The Daily Adventures of Managing Surgery

Tag: ASC

My top 10 infection control survey blunders…they may be yours too!

My top 10 infection control survey blunders…they may be yours too!

I have the privilege of assisting surgical facilities prepare for surveys.  I have seen countless wonderful, clean, well prepared centers where I would feel confident in having surgery or taking a loved one for surgery. Even in the most pristine facilities, there is sometimes an […]

Sometimes we can be a little tone deaf…

Sometimes we can be a little tone deaf…

  Do you know how some days just take on a vibe of their own? Like the days when everyone is working together as a team, smiles are all around, the cases are all going great and the patients all happy and kind?  Or those […]

Six things I would love to tell my patients…..

Six things I would love to tell my patients…..

Interacting with patients and their families can be very rewarding. Most are kind, grateful for the care we provide, and responsive to our instructions. Effectively communicating with patients can sometimes be challenging, and patients may say and do things that add to these challenges.

Here are six things I’d like to say to patients, as well as some steps that may help avoid saying them.

We love a good sense of humor, and also love sharing banter with you as we prepare you for surgery.  However, please do not tease about the stuff that matters:  what we are doing for you today, when you last ate  or drank, or other critical questions that require serious answers.

Sometimes, a simple…”these next three questions I require your attention as part of our safety process” may get the message across. 

Please tell your caregiver to dress warmly and bring an activity to pass the time.   For them, much of the time in our center will be both boring and cold, and we can’t fix that.  We hate it when they look cold and miserable, and our bath blankets are in limited supply.

Include caregiver expectations as part of the pre-op teaching process.  Something like “It tends to be cold and boring for caregivers here, so instruct them to dress warmly and bring something to do” . 

I wish we were not running late.  It is something we hate, and do everything to prevent it.  Once we are behind, however, we cannot fix it.  You would not want us to rush anything for your care, and we won’t do it for others either.

On late running days, I try to keep everyone updated, both in pre-op and in the lobby.  Proactive communication prevents some of the frustration.  Sometimes, a reminder to the the patient that they wouldn’t want us to rush their care helps.

NPO means NPO.  Please follow our fasting  guidelines.  It is not just an inconvenience for you, it may impact your safety.  A little food prior to surgery is not worth a hospital transfer and pneumonia or worse.

When providing NPO instructions prior to surgery, including that the reason is for their safety, which may mprove compliance.

We don’t judge you if you smoke. However, it will slow your healing and impact your post operative course.  Also, please don’t smoke as much as possible prior to arrival, as the smell stays with you and impacts others.  Same with perfume and cologne.  Even our “nurses noses” are impacted when overdone.

Including the no smoking or fragrances as part of the pre-op teaching.

Please don’t give us your driver’s license weight.  I know mine lists my goal weight.  We won’t tell anyone, and if we were good at guessing, we’d have joined the carnival.  We use your weight to make decisions about medication dosages and equipment safety.

Include weight measurement as part of the pre-operative process prior to surgery.

Do you have honest advice you would love to share with patients?  I would love to hear them!  Please share in comments, or send me an e mail at leslie@ascrubslife.com.  Thanks!

 

 

 

Three of my top surgical hacks and “Ideas that Work”…

Three of my top surgical hacks and “Ideas that Work”…

I don’t know about you, but I am always looking for ways to make things simpler, especially with all the challenges of managing surgery.  Life is rough enough.  Our brains are already saturated with to do lists, passcodes and deadlines.  With my dark nursing humor […]

Patient Satisfaction…tips to keeping patients happy

Patient Satisfaction…tips to keeping patients happy

We’ve all been there. We work hard to do everything right for our patients to ensure their safety, provide care in an efficient and timely manner and leave them with a positive impression. When we get their satisfaction survey back, we learn that they felt […]

A recipe for credentialing success..

A recipe for credentialing success..

Maintaining credentialing files can be a job in itself.  I think it’s the way you approach it.  Not unlike a challenging project or recipe, with good preparation, organization, and a little creativity, your credentialing files can be organized, up-to-date, and survey ready.  Whether you are the one doing credentialing, or supervising those who do, here is my “recipe” for getting it done.

1.  Review your “recipe”.  Typically, your facility’s by-laws will outline your credentialing requirements, including re-appointment times and malpractice limits.  Utilize this information, along with regulatory requirements determine what documents you will need.

2.  Create a “shopping list” for your “supplies”.  List any documents your files need.  Indicate which need renewal, and check when complete.  Indicate renewal dates, and keep updated for quick review.  AAAHC now requires a new application with every re-appointment.  Include a permission slip/waiver for applicant signature so you can run all your checks.

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3.  Gather the right tools for the job.  Maintain a template as to how your files will be set up, and use as a resource for new files.   I like segregating documents by appointment/re-appointment, privileges, licensure and verification, training and education, and health.  For the health file, I place in a removable folder for confidentiality.

4. Go shopping.  Prepare a request document and provide to your applicants that indicates everything they will need to provide.  E-mail the document with attachments of facility documents they will need to complete, including confidentiality agreement, a Hepatitis B requisition/declination form, and any policies or documents they may need to review.  Request attestation signatures as needed.

5.  Put it all together.  Once received, check it off the list and file.  Remind the applicant of anything missing.

6.  Check all your ingredients.  Primary source verification has four ingredients on my list:  A state license check, AMA, NPDB, and OIG.  Run all the checks and print verifications.  If you need web addresses, check out my “awesome resources” links.

7.  Add the topping.  Don’t forget to add the health file, training, and peer review. Get a health statement, current TB, Hep B form, current flu vaccination, provide flu vaccine and TB check if needed.  AAAHC requires safety and infection control training specific to your facility for everyone. They can read your policy and attest completion.

8.  Serve Complete.  Now that your recipe is complete, bring it to the Governing Board for approval, and get a sign off.  Make sure to include that peer review activities were part of the decision process.  Note the outcome in your minutes, and notify your applicant of the result.

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9.  Keep your recipe updated. Utilize your Outlook calendar or other tools or apps to remind you when documents need renewal.  I have started using the EasilyDo app as a reminder tool, and find it helpful.  As far as your delineation of privileges list is concerned, make sure you update it with any new requested procedures and get GB approval as that happens. Don’t forget to include non-procedure privileges, like moderate sedation and radiology.

10.  Try to keep it simple. Purge the unnecessary, and archive the old.  The best recipes work when the process is simple, organized, and practiced.

I plan on making peach cobbler for a Sunday cookout from my grandmother’s recipe.  I hope I follow my own advice.

Hospital transfers and the new Medicare rules…

Hospital transfers and the new Medicare rules…

When we have to facilitate a hospital transfer, we have to shift into high gear.  Not only do we have to ensure a safe and smooth patient transition, we have to re-route other facility operations as we shift focus, all while being concerned for our […]

They say you can’t go home again…

They say you can’t go home again…

  I am writing my blog this week as I sit in an old friend’s breakfast restaurant drinking coffee in the town where I grew up.  I came here for a long weekend to visit some great friends. It has been nostalgic driving down the streets where I […]

The day I met Jeff Foxworthy by my surgery center

The day I met Jeff Foxworthy by my surgery center

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A couple of years ago, I was getting ready for a busy day at my surgery center.  I got up showered, dressed, ran out the door got to work, and got in my scrubs.  It was one of those early mornings that taking the extra early minute was given to that cup of coffee, and not a lot of personal prep.

As a working manager, dressing up as you know is not always part of the job, but it wasn’t even on the list on this particular day.  Not even mascara.  Hair dried by the windows down method.  You get the idea.  I hit the ground running, and, when I got a minute to catch my breath, I ducked out to the building cafe to grab a bagel.

As I waited my turn…I noticed the guy in front of me.  He looked familiar.  Then it hit me.  So, in my my finest moment (not), I came up with the best thing to say I could think of…

“You look just like Jeff Foxworthy!  Yup! Genius, right?

So he responds…”well hell, I’d rather look just like Brad Pitt!” (more…)

Who is Anita Dorr and why should you thank her?

Who is Anita Dorr and why should you thank her?

  This is a picture of Anita Dorr.I recently learned that it turns out that Anita started out as an OR nurse, became a nursing supervisor, then joined the Army Nurse Corps to care for the injured during World War II.  When she returned from […]