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Ideas That Work
Home Care for Same-day Surgery Patients
Diana Procuniar
Publish Date: October 10, 2007   |  Tags:   Ideas That Work

Diana Procuniar, RN, BA, CNOR We're so focused on what happens to patients while they're in our facilities that it's easy to lose sight of what happens to them once they've gone home. Wouldn't it be nice if we could empower patients to take care of themselves? Here's what's worked for us.

Diana Procuniar, RN, BA, CNOR \ We give our patients post-operative instructions when they visit the clinic to schedule their cataract or plastic surgery, or by mail if they don't schedule in person. The instructions tell them everything they'll want to have or need to know after their surgery such as how to use the eye drops or to have a bag of frozen peas to use as an ice pack. Our orderly also puts together post-op kits for patients that include written discharge instructions, their prescriptions, cataract sunglasses, eyedrops and tape for their eyeshield. The kits are identified with the patients' names so when they are discharged, everything's ready in one place.

We even use this concept as a quality improvement monitor. If we find several patients calling with the same questions, we know what parts of the instructions to revise or simplify.

Denise Adams, BSN
Ambulatory Surgery Coordinator
Baltimore Washington Eye Center
Glen Burnie, Md.
writeMail("[email protected]")

Inventory-control Stickers
Accurate inventory control and case costing are critical to a well-run and profitable surgical facility. But count those supplies enough times and you can't help but think, "There has to be a better way to do this." We've found that putting stickers on all our inventory items makes it easier.

We have a Microsoft Word template that can print out a sheet of stickers with item names on each, the names that they're listed as in our inventory software. The person restocking the supplies puts a sticker on each item as she puts the item away.

They're the double-stick kind of stickers, so when an item is used for a case, the sticker is peeled off the item and attached to a page in the patient's chart. This ensures that all the supplies used in a case are charged to that case. As we enter patients' case histories, we automatically subtract the item from our inventory.

In the case of bulk items - such as Band-Aids, thermometer sheaths or tongue blades, and anesthesia supplies, we're not going to be able to sticker every one of those. We put one sticker on the box, which is peeled off and placed on an inventory supply room clipboard. We can then charge and deduct the items in bulk to general surgical supplies or anesthesia costs.

We used to do inventory every quarter, or even more frequently. It took us a day or longer each time. Now, with the help of the stickers, our count is much more accurate and takes only four hours. We do our physical counts only semi-annually and have better peace of mind that our inventory is much more accurate.

Ronda Chambers, RN
Nurse Manager
Physician Surgery Center, LLC
Rolla, Mo.
writeMail("[email protected]")

RMV->)Monitor at a Glance
In quality assurance and compliance fields, a dashboard is an easy-to-read report of key safety or performance indicators that lets you see how you're doing overall in a glance. At my hospital, I decided to draw our dashboard in the format of a car's dashboard. It was a clever way of making the chart more interesting to look at.

For the windshield, I included pictures of the staff; for the rear-view mirror, a copy of a photo from our hospital in 1901; for the steering wheel, the names of the departments conducting the audits (our steering committee) and for the dashboard itself, gauges that monitor areas we want to improve, such as the use of protective eyewear, sharps safety, hand hygiene and surgical site verification. The dashboard makes the information simpler to understand, generates interest among the departments and, most importantly, has helped us make huge strides in quality improvement.

Elizabeth Norton, BSN, RN
Staff Nurse
Children's Hospital of Boston
Boston, Mass.
writeMail("[email protected]")

Reschedule on the Spot
When a procedure is canceled, don't leave it to the patient to reschedule. Have your scheduler contact the doctor's scheduler while the patient is still at your facility. It takes a couple minutes, takes the burden off patients and eliminates you and the doctor's office playing phone tag.

Tracy Scota, RN
Director of Nursing
Delaware Valley Orthopedic
and Spine Surgicenter
Bala Cynwyd, Pa.
writeMail("[email protected]")

Staff Training Tips You Can Use

Shut Down for a One-day In-service
There's no two ways about it: You have to train, update and test your staff. It takes up valuable time. But it can be done in a way that's efficient and even fun.

For our annual skills day, we close our surgery center for an entire day, always a Tuesday (a slow day for us) in October. Everyone's required to attend, whether full-time, part-time or per diem, so we can get everyone on the same page at the same time. We review the center's financial status, new state and federal regulations, routine procedures and emergency drills, and employee health testing. We have a scavenger hunt to teach the staff where everything is, and we barbecue that day. Everyone gets to know each other, and we seem to have a pretty good time. Our surveyors are shocked that our board of directors is willing to forfeit a day's revenue for training, but the board sees the benefit of the training.

Phyllis Steer, MD
Medical Director
Heart of America Surgery Center
Kansas City, Kans.
writeMail("[email protected]")

Put Your Unused, Outdated Supplies to Work
Every surgery center has to stock certain emergency supplies that, with any luck, never get used and have to be thrown away once they've expired. Some distributors offer a return credit for unused, outdated supplies. But the education those items can give your staff is worth more than you'd ever get as a return credit. I use them during our yearly in-service when we renew our competencies and practice emergency drills. Staff mix dantrolene (until you do it, you don't realize how much effort it takes), pop open emergency drug vials and syringe containers (they're just not things you use for everyday clinical use) and place defibrillator pads on our CPR mannequins (unless you've used defibrillators, you don't know what they look and feel like). I keep our outdated supplies locked in my office until the in-service, then discard them afterward.

Marlene Brunswick, RN, CNOR
Director of Nursing
Findlay Surgery Center
Findlay, Ohio
writeMail("[email protected]")