Our pre-op nurses used to dread administering eyedrops to cataract patients. You know the drill: Dose patients with three separate eyedrops, four times each, which could take 20 minutes.

That was before one of our anesthesiologists brought "the wick protocol" to our attention. Instead of administering several rounds of eyedrops, we mix 1cc of each eyedrop solution (Cyclogyl 1%, Neo Synephrine 10% and Ocufen 0.03%) in a specimen cup, cut instrument wipes into 0.5cm-by-1.5cm strips (the wicks) and soak them in the mixture. When a cataract patient arrives in our pre-op holding area, we give him some numbing drops and place the wick in his lower eyelid for 10 minutes. To avoid corneal abrasion, we'll tape his eye shut and take care not to interrupt him so he can keep his eye still. After 10 minutes, we take the wick out, follow up with some antibiotic drops and he's ready to go.

We prepare the mixture and wicks on Monday for all the cases we'll have on Tuesday through Thursday, our cataract days, and refrigerate them. Then we're ready for the whole week. It used to take us two nurses to admit two cataract patients. Now one nurse can admit the whole day's patients.

Vicky Kranz, RN, BSN
Admissions/Recovery Charge Nurse
Mallard Pointe Surgical Center
Watertown, S.D.
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Change a Room's Purpose on the Fly
We've learned to adapt our two-OR surgical hospital to the demands of the day by thinking of titles like "admission," "recovery" and "discharge" more as levels of care than as locations. As long as a room is properly equipped for the purpose, it doesn't matter what it's called or where it's located. We've had great success in occasionally and temporarily changing the purpose of our rooms and rerouting our routine patient flow accordingly. For instance, on a busy eye day we'll see as many as 10 or 12 patients by early afternoon, keeping our recovery slots full. We'll move a few recovery beds into discharge, and our nurses can move some of the furniture in admission - now that all the patients are through it - and put out a snack tray to turn it into a makeshift discharge area. On days when we see a lot of pediatric cases, we try to keep admission and discharge separate, so the patients coming out won't upset the ones coming in. Then we can do private discharges in the recovery area. Sometimes it makes sense to change your patient flow. You just need to consider the possibilities in your facility.

Michael DeLano, CST/CFA
Director of Patient Services
Spearfish Surgery Center
Spearfish, S.D.
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Voluntary Day Off
For a number of years, we've had a volunteer day off. We have 45 nurses on staff - a high percentage of whom are part-time - and six ORs. We're scheduled a week in advance, so we can tell which days our caseload is going to be light and we're not going to need a full complement of nurses. So if, for example, we see that we'll only have three ORs in use on a certain day, on the day before we'll go down the list of nursing staff members and find out whose turn it is to take a day off. If they choose to take the day off, they can take a paid vacation day; otherwise, they can take the day off without pay. It's pretty well liked. The nursing staff enjoys having the extra time off, even if it's without pay, and it saves on staffing costs, since you don't have half your nurses sitting idle when you're not busy.

Doug Yunker, MD
Medical Director
Upper Arlington Surgery Center
Columbus, Ohio
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Better Than a Packet of Saltines
When patients come out of surgery and into the recovery room, our nurses take their vital signs and offer them cinnamon raisin toast. It's not nauseating, and even patients who don't want any are comforted by the scent. It smells like grandma's kitchen. We've been making toast for our post-op patients since we opened nearly four years ago. That was one of the things our medical director insisted on; he'd had it elsewhere. We bought a heavy duty commercial-grade toaster, our staff assistant orders the bread from our university's food services department at market cost, and a nursing assistant stocks the recovery room's "nourishment center" with a few loaves every day.

Mary Catalano, BS
Administrator of Perioperative Services
Stony Brook University Hospital ASC
Stony Brook, N.Y.
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Come-as-you-are Surgery
We let our cataract and pediatric ENT patients wear their street clothes during their procedures. If we need access to their arm for an IV or their chest for an EKG, we can roll up a sleeve or unbutton a shirt. The procedures are so short and simple that it might take longer to change clothes than to perform the procedures. There are comfort factors, too. For elderly patients with mobility or flexibility issues, changing clothes can be difficult; for children, surgery is scary enough that taking away their clothes just adds to the bad feelings. Some may question this policy on infection control grounds, but there's really little risk. The thing you're worried about is germs on patients, and their own clothes have their own germs that are already on their bodies.

Phyllis Steer, MD
Medical Director
Heart of America Surgery Center
Kansas City, Kans.
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