When the Joint Commission highlighted safe medication practices in its 2003 patient safety goals, it included a list of dangerous abbreviations to avoid. During my random reviews of medical records, I realized our nurses were using incorrect notations - even after they were notified of the Joint Commission's safety goal. To help correct the problem, I created a two-sided laminated guide that fits into a hanging transparent badge holder. This minimum list of dangerous abbreviations, acronyms and symbols serves as a handy quick-reference guide. Use Microsoft Word to create a two-columned table that notes the problem abbreviation and the corresponding correct abbreviation. I used Word's table feature and matched the layout to the size of business card laminating pouches: 311/16 inches by 23/16 inches. Here's how it's done:

• Set the table to two columns and 14 rows.
• Label the left column "Abbreviations" and the right "Preferred Term."
• Fill in the boxes with your abbreviations and preferred terms, then divide the rows into two roughly approximate tables with identical headers that read, "A minimum list of dangerous abbreviations, acronyms and symbols."
• Fill the table with problem abbreviations down the left column and corresponding correct abbreviations down the right column.
• Print the sheet using a color printer. I used black print on a yellow background to make the reference card easy to read.
• Fold over the hard copy of the table between rows to create a symmetrical, double-sided reference card.
• Seal the card in a business card laminating pouch. Any business supply store will have them.
• Place the laminated card in a clear, hanging badge holder for easy access.

Jeanne Linda, RHIT, CPMSM, CPHQ
Director, Medical Staff Services/Quality Review
San Leandro Surgery Center
San Leandro, Calif.
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Fine Your Late Surgeons $100
Delays in the surgery schedule can be costly and frustrating for everyone. That's why one of our centers decided to fine the culprits. Because your most expensive resources - nurses and physician resources - are generally paid by the hour, even a 30-minute delay can cost a center hundreds of dollars per day, not to mention delaying other physicians' cases that may ultimately be canceled or rescheduled.

While not for the faint of heart, you might consider this suggestion: If a case starts more than 15 minutes late due to a surgeon's showing up late (traffic, office, whatever), fine the physician $100. You can decide how many "warnings" you allow, but, on distribution day, the tardy docs don't get their check until they pay their fines in cash ($100 bills). The cash goes into a pool and is announced, quite publicly, at the partnership meeting. The pool is then used for incentives and lunches so that employees and other physicians may, of course, take the opportunity to thank that "fine" physician. I expect you'll see your schedule tightening up like those purse strings.

Gregory Cunniff
Chief Financial Officer
National Surgical Care
Chicago, Ill.
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Easing Up On the Pedals
Cataract surgery and other ophthalmic procedures rely on pedal-driven devices - phaco machines, microscopes and other equipment that the surgeon controls with his foot. Sometimes our doctors need to reposition a pedal, quickly, in mid-procedure, which they also do with their foot. But the non-slip backing on the bottoms of some pedal consoles can make this a little difficult. So every morning, as we're preparing the rooms for surgery, we slip a surgical bonnet over the bottoms of the pedals - it's a little trick our surgeons brought over from the hospitals they worked at before they opened our center. The bonnets make the pedals easier for the surgeons to move just a smidgen if they need to, without looking and without calling the circulator over to crawl under the table.

Vanessa Tobias, RN
Clinical Director
Pennsylvania Eye & Ear Surgery Center
Wyomissing, Pa.
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F? to C?...Avoid All Degrees Of Confusion
I really wish medical device manufacturers could get on the same page about Fahrenheit and Celsius. For instance, our autoclave monitors temperature in Fahrenheit, but the readings on the anesthesia monitor are in Celsius. You learn to adjust but, really, it's not just an annoyance to try to convert body temperature readings in your head - it can be downright dangerous.

To keep everything consistent, we have switched all temperature readings and recordings (except the anesthesia monitor) to Fahrenheit, because it's what everyone's most familiar with in their day-to-day lives. Plus, we keep F-to-C conversion charts handy all over the surgery department (to convert Fahrenheit temperatures into Celsius, subtract 32 from the Fahrenheit number, divide the answer by 9 and then multiply that answer by 5). When staff don't have to switch back and forth, you decrease the potential for errors in calculating meds and volumes.

Lynda Simon, RN
St John's Clinic, Director of Clinic Nursing
St John's Clinic: Head & Neck Surgery, OR Manager
Springfield, Mo.
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