Knowing When Implants Will Expire
This red dot sticker system will minimize wasted supplies.

Want to be able to track your implants' expirations at a glance? Go to your local supply store and buy some red dot stickers. Print the words "EXPIRES 2006" on the stickers, place them on those implants that expire this year, then write the month they expire on the sticker. As a result, the staff knows which implants to pull first, and I scan the shelves on the last week of each month to find out what's expiring. Then you can contact the manufacturer and see if it can swap out your soon-to-expire implants with a hospital that's about to use the same implants. This system has worked so well that I'm now using it for other surgical supplies, such as our sutures.

Shannon Holley, RN, CNOR, RNFA
Orthopedic Service Coordinator
The Toledo Hospital Surgery Department
Toledo, Ohio
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Lining Your Kick Bucket
We use the outer cover that our procedure packs come in to line our kick buckets. The nice strong material saves us from having to use another trash bag, and it's a great way to recycle.

Julie Hammersley, RN
Executive Director
St. Francis Mooresville Surgery Center
Mooresville, Ind.
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Let CNAs Ease Your Staffing Burden
In an effort to curb our staffing budget and deal with the ebbs and flows of our surgical schedule, we hired our first certified nursing associate three years ago to assist us in our recovery room. We had recognized that there are many activities in a surgical nursing environment that are essential to our patient flow but don't require the skills of a registered nurse. Since RNs earn $39 to $48 an hour in our area, $16 to $21 an hour for a CNA is a staffing bargain.

We immediately found ways for our CNAs to help in recovery. They can

• place monitors on patients admitted to recovery;
• assist patients with a bedpan or to the bathroom;
• help them to sit up and get dressed;
• escort patients to their cars;
• change beds; and
• stock linen and supplies.

The delegation of these duties freed up the RNs to focus on patient care at the bedside, as well as charting, administering meds and providing information to patient and family members at discharge. Because RNs were less rushed, we think the safety of our center improved. CNAs have been particularly helpful in those unpredictable times when, for example, we have a surge of patients coming from the OR or when several patients are ready to be discharged at the same time.

We've also cross-trained our CNAs to work in the pre-op department, where their duties include escorting patients to the pre-op area, verifying their identity, taking patient vitals, assigning patients to a bed and performing surgical site preparations. We now have three CNAs who are cross-trained to work in both the pre-op and recovery departments.

Before hiring our first CNA, we worked with the nursing staff to develop a scope of responsibilities for this position and then we wrote a job description. At first, some of our nurses were concerned about the fact that these CNAs would be working under their direction. But it became immediately apparent how helpful CNAs are.

Kate O'Connor, MBA, CASC
Administrator
Los Gatos Surgical Center
Los Gatos, Calif.
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Monitor Your Own Turnover Times
Our staff calculates its own turnover times. It's pretty simple. On a dry-erase board in the OR, staff write the time out of the last procedure and the time in for the next procedure on the board. It's a constant reminder that turnover time is a key marker for efficiency in surgical centers, yet discreet enough that patients won't notice or feel rushed. We set benchmarks as a group, and the staff can measure themselves against these benchmarks. In general, it's 10 minutes for a simple case, 15 minutes for a more complex case. If a turnover time is delayed, the staff cites the reason on a CQI sheet, whether it be due to an equipment or supply problem, a surgeon- or anesthesia-caused delay, a late-arriving patient, an incomplete chart or a case not having been picked. I communicate each staff member's average turnover times monthly, so she can measure her overall performance. Interestingly, I've noticed that our schedule affects our turnover times - the lighter the schedule, the slower the turnover, and vice versa.

Gregory P. DeConciliis, PA-C
Administrator
Boston Out-Patient Surgical
Suites, LLC
Waltham, Mass.
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On-site Tax Preparation
To make tax season more bearable, our hospital partnered with H&R Block to offer our staff and patients discounted on-site tax preparation. Tax preparers will staff a temporary tax station in our lobby until April 15. They'll prepare our returns at a $20 discount (an company representative says the average return is $50, but prices vary according to the complexity of the tax return). For healthcare professionals who work long hours and different shifts, it's nice to not have to take time away from work to get your taxes done.

Garth Gibson
Managed Care Analyst
Jackson Memorial Hospital
Miami, Fla
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Music in the OR We Can All Enjoy
Instead of one individual's iPod playlist dictating the music that's played in the OR and distracting everyone with overly loud music, I decided on a more democratic approach. I purchased a satellite radio (about $150 from XM Radio and a $12 monthly fee for satellite radio service) and play a variety of music throughout the day to accommodate everyone's tastes at a safe decibel level.

To play the radio in the OR, I tune the receiver to the setting that will let you play the FM band, then pipe the music into the overhead speakers. You could also run a cable from the satellite receiver to a speaker system.

I'm the DJ by default. I start off with light stuff in the morning, then go with a little jazz, country, R&B and soul. The nurses especially love not having to hear the same thing all day, every day, or the surgeons' favorites blaring.

Timothy Harwood, MD
Staff Anesthesiologist
Somnia, Inc.
Raleigh, N.C.
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Scan Paperwork and Save it to Disc
The paperwork that any business generates can be daunting, especially a business that deals with as many forms as a surgery center. We decided to do something about our less crucial paperwork. For $120 a month, we leased a copier that doubles as a document scanner and scans 65 pages per minute. Then we started to commit things like accounts receivable, payment batches, timesheets and payroll reports to disc and our computer's memory.

Paperwork such as payroll piles up quickly but is also confidential. Previously, we had to store them in secure locations and we were running out of locked cabinets to do that. Now the paperwork that we used to keep for seven years is committed to a hard drive and then shredded after six months.

If someone in my office needs to look up an explanation of benefit or other payment information, she gets it from the computer screen. Our case volume is small enough that our employees can quickly scroll through all documents to see what they want.

Just in case, though, we bought a copy of PaperPort software for less than $100 that makes all our documents searchable. The documents that are scanned go on my hard drive and are backed up to CDs, which are then stored off-site.

Already in 14 months, we've saved about two storage boxes worth of space and, in addition, recently committed five years of payroll records (four 3-inch notebooks for each year) to five CDs.

Wendy Taylor
Business Manager
Overlake Surgery Center
Bellevue, Wash.
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Are Your Mylicon Cups Labeled?
Here's a quick and easy solution if your Styrofoam cups with Mylicon solution aren't labeled in your endo labs. Preprint some Avery address labels with the information needed to properly label the solution - drug, dose, date and the initials of who prepared it. The only step the nurse needs to take is to apply the label and place her initials on the line left blank when she is setting up for the procedure. This helps us comply with JCAHO safety standards for medication labeling, save time and prevent errors. Remember that you must label the Mylicon cups because it's a medication out of its original container.

Marlene Brunswick, RN, CNOR
Director of Nursing
Findlay Surgery Center
Findlay, Ohio
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Keep Liposuction Patients Comfortable
We use a heating pad to heat up IV solutions, which is very effective for heating wetting solution before injection for liposuction.

Michael Kreidstein, MD, MSc, FRCS(C)
Director
Michael Kreidstein Medicine
Toronto, Ontario, Canada
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Hook Them Once, and Forget It
It's common to see PACU nurses struggling with jumbled cords and fumbling around under the patient's gown to rehook the EKG leads and put a BP cuff on an unconscious patient. These could be critical seconds and minutes ticking away for a patient with sleep apnea or an obstructed airway, or for a narcotized and apneic patient who is desaturating with every second. We leave the EKG leads attached to the cord and unhook the cord from the monitor, so that in the OR and PACU, all you have to do is plug and unplug the cord to the monitor. The same is true of the BP cuff. We leave it on the patient and hook and unhook the cuff from the monitors, saving a lot of time, a lot of clumsiness and maybe even some lives.

Jayesh Dayal, MD
President
White-Flint Surgery, LLC
Rockville, Md.
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