Double Check Your Scopes for Damage
A simple way to make your reprocessing staff accountable.
There's not much you can do to prevent scope damage that comes from wear and tear. But you can prevent the damage that results from improper handling. In addition to the normal documentation of scope in, scope out and quality checks, we added the following policy: The person washing scopes on a particular day is responsible for asking a co-worker to check the scopes at day's end.

Both people must be present and check the scopes together. They both record their initials next to the scope number in the log. They must visually examine each scope for such damage as frays, buckling, crimps, discoloration, peeling or snaking. They'll also feel the length of the insertion tube for damage and assess its bending diameter. Any discovered damages must be reported immediately.

Usually the scope washer will ask the person who's been assigned to wash scopes the following day to conduct the check. This lends an added level of vigilance to the process, since the next day's scope washer won't want any undiscovered damages to show up on her watch. Our non-punitive assessment helps to ward off the scourge of "I don't know when that happened." With a double check and initials on the record, we know exactly when the damage occurred and can educate staff accordingly for more careful handling in the future.

Doretha Smith, RN
Nurse Manager
Quad City Endoscopy
Moline, Ill.
[email protected]

Every Patient Gets an Allergy Bracelet
You probably place allergy bracelets only on those patients who communicate sensitivity to medications or latex. We place a red allergy bracelet on every patient — regardless of whether the patient has allergies. This process may seem like overkill, but for 12 cents per paper bracelet, it forces the periop team to look at every patient's bracelet. We document allergies if applicable or NKA if the patient denies any allergies. We place a corresponding red label in the chart noting the presence of allergies or NKA. We consider this a safety initiative that reassures us that we have complete patient information before the surgical procedure.

Louise DeChesser, RN, CNOR, MS
Administrator
West Hartford Surgery Center
West Hartford, Conn.
[email protected]

Buffered Lidocaine Is the Secret to Starting Ouchless IVs
The use of a lidocaine pre-IV stick has been around for a long time, but the lidocaine often burns when instilled, which does little to make the IV stick any less of a traumatic part of a patient's visit to your facility. Buffering the lidocaine takes the sting out of the stick — and is the secret to starting an ouchless IV. Here's how we do it.

• Add 1cc of sodium bicarbonate 8.4% to 10cc of lidocaine 1%. We used to mix our own buffered lidocaine. Now our pharmacy does it for us.
• Use an insulin syringe to draw up about 0.2ml of buffered lidocaine and take it to the bedside with your IV supplies.
• Let the patient know that you're going to give them a little shot under the skin to help numb the pain of the IV stick.
• Give the injection, which takes just a few minutes to work. The area that you infiltrated is the area into which you'll then insert the IV catheter.

This little extra step takes only minutes and costs pennies, yet patients frequently mention that the IV stick didn't hurt and remember the nurse who started the IV by name on satisfaction surveys.

Janny Drover, RN, and Kelly Phillips, RN
Lake Regional Health System
Osage Beach, Mo.
[email protected]

Merry-Go-Round For Patient Files
For situations when more than 1 person needs access to a patient's record, we created a carousel for files. The carousel is built into the wall so that it can be accessed from 2 different rooms: where patients' pre-op documentation is reviewed and the utility area used by anesthesia and clerical staff. The day before surgery, a staff member reviews each patient's pre-op chart. Any charts that require follow-up from anesthesia or another provider are placed in the color-coded cubbies in the carousel. Cases that need to be rescheduled or cancelled go in a red cubby, cases with questions for anesthesia go in a yellow cubby and cases ready to proceed go in a green cubby. The carousel keeps all the files in a single place and at the same time eliminates congestion at the desk where patients' files are reviewed.

Rena Hazelton, RN
Nurse Manager
Short Procedure Unit/PACU
Punxsutawney Area Hospital
Punxsutawney, Pa.
[email protected]