their persona is not easy. However, with the increased focus on patient safety and the risks for injury posed by jewelry, as well as the increase in the popularity of piercings and body jewelry, many outpatient program managers are looking at ways to improve their policies to address all situations.

Lynn Barrett, RN, operating room educator at Overlake Hospital in Bellevue, WA, is looking to revise the policy for surgical patients, and she sits on a hospitalwide committee that is considering the need for a policy throughout the hospital. "But even if there is not a policy for all departments of the hospital, I believe it is important for surgical services because body jewelry increases the risk of contamination and infection as well as the risk of arcing that can cause fire or burns to the patient," Barrett says.

Overlake Hospital's surgical policy states that all jewelry must be removed, but Barrett admits that staff members don't adhere strictly to the policy and will make decisions on a case-by-case basis. "I think we need a clear policy, not only about the removal of jewelry, but also about how to store it if there is no family member present to accept responsibility for the jewelry," she says.

At a hospital in Ohio, the surgery director is evaluating the policy that currently calls for removal of all jewelry, to the point of cutting wedding rings off in the operating room if the ring cannot be slipped over the knuckle. The policy is very specific and leaves no room for other options, according to the surgery director, who asked not to be identified. After she researched information from the Association of periOperative Registered Nurses in Denver and ECRI in Plymouth Meeting, PA, she says, "I believe that a patient can safely go through surgery with a wedding ring taped on a finger, if the patient, surgeon, and anesthesiologist agree."

The Ohio hospital is reviewing the policy to allow rings that cannot be removed or that the patient will not remove due to sentimental reasons. "This will be the exception rather than the norm," says the director. The ring will be removed if the hand on which the ring is located is to be operated, she says. The anesthesia department at the hospital also has stated that mouth jewelry must be removed, and all surgeons agree that all body jewelry must be removed, adds the director.

Moore (OK) Medical Center has revised its policy to address all jewelry, including body jewelry, says Patricia E. Mayo, RN, RNFA, CNOR, director of surgical services. [A copy of this protocol.] "The patient is informed that he or she will have to remove all jewelry when they initially discuss the procedure with the physician," Mayo says. If patients show up on the day of surgery with jewelry, staff ask them to remove it and give to the family member or friend who came with them, she explains. "We explain that any type of jewelry that can conduct electricity poses a risk for burns," Mayo says.

If the patient refuses to remove, or cannot remove the jewelry and the jewelry is not in the sterile field, a nonconductive tape is placed over the jewelry, if the surgeon and anesthesiologist agree, says Mayo. "Not only do we need to place the tape over the jewelry to prevent arcing, but we also need to make sure that the jewelry will not snag the drapes, causing us to pull on the jewelry or causing the drapes to slip out of place," she explains.

Anesthesiologists almost always require the removal of tongue jewelry, and usually genital jewelry must be removed as well, Mayo says. This jewelry can interfere with urinary catheterization as well as airway access, she explains.

While most patients understand the safety implications of removing jewelry, Mayo admits that occasionally a patient does not want to remove jewelry. "We explain all of the potential risks and then we explain that if we cannot safely perform the surgery with the jewelry in place, we may cancel the procedure," she says. Although no procedures have been canceled, the policy does allow for cancellations, she adds.

"Most of our physicians have been very proactive in helping us make sure the jewelry policy is presented to patients before the day of surgery," says Mayo. "We always do find some surprises because a physician doesn't always know about every piercing a patient may have."

Sources

For more information about body piercing policies, contact:

  • Lynn Barrett, RN, Operating Room Educator, Overlake Hospital, 1035 116th Ave. N.E., Bellevue, WA 98004. Telephone: (425) 688-5000. Fax: (425) 688-5654. E-mail: lynn.barrett@overlakehospital.org.
  • Patricia E. Mayo, RN, RNFA, CNOR, Director of Surgical Services, Moore Medical Center, 700 S. Telephone Road, Moore, OK 73160. Telephone: (405) 912-3465. Fax: (405) 912-3095.