OR Today - March 2014 by MD Publishing

PRODUCT FOCUS

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MARCH SPRING INTO ACTION CONTEST

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NURSES • SURGICAL TECHS • NURSE MANAGERS

MARCH 2014

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COMMUNICATION VITAL IN OR CSP, OR departments must team up for positive outcomes

SPOTLIGHT ON

Kate Redfern, RN, BSN, CNOR

Address Service Requested MD Publishing 18 Eastbrook Bend Peachtree City, GA 30269

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COMMUNICATION IS VITAL The teamwork of the central sterile processing department and the operating room personnel is critical in the achievement of positive outcomes for surgery patients. Communication, collaboration and a commitment to excellence are all very important in the OR.

OR Today | March 2014

spotligh t on Kate Redfern has the best of both worlds. She enjoys working as a nurse in the operating room at Connecticut Childrenâ&#x20AC;&#x2122;s Hospital because she loves the work, but also because working part-time allows her to spend time with her husband and their three children.

OR Today (Vol. 14, Issue #2) March 2014 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 302691530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. ÂŠ 2014

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March 2014 | OR TODAY

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

EDITOR

John Wallace | jwallace@mdpublishing.com

ART DEPARTMENT Yareia Frazier Jonathan Riley

ACCOUNT EXECUTIVES

Sharon Farley | sharon@mdpublishing.com Warren Kaufman | warren@mdpublishing.com Jayme McKelvey | jayme@mdpublishing.com

CIRCULATION Bethany Williams

ACCOUNTING

INDUSTRY INSIGHTS 11 17

News & Notes AAAHC Update

COMPANY SHOWCASE

Sue Cinq-Mars

WEB SERVICES Nam Bui Taylor Martin Michelle McMonigle

20 Polar Products

IN THE OR 24 28 29 34

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 58 63 66 68 72

Health Fitness Nutrition Recipe Pinboard

MD PUBLISHING | OR TODAY MAGAZINE 18 Eastbrook Bend, Peachtree City, GA 30269 800.906.3373 | Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com

PROUD SUPPORTERS OF

77 Index

OR TODAY | March 2014

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NON-LATEX SENSITIVE SURGICAL GLOVE FEATURING SENSOPRENE® FORMULATION. Non-Latex Sensitive

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GENIUS IN YOUR O.R. INSPIRED REVOLUTIONS IN SURGICAL GLOVE TECHNOLOGY. The surgeon saw the obstructed artery and instantly knew — this procedure was crucial. Every second of the four-hour operation mattered. And each piece of surgical equipment could make a difference. GAMMEX Non-Latex Sensitive surgical gloves, featuring the innovative SENSOPRENE formulation, were developed specifically for moments like these. • Superior sensitivity while maintaining glove strength • Chemical accelerator-free formulation delivers comprehensive allergy protection • The fit, donning properties and grip you expect • Exceptional value in synthetic category For additional information or to request a sample, call Ansell today at (855) 868-5540 or visit us at www.ansellinfo.com/sort

® and ™ are trademarks owned by Ansell Limited or one of its a lia tes. ©2014 Ansell Limited. All Rights Reserved. Story is provided solely for illustrative purposes and does not describe any actual surgeon, procedure or patient.

industry insights new s & notes

STAFF REPORTS

SURFACE MEDICAL ANNOUNCES THE LAUNCH OF CLEANPATCH IN U.S.

urface Medical Inc. has announced the launch of CleanPatch in the U.S. market through a network of leading specialty distributors. Hospital beds, stretchers and other high-touch surfaces are prone to damage, and have been shown to harbor pathogens that contribute to healthcare-acquired infections. To date, there has been a lack of cost-effective and clinically validated solutions to this problem, with surgical or duct tape being tried unsuccessfully in many facilities. Inspired by a nurse, SMI developed and validated CleanPatch: a first-in-class medical surface repair patch for hospital beds and stretchers that restores damaged mattresses to an intact and hygienic state. Having completed more than 18 months of testing, including a clinical study in a hospital last year, patent-pending CleanPatch successfully launched in the Canadian market in mid-2013, and more than 60 facilities are using the product as part of their preventative maintenance repair solution on damaged mattresses, stretchers and other surfaces. CleanPatch a Class 1 medical device under the FDA is now available in the U.S. through a network of regional distributors.

For more information, about Surface Medical, visit www.surfacemedical.ca.

Spectrum Surgical Instruments provides th ree options

Spectrum Surgical Instruments Corp. offers three grades of surgical instruments to fit any budget. First, Spectrum’s highest-quality, German-made, German-crafted operating room instruments are backed by the company’s lifetime warranty against cracking, pitting, rusting and breaking. Spectrum maintains a large inventory of all common patterns for same-day shipping. Customers can use any manufacturer’s order number/ part number for a price quotation. Second, Spectrum offers Middleline, the company’s best-selling alternative to German instruments. This line costs approximately 50 percent less than German instruments and is backed by a 24-month warranty with free replacement. Finally, Spectrum’s Floorgrade/Economy instruments are reusable quality, manufactured from Pakistan steel and backed by a value-driven warranty. Hundreds of patterns are available for same-day shipping. For more information, about Spectrum Surgical visit www.spectrumsurgical.com.

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March 2014 | OR TODAY

industry insights new s & notes

staff reports

Ecolab’s new drapes he lp h ospitals reduce environmental impact Ecolab introduces Genesys, a new line of plastic drapes and waste bags featuring technology that speeds the breakdown of material into primary organic matter when disposed of in biologically active landfills. The products do not need to be separated from other waste material. “Hospitals are making meaningful commitments to protect the health of their communities by becoming better stewards of the environment,” said Andrew Gaillard, Ecolab Global Healthcare’s vice president of marketing. “The Genesys line of surgical drapes and waste bags are designed to help hospitals protect patients and staff from infections acquired in the operating room, and achieve environmental goals without changing current clinical practices.” It is an accepted fact that petrochemical-derived plastics, such as polyethylene, which are used in most surgical equipment drapes and waste bags, do not biodegrade. Genesys products use a proprietary organic additive that enhances the plastic’s ability to absorb moisture, attract microbes and facilitate conversion into primary organic matter and gas. The plastics break down up to 35 percent in 21 months when tested according to the American Society for Testing and Materials D5511 test. A recent report by the Commonwealth Fund, a private foundation working toward a high-performing healthcare system, found that health facilities create 6,600 tons of waste each day, much of which is transported to landfills. Operating rooms account for about 33 percent of all hospital supply, energy and waste costs. For more information on the Genesys line, visit www.ecolab.com/genesys or call 800-824-3027.

SEPS KIT aims to prevent surgical errors The mission of the Surgical Error Prevention System (SEPS) is to prevent wrongside, wrong-site and wrong-patient surgical errors through the integration of standardized practices and innovative technology, along with visual and hands-on tools. SEPS values patient safety, education, awareness and providing public support while also implementing an easy method to train healthcare professionals in reducing potentially devastating surgical errors. The patented SEPS kit includes an easy three-step, three-color visual for preventing errors during every operating room procedure. The easy three-step system forces surgeons, nurses and medical professionals to verify the location and procedure “before” operating. For more information about SEPS, visit sepsinfo.com.

OR TODAY | March 2014

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news & notes

PRIMUS installs sterilize rs at FDA facility PRIMUS Sterilizer Company has announced the recent installation of 29 steam sterilizers at the new Food and Drug Administration Headquarters – the White Oak Federal Research Center – in Silver Spring, Md. This is one of several large research facilities throughout the United States supported by PRIMUS steam sterilizers. PRIMUS’ steam sterilizers were equipped with standard P6 - Drain Water Conservation Quench and the optional P24-PRI-Saver Water Conservation System. These proprietary systems will significantly support the FDA’s LEED utility conservation measures at the White Oak campus. With the PRIMUS PRI-Saver, the White Oak facility will use up to 95 percent less water each time a sterilizer cycle is conducted. By choosing this green option, the U.S. government will save of thousands of dollars each year through reduced water usage. PRIMUS provided sterilizers for the BSL-2 and BSL-3 laboratories as well as the Vivarium. These laboratories support the advancement of cell, gene and tissue therapies, blood and blood component products, vaccines, allergenic products and other important biologics. PRIMUS sterilizers played an important part in establishing these laboratories, which are instrumental in supporting the efforts of CBER scientists to ensure safe and effective biological products.

Wall graph ics can increase communication Healthmark has announced a new wall graphic product that increases department communication in a fun and exciting way. Wall graphics are printed on white, durable, precision cut vinyl and are fade resistant. These removable and reusable wall graphics are easy to apply and are a fun and effective way to communicate messages throughout your department. Wall graphics can be made in a variety of sizes. You can use Healthmark supplied art or your own images. For more information, go to http://hmark.com

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March 2014 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

NEW CLASSIFICATION SYSTEM TO IMPROVE SCHEDULING OF EMERGENCY SURGERY Researchers in Finland have implemented a classification system for emergency operations that allows for a fair and efficient way to manage a large volume of such surgery. The system is described in a special issue of the BJS (British Journal of Surgery) that focuses on emergency surgery. Among hospitals there is growing interest in centralizing emergency surgery into specialized centers that have sufficient resources and available expertise to improve patient care and save more lives. Increasing the volume of emergency operations in such regional centers — which also perform elective, or planned, surgery — requires new structural and organizational elements that allow patients needing emergency surgery to be operated on without unnecessary delay, but also ensure that elective operations are not negatively affected. Ari Leppäniemi, MD, PhD, and Irma Jousela, MD, PhD, of the University of Helsinki, in Finland, now describe a system that has been in use at their hospital for several years that addresses these issues. The system introduces elements such as having a significant number of operating tables designated specifically for emergency surgery during the daytime. Also, because some emergency operations can be safely postponed until the next day, only operations that are truly urgent can be performed in the evenings and at nighttime. A color-coding system categorizes emergency operations by urgency and helps to optimize the timing of emergency operations in a rational and fair way. The computerized system also enables the investigators to monitor how effective their system is and whether there are systematic errors or problems that need to be solved. “Our study documents some of the objectively measurable benefits of the system. For example, the proportion of nighttime emergency operations has clearly decreased without causing disturbances in elective surgery or delaying surgery for those patients who need it urgently — the red code patients,” Leppäniemi explained.

In 1979 the Steelers won the Super Bowl. Saturday Night Fever was the album of the year. And AAAHC began accrediting ambulatory health care organizations.

YEARS STRONG

We’ve been raising the bar on ambulatory care through accreditation for 35 years. The secret of our success? Our peer review. AAAHC surveyors are physicians, nurses, anesthesiologists, medical directors and administrators. Which is why organizations routinely heap praise on us for our consultative and educational survey process. And why we are the leader in ambulatory accreditation.

If you would like to know more about AAAHC accreditation, call us at 847-853-6060. Or email us at info@aaahc.org. Or you can visit our web site at www.aaahc.org. Improving Health Care Quality through Accreditation

OR TODAY | March 2014

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industry insights AAAH C UPDATE

by Raymond E. Gru ndman , MSN, MPA, FNP-BC, CASC

Advance Directives: The way to let patients have their say

he Patient Self-Determination Act, passed by Congress in 1990, requires many healthcare providers to furnish information about advance healthcare directives. Its purpose was to inform patients of their rights regarding decisions on their own medical care, and ensure that these rights are communicated by the healthcare provider – in particular, the rights of the patient to dictate their future care by such means as a living will or power of attorney should they become incapacitated. Since then, many healthcare providers, including ASCs, have struggled with how best to respond to these directives.

W h at is an Advance Directive? According to CMS Interpretive Guidelines §416.50(c), “An advance directive is a written instruction, such as a living will or durable power of attorney for healthcare, recognized under State law (whether statutory or as recognized by the courts of the State), relating to the provision of healthcare when the individual who has issued the directive is incapacitated. (See 42 CFR 489.100.) Each ASC patient has the right to formulate an advance directive consistent with applicable State law and to have ASC staff implement and comply with the advance directive, subject to the ASC’s limitations on the basis of conscience. To the degree permitted WWW.ORTODAY.COM

by State law, and to the maximum extent practicable, the ASC must respect the patient’s wishes and follow that process.” The CMS Interpretive Guidelines further state: “the ASC must include in the information concerning its advance directive policies a clear and precise statement of limitation if the ASC cannot implement an advance directive on the basis of conscience or any other specific reason that is permitted under State law. A blanket statement of refusal by the ASC to comply with any patient advance directives is not permissible. However, if and to the extent permitted under State law, the ASC may decline to implement elements of an advance directive on the basis of conscience or any other

reason permitted under State law if it includes in the information concerning its advance directive policies a clear and precise statement of limitation.” Advanced Directive Statement of Limitation Subject to the laws in your state, an example of what a statement of limitation might look like is as follows: All patients have the right to participate in their own healthcare decisions and to make advance directives or to execute powers of attorney that authorize others to make decisions on their behalf based on the patient’s expressed wishes when the patient is unable to make decisions or unable to communicate decisions. This surgery center respects and upholds those rights. However, unlike in an acute care hospital setting, the surgery center does not routinely perform “high risk” procedures. Most procedures performed in this facility are considered to be of minimal risk. Of course, no surgery is without risk. You will discuss the specifics of your procedure with your physician who can answer your questions as to its risks, your expected recovery and care after your surgery. March 2014 | OR TODAY

industry insights AAAH C update

Therefore, it is our policy, regardless of the contents of any advance directive or instructions from a healthcare surrogate attorney in fact, that if an adverse event occurs during your treatment at this facility, we will initiate resuscitating or other stabilizing measures and transfer you to an acute care hospital for further evaluation. At the acute care hospital further treatment or withdrawal of treatment measures already begun will be ordered in accordance with your wishes, advance directive or healthcare power of attorney. Your agreement with this policy does not revoke or invalidate any current healthcare directive or healthcare power of attorney. If you wish to complete an Advance Directive, copies of the official State forms are available at our facility. A Do not resuscitate (DNR) is a request not to have cardiopulmonary resuscitation (CPR) in the event of a cardiac or respiratory arrest. An advance directive is not required in order to have a DNR request – advance directives may or may not contain a DNR request. Many ASCs have mistakenly adopted a policy of not honoring a patient’s advance directive when what they actually intended was to not honor a DNR request. A Living Will is the oldest type of healthcare advance directive. It is a signed, witnessed or notarized document called a “declaration” or “directive.” It is called into use only if the individual has been rendered unable to give informed consent or refusal due to incapacity. Since an attending physician who may be unfamiliar with the signer’s wishes and values has the power and authority to carry out the signer’s directive, certain terms contained in the document may be interpreted by the physician in a manner that was not intended by the signer. 18

OR TODAY | March 2014

The Five Wishes combines a living will and healthcare power of attorney – as well as addressing matters of comfort care and spirituality. Family members and others who are familiar with the signer’s values and wishes have no legal standing to interpret the meaning of the directive. These deficiencies led to the development of a second generation of advance directives – the Healthcare proxy appointment or Medical power of attorney. A Durable Power of Attorney for Healthcare is a signed, witnessed (or notarized) document in which the signer designates an agent to make healthcare decisions if the signer is temporarily or permanently unable to make such decisions. It does not, however, require that the signer have a terminal condition. The signer should carefully discuss his/her values, wishes and instructions with the agent before and at the time the document is signed. These discussions may also continue after the document is signed. It is important that the agent be willing and able to exercise his/her authority to make certain that the signer’s instructions are respected. The main benefit of second-generation advance directives is that the appointed representative can make real-time decisions in actual circumstances, as opposed to advance decisions framed in hypothetical situations, as recorded in a living will. This newer form of advance directive has been well received with supporting legislation in most states. The F ive w ishe s The Five Wishes combines a living will and healthcare power of attorney – as well as addressing matters

of comfort care and spirituality. Wishes 1 and 2 are both legal documents. Once signed, they meet the legal requirements for an advance directive in 42 states. Wishes 3, 4 and 5 are unique to the Five Wishes, in that they address matters of comfort care and spirituality, adding forgiveness and final wishes.

The Person I Want to Make Care Decisions for Me When I Can’t This section is an assignment of a healthcare agent (also called proxy, surrogate, representative or healthcare power of attorney). This individual makes medical decisions on the signer’s behalf if they are unable to speak for themselves.

The Kind of Medical Treatment I Want or Don’t Want This section is a living will — a definition of what life support treatment means to the patient, and when they would or would not want it.

How Comfortable I Want to Be This section addresses matters of comfort care — what type of pain management the patient would like, personal grooming and bathing instructions, and whether they would like to know about options for hospice care, among others.

How I Want People to Treat Me This section speaks to personal matters, such as whether the WWW.ORTODAY.COM

AAAHC UPDATE

patient would like to be at home, whether they would like someone to pray at their bedside, etc.

What I Want My Loved Ones to Know This section deals with matters of forgiveness, how they wish to be remembered and final wishes regarding funeral or memorial plans. To recap, remember that advanced directives are not just DNR orders. Adult patients should be encouraged to have an advanced directive, and ASCs should discuss advanced directives with their patients prior to admission. Remember also that state guidelines

may vary, so work with a legal advisor to make sure you are complying with the state regulations and check with your professional liability insurance carrier for additional guidance. In a recent survey by the Pew Research Center that explored whether doctors feel they should do everything in their power to prolong a life, results were mixed – some physicians strongly opposed; some highly supportive. What the study findings did reveal, however, was that patients want more control over decision-making about their care. Advanced directives are an effective way to make that happen.

ABOUT THE AUTHOR Ray Grundman has been involved in ambulatory healthcare for over 30 years in a variety of roles, as a clinician, educator and administrator, practicing as a board certiﬁed family nurse practitioner, medical group practice administrator, and founder and executive director of several surgery centers. He is the Senior Director for External Relations at AAAHC and is a member of the AAAHC surveyor training faculty and an active surveyor.

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#6000 ©2014 STERIS Corporation. All rights reserved. STERRAD 100NX and NX are registered trademarks of Johnson & Johnson Corporation. 1As of 6/12/13, V-PRO maX sterilizes with 59% hydrogen peroxide in ALL cycles versus 90-94% in some STERRAD® cycles (STERIS vs STERRAD Comparison #M3644). 2As of 6/12/13, STERRAD 100NX and NX sterilizers deliver a dosage of over 25 mg/L of hydrogen peroxide; V-PRO maX only uses 9.1 mg/L per dose (STERIS vs STERRAD Comparison #M3644).

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March 2014 | OR TODAY

COMPANY SHOWCASE POLAR PRODUCTS

POLAR PRODUCTS OR Personnel Cooling Systems and Cold & Hot Therapy Products

his year, Polar Products is celebrating its 30th year as a family-owned business manufacturing a full line of body cooling systems and cold and hot therapy products.

“Polar Products has grown and prospered due to our commitment to manufacturing innovative, highquality products and by listening to our customers’ feedback to continually improve our products and service,” says William Graessle, President and CEO. Their highly successful operating room and surgical cooling systems have recently been redesigned with new innovative features that deliver outstanding cooling benefits in operating rooms. “We are excited to announce the product launch of Polar’s new CoolOR® System, a circulating water cooling vest unit designed specifically to meet the needs of surgeons and OR staff,” says Jacob Graessle, Vice President and Surgeon and OR Systems Specialist for Polar Products. “We’ve taken our best-selling Cool Flow® vest and updated the system specifications based on years of feedback from hospitals nationwide.” 20

OR TODAY | March 2014

“Our new CoolOR® system is a great example of Polar’s commitment to providing customers the finest body cooling and therapy systems available,” added Jacob. Polar Products recently moved into a new 20,000 square foot manufacturing facility located in Cuyahoga Falls, Ohio. Polar began manufacturing cold and hot therapy packs and wraps in the early 1980s and expanded to body cooling systems in the late 1990s. Circulating water therapy and cooling systems like the CoolOR® System were developed in the 2000s. Today, Polar Products manufactures every type of cooling technology. “We are so confident that medical professionals will prefer Polar Products’ cooling systems that we offer hospitals a free 30-day trial on any product we sell,” says Jacob. “If after 30 days the cooling system or product does not meet your

CoolOR® System

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Polar Products is committed to ensuring complete customer satisfaction and long-term customer loyalty. needs, return it and pay only the return freight.” A key feature of the new CoolOR® cooling vest system is that electrical cords have been eliminated! The system is run on an efficient, convenient lithium-ion battery pack which provides increased portability and more than six hours of power. All of the electrical components are UL Listed. This, along with a wheeled cart and dry quick disconnect couplings, makes the CoolOR® System the most portable and flexible cooling vest system available for operating rooms worldwide. Multiple styles of cooling vests allow the surgeon to choose his or her preference, which is an example of Polar Products’ focus on meeting the unique needs of each individual customer. Polar Products currently offers three different vests styles for the CoolOR® System; with two new additional styles currently in development, Polar Products offers the most comprehensive line of OR cooling systems on the market. Polar Products is a worldwide leader in manufacturing body cooling systems, with over 25 years of experience cooling people in diverse applications, including industrial safety, construction, emergency services, athletics and fitness, the military and people with medical heat-sensitivity. Polar Products will also manufacture custom systems to meet unique needs, including multiple person cooling from a single system. In addition to providing cooling systems for OR staff, Polar Products WWW.ORTODAY.COM

has supplied systems for research studies to a wide variety of institutions such as American universities and hospitals, including Joslin Diabetes Center, Inc. at Harvard University, Vanderbilt University, University of Saint Mary in Leavenworth, Kansas, University of Hawaii, Johns Hopkins Medical Institute, Massachusetts General Hospital. Polar Products has also supplied international universities and hospitals, including University of Roehampton in London, University of Copenhagen, and Hôpital Européen Georges-Pompidou in Paris. Polar Products is committed to ensuring complete customer satisfaction and long-term customer loyalty. “We pride ourselves on our commitment to stand by our products unconditionally and to always do what is right,” says President William Graessle. Polar Products also manufactures Active Ice® therapy systems for patients’ post-surgery pain relief. This easy-to-use circulating water cold therapy system offers comfortable, convenient and portable drug-free pain relief, includes a convenient 30 minute timer and is ideal for after surgery, when serious pain relief is required.

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For more information on Polar Products’ complete line of body cooling systems and hot and cold therapy products, visit www.polarproducts.com.

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The Aquavac® reusable suction mat is made in the USA from a special compound of high grade rubber precisionmolded to ensure full contact water seal on the Operating Room floor. The mat is an effective and economical solution for fluid control and prompt turn-over time for reuse of the Operating Room. The mats suction 1 gallon of fluid every 70 seconds, connect to any standard operating room suction equipment, decrease slips, falls, and personal injury, as well as increasing the rapid removal of contaminated body fluids. MADE IN THE U.S.A.

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March 2014 | OR TODAY

In The OR suite talk

Suite Talk

Conversations from the OR Nation Listserv

Burn prevention What are some tips or advice on how to avoid burns from energy devices? A: The scrub nurse needs to maintain due diligence with any device which may injure the patient. A cautery tip/bovie pencil needs to be quarantined in a holster when not in use. Laparoscopes and light cables must not be allowed to lie on the draped area, even when off. Heat generated from a laparoscope tip or light cable cannot only produce a burn to the patient’s underlying skin surface but also may potentiate a fire. A: The sterile processing department should also be checking for any cracks in the light cords and reusable monopolar/bipolar energy cords. They should purchase an insulation tester to test the insulation on cords, insulated forceps, and laparoscopic sheaths. Any defect in the insulation is another place for potential burns. A: A great reference we purchased that has basic information is: “The SAGES Manual on the Fundamental Use of Surgical Energy (FUSE)” by L.S. Feldman, P.R. Fuchshuber, and D.B. Jones. You can get more information at http://tinyurl. com/nzbeafh. It has lots of great tips! A: Cautery pencils should always remain in their holsters when not in use; endoscopic light sources should be turned off when not in use and laser beams should be off. We did a mock fire scene as part of our competency. One scenario was a fire that engulfed the surgical drapes, it was left unattended. There was a change of shift and no report of the device was given. It smoldered for over an hour before anything happened. Also, had one on the cautery in which the patient was accidently burned because the tip was placed on the abdomen. It’s always educational for staff to see “What Ifs.”

24 OR TODAY | March 2014

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su ite talk

implant sheet placement Some facilities put the Synthese implant sheet in the tray prior to sterilization. There is controversy about this. Certain facilities say this is not acceptable. A new situation has presented itself. A number of places have started folding implant sheets, (un-sterile) and shoving them into the fold of a sterilized set. Has AORN addressed this? A: General Hospital Supply Corp. has a product called the “count me out” it attaches to the wrapped tray and you place the implant sheet in the pouch. There is a pouch for the containers also. A: We bought special bags that can be sterilized and attached to the outside of the trays. A: We use Aesculap trays and the count sheet is folded and attached to the outside handle. It works for us.

vital signs charting When doing endoscopy cases, the vital signs are monitored. Vital signs are included in the charting, by being imported from a monitor or printed, in most cases. Is it necessary to state the patient’s status with a sedation scale? If the case is uneventful, would not the vitals reflect this? A: Not necessarily. If the patient is on Beta-Blockers his vital signs (i.e. HR, B/P) would possibly register in the “normal” range and not cause alarm if they were having difficulties — until it’s too late. Also, if the GI case is done with Propofol without Capnography it may not be noticed that the patient is obtunded until they start showing signs of respiratory distress.

These posts are from OR Nation’s Listserv For more information or to join the conversation, visit www.theornation.com.

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March 2014 | OR TODAY

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March 2014 | OR TODAY

In The OR market analysis

market analysis

by JOhn Wallace

Sterilization market forecast to reach $2.7B by 2015

atient safety is a top priority at every hospital and healthcare facility. There are guidelines and regulations for a wide variety of medical procedures. Many healthcare facilities even have instructions for everyday processes.

Surgery is one area where patient safety is paramount. There are rules and regulations for every aspect of the process to make sure errors are prevented. One of the most critical aspects of surgery that deal with patient safety is the disinfection and sterilization of surgical instruments. As the U.S. population continues to be impacted by an aging baby boomer generation it seems that more and more surgeries are being performed on a daily basis increasing the demand for sterilization equipment. Other factors are also expected to fuel the growth of the sterilization equipment market. A report by Transparency Market Research on the sterilization equipment market expects steady growth over the next few years. “Global sterilization equipment market is forecasted to reach a market value of $2.7 billion by 2015,” according to a description of the report. “Some of the major factors driving the growth of this market include the enduring need for efficient infection control measures, threat of biological and chemical warfare, and recurrent outbreaks of emerging infectious diseases.” Cost-saving measures are also expected to fuel growth in the market according to Transparency Market Research. 28

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“Sterilization equipment is one of the most critical equipments in the medical industry as effectiveness, efficacy, and success of surgeries, medical examinations and research depends on the ability to prevent cross infections,” according to the report. “Growth of the sterilization devices industry in the immediate future is expected to be driven by increased reprocessing of medical devices as a method of cost saving in the weak economy. Reprocessing of medical equipment is rapidly emerging as an important survival strategy for cash-strapped hospitals in developed nations. The consequent rise in the third-party reprocessing industry is expected to rake in additional market opportunities for sterilization equipment.” A news release by Reportlinker.com announcing a market research report on the infection control market forecasts growth through 2017. “Sterilization and disinfection are essential components of infectioncontrol procedures. There has been a surge of cleaning standards and mounting pressure for sterilized medical devices and disinfection in hospitals and clinics, which has triggered the growth of the medical sterilization and disinfection market,” according to the news release. “With an increase in aging popula-

tion across the globe and a demand for healthcare services, change in the healthcare reimbursement policies is pushing the providers of sterilization and disinfection to improve their operations by providing high-quality service at lower costs. These factors are expected to propel the growth of this market.” The news release says there has been an increase in demand in the sterilization services market, which includes healthcare facilities. “Contract sterilization services, in particular, is a common trend due to stringent regulatory requirements imposed by regulatory agencies like International Organization for Standardization (ISO) and Association for the Advancement of Medical Instrumentation (AAMI). Original Equipment Manufacturers (OEMs), hence, prefer outsourcing, as it reduces costs on sterilizing and disinfecting equipment in-house by focusing on their other business core competencies,” according to the Reportlinker.com news release. The key players in the sterilization equipment market include Steris Corporation, Getinge AB, Advanced Sterilization Products, 3M and Belimed. Key players in the North America contract sterilization services market are STERIS Isomedix (U.S.), Sterigenics (U.S.), Medivators (U.S.), and Nordion (Canada). The disinfection market is dominated by Medivators, Cardinal Health and Kimberly-Clark along with the likes of Getinge, STERIS, ASP, 3M and Belimed. WWW.ORTODAY.COM

In The OR product sh ow room

3M™ Steri-Vac™ 3M™ Steri-Vac™ Sterilizers/Aerators use 100 percent ethylene oxide (EO) in single-dose canisters to safely, effectively, and economically sterilize heat or moisture sensitive equipment, representing the “gold standard” for low temperature sterilization for over 50 years. In fact, over half of all heat or moisture sensitive devices (including sterile single-use devices) are sterilized with ethylene oxide. Within the sterilization chamber, ethylene oxide is converted to a highly penetrating gas, offering superior effic y for complex instrumentation, such as fl xible endoscopes. Steri-Vac Sterilizer Systems, backed by 3M service and support, can help meet the challenges of modern sterile processing departments. More information at http://go.3M.com/lowtemp

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Produ ct Showroom

AMSCO V-PRO® maX from STERIS The AMSCO V-PRO maX Low Temperature Sterilization System is a vaporized hydrogen peroxide sterilizer designed to process heat and moisture sensitive devices with record time: • 35-minute fl xible cycle • 55-minute lumen cycle • 28-minute non-lumen cycle The system can process dual-channel surgical fl xible endoscopes, has 136 liters of usable chamber space and can process loads up to 24 pounds.

30 OR TODAY | March 2014

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In The OR product sh ow room

ASP STERRAD® Steriliz ation Systems STERRAD® Systems from Advanced Sterilization Products (ASP) sterilize medical devices through an innovative and proprietary hydrogen peroxide gas plasma technology, giving customers the confiden e of terminal sterilization with easy-to-use systems that deliver productivity, fl xibility and reliability. As a low-temperature hydrogen peroxide gas plasma technology, STERRAD® Systems sterilize a wide range of instruments including singlechannel fl xible endoscopes, semi-rigid ureteroscopes, cameras, light cords, power drills, rigid scopes, rechargeable batteries and much more without the instrument damage associated with high-temperature steam sterilization. The ASP proprietary plasma phase efficiently elimi tes hydrogen peroxide residuals from devices, protecting instruments, users, patients and environments in healthcare facilities. To help healthcare professionals comply with IFU s, ASP developed the STERRAD® Sterility Guide (SSG) website and mobile app, which allows customers to quickly and easily identify which devices fall within STERRAD® System sterility claims.

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IN THE OR CONTINUING EDUCATION 678

BY CYNTHIA SAVER, RN, MS

continu ing edu cation 678

Ch anging Specialties in Th ree Easy Steps The goal of this program is to help nurses transition from one specialty to another more effectively. After studying the information presented here, you will be able to: • Identify three steps to managing a specialty change • Describe how to research a potential specialty • Discuss how to prepare to make a career change

Gannett Education guarantees this educational activity is free from bias. The planners and authors have declared no real or perceived conflicts of interest that relate to this educational activity. See page 43 to learn how to earn CE credit for this module.

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aren has been working on medical/surgical units for the past 10 years, ever since she graduated from nursing school. Karen has always enjoyed her work, but lately, she has been restless, feeling like she needs a change. Karen likes settings where there is a rapid turnover of patients and where she has the opportunity to regularly use cuttingedge technology — she has always been interested in new devices designed to improve patient care and make nursing care delivery more efficient. aren’s coworker, who used to work in the OR, suggests she switch to perioperative nursing. At fir t, Karen is excited as she realizes how much she enjoys caring for surgical patients and would like to enhance her knowledge about what happens during an operation. But then, her excitement cools as she tells herself she has no experience that would be applicable in the OR. Or does she? On further reflection, aren identifies c ossover skills, researches the specialty and lands a job in the OR of a hospital closer to her home. A year later, Karen is happily working in her new specialty. Have you ever considered changing your nursing specialty but were intimidated by the process? You may have felt you didn’t have the skills you needed to change or perhaps didn’t know how to attempt to make the switch. Maybe, like Karen, you wanted to make what at first glance appeared to

be an insurmountable change: from med/surg to the OR. Or maybe you wanted a change but weren’t sure which specialty to choose. You are not alone. Although no data seem to exist as to how many and how often nurses change specialties, most of us either know nurses who have March 2014 | OR TODAY

In The OR continuing education 678

changed or we have done so ourselves. Perhaps the original specialty wasn’t a good fit. For example, one nurse this author worked with who was unfulfilled in the cardiac care unit found her niche in dialysis. At times, a nurse’s professional goals evolve with experience. Or a nurse may stumble into a new specialty by accident by taking a job for other reasons, such as expanding his or her employability by moving into a specialty where there is high demand or the need to relocate. The good news is that nursing provides a wealth of opportunities, and you can tap into those opportunities by purposefully transitioning from one specialty to another. All it takes is research, planning and allowing yourself time to adjust to your new role. But first, you need to ask yourself a question. Do You Really Nee d a Ch ange? Before deciding you want to switch specialties, first examine your motivation for making a change. Do you really want to explore another specialty, or is it simply that you dislike your current manager or are tired of your long commute? To answer this question, separate the job itself from environmental factors such as managers, coworkers, hours worked, commute and mission of the organization. If you decide you like the specialty, but not your current job, you’ll need to try to adapt your environment (for example, perhaps you can transfer from one med/surg unit to another) or seek a new job elsewhere, but in the same specialty. Let’s say you, like Karen, decide you’d like a change. Here are three steps to get you there: Choose the 36

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specialty, prepare for the change and manage the transition. Ch oose the Spe cialty The first step in transitioning into a new specialty is to determine which one is the best fit for you. That involves a two-step process: completing a self-inventory and conducting research. Self-inventory: taking stock. Richard Bolles, author of the classic book “What Color Is Your Parachute: A Practical Manual for Job-Hunters and Career-Changers,” writes that doing a self-inventory is the most successful way to land a job.1 For general job hunters, it has an 86 percent success rate (meaning that out of 100 people who seek a job, 86 will find one) compared with, for example, a mere 7 percent success rate for mailing or posting your resume. Bolles believes the analysis enables you to better target what you are looking for, more accurately describe to others what you are seeking and help you shine in interviews. To begin your inventory, deepen your understanding of your values and strengths. Values are our foundation, the principles we live by; your job must be congruent with your values for you to feel successful. Examples of values include fairness, wisdom, tolerance and openness. Strengths are our attributes — we are able to perform them consistently well. Your strengths, or talents, are unique to you, and the greatest room for growth is in the area of your greatest strengths.2 It’s been said that the secret of success is to find your strengths, reinforce them with practice and learning, and then find a role that draws on those strengths every day.2 Yet too often we focus on

our weaknesses instead of our strengths. Fortunately, you can identify your strengths through free online testing (such as at www. authentichappiness.sas.upenn.edu [look under “Engagement Questionnaires” for the “VIA Survey of Character Strengths”] and at http:// www.jobhuntersbible.com/counseling/index.php) and self-reflection (see sidebar).3,4 Now you are ready to identify your transferable skills — skills you can apply in any nursing specialty. Transferable skills are sometimes categorized as “hard” and “soft.”5,6 Hard skills are those that stay the same from job to job and that you can be “trained” to do. For instance, the abilities to start an IV or suction a patient are hard skills. Unlike hard skills, soft skills — sometimes called “people” skills — change according to circumstances. For example, effective communicators will vary how they approach people depending on the situation and who is involved.5 Other examples of soft skills include patience and the abilities to persuade, negotiate and organize. Traditionally, it has been thought that soft skills are learned through social and cultural interactions. Many experts believe that soft skills can also be taught. You might have great skill in connecting with people, for example, but a course on conflict management would likely still be helpful to you. Both soft and hard skills are important for career success. Start with skills and challenges that you enjoy and are good at. When doing something we love, we tend to lose track of time and become wholly focused on the task at hand, an experience that psychologist Mihaly Csikszentmihalyi refers to as “flow.”7 Engaging in activities that offer this WWW.ORTODAY.COM

continu ing edu cation 678

Self-Inventory: W h o You Are, W h at You Have and W h at You Want You migh t w ant to start your self-inventory by asking the se q uestions designed for internal reflection: (From Jackie Shaffer, president of CommonGround, www.commongroundpartners.com, September 19, 2012) How do I define success? What motivates and inspires me? What external factors are necessary for me to feel comfortable (secure and happy) in my work? What internal factors are necessary for me to feel comfortable (joy-filled and pea eful) in my work? What gives life meaning and a sense of peace for me? What makes me come alive? (What do I get excited about?) H ere are some q uestions you can ask yourself to pin dow n your interest areas:10,19 What are my clinical interests? What are my likes and dislikes?

• • • • • • •

How much patient interaction do I like? What age of patients do I like? How much technology do I like? Do I prefer a small number of acutely ill patients or a broader number with whom I can provide more patient education? What kind of pace do I like? Some nurses thrive on the high-paced environment of a busy urban ED while others prefer a slower pace. What kind of work environment do I like? You might prefer a small rural hospital over a university hospital. How much responsibility do I want?

What are my personal needs and interests? • • • • • • •

What priority is my career at this time in my life? What kind of schedule do I want? Will I accept rotating or on call? What are my physical limitations? What is my best time of day? What will be the impact of my schedule on my family? Can I relocate? What salary do I need to support myself and my dependents?

What are my career goals? Write down you goals for the next year and a few years into the future. If you are stuck, consider the se q uestions: What things do I frequently get complimented on or praised for? What do people ask me to help them with or do for them? What am I good at? What did I do for fun as a child?

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In The OR continuing education 678

Clinical Vignette John Miller has been a staff nurse in on ology for eight years; he currently works on an inpatient oncology unit. John is considering changing his specialty to emergency nursing and is unsure about how to do that. After asking himself a key question, he performs a self-inventory and conducts research, including informational interviews. He finds th t his knowledge provides a sound basis for working in the ED and lands a job with a formalized internship program and built-in support.

What was the key question John asked himself? a. Will I be more employable if I make this change? b. What is the national organization for emergency nursing? c. How can I sign up for LinkedIn? d. Do I really need a change?

Which of the following is a question John likely asked during his informational interviews? A. What is your typical day like? B. Which companies are hiring? C. Where do I obtain a job application? D. Could you provide a reference for me?

A soft skill that may have been on John’s list is: A. Starting central line B. Administering IV medications C. Organizing his work group to write a new policy D. Disposing of chemotherapy equipment correctly

Which will help John achieve success in his new ED position? A. U nderstanding that he will begin at a different expertise level B. U nderstanding that he will be able to serve as an expert clinician C. Listing all the things that contributed to his errors in a journal D. Listing in a journal all the negative comments he received

4. Correct Answer: A — When changing specialties, it takes time to become an expert. 3. Correct Answer: C — Soft skills are not technical skills. 2. Correct Answer: A — At this stage, John should just collect information and not seek help to land a job. 1. Correct Answer: D — John first needs to know if he really wants a change or if he is simply unhappy with his current position. 38

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type of reward leads to optimal fulfillment and happiness. When you are done, rank your skills as to ability and level of enthusiasm you have for them. It is not enough to be able to do something well. You want a position that allows you to tap into the work you do well and most enjoy. Some people struggle to identify their strengths and skills. It may help to take a survey and ask others for feedback.4 You might ask colleagues or supervisors questions such as What is my greatest strength? What is my greatest weakness? What do you see as my special talent, ability or gift? What do I do naturally and effortlessly that is special? If I were

on the cover of a magazine, what magazine would it be and what would the article be about?8 Among Karen’s transferable skills were flexibility and organizing, and the abilities to be an effective patient advocate and to juggle multiple priorities — great skills for the OR. Once you have identified your strengths and skills, consider other factors such as: • Location. Where would you like to work? Some nurses dislike hospitals, but thrive in the community setting.9 You may prefer older patients over younger ones or a small hospital instead of a large one.

• Responsibility. How much responsibility do you want?1 Do you prefer a staff position and like being part of a team? Do you want to be the head of a team or a nurse administrator? • Lifestyle. Ask questions such as How long a commute is acceptable to me? What kind of shifts am I willing to work? How much time am I willing to devote to my job? At some stages of life we might have to cut back on the level of commitment to our careers, for example, if you are responsible for caring for young children or elderly parents. Karen identified her skills and lifestyle requirements. She read

Informational Interview ing

Informational interviewing is just what the name implies: interviewing people to collect information. You are not seeking a job; you are simply trying to learn more about a specialty. The good news is that most of us have ready access to people who are in the specialty you desire; they often work at your own organization. If you don’t know of someone, try contacting an officer in the organization of the specialty you aspire to. You should interview at least three people. Before you meet, establish time parameters; be aware of the person’s busy schedule, and don’t ask for more than 30 minutes of time unless he or she offers it. Here are suggested questions:1,10 • How did you get into this specialty? • What do you like best about it? • What do you like least about it? • What is a typical day like? • How do I get into this specialty and what is the demand for it? • How easy is it to find a job in this specialt ? • Who else would you recommend I learn more about for this specialty? Don’t hesitate to ask people for their time. Most are happy to help others; after all, that is what we do as nurses. You might take the person to lunch or meet over a cup of coffee in the cafeteria.

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In The OR continuing education 678

about different types of specialties and selected perioperative nursing as the field that seemed to best meet her needs. To be sure you consider all options — and to help you narrow your list of potential specialties — consider turning to a resource that summarizes multiple nursing careers. For example, each of the career listings in the book “201 Careers in Nursing” includes a basic description, educational requirements, core competencies, skills needs and related websites and professional organizations.9 Karen was pleased to learn that listed competencies and skills for the perioperative nurse included “knowledge and skills needed to assist in preparing and operating the technological tools involved in new surgical techniques.”9 Because she was already viewed as the technology “guru” on her unit, she knew she had a transferable skill. She was also pleased to see “skill in providing comfort measures to the patient,” which reassured her that the OR isn’t just about technology; it’s also about the patient. Research. Now that you have a potential specialty in mind, you need to learn more about it through several different strategies. You might begin, as Karen did, by Googling the specialty to find resources and reading the journals targeted toward perioperative nurses. Karen also tapped into social media; she “liked” the Association of periOperative Nurses on Facebook and followed the association on Twitter. She found several perioperative nurses who blogged, and she read their entries. Another search technique is attending local chapter meetings of 40 OR TODAY | March 2014

the specialty association, which Karen did. This provided her the opportunity to learn more about the types of nurses who enjoy perioperative nursing. If you have funds, consider attending a national convention of the specialty association you are interested in. You might also attend career fairs, where you can find nurses working in your desired specialty and employers who might offer internships.10 Karen then felt ready to conduct informational interviews. Informational interviews allow you to learn more about a specialty in a “safe” setting because you are not looking for a job — you are looking to learn. (See sidebar for more about informational interviewing.) Karen contacted nurses in the OR of the hospital where she practiced to set up time to talk. She also interviewed nurses she met at the chapter meetings. Another tactic is to interview faculty members who teach in the specialty area you’re interested in. If the specialty is available in the organization where you work, you might want to arrange to shadow a nurse who does the job you aspire to or at least tour the department or unit. Enlist your current manager’s support; most want to see employees satisfied and will provide support and guidance to help a nurse explore another option within the same organization. You should also check out the hospital’s policy for internal transfers. Extensive research enables you to paint a detailed picture of the specialty so that you can make a final decision as to whether it’s a good fit or if you need to go back to the drawing board to research other specialties. It also helps clear up misconceptions about a specialty. For

example, you might think you would like to move from dialysis to the ED but worry about giving up patient teaching. However, your research shows that patient education is an integral part of the ED nurse’s day, and the short time frames for teaching will provide new challenges. In Karen’s case, her concerns about not having any OR experience were allayed once she learned that many hospitals recognize the need to support those who are changing specialties and offer orientation and preceptor programs for those new to the OR to make the transition easier. Karen’s research helped her realize that perioperative nursing was a good fit for her. Prepare for the Ch ange Once you have chosen your specialty, assess what you need to do to set yourself up to make the change. Look at the specialty’s standards of care and core curriculum for certification. This information is usually available from the national association or the American Nurses Association. No one expects you to be an expert in these areas, but at least you will know more about what is expected. Here are some other tactics: • Determine if you need any additional education, knowing that it doesn’t necessarily mean you have to return to the formal school setting. You might want to take a few continuing education classes (in person or online) so that you can add them to your resume. This type of initiative shows potential employers that you are committed to the change. • Revamp your resume to highlight the transferable skills that are WWW.ORTODAY.COM

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relevant to the specialty. For example, Karen focused on her ability to work well under pressure, adapt to change, communicate effectively and deal with technology — key skills for success in the OR. • Continue networking. Networking is, in essence, establishing relationships and connections.11 At this stage, you know what you want, so your networking is more purposeful. Be ready to describe what you are looking for in a brief sentence, such as Karen’s statement: “I’m a med/surg nurse with 10 years’ experience who wants to use my technology and organizational skills in the OR.” You should network in person by, for example, attending meetings and other events, and you should network through social media. Reading nursing chatrooms and specialty listservs also gives you valuable insights. Three advantages of online networking are that it expands access to information, connects you with people with similar interests and provides a springboard for face-to-face networking.11 • Consider signing up for LinkedIn, a professional networking site. Be sure that you complete your profile and keep it up to date.1 The basic profile is easy to complete and available at no charge. • Let as many people as possible know that you are interested in a particular specialty both online and in person.9,12 The saying “It isn’t what you know, but who you know” applies here. Many nurses have landed their perfect job through word of mouth. WWW.ORTODAY.COM

• Find a mentor who can help you not only with this particular change, but with your professional development during your career.9 Research has shown that mentoring is “an essential human and professional developmental relationship that empowers” nurses and “contributes to their success, satisfaction and excellence in the profession.”11 • Take a cue from Olympic athletes and visualize your success. Picture yourself working in the job you desire. You may want to collect images that represent your goals and tack them up on a bulletin board or whiteboard to create a visual reminder of your goals.8 For example, Karen wanted to work in the OR, so she collected photos of the OR and even glued her photo on the cover of AORN Journal. • Write down your goals. There is power in writing what you want. In fact, the act of writing focuses the brain.13 You will find you’re more aware of anything in your environment that might help you achieve goal. Think of writing your goal as sending a message that you are in charge of where you want to go. • Finally, be flexible. Understand that you might not find a job that is a 100 percent match but is a stepping stone to getting where you want to go. For instance, a nurse who wants to work in an ED in a large university hospital might need to start in a smaller setting. Manage the T ransition Once you start your new specialty, remember to be kind to yourself.

You may have become accustomed to being the expert in your area and be humbled by all you need to learn. Keep in mind Patricia Benner’s stages of clinical proficiency, which include novice, advanced beginner, competent practitioner, proficient practitioner and expert.14 You started your nursing career at the advanced beginner stage and may currently be at the expert stage, where you have an intuitive grasp of each situation based on your knowledge and experience.14 As an expert nurse, you may just “know” a particular situation is critical without having to consciously think about it. When you switch to another specialty, it’s not realistic for you to continue to expect yourself to perform at the expert level. You will require more conscious internal processing before making decisions, so you will likely function at the proficient or even competent level. As you gain experience with your new specialty, you will gain knowledge and expertise, but understand that it won’t happen overnight. You should have a preceptor during your orientation; be sure to establish a good relationship with that person. Identify other mentors who will provide support. Karen connected with a coworker who had 10 years of OR experience and enjoyed teaching and answering questions. Stay focused on your past successes. For example, a colleague told this story: She knew a great nurse who moved from med/surg to the ICU. At first, the nurse was extremely fearful of doing something wrong. Her feelings led to lack of confidence, a “brain drain” that inhibits learning and March 2014 | OR TODAY

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performance. The colleague took her aside and said, “Look at all you have done in your career. You’re one of the best nurses I know. It gets easier. You KNOW you can do this!” This nurse became the charge nurse within a year. To encourage yourself, use positive self-talk. Use phrases like “I can” instead of “I can’t.” Keep a journal where you list what went well. Most important, ask for feedback from peers, preceptors and your supervisor. Often we have misconceptions of how we are doing and need factual information. One you feel comfortable in your role, consider obtaining certification in your specialty. In a survey of certified and noncertified nurses, 97 percent of respondents agreed that certification provides personal satisfaction, and 88 percent agreed that certification enhances personal confidence in clinical abilities.15 Th is is Your Time Change can seem overwhelming. Take a page from the principle of Kaizen, which says that small changes can lead to big results.16 “Kaizen” is the Japanese term for the philosophy of taking small steps to achieve improvement. This approach was developed by W. Edwards Deming, who introduced the concept to Japanese businesses in the 1950s. His work helped the businesses reach high levels of success. Take your own small steps toward achieving your goals and success. It may help to schedule those steps. For instance, put time on your calendar to attend a meeting of a specialty group. Your next step might be to determine which people you meet you should approach about an informational interview. Soon you 42 OR TODAY | March 2014

will be on your way to achieving your goals. Consider that the U.S. is at the cusp of a nursing shortage as the temporary “bubble” of the expanded registered nurse workforce deflates.17 The projected shortfall of RNs is 260,000 by 2025.18 This situation provides an opportunity to explore new horizons — such as new specialties — and grow professionally. Don’t delay your chance to live your dream.

ogy of Optimal Experience. New York, NY: HarperCollins Publisher; 1990. 8. Miedaner T. Coach Yourself to a New Career. New York, NY: McGraw Hill; 2010. 9. Fitzpatrick J, Ea E. 201 Careers in Nursing. New York: Springer Publishing Co; 2011. 10. Cardillo D. How to change specialties. Donna Cardillo and Associates Web site. http://www.dcardillo.com/articles/changespecial.html. Accessed September 19, 2012. 11. Vance C. Fast Facts for Career Success in Nursing. New York, NY: Springer Publishing Co; 2011.

Cynthia Saver, RN, MS, is president of CLS Development Inc., in Columbia, Md. References 1. Bolles RN. What Color Is Your Parachute? A Practical Manual for Job-Hunters and Career-Changers 2012. Berkeley, CA: Ten Speed Press; 2012. 2. Buckingham M, Clifton D. Now, Discover Your Strengths. New York, NY: The Free Press. 2001. 3. Seligman M. Authentic happiness: VIA Survey of Character Strengths. http://www. authentichappiness.sas.upenn.edu/Entry. aspx?rurl=http://www.authentichappiness. sas.upenn.edu/tests/SameAnswers_t. aspx?id=310. Accessed February 7, 2013. 4. Counseling, testing & advice. JobHuntersBible.com Web site. http://www. jobhuntersbible.com/counseling/sec_page. php?sub_item=051. Accessed February 7, 2013. 5. Han L. Hard skills vs. soft skills—difference and importance. Be My Career Couch Web site. http://bemycareercoach. com/1704/soft-skills/hard-skills-soft-skills. html. Accessed February 7, 2013.

12. Vallano A. Your Career in Nursing: Manage Your Future in the Changing World of Healthcare. 5th ed. New York, NY: Kaplan Publishing; 2008. 13. Klauser HA. Write It Down, Make It Happen: Knowing What You Want — and Getting It! New York: Simon & Shuster; 2005. 14. Benner P, Tanner C, Chesla C. Expertise in Nursing Practice. 2nd ed. New York, NY: Springer Publishing Co.; 2009. 15. Niebuhr B, Beil M. The value of specialty certific tion. Nurs Outlook. 2007;55(4):176-181. 16. Maurer R. How One Small Step Can Change Your Life: The Kaizen Way. New York, NY: Workman Publishing Co; 2004. 17. Staiger DO, Auerbach DI, Buerhaus PI. Registered nurse labor supply and the recession — are we in a bubble? N Engl J Med. 2012;366:1463-1465. 18. Buerhaus P, Auerbach DI, Staiger DO. The recent surge in nurse employment: causes and implications. Health Aff. 2011;28(4):w657-w668. 19. Z erwekh J, Z erwekh Garneau A. Nursing Today: Transition and Trends. 7th ed. Philadelphia, PA: Saunders; 2011.

6. Rigdon L. How to Change Your Career and Do the Work You Really Love: A Stepby-Step Plan for Making It Happen. Ocala, FL: Atlantic Publishing Co; 2009. 7. Csikszentmihalyi M. Flow: The PsycholWWW.ORTODAY.COM

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Deadline Courses must be completed by March 11, 2015 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer. 4.

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March 2014 | OR TODAY

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“IT IS AN ‘ALL OF US FOR THE PATIENT’ SITUATION.” — Natalie Lind,

educational director for IAHCSMM

When there is strong communication and a healthy relationship between the OR and CSP departments, each side can better respond to changing instrument needs.

by Don Sadler

COMMUNICATION

VITAL IN OR CSP, OR departments must team up for positive outcomes

here’s no question that the central sterile processing (CSP) department plays a vital role in the achievement of positive surgical outcomes for patients. OR personnel rely on CSP to provide the clean, sterilized instruments they need for surgical procedures — when they need them. This makes it vital that there be a healthy relationship between individuals in the CSP and OR departments.

Such a relationship starts with open and honest communication between OR and CSP personnel. “The two departments need to form and nurture a communication program that allows for everyone to communicate honestly, without demeaning others or pointing fingers,” says Patti Koncur, educational specialist with the International Association of Healthcare Central Service Materiel Management (IAHCSMM). “A good communication system will allow the departments to work together to find the cause of any problems or concerns and solutions that will work effectively for both departments.”

COMMUNICATION

VITAL IN OR

A COMMON GOAL The first step in making the communication process go more smoothly is to acknowledge that both groups have the same goal: to care for the patient. “It is never an ‘us against them’ situation,” says Natalie Lind, educational director for IAHCSMM. “Rather, it is an ‘all of us for the patient’ situation.” Ramona Conner, MSN, RN, CNOR, manager, Standards and Recommended Practices for the Association of periOperative Registered Nurses (AORN), concurs: “Everyone has a common goal: to ensure that fully functioning sterile devices are received at the point of use in the OR when they are needed. To accomplish this, communication between OR and CSP personnel has to be ongoing. They have to be aware of the unique challenges faced by each other.” Many perioperative nurses aren’t aware of the complexities of sterilizing and decontaminating surgical instruments, Conner adds. “This is especially true when it comes to sensitive and intricate instruments like robotic devices. Instruments like these weren’t around when many of us were trained,” she says. “As medical technology continues to evolve and more complex, heat-sensitive instruments are introduced, instrument sterilization will grow even more complex.” Koncur says that meeting each other in person and in the different departments helps both sides see the entire operation and the challenges faced on a daily basis. “Working together to form solutions when all the challenges are known makes for an effective partnership,” she adds. Lind suggests that OR and CSP personnel set aside some time when there are no immediate 48

OR TODAY | March 2014

“Everyone has a common goal: to ensure that fully functioning sterile devices are received at the point of use in the OR when they are needed.”

RAMONA CONNER,

MSN, RN, CNOR, manager, Standards and Recommended Practices for the Association of periOperative Registered Nurses (AORN)

needs and discuss the actual processes, as well as why specific processes are followed. “Keep an open mind and listen to each other’s ideas. Developing understanding and a spirit of respect and cooperation can go a long way in strengthening the relationship,” Lind says.

Conner says she has worked at facilities where there was healthy interaction and communication between the OR and CSP departments, with strong collaboration and cooperation, and at facilities where the interaction was less healthy. “Since we’re all human, there are bound to be conflicts at times,” she says. “These should always be resolved through direct, face-to-face communication. There’s no substitute for personal observation of what each other is doing on their turf to raise awareness of the challenges staff in each department face.” When there is strong communication and a healthy relationship between the OR and CSP departments, each side can better respond to changing instrument needs, says Koncur. “For example, when CSP is aware of changing instrumentation needs in the OR due to add-on cases, cancellations, trauma, etc., they can better respond to these needs,” she adds. “And when OR personnel are informed in advance about instrumentation issues in CSP, they may be able to substitute instruments, change schedule order, or compensate in some other way to allow the case or the day to run smoothly.” TRENDS IN STERILIZATION According to Conner, one of the biggest trends in instrument sterilization is the shift away from flash sterilization to immediate use steam sterilization. This has been enabled by the introduction of new rigid instrument containers that are designed for abbreviated steam cycles, she explains. “There is still a lot of confusion about the differences between flash sterilization and immediate use steam sterilization,” says Conner. WWW.ORTODAY.COM

“With flash sterilization, surgical instruments are placed into the sterilizer on an open tray. The drying cycle is abbreviated or eliminated so instruments are delivered to the point of use on an open tray, wet and hot. This makes it hard to ensure that instruments are not contaminated before reaching the point of use. “With immediate use steam sterilization, surgical instruments are placed in a rigid container that’s validated for abbreviated sterilization cycles,” Conner adds. “This protects them from contamination during transport to the point of use.” Janet Pate, JD, MHA, BSN, RN, director, Environment of Care and Employee Health at The Kirklin Clinic at the University of Alabama Health Services Foundation, also stresses the importance of safe transport of instruments from CSP to the OR. “Surgical instruments should always be transported to the OR in closed, puncture-resistant containers for safety purposes,” Pate says. “Ideally, instruments should be sent to the OR and received with only enough time to prepare for the case,” Koncur adds. “Sending instruments up the day, or even many hours, before they are needed reduces the flexibility for both departments to respond to the changing needs of the day.” Perioperative nurses should also be educated on the pre-cleaning steps they should take while dirty instruments are still in their hands to help CSP personnel do their job more effectively, Pate says. This includes the use of sterile water and instrument transport humectant pre-cleaners to help prevent the adhesion of bio-film and WWW.ORTODAY.COM

“The pre-cleaning process is critical to disinfection and sterilization, because you can’t sterilize bloody instruments. It gets the cleaning process started immediately, because the sooner breakdown occurs, the better. ”

bio-burden on surgical instruments before they are transported back to CSP. “The pre-cleaning process is critical to disinfection and sterilization, because you can’t sterilize bloody instruments. It gets the cleaning process started immediately, because the sooner breakdown occurs, the better. These pre-cleaners break down proteins and enzymes in blood and body fluid to better prepare the instruments for CSP, which receives a cleaner instrument before sterilization even starts.” For example, Prepzyme® Forever Wet Spray from Ruhof is an enzymatic pre-cleaning spray that helps prevent bio-burden from drying on the surface of instruments and scopes. It gently coats soiled instruments and scopes to maintain moisture for up to 72 hours. There is no single cleaning, inspection or sterilization process that works for every instrument. “CSP professionals must be familiar with the manufacturer’s Instructions for Use (IFUs) for each instrument, and staff must follow those recommendations for each instrument,” Lind says.

Robotic instruments, in particular, pose special reprocessing challenges, she adds. “Proper cleaning of robotic instruments requires a knowledgeable technician and the time and tools necessary to do the job correctly,” Lind adds. “As with all instruments, robotic instruments must be reprocessed in accordance with the manufacturer’s IFUs.” ON THE SAME PAGE IAHCSMM President Sharon Greene-Golden, CRCST, FCS, stresses that improving the relationship between CSP and OR personnel takes an understanding by everyone that they are all working together for the good of the patient. “Both teams need to understand that we need each other in order to function as a well-oiled machine,” Greene-Golden says. ‘”We must get on the same page and work together with respect and integrity for the jobs we all do daily. In the end, our patients win — and positive working relationships are formed out of the need to provide great service to the patient.”

March 2014 | OR TODAY

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n days when the weather cooperates, the Redfern family likes to take in seasonal activities in New England â&#x20AC;&#x201D; hiking in the spring, visiting the beach in the summer, diving in leaf piles in the fall and building snowmen in the winter.

Pediatric nurse

balances family, career By Matt Skou falos

Pediatric nurse Kate Redfern, RN, BSN, CNOR, has more of an opportunity to enjoy all those things with her husband, Paul, and children John, Sophie, and Will, since moving to part-time status at Connecticut Childrenâ&#x20AC;&#x2122;s Hospital in Hartford, Conn.

“I must say that it is wonderful to have your career and be at home with your kids,” Redfern said. “Currently, I am fortunate to work part-time. It’s a wonderful work/life balance. I’m able to have my career and at the same time able to volunI’ll never leave the OR. teer in my kids’ classrooms. “[But] I truly love where I work, I I absolutely love it. I love that love what I do, and I love the people that I work with,” she said. “Where it’s different each day, and else could you find that?” For Redfern, the job of being a I love that you have one mom extended naturally from the things she loved about her career, as a patient to care for at a time, one pediatric nurse, which boils down to one thing. patient to totally focus on, and in some “I really wanted to help people,” she said. “I was always interested in ways, you can’t be distracted from that. helping others and seeing that people can be the best that they can be.” — Kate Redfern, RN, BSN, CNOR After graduating nursing school, Redfern completed the usual circuit of assignments — hospice care, emergent care — and finally landed in the operat“I think sometimes you see, ‘Oh grace for families facing such ing room at Connecticut Children’s that [patient is] the same age as my significant medical issues is the Hospital, where she found her niche. son or my daughter,’ ” she said. “It superior level of care provided “I’ll never leave the OR,” she said. definitely brings [an emotional there. A myriad of specialists can “I absolutely love it.” component], but I think that you’re confer on difficult cases without “I love that it’s different each going to give the best care possible to families needing to travel to day, and I love that you have one that child [regardless].” multiple locations in order for their patient to care for at a time, one Caring for children in such a children to be seen. patient to totally focus on, and in setting is tough yet rewarding, “You have all the experts right some ways, you can’t be distracted Redfern said, and for the most part, there at your fingertips,” she said. “If from that.” the children set the tone. v Pediatric nursing is, in many ways, “You have some days that you’re And Redfern should know: she’s far more challenging than other leaving in tears, maybe, if things worked at the facility for almost 14 forms of nursing, because the didn’t turn out so great,” she said, years. As Connecticut Children’s patients are so vulnerable, and the “but kids are so positive, no matter Hospital pushes to earn a magnet stakes are tremendously high. what they’re facing.” designation, Redfern said she’s seen Redfern acknowledges that responsi“How can that not put a smile on nurses take a larger role in its bility, but said it doesn’t distract her your face if someone’s going through leadership, from establishing a from getting the job done. something so tough and they can still nursing practice council to instituting “Typically people who work with smile and give you a high-five?” shared governance as part of a children, I just think that that’s where At Connecticut Children’s coordinated care team. they really want to be,” she said. Hospital, Redfern said, the saving “Our goal is to give nurses a unified 54 OR TODAY | March 2014

WWW.ORTODAY.COM

Kate Redfern, RN, BSN, CNOR, is a pediatric nurse at Connecticut Children’s Hospital.

Kate Redfern’s children John, Sophie, and Will are seen at Storyland.

Pediatric nursing is, in many ways, far more challenging than other forms of nursing, because the patients are so vulnerable, and the stakes are tremendously high. Redfern acknowledges that responsibility, but said it doesn’t distract her from getting the job done. voice, and go over what our practice currently is and how it can change for the better,” Redfern said. “We’re focusing on evidence-based practice, and just really trying to give nurses a bigger voice in the hospital.” Whether contributing to research, quality assurance, staff development, or patient and family needs, Redfern feels nurses at Connecticut Children’s Hospital have driven progress in a variety of areas in the past year. “I think we’re making strides,” she said. “I think everyone realizes that we can change some of the things that we do, even with just handoffs to fellow nurses; ways to simplify things for the organization and make it streamlined.” WWW.ORTODAY.COM

“I enjoy the people that I work with,” she said. “We’re definitely a team and we stand behind each other 100 percent. I don’t doubt that my coworkers have my back and I have theirs.” Redfern credits her director-level executives with giving nurses the opportunity to have more of a voice in the facility as well. “Right now, we have a chief nursing officer that is very focused on giving a voice to nurses, and thinking ‘How can we thrive and make this the best hospital we can be with the best practice?’ ” she said. “I think people are much more in tune with change coming down the road, and maybe sometimes

giving it a chance.” Redfern said ongoing education is a big component of the nursing career track, whether healthcare workers pursue bachelor’s or master’s degrees, or other advanced certifications. Yet even as nurses work to educate themselves to be better prepared to take on more responsibility at the hospital, Redfern said she believes that the cost-consciousness that affects so much of healthcare still plays a big part in its day-to-day operations. Being “cognizant of the fact of healthcare changes,” of “not getting as much [financial] reimbursement and support” in the field affects every decision, she said, even in deciding whether to open a package of surgical tools before performing a procedure. “I see that nurses are going to have a bigger voice and a bigger role to play, and along with that is accountability too,” she said.

March 2014 | OR TODAY

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“Gel pad water blanket warming was more effective in maintaining normothermia after cardiac anesthesia compared with convective warming. This can be considered an advantage as the gel pad system is easy to use and quiet. Gel pad warming has replaced underbody convective warming during cardiac anesthesia at our institution.” — Charles E. Smith M.D., MetroHealth Medical Center ASA Poster, November 2009

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OUT OF THE OR HEALTH

BY MARILYNN PRESTON

ENERGY EXPRESS Lose Weight Fast! While You Sleep! Fat Chance!

ur obsession with obesity and idiotic diets is something I just wish would go away, like smoking indoors. “Snap out of it, America!” is the theme of my merry assault on addictive and fake foods. Eat real food. No added sugar. Exercise regularly. Be mindful about portion size. End of story!

OR TODAY | March 2014

But no. The more we learn, the less we know. This December, the Nutrition Action Healthletter – one of my favorite ways to keep up with smart-eating information – featured the work of Dr. Christopher Gardner, a leading obesity researcher and director of nutrition studies at the Stanford Prevention Research Center. It turns out, we’ve been led astray. Way, way astray. “We had three decades of low-fat and we had a decade of ‘Oh wait, no,

maybe low-carb,’ and then at the end of that, we said, ‘Oh, never mind, neither of them works,’ ” Gardner told reporter Bonnie Liebman. In his A to Z Weight Loss Study, Gardner and his team measured the effectiveness of the low-carb Atkins and low-fat Ornish diets, with the Zone and LEARN diets in between. His research found very few differences between these popular diets, and a review of the literature shows that how people lose weight and WWW.ORTODAY.COM

HEALTH

Eat real food. No added sugar. Exercise regularly. Be mindful about portion size. End of story! keep it off is still individual, elusive and mysterious. “If you pool all the studies, there’s no difference in weight loss between low-fat and low-carb diets . . . but even more disappointing, neither is very good for the average person.” I’m going to break into Gardner’s quote and repeat it: “Neither is very good for the average person.” “People aren’t losing a lot of weight and keeping it off, regardless of which diet they follow. You can argue about petty differences, but when you look at average weight loss, it’s hugely disappointing.” So much for what’s going wrong on a national scale. What about your scale? Diets don’t work, so what does? Here are a few more tasty tidbits gleaned from Gardner’s research and others: GET ENOUGH SLEEP Scientists have discovered people who sleep less (usually six or fewer hours a night) are more likely to gain weight over time than people who sleep more (seven to eight hours). WWW.ORTODAY.COM

Why? The studies are detailed in the Nutrition Action Healthletter (www.cspinet.org), but I’ll sum up: If you cheat yourself of sleep, the part of your brain that involves impulsecontrol goes haywire, and suddenly, you’re reaching for that second handful of candy. Other studies show that lack of sleep also raises blood sugar, making insulin less effective and boosting production of ghrelin, a hormone that stimulates your appetite. Give your body the sleep it needs and it won’t rebel by making you eat more. GROW HEALTHY MICROBIOTA Your stomach has a wisdom of its own, and scientists are discovering that having healthy microbes in your gut appear to help in regulating weight. “Healthy microbiota thrive on a high volume of diverse fiber,” Garner explained in the Nutrition Action Healthletter. And what foods have diverse fiber? “Whole grains, beans, vegetables and fruit.” Eating high-quality food is also essential: organic and seasonal vegetables; pasture-raised chicken and eggs; and grass-fed beef or pork.

“If they want cheese,” Gardner says, “we’d say, ‘Don’t go for the Kraft Singles.’ ” EAT REAL FOOD “We ask everyone to eliminate added sugars. That means less processed, packaged food and more cooking. I tell people to go to farmer’s markets more, because those words are somehow more intuitive that telling them to add up how many grams of unsaturated fat, how many grams of fish oil, how many grams of fiber, soluble or insoluble, glycemic index or . . . ‘My brain’s on overload,’ ” Gardner explains. “So I say, ‘Go to the farmer’s market and buy what’s fresh.’ ” Could it be any simpler? Eat more plant foods as opposed to foods made in plants. MARILYNN PRESTON – healthy lifestyle expert and Emmy-winning producer – is the creator of Energy Express, the longest-running syndicated ﬁtness column in the country. She has a website, marilynnpreston.com, and welcomes reader questions, which can be sent to MyEnergyExpress@aol.com.

March 2014 | OR TODAY

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out of the or fitness

Take simple precautions to prevent inj uries whe n you exe rcise

hether you’ve been exercising for years or are starting a fitness program, it’s important to avoid injuries so you can keep moving toward your fitness goals. We become more vulnerable to injuries as we get older, in part because we’re less agile than we used to be, and we’ve also lost some of our former bone and muscle mass.

“Recovery from injury can also slow with age,” says Dr. Eric Berkson, an instructor in orthopedic surgery at Harvard WWW.ORTODAY.COM

Medical School and director of the Massachusetts General Hospital Sports Performance Center. “It can take longer to recover from a smaller injury, and the injured areas remain vulnerable during the recovery period.”

Some of the most common exerciserelated injuries Berkson sees include: Sprains: Injuries to ligaments, the tissues that connect bones to one another Mu scle strains: Injuries to muscles or tendons, the tissues that connect muscles to bones

Tendinitis: Inflammation of a tendon, often due to overuse

ACL and meniscu s tears of the knee: A rip in one of the

ligaments that helps stabilize the knee or cartilage that cushions the knee joint

Rotator cu ff tears: Rips in the group of muscles and their tendons that hold the arm in the shoulder socket. To avoid getting laid up for days – or even weeks – with an injury, take these precautions when you work out: March 2014 | OR TODAY

out of the or fitness

program. Try to drink a glass of water before you exercise, and then take a few sips of water every 15 minutes throughout your routine.

8. Cool down 1. Talk to you r doctor

Don’t start any exercise program without first checking with your primary care provider. Your doctor can determine whether you’re healthy enough to exercise, and what, if any, modifications you’ll need to make to your program. “Exercise programs should be customized to the individual whenever possible to account for any limitations and ongoing medical conditions,” Berkson advises.

2. Choose you r workou t carefu lly

High-impact exercise programs aren’t ideal for women with conditions like arthritis or osteoporosis. Non-impact exercises, including swimming or using an elliptical exercise machine, will give you aerobic conditioning without stressing your joints.

3. Learn the proper techniqu e

Don’t start any new exercise without first learning the correct form. Work with a trainer at home or in the gym, or consult a physical therapist to help you tailor a workout to your health conditions and physical capabilities.

4. Get the right gear

Buy a pair of sturdy, comfortable sneakers that provide good arch support and have a cushioned heel to 64 OR TODAY | March 2014

absorb shock. Wear loose, comfortable clothing that gives you room to move and breathe.

5. Start gradu ally

Don’t jump into a new exercise program. “The greatest risk of injury comes with changing an exercise program or adding a new exercise,” Berkson says. Start slowly. If you’re cycling, for example, set the bike’s controls on the lowest speed and tension, and pedal for just a few minutes your first few times. Gradually increase the speed and intensity only when you feel ready.

6. Warm u p

Cold muscles are more injury-prone. “A proper warm-up can improve blood flow to the working muscle and reduce stiffness, potentially lowering the risk of injury,” says Berkson. Your warm-up should be active, meaning that you walk or do dynamic stretches, such as arm or leg lifts, for five to 10 minutes. Avoid passive stretches in which you assume a position and hold it, because they can lead to muscle tears. Use the right form when you exercise to prevent injuries.

7. Stay hydrated

When you work out, you sweat, and that means you lose some of the essential fluids your body needs to take you through your exercise

Finish your workout with a slow walk or gentle stretch for five or 10 minutes to cool down and maintain flexibility.

9. Vary you r workou ts Even if you love yoga, alternate it with other programs, such as dancing, tennis, or water aerobics. The variety will work different muscle groups, prevent boredom, and give your body a chance to recover between sessions.

10. Know when to stop

You never want to work out to the point of pain. If an activity hurts, stop doing it right away. “Playing through pain can often prolong your healing time and take you away from the game or exercise you enjoy,” Berkson says. “Remember to seek the advice of a medical professional whenever pain seems abnormal or is not improving.” Get help immediately if you suddenly feel dizziness, shortness of breath, or chest pain.

HOW TO TREAT EXERCISE INJURIES

By following all 10 steps outlined above, you should minimize your chances of injury. Yet no preventive strategy is foolproof. If you do wind up with a sprain or strain, here are some tips for treating it at home:

Ice it. Right after the injury, apply an ice pack for 15 to 20 minutes at a

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fitness

time, about once an hour. Cover the ice with a towel to protect your skin from the cold. Reapply the ice about four times a day. After 48 hours, you can put heat on the injury if the warmth feels good.

Wrap it. Wrap the injured area

in an elastic bandage. The bandage should be snug, but not too tight.

Relieve it. Take an over-thecounter nonsteriodial antiinflammatory drug (NSAID), such as ibuprofen, to bring down swelling and reduce pain. If your doctor says you should not take NDAIDS, acetaminophen can help relieve aches and pains.

Rest it. Avoid using the injured area until it heals. â&#x20AC;&#x201D; Harvard Womenâ&#x20AC;&#x2122;s Health Watch

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March 2014 | OR TODAY

out of the or nutrition

by Heidi McIndoo, M.S., R.D.

Granola can add some important nutrients to your diet

ranola used to be one of those foods, like yogurt, that you could only find in health ood stores where earthy, healthconscious people shopped. Fortunately, now granola is mainstream. Not only does every grocery store sell it, but they also carry all kinds of fl vors and varieties, with additions such as fruit, spices, nuts, flax, cho olate, honey and more.

Granola is great on its own as a breakfast cereal, but it’s also fun to sprinkle over yogurt to add a little crunch, to mix with dried fruits for a mid-day snack, or to just eat right out of the bag for an anytime snack. Bare bones granola is basically oats, with perhaps some nuts and sweetener, toasted until crunchy. Muesli contains similar ingredients, but it’s not toasted and has a chewier 66 OR TODAY | March 2014

texture. Oats, nuts, seeds and dried fruits can add important nutrients to your diet, including heart-healthy soluble fiber, protein, vitamins, minerals, healthy fats and phytochemicals (plant compounds with health-protective activities). But many supermarket granolas and muesli have extra ingredients that contribute to high fat and/or high sugar contents. HE LPFUL H INTS Before you grab some granola, check these tips to make sure it’s a healthy part of your diet: Pare down portions. Though it can be healthy, granola isn’t necessarily a low-calorie food. If you’re sprinkling it on yogurt, limit it to a few tablespoons. If you like it as a breakfast cereal, mix one-half cup of granola with one-half cup of another whole grain cereal, such as shredded wheat, oatmeal cereal, or bran cereal.

Check the su gar. Some granolas are loaded with sugar; flip the box over and check the label before tossing it into your cart. Look for those with 10 grams (2.5 tsp) of sugar or less per serving. Keep in mind that the grams of sugar listed on the label include those found naturally in fruit. Look to the ingredients list to identify sources of added sugar, which can include forms like honey, agave nectar and corn syrup. Know the ingredients. Granola is a fairly simple food, so the ingredient list should be short and include ingredients you can find in your own kitchen. Environmental Nutrition is the award-winning independent newsletter written by nutrition experts dedicated to providing readers upto-date, accurate information about health and nutrition in clear, concise English. For more information, visit www.environmentalnutrition.com. WWW.ORTODAY.COM

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OUT OF THE OR RECIPE

BY DIANE ROSSEN WORTHINGTON

ENDIVE SALAD WITH PEAR, PECANS AND GORGONZOLA A Seriously Simple ямБrst or last course

recipe

risee and Belgian endive are both from the chicory family. Sometimes mistaken for escarole that has broad leaves, frisee is really curly endive with frilly slightly peppery leaves. This member of the chicory family — which also includes radicchio, Treviso and Belgian endive — has white roots and green, spiky leaves. Ask your greengrocer to point it out if you’re not sure of what it looks like.

Ingredients:

Belgian endive (pronounced “on-DEEV”), with its tight stalk, is pretty easy to find at the market. This cool-weather salad combines the best of winter’s produce. I like the crisp, sweet, slightly creamy pear flavor contrasting with the Belgian endive and frisee along with the toasted pecans. Any Italian blue cheese will be delicious, but I am partial to Gorgonzola Dolce Latte, a rich and creamy yet delicate blue cheese. If you can’t find it, just substitute with other crumbled blue cheese. This is really a nice beginning to any lunch or dinner. It is equally delicious as the ending to a meal with its fruity sweet flavor notes. This recipe also can be doubled.

•

Belgian Endive Tips • Choose crisp, firmly packed heads that are white or pale yellow in color. Red endive should be bright colored with no wrinkled leaves. If the endive is very green, it might be more bitter than the lighter colored endive stalks. • Store endive in the vegetable drawer of your refrigerator. I like to wrap the stalks in paper towels in a lock-top plastic bag. • Wipe the outer leaves with a damp paper towel. Remove any torn or damaged leaves, trim the bottom, and use them as the recipe suggests. Diane Rossen Worthington is an authority on new American cooking. She is the author of 18 cookbooks, including “Seriously Simple Holidays,” and also a James Beard award-winning radio show host. You can contact her at www.seriouslysimple.com.

Serves 4 to 6.

Dressing: 3 Tablespoons sherry vinegar 2

Teaspoons honey Dijon mustard

Tablespoon lemon juice

1/2 Cup olive oil Salt and freshly ground black pepper

Salad: 1/2 Cup pecans 1

Medium head baby curly endive or frisee, rinsed, dried and torn into bite-size pieces

Belgian endive, ends removed and thinly sliced into vertical strips

Medium bosc or comice pear, peeled, cored and sliced

1/2 Cup crumbled Italian blue cheese like

Gorgonzola Dolce Latte

Directions: 1. In a small mixing bowl, combine the vinegar, mus-

tard and lemon juice, and whisk to combine. Add the oil and whisk it in slowly until it is emulsified. Season with salt and pepper. Taste and adjust the seasonings. Reserve.

2. Preheat the oven to 350 F. Place the pecans on a baking sheet and toast for 7 to 10 minutes or until lightly browned and aromatic. Reserve. 3. In a salad bowl combine the lettuce and endive with the pears and the toasted pecans. Arrange the blue cheese over the salad. 4. To serve, drizzle the vinaigrette over all and toss to mix well. Advance Preparation: May be prepared up to 4 hours ahead through step 3, covered and refrigerated. The dressing can stay at room temperature.

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OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS MARCH

Spring into Action! Spring is here, we have an extra hour in the month

thanks to Daylight Savings. So, what are YOU or your department doing to celebrate? Planning Continuing Education classes? Improving department processes? Let us know your “Spring Cleaning” plans and you could win lunch for your team! Submissions with pictures get a FREE T-shirt!

THE WINNER GETS LUNCH FOR THE ENTIRE TEAM!

SLEEP DEPRIVATION MAKES US APPEAR UNATTRACTIVE AND SAD from our Health and Nutrition Board

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NOISE-INDUCED HEARING LOSS (NIHL) OCCURS WHEN TINY SENSORY HAIR CELLS IN OUR INNER EARS ARE DAMAGED BY NOISES THAT ARE TOO LOUD AND THAT LAST FOR TOO LONG. The max volume of music in headphones is about 105 decibels. That’s 100 times louder than the noise level (85 decibels) at which workers are required to start using hearing protection. Listening to very loud music in headphones for even a few minutes puts you at an increased risk for hearing loss. Your ears can be your warning system for dangerous noises around you.

Nurses dispense comfort, compassion, and caring without even a prescription. — Val Saintsbury

THE H HOLIDAYS HAVE COME AND GONE. Most of the country has already been in a deep freeze, and there are still long, harsh months of winter yet to come. It’s no wonder many people come down with a case of the “winter blues.” This bummed out reaction occurs when the days are shorter and you spend much more time inside. To combat these feelings, you might try light therapy, and increasing physical activity. If it lasts more than a ﬂeeting day or two, it could be seasonal a° ective

The noise is too loud when: * You have to raise your voice to be understood by someone standing nearby. * The noise hurts your ears. * You develop a buzzing or ringing sound in your ears, even temporarily. * You don’t hear as well as you normally do until several hours after you get away from the noise. If you are around noises at this level, take protective action. To avoid NIHL: * Block the noise (wear earplugs or earmu°s ). * Avoid the noise (walk away). * Turn down the sound.

disorder (SAD) – a serious form of depression occurring in the winter months when there is less exposure to natural sunlight. Some symptoms of SAD include: Feelings of worthlessness or helplessness • Loss of interest or pleasure in activities you used to enjoy • Fatigue or decreased energy If you suspect your mental state is more than just a bad day, consider these ways to get help: • The Substance Abuse and Mental Health Services

Join the community!

Administration (SAMHSA) has a 24-hour helpline (800-662-HELP) for mental health services if you or someone you know needs immediate attention. • Find a doctor. SAD is not something you should deal with without consulting a professional. After evaluation, they may be able to prescribe a medication to help you. YOU CAN LEARN MORE about depression and other health issues at USA.gov.

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Clamps Innovative Medical Products, Inc… ………………… 5

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CS Spectrum Surgical Instruments Corp.… ……… 78

OTHE R Select Surgical Technologies…………………………… 4

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Patient Aids Innovative Medical Products, Inc… ………………… 5

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