Place a temperature strip on the forehead of patients of all ages as they enter your pre-operative area, and leave the strip on throughout their stay — even after discharge. The many benefits of this practice include:

• Nursing time conservation. Each temp strip takes the place of obtaining numerous oral or tympanic temperatures while in the facility. This not only saves you from using three or four thermometer probes, but considerable nursing time as well. Imagine not having to spend time looking for a thermometer, placing a probe and waiting for the reading. These strips give you a consistent temperature reading that is immediately available when needed, providing non-invasive, uninterrupted and reliable monitoring wherever the patient is in the surgical process.
• Decreased anxiety. Children tend to be very anxious when they see a nurse holding a thermometer. We've found that most children don't even know the temp strip is there (even if they do find it, they refer to it as just "a sticker"). Many parents inquire upon discharge if the temp strips can be left in place so they can monitor their child's temperature changes at home, after surgery, and are pleased when they find out that they can.
• Effective monitoring. Temp strips work off of body skin temperature, so one of the most important aspects for accuracy is to ensure they're not placed in an area that could be affected by outside factors (such as open top facemasks or patient warming devices blowing air on them). They also offer a way around some of the problems associated with other methods. For example, oral temperature readings can be greatly affected by mouth breathing and oral fluids. Obtaining accurate tympanic readings may be limited by the surgical procedure (such as tubes or tympanoplasty) and the skill of the nurse using the tympanic monitoring device.

The only disadvantage we've seen in using the temp strips is when patients (or parents) question their accuracy. But according to the manufacturer of the temp strips that we use, the strips are more accurate and have a faster response time when compared with numerous other temperature indicators. They have a temperature reading of 92 ?F to 106 ?F and react quickly to temperature changes.

• A cost-effective solution. We spend a little less than $1 per strip, so they're considerably more expensive than probes or covers for oral or tympanic monitoring devices. But when compared with the cost-savings associated with decreased nursing time, batteries needed for mechanical monitors and maintenance and replacement of older monitors, the cost is significantly less overall. Based on our patient volume, hourly nursing salaries and supply costs, we estimated a savings of $18,000 last year.

Donna Reid, MSN, RN
PACU Manager
The Surgery Center of Oxford, Ala.
[email protected]

Doctor, Would You Please Sign My Site?
Here's a simple idea to get your surgeons to mark the surgical site every time. After your pre-operative nurse educates the patient about the importance of surgical site marking, she hands the patient a single-use marking pen and instructs him to give it to the surgeon when he arrives, asking, "Would you sign my site, please?" This involves the patient in the process and, as we all know, patients like to see their surgeon before going into the OR. Above all, it helps ensure that the surgeon will mark the site. Let the patient keep the marker as a souvenir of surgery.

Bruce R. Grendell, RN
Director, Perioperative Services
Palomar Medical Center
Escondido, Calif.
[email protected]

Keeping Tabs on Patient Escorts
It's nice to be able to reach a patient's escort quickly and easily when delays occur or you're ready to discharge the patient and the escort can't be found. Here's what works for us. First, develop a concise contact form such as the one we've shown here from our facility. We originally printed the forms on white paper, but switched to using a bright pink tone so they're easy to locate in patients' charts. Affix a patient ID label to the top of the form, and ask the patient to note their preferred day-of-surgery contact, their relation to that person and the contact's home and cell phone numbers. If an escort leaves your facility, ask her to note her expected return time or how long it would take to return after she's called. That way your staff knows when to contact the escort so she's present when the patient is ready for discharge. This communication tool has been a positive addition to our perioperative process. Surgeons and staff like that the forms let them contact the appropriate person quickly with updates on a patient's status. Post-op patient surveys, meanwhile, show increased satisfaction with our communication practices on the day of surgery.

Deb Rhode, RN, CNOR and Judy Van Boening, RN, CNOR
Scottsdale Healthcare
Scottsdale, Ariz.
[email protected] and [email protected]

Leftovers: Give Them to the Dogs
Not everything in a surgery pack ends up being used during a procedure. The leftovers (supplies that weren't contaminated with blood or body fluids) are no longer sterile, so we can't use them. Rather than throw these supplies away, we give them to a local veterinary clinic. This lowers our waste disposal costs and helps the pets in our community. After a procedure or a cancelled case, we set aside unused and leftover drapes, suture, towels, tubing, dressings, cautery pencils and tips, blades and sponges. We keep them in a box on a rack in an equipment storage area. When the box is full, someone from the center delivers the box to the vet. A recent box weighed 18 pounds. This saved us $13 in garbage fees. We usually make two drop-offs per month. That's a savings of about $325 per year, and it keeps more than 430 pounds of waste out of the landfill.

Holly Adams, RN, BSN, CNOR
Director of Nursing
Yellowstone Surgery Center
Billings, Mont.
[email protected]

It's Time to Get Serious About Surgical Smoke Evacuation
You're probably aware of the health hazards of surgical smoke, but, particularly in the case of electrosurgery plume, your surgeons may not always be as up to speed — or as willing to take the necessary precautions. The answer to this problem lies in education. Once doctors understand the negative consequences of surgical smoke and the relatively easy ways to reduce the risks, they're much more willing to take action. Here are a few simple steps you can follow to get your surgeons to use smoke evacuation systems.

First, consult your facility's policy on surgical smoke evacuation and identify whether it's being enforced. Don't have one? Many resources are available, including the AORN Standards and Recommended Practices and the sample policies provided by Nurses Advocating Smoke-Free Theaters Immediately (www.becomenasti.com).

The next hurdle you'll likely face is resistance from your fellow nurses, staff and especially the doctors. You can point out three things to the skeptics:

• It's dangerous. Exposure to surgical smoke is dangerous to patients and perioperative professionals, says AORN in its Position Statement on Surgical Smoke and Bio-aerosols. "Studies have confirmed that plume and bio-aerosols contain odor-causing and odorless toxic gases, vapors, dead and live cellular debris (including blood fragments) and viruses," reads the statement. "These airborne contaminants can pose respiratory, ocular, dermatological and other health-related risks, including mutagenic and carcinogenic potential, to patients and operating room personnel."
• It's easy to reduce the risks. Evacuation equipment is readily available, easy to use and a small but worthwhile investment to protect the most valuable resource in surgery departments — the surgical team.
• It's the law. Under OSHA's general duty clause, hospitals and surgery centers can run into legal trouble if they fail to provide a safe environment for their workers. For example, if OSHA receives an anonymous report that a facility is not using smoke evacuation technology, the agency can conduct a surprise inspection, fine the facility and mandate that evacuation equipment and supplies be used.

Kay Ball, RN, MSA, CNOR, FAAN
Chairwoman of AORN's Smoke Evacuation Task Force
Lewis Center, Ohio
[email protected]

Could Shared Governance Work for You?
When you tell your staff to do something, they'll do it because they're under orders. But if they've developed the rules themselves, they'll be more inclined to follow them, having had a hand in their creation. That's the idea behind our shared governance model. It's still a work in progress, but already it's contributed to our low staff turnover rate and the feeling that our surgery center is a place where people want to work.

Shared governance is based on the participation of staff in committees. There are four of them: the practice, quality, operational and scheduling committees. All of our employees — nurses, surgical techs, central supply personnel, business staff and coders — choose which committees they'd like to belong to, as long as it's not all OR nurses in one committee, for instance, and all PACU nurses in another. We want representatives of each department to share their expertise with personnel from other departments.

Each committee elects a chair and co-chair, who sit on a steering committee that also includes the center's leadership: the administrative director, director of nursing, medical director and OR team leader. If a new policy is needed in the area of surgical practice, quality of care, center operations or staff scheduling, the relevant committee is commissioned to research the issue and draw up the rules.

Shared governance doesn't mean that the committees make all of our center's policies; the administrators are still in charge and we're still accountable to regulations. But the end result is that our staff is encouraged to work as a team. Plus, by treating our employees like the professionals they are, we all enjoy a more collegial environment.

Pamela Ertel, RN, BSN, CNOR, RNFA, FABC, CASC
Administrative Director
The Reading Hospital SurgiCenter at Spring Ridge
Wyomissing, Pa.
[email protected]