Letters & E-mails

Don't Text and Operate
Re: "Don't Give in to the Gadget" (June, page 16). All operating room staff should be mentally present 100% of the time during any patient encounter. If they are tweeting, texting, surfing the internet or posting "selfies," they are not paying full attention, but instead making a conscious decision that puts the patient at risk. Nurses as advocates have an ethical responsibility to stand for the well-being of the patient. This means speaking up when a patient's safety is threatened because a member of the healthcare team is preoccupied with the score of the World Cup.

Alyssa Turpin, RN
Graduate Nursing Student
Florida Atlantic University
Boca Raton, Fla.
[email protected]

Pain-Free Surgery
Re: "Managing Post-Op Hernia Pain" (Manager's Guide to Abdominal Surgery, March, page 20). Careful attention to established techniques, along with appropriate adoption of new technologies, has certainly made it more likely for our patients to achieve a pain-free result, with a reduced reliance on opioids. I was quite surprised that there was no mention of an agent I have been using for the past year or so: Exparel (bupivacaine liposome injectable suspension). This agent is a single injection placed during the case, but allows for release of bupivacaine for up to 96 hours. After using it in more than 150 patients, the data from my patients continue to demonstrate that they have had less pain requiring fewer narcotics.

Lawrence Biskin, MD
Chairman, Hernia Committee, Society of Laparoendoscopic Surgeons
Pittsburgh, Pa.
[email protected]

Evidence-Based Practice
Re: "Do You Follow AORN Recommended Practices?" (June, page 6). Yes, the choice is yours to follow AORN's Recommended Practices, but as healthcare providers we have an ethical responsibility to minimize potential risks to patients and provide care that keeps them safe. Healthcare providers cannot practice on the premise of "that is how I have always done it." Practice has to be based on evidence. AORN's Recommended Practices are reviewed and accepted by National Guideline Clearinghouse and follow the standards of guideline development set forth by the Institute of Medicine. AORN's Recommended Practices are used by CMS and other accrediting bodies. Facilities may be cited if they are not followed. As healthcare reform continues to evolve, quality and value will be expected at every facility. It is imperative that we practice based on the evidence and not how we have always done it at our facility.

Lisa Spruce, RN, DNP, ACNS, ACNP, ANP, CNOR
Director of Evidence-Based Perioperative Practice,Association of periOperative Registered Nurses
[email protected]

The "Karwoski Calculator"
Re: "Know When Multi-Use Vials Expire at a Glance" (June, page 9). As a consultant pharmacist, I've seen variations of the 28-day calendar. The downfall is you must place the calendar in all areas and look it over at the time you open the vial. I've come up with a quick calculation that is efficient for everyone — regardless of where they are in the facility. When you open a multi-dose vial, take the current date, go 1 month ahead and subtract 3 days. This becomes your new expiration date. There are a few months when it will be less than 28 days, but it is never more than 28 days. Some of my clients have coined this the "Karwoski Calculator."

John Karwoski, RPh, MBA
Wenonah, N.J.
[email protected]