To comply with the Health Insurance Portability and Accountability Act (HIPAA), we went out and a bought a paper shredder and paid a couple of teenagers $8 an hour to feed our medical records into the shredder - one page at a time. I cringed every time I passed this entirely inefficient operation. We've since hired a paper-shredding company to come to our facility once a month and empty the locked mailbox-sized containers spread around our offices into an automated shredder built onto to a truck. The documents are shredded right in our parking lot, and we're left with a receipt to show our accreditation surveyor. In addition to insurance verification forms, EOBs, ID bracelets and anything else with a patient's name on it, we also shred sensitive financial data. Monthly cost: $60.

Mary Ann Gellenbeck, RN, CNOR, CASC
Chief Operating Officer
Premiere Healthcare Partners
Cincinnati, Ohio
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New pair of gloves every hour
Change gloves hourly to prevent prolonged exposure to latex proteins. After you remove your gloves, wash your hands with a mild soap and thoroughly dry them before donning another pair. Damp hands are more likely to chafe, making you more susceptible to contact dermatitis.

Anna Gilmore-Hall, MS, RN
Director of Nurse Advocacy Program
American Nurses Association
Washington, D.C.
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Do-it-yourself lidocaine pouches
Lidocaine jelly jets can be expensive - about $12.50 per 30ml - to purchase, so we started making our own by using 2% viscous lidocaine and drawing it up using sterile technique. Here's how we do it:

• We place self-seal pouches in the autoclave.
• While the cycle is running, we draw up 5cc or 10cc of the 2% viscous lidocaine.
• When the autoclave cycle is done, we remove the pouches with sterile gloves.
• We then place the lidocaine in the sterile, self-sealing pouches, seal them and store them.

This technique may be time-consuming, but when you consider that you can buy a 100mL bottle of viscous lidocaine for about $3, the savings may far outweigh the inconvenience.

Melissa Kozee, CMA
Surgery Center Coordinator
South Dayton Urological Associates
Kettering, Ohio
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Basins should be rectangular, not round
Replace round basins in the OR with rectangular basins - especially for laparoscopic surgeries. For one, you can package drapes and supplies in rectangular basins. You can also completely immerse laparoscopic instruments in a liquid chemical germicide at the end of a procedure. This is impossible with a round basin, and instruments must be placed in a transfer pan for transport to the instrument reprocessing room. With a rectangular basin, the disinfection process begins immediately.

JoAnn V. Forno, RNFA, BS, MPM, CNOR
Nurse Manager, Surgical Services
Garrett County Memorial Hospital
Oakland, Md.
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An organizational chart with no names
Your facility probably uses an organizational chart to specify functional relationships and their structure. Here's a tip to keep in mind when designing your chart: List position titles rather than individual names in the boxes. With the turnover of staff, which sometimes happens quickly, you won't have to continuously update your chart to make it current and relevant to your organization.

Barbara Ann Harmer, RN, BSN, MHA
Senior consultant
Healthcare Consultants, Inc.
Celebration, Fla.
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Sharing staff members
We've negotiated an agreement with our hospital partner to share some of our staff. We have about 10 nurses who work at either our surgery center or the hospital, which is just a few miles away. Most of they time their schedule is set ahead of time, but they're also available if someone calls out sick or even to cover lunches.

Terry Elquist, RN
Administrator
Rocky Mountain Surgery Center
Pocatello, Idaho
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