MH Reference Guide

COVID-19 Screening Tool

References for Diversity in Surgery special issue

Performance Improvement Opportunity Form

National Correct Coding Initiative Policy Manual for Medicare Services

Budget Worksheet
Courtesy of Dan Simonson, CRNA, MHPAD

Operating Room Checklist
Courtesy of Lorne King Rosenfield, MD

Same Day Surgery Handoff Card
Courtesy of Pegi Wasserman, RN, BSN

Wipe Product Selection Guideline
Courtesy of Heather Hohenberger, BSN RN CIC CNOR

NPO Questionaire
Courtesy Surgicare of Boca

"Pre-Anesthesia Evaluation Form"
Courtesy of Anesthesia Professionals Inc.

"Morcellation Consent Form"
Courtesy of Vicki V. Schultz, RN, CASC

"OR Cleaning/Terminal Cleaning Checklist"
Courtesy of Kathleen Pressimone, RN, CNOR, and Jeanne Sedgwick, RN, MSN, CNOR

"Why Scrub When You Can Rub?" References
Courtesy of Janet P. Haas, RN, DNSc, CIC

"What's Inside Your Credentialing Files"
Courtesy of Gordon C. Merrick, MBA

"Hand Hygiene Monitoring Tool"
Courtesy of Carol Cappella, RN, MSN, CNOR

Ideas That Work: Patient Transfer Form
Courtesy of Linda W. Frix, RN, BSN, CAPA

Ideas That Work: Pre-Op Patient Assessment
Courtesy of Katie Keller-Guglietta, RN

"How Well Do You Know Your Microorganisms?"
Courtesy of Ann Marie Pettis, RN, BSN, CIC

"Your Guide to Obstructive Sleep Apnea Patients"
Courtesy of Girish P. Joshi, MB BS, MD, FFARCSI

"Surface Disinfection: How Do You Rate?"
Courtesy of Ann Marie Pettis, RN, BSN, CIC

"Know Your Wipes, Mops & Sprays" References
Courtesy of Ann Marie Pettis, RN, BSN, CIC

10 Look-Alike/Sound-Alike Drugs for Surgical Facilities
Courtesy of Sheldon S. Sones, RPh, FASCP

New Allergy Process
Courtesy of West Hartford Surgery Center

"14 Irrefutable Reasons to Eleminate Surgical Smoke" References
Courtesy of Kay Ball, PhD, RN, CNOR, FAAN

Crash Cart Drawer-by-Drawer Breakdown
Courtesy of Dan Simonson, CRNA, MHPA, Spokane Eye Surgery Center

"Wipe Out the Confusion Over Surface Disinfection" References
Courtesy of Donna Nucci, RN, BSN, CIC

Receiving and Returning Borrowed Surgical Instrument Tray from Other Hospitals — Process Map
Courtesy of Randy Hillman

"Infection Prevention: How to Handle Patients with MRSA" References
Courtesy of Peggy SaBell, RN, MS, CIC

Patient Satisfaction Survey
Courtesy of Bone and Joint Surgery Center of Novi

Safety Orientation Checklist and Guideline
Courtesy of Kristie Jolliff, RN, BSN, CNOR, RNFA

Employee Counseling & Improvement Plan
Courtesy of Ann Geier, RN, MS, CNOR, CASC

STOP-BANG Questionnaire
Courtesy of Outpatient Surgery Magazine

Ideas That Work: Nerve Pathways
Courtesy of Outpatient Surgery Magazine

Sterilizer Failure Checklist
Courtesy of Outpatient Surgery Magazine

Perioperative Block Record
Courtesy of Cathy Rice, MD

The "9" Count
Courtesy of Outpatient Surgery Magazine

Example of a Hand Hygiene Monitoring Tool
Courtesy of Outpatient Surgery Magazine

Crew Resource Management Pre-Procedure Checklist
Courtesy of Memorial Hospital, Pembroke, Fla.

Intraoperative Ophthalmic Checklist
Courtesy of Outpatient Surgery Magazine

SSI Outbreak Checklist
Courtesy of Outpatient Surgery Magazine

DonJoy IceMan Post Op Instructions
Courtesy of Kernan Orthopaedics and Rehabilitation, University of Maryland Medica, Baltimore, MD

Post-Operative Discharge Instructions for Lumbar Spine Surgery
Courtesy of Diagnostic and Interventional Surgical Center

"Legal Update: ASC Hospital Transfer Requirements Summary, by State" References
Courtesy of Outpatient Surgery Magazine

Cataract Cost Sheet
Courtesy of Outpatient Surgery Magazine

"What Do You Know About Products Treated With Antimicrobials" References
Courtesy of Outpatient Surgery Magazine

Infection Control Surveyor Worksheet
Courtesy of Outpatient Surgery Magazine

"Protect Yourself from Head to Toe" References
Courtesy of Outpatient Surgery Magazine

Perioperative Skin Assessment Tool
Courtesy of Christine Kennedy, RN, BSN, MA, CNOR

"Recipe for a Successful Safety Scalpel Trial" References
Courtesy of Outpatient Surgery Magazine

"What Do You Know About...Pre-op CHG Showers" References
Courtesy of Outpatient Surgery Magazine

Making Time for Blocks References
Courtesy of Michael F. Mulroy, MD

Pre-op Form 1: Patient Questionnaire
Courtesy of Truvista Surgery Center

3 Steps to Right-sizing Your Suture Stock
Courtesy of Robert Schaff

What's Your Consciousness Telling You? References
Courtesy of Colletta A. Richards, MD

Prep Instructions
Courtesy of Denise Kohler, RN, BSN, MSN

Eye Preps: When You Can't Use Povidone Iodine
Courtesy of Jean Hill, RN, MSN, CRNO and Lisa (Mary) Hill, RN, BSN

Surgical Pricing Schedule
Courtesy of Jay Schorr of Advanced Cosmetic Laser Center

2006 Medicare Injection and Infusion Flowchart
Courtesy of Lolita M. Jones, RHIA

Sample Assignment of Benefits Form
Courtesy of MedBridge Development, LLC

Sample Provisions for Partnership Agreements
Courtesy of Scott Becker, JD, CPA and Alison Vratil Mikula, JD of McGuire Woods in Chicaco, Ill.

Sample Surgeon Survey
Courtesy of Janice E. Rey, MP (ASCP), CIC, St. John Hospital and Medical Center, Detroit, MI

Ambulatory Surgery: Surgical Site Infection Surveillance: Pt 2
Courtesy of Janice E. Rey, MP (ASCP), CIC, St. John Hospital and Medical Center, Detroit, MI

Infection Control Construction Permit
Courtesy of Janice E. Rey, MP (ASCP), CIC, St. John Hospital and Medical Center, Detroit, MI

Patient Surgery Cost Sheet
Courtesy of Betsy Sharp, Administrator, Orthopaedic Associates Surgery Center LLC in Augusta, Georgia

General Post-operative Guidelines for Patients with Known History of Obstructive Sleep Apnea Requiring Use of CPAP
Courtesy of Marjorie N. Blouin, RN and Shannon Magro, RN, Frederick Surgical Center, Frederick, Maryland

Myths of Pediatric Anesthesia References
Courtesy of Zeev Kain, MD, MBA, Professor and Chief of Pediatric Anesthesiology, Yale University School of Medicine

Adverse Incident Report
Courtesy of The American Society of Plastic Surgeons

Adult Pre-Operative Antibiotic Physicians Order Form
Courtesy of Southwest Generat Hospital Center, Middleburg, Ohio

Sample Narcotics Form
Courtesy of Kris Fisher, RN, CNOR, BSN, Turtle Creek Surgery Center

July "Legal Update" References
Courtesy of Outpatient Surgery Editors

NCMC/SPC Case Cart Quality Inspection Sheet
Courtesy of Jennifer L. Misajet, RN, BBA, CNOR: Director of Surgical Services, Western States Burn Center

Sample EOC Plan
Courtesy of Nancy Burden, RN, MS, CPAN, CAPA

Coding the Most Common Colonoscopies
Courtesy of Stephanie Ellies, RN, CPC

March "Overcoming the Roadblocks to Regional Anesthesia" References
Courtesy of Outpatient Surgery Magazine

February "Fast Facts About Fast Track Anesthesia" References
Courtesy of Outpatient Surgery Magazine

NCMC/SPC Case Cart Quality Inspection Sheet
Courtesy of Jennifer L. Misajet, RN, BBA, CNOR: Director of Surgical Services, Western States Burn Center

Medicare Survey Checklist
Courtesy of Genesee Associates, Inc.

Employee Human Resource File: Chart Order
Courtesy of Genesee Associates, Inc.

Initial Medical Executive Committee/Board Meeting Surgery Center
Courtesy of Genesee Associates, Inc.

Surgery Center Organizational Chart
Courtesy of Genesee Associates, Inc.

Development Team Assignments / Time Line: Surgery Center
Courtesy of Genesee Associates, Inc.

Medicare Program; Update of Ambulatory Surgical Center List of Covered Procedures
Courtesy of Department of Health and Human Services

"If You're Thinking of Buying..." References
Courtesy of Outpatient Surgery Magazine

Crash Cart Inventory Checklist
Courtesy of Progressive Surgical Solutions, LLC.

Pain Management Fee Schedule
Courtesy of Mowles Medical Practice Management, LLC.

Surgical Glove Evaluation
July, 2004

Sample Man Hours/Case Worksheet
Courtesy of Caryl A. Serbin, RN, BSN, LHRN

Sample Surgical Site Infection Tracking Form
Adapted from St. John's Mercy Medical Center Infection Control Department

Professional Associations and Nursing Organizations
Courtesy of Ann Geier, RN, MS, CNOR

Patient-Controlled Analgesia (PCA) Pump Safety Protocol
Courtesy of Institute for Safe Medication Practices (ISMP), Huntingdon Valley, Pa.

Nurse Endoscopy Training Protocol
Courtesy of Alaska Native Medical Center, Anchorage, Alaska.

Flexible Sigmoidoscopy Screening Protocol
Courtesy of National Naval Medical Center Division of Gastroenterology, Bethesda, Md.

Index of Corporate Partners, Managers and Consultants

A Sample Policy on Supply Pilfering
Courtesy of Jerrie Smith

Provider-Specific Trends: Rennaissance and Baroque Artists Hospital
Courtesy of Siegel and Krohn, PC

2004 Patient Safety Principles for Office-Based Surgery Utilizing Moderate Sedation/Analgesia, Deep Sedation/Analgesia, or General Anesthesia
Courtesy of American College of Surgeons

The Fraud and Abuse Statute and Investor-Owned Ambulatory Surgery Centers
Courtesy of Scott Becker and Nicholas Harned

4 Tips for Assessing Post-op Pain in Elderly Patients
Courtesy of M. McCaffrey and C. Pasero

A Latex Allergy Patient Screening Questionnaire
Courtesy of Lauren Charous, MD