Right when gossip was starting to undermine our surgical department, one of our nurses brought in a box of purple bracelets that read "A Complaint Free World.org." The premise of the bracelets is simple: If you catch yourself complaining, move the bracelet to your other wrist. If you hear someone else who is wearing a bracelet complain, you may point out her need to switch the bracelet to the other arm; but if you're going to do this, you must move your bracelet first.

It only took a few days for our staff to get the point and leave the grumbling behind. Then it became more of a fun activity. A nurse would complain and then say, "there I go again" as she moved her bracelet to the other wrist. If she was being gossiped to, she'd half-jokingly say, "You should switch your bracelet for that." After a few days, most of us could make it through the day without switching our bracelets, as we began to use our internal filters and became more aware of how often we gossiped or complained. It was eye-opening and helped us address a difficult issue in a playful manner. More than 6 million people in more than 80 countries have taken the Complaint Free challenge at www.acomplaintfreeworld.org.

Karen Gordon, RN
Director of Pre-op/PACU/PAT
Baylor Medical Center at Trophy Club
Trophy Club, Texas
[email protected]

Keep Loved Ones in the Loop
Waiting for a friend or family member in surgery can be an anxious experience. It's normal for loved ones to ask nurses for the status of a procedure or when the patient will leave the recovery area. When you handle several dozen patients per day, questions about patient status can eat up a lot of time. We've solved that problem with a patient tracking system that displays patients' whereabouts on computer screens in the waiting area. This keeps family members informed and out of the way.

To protect confidentiality, we give each patient a code number on admission. Waiting family members get the number and a brochure explaining how the patient tracking system works. The screens list the patient's code number, the last name of the physician and the patient's location. As the patient proceeds from pre-op to recovery, the background color changes. Some facilities also make the information available on a Web site.

Family members aren't the only ones who pay attention to the tracking system. Administrators use it to gather benchmarking stats. We also use it to keep track of doctors. And housekeeping uses it to learn when rooms are free for turnover.

MaryAnn Earl, RN, BSN, CNOR
Director of Perioperative Services
Harbor Hospital
Baltimore, Md.
[email protected]

3 Keys to Managing Intra-articular Infusions
We routinely place intra-articular and subacromial catheters after shoulder surgery. While there is controversy about how well they work, we find them to be effective when used as part of a multimodal pain control regimen. Here are three keys to our success:

• Coil the catheter. We secure catheters in place with adhesive tape and dressing, but we also coil them under the bandage. This gives the catheter some "give" so it won't pull out of the skin if tugged on inadvertently. This helps prevent catheter loosening and dislodgement.
• Consider catheter breakage. We've recorded three cases of catheter breakage, in which the remnant of the catheter tip remained in the joint and required arthroscopic removal. While we're unsure if clinical factors increased this risk, all three cases were intra-articular infusions. I no longer place catheters into the joint if I plan to begin rehabilitation immediately, as motion may contribute to catheter breakage, but I place catheters in the subacromial space regardless of the rehab plan.
• Offer patient education. As with any infusion, patient education is key. Place relevant product literature such as the insert that comes with the catheter, the patient's prescriptions, arthroscopy photos, signs and symptoms of complications, catheter site care instructions, and an anatomic drawing of the shoulder into a take-home folder. There's a danger of overwhelming patients with too much information, so we focus on the most critical points during face-to-face meetings. For all patients, a key take-home message is to be sure they know when to remove the catheters, as complications can arise if catheters remain in place too long. Stress this with all patients, and call all patients after surgery to ensure that catheters are removed on time.

There are many ways to keep your patients safe and comfortable, including careful catheter placement, consideration of clinical factors like the potential for breakage and a comprehensive patient education program.

Warren R. Dunn, MD, MPH
Department of Sports Medicine
Vanderbilt University Medical Center
Nashville, Tenn.
[email protected]

A Homemade Test Pack for Your Autoclave
The Association for the Advancement of Medical Instrumentation (ST79:2006 10.5.4) requires you to include a class integrator in each autoclave load as part of general monitoring of the sterilizer, load configuration and packaging. The process challenge device should be placed in the area of the autoclave where steam penetration is most difficult, typically near the autoclave's drain. Manufactured test packs are available, but we make our own.

First, buy Class 5 integrators separate from pre-constructed packs. Place the integrator in an empty instrument container and fill the container with broken or outdated instruments — we have a bin of such tools, you might, too. Fill the container until it weighs about 16 lbs. Place the container near your autoclave's drain. After the autoclave's cycle is run, the integrators in the container will tell you if your simulated instrument pack was sterilized. These homemade devices won't save you a great deal when compared to commercially available models, but they'll help if your facility is really counting its pennies or runs out of brand-name test packs.

Terri Matthews RN, CNOR, CSPDM
Director Patient Care, Central Sterile Processing
Community Medical Center
Toms River, NJ
[email protected]