Here's how we streamlined our paperwork system. We paid a computer programmer about $600 to write a program for our electronic charting system that pulls information from certain fields on the electronic OR record to instantly create a separate post-op note. The post-op note includes all the JCAHO-required elements: surgeon, assistant surgeon, pre-op diagnosis, post-op diagnosis, procedure/findings and specimens. That way, the RN circulator only enters the information to the surgical record one time. The note prints on a dedicated printer in the dictation room (which has no traffic aside from surgeons and a unit clerk and is thus HIPAA compliant). By surgeon request, we also have fields for estimated blood loss, IV fluids used intraoperatively, drains and progress notes. The surgeons enter this information when reviewing the note, which is then signed and placed with the patient's chart.

Maureen Spangler RN, CNOR
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Eye pack bags do double duty
Why not reuse the outer plastic bags that your custom eye packs come in? They're great as trash bags and in any place you need a smaller plastic bag. Here at the Oregon Eye Surgery Center, we use large clips to attach the bags to the sides of carts and trash cans, then fill them with certain types of refuse, such as recyclable plastic and clean trash from the anesthesia cart.

Ginny Pecora, RN
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Stock tip: Rotate your surgical supplies
To prevent supplies from expiring and going to waste, each time I order supplies, I move the current items in front. For example, when a new shipment of IV fluids arrives, I remove the bags of IV already in the baskets we use to store them in, stock the new ones, then put the "old" ones on top. We do the same with sutures and other time-sensitive items.

Donna Billings, CST
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ID switches, buttons on equipment
Label switches and buttons with colored tape to identify those that need to be turned on for a machine's use. This helps new employees and others who may not use the equipment often enough to remember which button is correct (cross-trained nurses working outside their usual assignments, for example). This is especially helpful on towers that house light sources, cameras and monitors. Marking switches and buttons and posting helpful notes right on the equipment facilitates the circulator's job and expedites procedures - which helps keep surgeons happy.

Linda Vrooman, RN, BSN, CNOR
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Why we prefer one-on-one teaching
For pre-op patient instruction at our hospital, we used to show a group of patients having surgery within the next day or two a video about what to expect from their surgery. Since we changed to one-on-one teachings with patients (in addition to giving them written instructions), we've had much better patient satisfaction. When you talk to patients one-on-one, they pay more attention, ask more questions - which prevents mix-ups the day of surgery - have less anxiety and recover faster.

Luz Robles
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