Re: "Preventing Surgical Infections a Timing Game" (March, page 8). Perhaps we should incorporate the confirmation of antibiotic administration into the time out that many ORs take before surgery. When the OR personnel stop to confirm patient identity, scheduled procedure and laterality of procedure (if applicable), they can confirm antibiotic administration. If the antibiotic has been given, continue with your preparations. If the antibiotic hasn't been given, there is still time for the antibiotic to take effect before incision. With this measure, one would anticipate increasing the rate of proper administration from 55 percent to something approaching 100 percent.

Richard A. Stauffer, MDA, MBA
Henrico Doctors' Hospital
Richmond, Va.
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Controlling Body Temperature in the OR
Re: "Patient Warming Gets Proactive" (February, page 53). I was very surprised to find that MTRE (Medical Thermo Regulation Expertise) was left out. MTRE develops, manufactures and markets innovative solutions for body temperature management. MTRE provides solutions designed for cooling therapy in cardiac arrest, traumatic brain injury (TBI) and stroke victims, and offers systems for maintenance of normothermia, primarily for the operating room.

Dani Atoun
Regional Manager
MTRE
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Nurses Performing Endoscopy
Re: "Nurses Doing Flexible Sigmoidoscopy and Colonoscopy" (May 2004). I was so surprised to read the negative opinions you received regarding advanced practice nurses performing endoscopy. Your comments are from a sample of nurses who aren't familiar with and don't embrace the concept of the advanced practice role. How would your sample react knowing that nurse practitioners insert Swan-Ganz lines and chest tubes? Your readers seem resistant to the advanced practice role.

I have been performing flexible sigmoidoscopies for more than seven years in California. I perform biopsies, interpret the results and order medications to treat the endoscopic findings. I also participate in a training course for registered nurses to learn endoscopic skills. I feel that GI lab nurses are the perfect fit for the expanded advanced practice role in gastroenterology and endoscopy. The key to safety and efficacy is mentoring and developing training programs that parallel physician-training guidelines. The American Society of Gastroenterology Endoscopists has endorsed non-physician endoscopists for many years. This is why I am so amazed at how negative your readership was regarding nurses and nurse practitioners performing sigmoidoscopies and colonoscopies. Physicians will not be the barrier to advancing nurses' skill sets; it will be the negativism and lack of support from their peers.

Jill Olmstead, MSN, NP-C
St. Joseph Heritage Health Foundation
Fullerton, Calif.
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For the Record
Unused, opened supplies are gas sterilized for decontamination purposes only and then shipped clean by St. Joseph's Wayne Hospital in Wayne, N.J. This was not made clear in "Donate your unused open surgical supplies" (Ideas That Work, January, page 19).