As in most surgical facilities, avoiding wasted OR time is one of our goals. To target this problem, we developed a comprehensive plan that includes this "interactive" tool: We draw a barometer on a dry-erase board to show daily OR start times and the percentage of on-time starts for the day. The charge nurse updates the barometer throughout the day and records this information at the surgical control desk. Our staff has become more engaged in the importance of being on time because they can see the progress toward the goal, and, thanks in part to this visual aid, we have improved our on-time starts by more than 70 percent.

Michael D. Williams, MBA
Administrator
Charleston Area Medical Center, General Hospital
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Use self-adhesive wrap instead of tape
In the pre-op area, we use a self-adherent elastic wrap (in our case, Coban) to secure the IV tube to the patient's arm instead of taping it. When the patient is ready for discharge, we remove the Coban - which contains a cohesive material that makes it stick to itself but not to other materials or skin - and reuse it to secure a 2x2 over the IV puncture site when discontinuing the IV. It costs only 7 cents more per patient to use Coban instead of tape, and patients find it much more comfortable than tape on arm hairs and skin.

Abbe DeSousa, RN
Nurse Manager
UOC Surgery Center
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Plastic basin instead of prep tray
Instead of using the regular prep tray on a small surgical area such as an excised lesion, we use a small plastic sterile basin and 4x4s as our prep tray. It's cheaper and works equally well.

Pam Moss, RN, MICN, ACLS, PALS, BTLS
OR/OP Clinical Supervisor
Allegheny Memorial Hospital
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Other uses for gowns, drapes
We give opened, unused gowns and drape sheets to patients to cover their car seats on their ride home or for our plastic surgery cases that have the potential for draining, especially liposuction procedures. We also keep the opened, unused mayo covers to cover equipment in the event of a hurricane threat.

Sharon Pugh, RN
Administrator
Summerlin Bend Surgery Center
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Easy eye-drop prep
Here's how we save time on administering eye drops to our cataract patients: Our physicians order three sets or drops, so we combine administering drops with admitting the patient; it's a simple three-step system. We have the patient sign the permit and verify allergies and do the first set of drops right away. The patient changes, then we do a second set of drops. After that, we admit the patient, do a third set and the patient is ready for his procedure.

Laurie Wensink, BSN
Director PACU, Day Surgery, GI Lab, Pre-op
Testing & Holding
Columbia-St. Marys Ozaukee Campus
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RMV->)Mark the nerve-block insertion site as well
One of our RN circulators pointed out that we need to not only initial and mark the surgical site for shoulder, knee, hand and foot procedures, but that we should also mark the nerve-block insertion site as an extra check in our effort to avoid wrong-site surgery. This is the plan we developed: Our RNs mark and initial the nerve-block insertion site based on laterality. Now we also require that, when the anesthesia staff do a block, they uncover the marked shoulder and verify the side, so they block the correct limb. All our RNs love the idea, and it doesn't take much time to add this extra mark. We wrote the new marking procedure into clinical policy and we follow the guidelines for correct surgical site identification per AORN Standards.

Holly Adams, RN, CNOR
Clinical Director
Yellowstone Surgery Center
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