0ur ORs have been striving to reduce overhead. The days of cost-cutting are here to stay, but it's sometimes a bitter pill to swallow.

• Recycling instruments. Months ago, when our OR went on a recycling spree, we used reusable arthroscopic shavers and burrs. The idea certainly had some merit: Why should an expensive shaver blade be tossed after only 5 minutes of usage? Several problems ensued. Some shaver blades sounded as if they were on life support and removed tissue at glacial speed. Some of the burrs were duller than a visit from the in-laws. Not to mention, rumors began to circulate that trace amounts of a previous patient's DNA could be detected in the recesses of the shaver tips. Great, we saved a few bucks on the shoulder scope, but the patient contracted mad cow disease!
• Standard shoulder anchor. Our administration has long urged our shoulder surgeons to use the same implant system. This is truly a tall order to fill. One commonly used anchor set has more parts than my hard drive. A rotator cuff anchor used by a colleague is straightforward and simple, but it has the pullout strength of sugarless bubble gum. Plus, since the material science of implants has exploded, the minute I may decide on one anchor, another stronger, more user-friendly and, yes, more effective anchor manifests.
• Reusable gowns. Some time ago, we trialed recyclable OR gowns; yes, gowns that could be washed and used repeatedly. Truly a throwback to my days of residency. Now I have no issues with reusable garments, be they cloth or synthetic. However, the gowns that we trialed were better suited for Nanook of the North. They had to have an insulation rating of at least 90! With these gowns, 5 minutes into the case I was drenched in perspiration. "Ice pack to my neck STAT!" was a common refrain. During one particularly long and difficult surgery, I developed heat stroke. Three liters of Lactated Ringer's later the cramps subsided. The ice packs to the groin were no fun either. Our administration was faced with the decision — either recycle the gowns or the surgeons. I guess we won.

Grocery shopping
As long as nurses and physicians have a say in matters, patient care will not be compromised. To quote famous football coach Bill Parcells: "If they want you to cook the dinner, at least they ought to let you shop for some of the groceries."

TICK, TICK ... BOOM! Surgeons must wait until the bomb goes off to begin the case.

DROP THE BOMB
A Fun Way to Mark the Prep Dry Time

To safeguard our 3-minute dry time on surgical preps, we call up a website (online-stopwatch.com/bomb-countdown) on our monitor that counts down from 3 minutes until a "bomb" explodes on the screen. This way, everyone knows the required dry time has been met. It's a fun and effective way to mark the dry time.

Mary Haugen, MA, RN
TRIA Orthopaedic Center
Bloomington, Minn.
[email protected]