SEPTEMBER 2006, VOL 84, NO 3 • AORN JOURNAL • 367© AORN, Inc, 2006

Patient discharge criteria;single versus double wrap

L E T T E R S T O T H E E D I T O R

The AORNJournalwelcomes letters for its“Letters tothe Editor”column.Letters mustrefer toJournalarticles or columnspublishedwithin thepreceding sixmonths. Allletters aresubject toediting beforepublication.Authors ofarticles orcolumnsreferenced inthe letter tothe editormay be given theopportunityto respond.Letters thatare includedin the “Letters”column mustcontain thereader’s name;credentials, ifapplicable(eg, RN, BSN, CNOR); positionor title; employer; andemployer’saddress.

PATIENT DISCHARGE CRITERIA

Iwas confused and concerned thatthe authors of the article “Determin-ing Patient Discharge Criteria in an

Outpatient Surgery Setting” (vol 83,June 2006) could state “Nurses current-ly have no formal evidence-based clini-cal criteria to assist them in determin-ing outpatient surgical patients’ readi-ness for discharge to home.” As a sea-soned recovery room nurse, I know wehave used the American Society ofPeriAnesthesia Nurses (ASPAN) stan-dards and the Modified Aldrete Scoreto guide practice for decades. TheAldrete score was modified more than10 years ago to take into accountchanges to anesthesia and fast trackingof patients. We don’t need to reinventthe wheel, although, of course, changesfrom time to time will be unavoidablewith the advent of new medications,equipment, and procedures.

GEOFFREY HIBBERTRN, BSN, BSBA

DIRECTOR OF NURSING

CENTER FOR SPECIAL SURGERY

GREENVILLE, SC

Author’s response. The intent of ourproject was not to recreate the wheelnor attempt to change the standards ofcare established by ASPAN. It wasobserved that nurses use more thanthese standards when determiningwhen an outpatient is ready to leaveour facility. Patients meet Aldrete-typecriteria before leaving our postanesthe-sia care unit and are discharged fromthe outpatient surgery area. The projectresults showed that outpatient surgerynurses not only weigh objective dataheavily but also consider other assess-ed needs. It showed that the outpatientnurses in our facility use a holisticapproach in their assessment and care.

It can be inferred that the nurses at ourfacility provide compassionate carethat does not rely solely on a minimalscore to discharge patients to their fam-ily members’ care.

The daily grind can cause us to losetrack of how important our trainingand professional skills are to ourpatients. This project illustrates theimportance of the nursing assessment.A holistic assessment was used by thenurses in this project even thoughtheir backgrounds and training varywidely. This is not mandated by policyand procedure but is expected by theinstitution as a professional skill.Future research of this type couldincrease the awareness of professionalnursing skills, thus increasing thevalue of nursing to the public andfacilities that employ nurses.

KEVIN NEWMAN RN, BSN

STAFF NURSE, OUTPATIENT SERVICES

FLAGLER HOSPITAL

ST AUGUSTINE, FLA

SINGLE VERSUS DOUBLE WRAP

Based on the clinical implicationsand potential cost savings ofusing single wrap versus double

wrap for sterile instrument packs(Evidence for Practice, vol 83, January2006), I did a literature search and dis-covered that the study was supportedby Kimberly-Clark Australia, and thatthe single-wrapped items were actuallywrapped in a single double wrap. Myconcern is that others may interpret thestudy synopsis in the same way I did,and in the interest of achieving costsavings, they will start to use a single-layer wrap. I don’t believe that thestudy implies that a single layer wrapprovides a microbial tortuous path (ie,barrier), but rather implies that a single