The Mayo Clinic's recent findings that the use of cellular phones has no noticeable impact on the performance of patient care equipment or other medical devices will inevitably be echoed to you, at some point, by a patient escort who wants to chat on his mobile in the recovery area. And while the findings may be valid, interference with medical equipment in your facility shouldn't be the sole concern nor the primary reason for requiring that cell phones be turned off in patient care areas.

For one thing, many cell phones are now equipped with cameras. Photographing patients without their permission is a privacy violation. For another, patients emerging from anesthesia as well as their escorts likely don't want to have to listen to someone else's conversations. Further, mobiles do pose an interference issue - just of a different variety.

I work in a hospital-based PACU with both inpatients and outpatients in phase I and phase II care and I can tell you, it's difficult to control noise levels and more difficult to maintain privacy. I'm not willing to risk inadvertent photos of other patients while people "capture" their loved ones at less than their best. I also don't want the staff subjected to being photographed without their permission. Patients don't need the extra disruption, and the nurses need to be able to communicate discharge instructions to patients and their caregivers without being interrupted by cell phone usage.

If a patient escort takes his phone out, politely explain that it's your policy that mobiles not be used in patient areas to ensure optimal communication and care. You might also add that staff members aren't permitted to use their cell phones while on duty. If he insists that his phone call is more important than the patient, let him go to the waiting room. The Mayo Clinic's study results mean only that your docs and nurses can use their phones while on break, in the locker room or staff lounge - not that patient escorts can feel free to talk away whenever they'd like.

Susan Russell, RN, JD, CPAN, CAPA
Clinical Manager for PeriAnesthesia Services
Seton Northwest Hospital
Austin, Texas
writeMail("[email protected]")

Shop Online for Office Supplies
Our surgery center is located in a strip mall right next door to a Staples, so you'd think I'd simply walk a few steps to buy my office supplies. But I choose to buy online because I earn a free gift for every $100 that I spend. Whenever the rollerbags, stadium blankets or radios arrive, I raffle them off to our staff, who appreciate the fun rewards. Another benefit of online ordering is that I get free delivery on orders of $50 or more. The delivery person stacks the items in our medical records rooms, saving me the hassle of doing so myself.

Monica Ziegler, MSN
Administrator
Physicians Surgical Center
Lebanon, Pa.
writeMail("[email protected]")

Rotate Team Leaders
We've found that nothing is more empowering and enriching than rotating staff to the team lead position in every department of your facility. Exposure to big picture decisions and operations lets them understand process, efficiencies and rationale for decisions.

It's important to coach each staff member in this role until she establishes a comfort level. This is individualized to meet each staff member's needs and abilities. It's most exciting to watch staff gain confidence each time they take this important leadership role. Surgeons have gained a new respect for staff that they see in leadership positions.

Elizabeth Edel, RN, MN, CNOR, CNS
Director, Ambulatory Surgery Center Operations
MD Anderson Cancer Center
Houston, Texas
writeMail("[email protected]")

Need to Spread the Word? Blog It
If you're not especially tech-savvy, but you'd like to tap the power of the Internet in order to get information out to staff and physicians, here's an easy solution: Get a blog. While blogs, short for Web logs, are traditionally personal journals or compilations of news links, you certainly don't have to use them that way. Further, several Web sites have been developed specifically for do-it-yourself blog hosting; often, they have both free (if you just want the basics) and paid (if you want to be able to play with the layout) options. But even the free blog hosts allow for creativity with the look or design. Staff can easily check the blog from home or share with peers at other institutions by providing the link via e-mail.

I chose to go with Blogger when setting up Brigham and Women's blog because I found it the easiest to get started with, and it's been a boon to communications. I've used it to announce contests and project launches, remind about Joint Commission visits and even post up-to-the minute safety alerts. Of course, given the potentially very public nature of a blog, some more sensitive subjects are still handled within more typical channels, such as our Intranet. All readers can add content; they need only get free accounts from the hosting service you decide to use, then be added as "team members" or "community members" (term names depend on the site).

While we had started with the intention of letting our staff members blow off steam in a non-confrontational manner or present new ideas to the staff at large, we've not had as much posting traffic as I'd hoped. As the point person for the blog, the staff seem more comfortable having me add their content. However, the hits have been incredible: I have embedded some analytic software in the blog to track where the people who view the Web page are coming from, and it's seeing about 30 a day just from inside the hospital, and we've even had hits from as far away as South America!

Eric C. Hahn, RN
Perioperative Informatics Nurse
Brigham and Women's Hospital
Boston, Mass.
writeMail("[email protected]")

Reduce Flash Sterilization in the OR
When I was an administrator, we did a lot of flash sterilization at our facility because our surgeons often seemed to lack commonly used instruments for their procedures. We didn't think much of it until inspectors from the state gave us a citation for flash sterilizing too often. After that, the administration was very supportive in our efforts to cut down on flashing.

We started by going over our records for the past three months and noted how many times we flashed compared to the number of procedures we performed. This gave us a rough percentage of how many operations required instruments that were flashed. Our goal was to reduce this by one-fourth over the next six weeks.

The first step was to take a closer look at the items that were most often flash sterilized. Then we went through our inventory supply room to check the sets of surgical instruments that either weren't being used or were dedicated trays for surgeons who no longer operated in the facility. We took instruments from these and put them into our currently incomplete trays.

Then we looked at scheduling and determined that with some changes we could increase the time available to process instruments. We also took a close look at what we were sterilizing most often and what we didn't have replacements for. It turned out that we were routinely reprocessing some very inexpensive devices, such as mouth guards. We reviewed the costs for our repeatedly sterilized items and calculated what it would cost to purchase the additional items we'd need to complete sets and thereby dramatically reduce the incidence of flash sterilization. Because we had streamlined our needs list, the administration supported the idea.

While tracking instrument flow through our facility, we leaned that some staff were hoarding instruments. They were so afraid of shortages and not getting a quick turnaround from the sterile processing department that they'd keep instruments in a locker so they'd be available as needed. The "us versus them" mentality between the central sterile and the OR was hindering efficiency.

To overcome this, we scheduled meetings between the departments and encouraged all to respectfully "let it all hang out." Afterwards, we discussed the need for cooperation and developed several successful strategies for working together more efficiently and cooperatively. For example, the OR complained that instrument sets were "almost never complete" and that they didn't trust CS to deliver a complete set. We decided to document each incomplete set and document what was missing from the set. The list that was generated confirmed that "almost never complete" wasn't accurate, but this didn't diminish the critical nature of the problem and the need to develop a system that would foster trust. The list also helped us identify and trend what instruments were missing most often, track down the reasons and rectify the situation, either by ordering specific instruments that were in short supply or adding the needed instruments from sets that were dismantled because they were no longer being used. One of the keys to success was the guideline laid down early in the project: This exercise was not in any way to name, blame or shame individuals. This was an exercise to examine a system that was not working and to work together to determine solutions.

The cooperation that developed let us reassure the surgeons that they'd have instruments as needed and to tell administration, with confidence, that the incidence of flash sterilization would be dramatically reduced. This dialogue showed everyone in the facility that there was a need to trust each other.

Thanks to these measures, we surpassed our goal for less flash sterilization after six weeks, and over the following months reduced it even further until it became a very rare practice. In retrospect, we were glad we received that citation from the state because it prompted us to raise our standards of practice and to become more efficient.

Cynthia Spry, RN, MA, MSN, CNOR
International Clinical Sterilization Consultant
Advanced Sterilization Products
writeMail("[email protected]")

The Cure for an Idle OR
Nothing's worse than an idle OR. Our solution: parallel workflow, which is just a fancy term for two people doing two things at once.

We created a team comprised of members from each OR specialty as well as representatives from ancillary services, such as housekeeping and central supply, and even a few consultants to design a new process. This gave everyone a chance to discuss what they do and how others could work with them to make their tasks easier or do their duties simultaneously. Here are the steps we've taken:

• Split the anesthesia personnel's duties so one person will take the patient to the PACU while the other prepares the OR for the next patient.
• Have case carts ready in substerile areas before room cleanup begins.
• Let environmental service personnel begin their duties as dressings are applied to patients.
• Have the circulating nurse scrub open instruments to prepare the room during cleanup.

It took two weeks of monitoring to be sure that everyone was doing her new duties correctly. After this period, our staffers learned their new routines and could do their jobs alongside each other with no disruptions. Now our turnover time is much quicker - we've cut our non-operative time by one-third.

Maureen Harders, MD
Director, Anesthesia for Ambulatory Surgery
MetroHealth Medical Center
Cleveland, Ohio
writeMail("[email protected]")