Give Your Staff a Summer Break
Everybody gets a holiday when you close your facility for a week.
Summer vacations are meant to be enjoyable, but for a nurse manager trying to coordinate schedules, they're anything but a day at the beach. Surgeons vacation frequently throughout the summer, and for some reason their plans never seem to coordinate with when the nursing staff want their time off. To combat this, three years ago we started closing down our facility for the entire Fourth of July week. Not only does it lower our overhead (since that's typically a light volume week anyway), but it also lets surgeons and staff plan their vacations in advance, during a week when they know the facility will be closed. Our staff love the convenience and peace of mind of knowing their vacations will be approved and won't disrupt the facility's operations.

For an added bonus, pay your full-time staff for some (or all) of these vacation days — it's like a summer bonus, and it goes a long way toward boosting staff morale.

Greg DeConciliis, PA-C, CASC
Physician Assistant and Administrator
Boston Out-Patient Surgical Suites
Waltham, Mass.
[email protected]

To Save on Transcription, Pay By the Minute, Not the Line
Until we convert to an EMR system (see "The Day After You Go Paperless" on page 48), all 45 of our surgeons rely on transcription for the dictation of their operative notes, and some for their H&Ps. We saved about $10,000 last year when we contracted with a new transcription service that charges us by the minute, not by the line, of dictation. Because we use templates for such routine ENT procedures as tubes, adenoids and tonsils, we're only being charged for the time it takes to transcribe the variable information. The new service also faxes the reports over secure fax lines to the physicians' offices at no extra charge, a task that our staff performed previously.

Here's how the system works. Physicians dial in and dictate from the facility or from their offices. For procedures with templates set up, the physicians just indicate the template type and dictate the variable information. The service sends the operative reports via secure e-mail. Reports from morning cases are sent to us within a few hours and those from afternoon cases either arrive in the late afternoon or early the next morning, depending on the time of the case.

The service faxes the operative reports to the physicians' offices usually on the same day the procedure is performed or before their offices open the next morning.

Donna H. Smith, MT (ASCP)
Administrator
The Surgery Center of Oxford (Ala.)
[email protected]

Turning Blue Sterilization Wrappers Green
When we opened our surgical center, we faced a common waste issue: What should we do with our used sterilization wrapping since we didn't have a burning permit? Initially we processed it with the rest of our trash, which cost money because we pay per pound for our trash removal. It also left our staff feeling bad about increasing the amount of waste in landfills.

When I helped my daughter and son-in-law pack for an upcoming move, I decided to use some of the blue sterilization material to wrap their things with before putting them in the moving boxes. My son-in-law's stepfather, who runs a home restoration business, was also helping. He was fascinated at how effective the wrap was as a packing material. He was also surprised to learn we just throw this away, and that's when we came up with a mutually helpful idea.

We now save our used wrap in a special bin and give it to him free of charge. He makes a weekly pickup and uses it to pack his customers' possessions because the material is so durable and can be reused numerous times before it gets too dirty or worn out. When the wrap's useful life is finished, he can burn it so it breaks down into carbon dioxide, which means it doesn't go into a landfill.

This arrangement is a win-win. We save a little on our trash disposal costs and our staff gets the satisfaction of knowing we're doing something to help the environment by reducing landfill waste. He saves money by getting free packing supplies and passes the cost savings along to his customers.

Diana Krause, RN, BSN
Administrator
Renaissance Surgery Center
Oshkosh, Wis.
[email protected]

How Fragile is an Endoscope? See for Yourself
Your staff knows why it's important to clean endoscopes, but they may not appreciate how fragile these devices are. As a result, they can be rather rough on them during reprocessing despite repeated training efforts — a scary thought when you consider what it costs to repair or replace equipment.

To show our staff why they should handle endoscopes with care, I ask our vendors to bring in one of their scopes that's already broken to pieces. This lets my staff see and feel all the instruments' small parts, including the canals and lenses. After that, they appreciate the need to handle scopes with care.

It's no trouble for the vendors to do this, because they often have damaged or destroyed endoscopes on hand. And it's invaluable for education purposes because it reinforces the lessons with a tactile and visual element.

Tracy Humphreys, BS, CRST, CSPDT
Central Sterile Manager
Metro Health Hospital
Grand Rapids, Mich.
[email protected]

They Imagineered an Air Bladder Axillary Roll
At Barnes Jewish Hospital in St. Louis, Mo., the orthopedic team noticed that the gel axillary rolls that they used for positioning were causing enough discomfort to arouse patients in the lateral position from IV sedation. Patients also complained of post-op axillary pain.

So last fall nurses Butch Blake, RN, and Thomas Connor, RN, started looking for an alternative to the gel roll. Working with a local manufacturer, Mr. Blake attached a pressure gauge and an air ball from a blood pressure cuff to an 8.5-inch-by-15-inch inflatable thyroid pillow. The air-bladder device appears to reduce patients' pain.

"The pillow supports the patient's weight evenly, preventing the possibility of axillary nerve damage," says Mr. Blake. It creates patient-specific pressurized axillary rolls that don't exceed the AORN-recommended guidelines of 32mmHg. It also lifts the patient's axillary region one-half inch to two inches off the table.

Mr. Blake and Mr. Connor experimented with patient positioning techniques on staff members before using them on actual patients. They then tested the bladder roll against the gel axillary roll and one-liter IV bags, which are often used as axillary rolls. They evaluated 16 patients in the lateral decubitus position and found no complaints of pain. The local manufacturer of the thyroid pillow loaned the hospital a computerized pressure mapping system designed to evaluate pressure against a person's skin. This let them evaluate precise pressure points exerted against the staff members before trying it out on patients.

Mr. Blake and Mr. Connor derived the patient settings by assessing how much air was needed according to the staff model, while conforming to the AORN standards and maintaining patient comfort. Each patient's BMI and body surface area was used to approximate the amount of pressure needed to support the patient during surgery.

The evaluation revealed that:

• using the air bladder as an axillary roll, patients are able to remain sedated without additional medications; and
• any wrinkle in the fabric used to cover the device greatly increases the pressure exerted against the skin.

— Kent Steinriede

Appoint a Patient Safety Advocate
We were so busy with the smooth operations of our 16-OR surgery department that it was hard to make patient safety a priority. So we created assistant nurse manager positions, whose job is to focus solely on OR quality and safety. For example, they make sure that timeouts and surgical site markings are done according to policy. They watch for pressure ulcers, latex allergies and retained objects. It's a luxury that's working out very well for us.

Don Millbauer
Director of Peri-Operative Services
Harborview Medical Center
Seattle, Wash.
[email protected]