Our individual patient pre-op/recovery rooms are great for patient privacy, but not so great when it comes to nurse-physician communication. If a nurse isn't in the same room as a physician or anesthesiologist to receive oral instructions from them and if the doctor neglected to make a note on the patient's chart, nurses had no quick way of knowing what the doctor wanted.

For instance, we have one physician who likes to see patients in recovery before they are discharged, but oftentimes a nurse, assuming the doctor had visited, would discharge a patient prematurely. Or our anesthesiologists would put some Versed in a patient's IV, but wouldn't tell the nursing staff, who then needs to monitor the patient.

So we started looking for a solution, and found a color-coded flag system that has prevented the mix-ups. Four plastic, different-colored flags on hinges are mounted outside each pre-op/recovery room door, next to the right side of the doorframe. Each color represents a common instruction:

• Red means a patient has received Versed pre-op.
• Yellow means that a patient has received a reversal agent and must be kept two hours after the reversal was administered.
• Green means NPO post-op.
• White means the doctor needs to see the patient before discharge.

When the plastic flag is flipped open across the doorframe, it is a signal from the physicians to the nurses that the instruction that corresponds to the color needs to be carried out. We've found this to be a simple way to streamline communication, avoiding mix-ups for simple tasks.

Kay Beaudett, RN, BSN, CNOR
Nurse Manager, Limestone Surgery Center
Wilmington, Del.
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Test your ophthalmic knives' glue
If you're trying out metal reusable ophthalmic knives, assign the person who handles your knives to test the glue that secures the blades by running them through the autoclave several times. If you tend to reuse your blades over and over, and the glue doesn't withstand the high autoclave temperatures, it can become soft and either make the blade loose or cause the blade to fall out - neither of which you want to happen before or during a procedure. If you figure out how many cycles the knives can, on average, withstand, document each time knives run through the autoclave and dispose of them after they hit that number, you shouldn't have to delay a procedure to replace a knife with a loose blade.

Gina Stancel, HCRM, CST, COA
Surgical Administrator, Eye Centers of Florida
Fort Myers, Fla.
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