OR Today - May 2014

AAAHC UPDATE

ARE SHARPS INJURIES A THING OF THE PAST?

SPOTLIGHT ON

JOYCE P. MILLER, DNP, RN: A PASSION FOR CARING

TAKE GOOD CARE

NURSES • SURGICAL TECHS • NURSE MANAGERS

GOING MOBILE:

REPLACING

COWS The move to replace computers on wheels with tablets in the OR

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

READ OUR CORPORATE PROFILE ON PAGES 42-45

MAY 2014

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CONTESTS AND WINNER

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• The humectant formulation creates a moisture retention barrier which keeps soiled instruments and scopes moist for a prolonged period of time – unlike a GEL which HAS NO MOISTURE RETENTION properties • Operating room safe, non-aerosol, multi-tiered enzymatic spray helps prevent bio-burden from drying on the surface of soiled instruments and scopes • Ideal for transporting soiled instruments that may sit for an extended period of time • Reduces tray weight during transport compared to liquid presoaks • Soiled sharps are visible through humectant • Decreases spills and potential cross-contamination

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Some people just look at the surface.

We go right to the core.

Introducing the 3M SpotOn Temperature Monitoring System ™

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From the makers of 3M™ Bair Hugger™ therapy and the 3M™ Bair Paws™ system comes an amazingly simple, accurate and non-invasive way to monitor core body temperature throughout the perioperative process. To learn more about this ingenious technology, visit spotontemperature.com.

3M is a trademark of 3M Company, used under license in Canada. SPOTON, BAIR HUGGER and BAIR PAWS are trademarks of 3M Company, used under license in Canada. ©3M 2014. All rights reserved. 603630O 3/14

CONTENTS

features

OR TODAY | May 2014

42 CORPORATE PROFILE

Cincinnati Sub-Zero continues to delivery patient temperature management systems to healthcare professionals more than 50 years after it opened its doors in 1963. The company’s line of hyper-hypothermia products includes therapeutic heat and cold therapy units. CSZ also offers warming and cooling blankets for healthcare providers.

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GOIING MOBILE: REPLACING COWS

OR Today looks at the future of computers on wheels (COWs) in the healthcare environment.

Technology has advanced every year since Apple introduced the first iPad in 2010 and tablet computers could soon replace COWs in the OR. Handheld computers could also soon be common in the surgery suite as well as in patient rooms.

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SPOTLIGHT ON

Joyce P. Miller’s career as a nurse has armed her with vast amounts of knowledge. She is now sharing her experiences with nursing students at Augsburg College in Minneapolis, Minn., where she stresses the importance of listening to patients and making them comfortable.

OR Today (Vol. 14, Issue #5) May 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. © 2014

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May 2014 | OR TODAY

7

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

16

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

EDITOR

11

John Wallace | jwallace@mdpublishing.com

ART DEPARTMENT Jonathan Riley Yareia Frazier Jessica Laurain

ACCOUNT EXECUTIVES

Sharon Farley | sharon@mdpublishing.com Warren Kaufman | warren@mdpublishing.com

24

71

INDUSTRY INSIGHTS 11 15

News & Notes AAAHC Update

COMPANY SHOWCASE 16

Jayme McKelvey | jayme@mdpublishing.com

CIRCULATION Bethany Williams

ACCOUNTING Sue Cinq-Mars

WEB SERVICES Nam Bui Taylor Martin Michelle McMonigle

Didage Sales Company

IN THE OR 20 23 24 32

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 62 64 69 71 74

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

76 Index

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OR TODAY | May 2014

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

With an operation this sensitive, you can’t by-pass feel.

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 affiliates. ©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 NEWS & NOTES

STAFF REPORTS

COOK MEDICAL INTRODUCES ECHOTIP PROCORE ENDOBRONCHIAL ULTRASOUND NEEDLE

C

ook Medical is introducing the first endobronchial ultrasound (EBUS) needle in the U.S. that can acquire histological samples. The EchoTip ProCore Endobronchial Ultrasound Needle gives physicians the ability to retrieve cell and tissue samples from lymph nodes or tumors in the pulmonary area.

It is a single-use needle that collects cell and tissue samples in order for a physician to diagnose lung cancer and various mediastinal diseases. The needle can be used for fine-needle biopsy of lesions of submucosal and

extramural lesions within or adjacent to the tracheobronchial tree or gastrointestinal tract.

Prior to the availability of the EchoTip ProCore EBUS needle, tissue samples from the pulmonary area could be obtained only by surgical methods. Minimally invasive procedures could obtain cell samples only through fine needle aspiration.

The EchoTip ProCore EBUS needle is designed with a core-trap technology that allows physicians to collect tissue samples through a minimally invasive procedure.

FIND OUT MORE: www.cookmedical.com.

FDA APPROVES BIOSENSE WEBSTER CATHETER Biosense Webster Inc. has received approval from the U.S. Food and Drug Administration for its ThermoCool SmartTouch catheter. It is the first therapeutic catheter approved in the U.S. that enables direct and real-time measurement of contact force during catheter ablation procedures for patients suffering from drug-resistant paroxysmal atrial fibrillation (Afib), sustained monomorphic ischemic ventricular tachycardia and Type I atrial flutter.

Providing doctors with contact force stability when applying radiofrequency energy against the heart wall during catheter ablation has been shown to improve outcomes as inconsistent tissue contact may result in incomplete lesion formation that could result in the need for WWW.ORTODAY.COM

additional treatment, and too much contact may result in tissue injury, which may lead to complications. The ThermoCool SmartTouch catheter enhances a physician’s ability to achieve stable and consistent application of contact force by providing direct, real-time quantitative feedback graphically displayed on the company’s Carto 3 system upon tissue contact. Without this technology, catheter tip-to-tissue contact has to be estimated through other indirect measures such as electrogram parameters and impedance but they have been shown to be poor predictors of contact force.

MORE INFORMATION can be found online at www.biosensewebster.com.

May 2014 | OR TODAY

11

INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

IMP PRODUCT HOLDS X-RAY CASSETTES DURING SURGICAL PROCEDURES Innovative Medical Products has designed the X-Ray Cassette Holder to hold an X-ray cassette allowing the surgeon to take intra-operative X-rays. The product is for use with IMP’s Universal Lateral Positioner that provides stable, lateral positioning for patients undergoing hip or other lateral surgery.

When the X-Ray Cassette Holder is employed, the anterior support column must be used with the hyperflexion plate in the Universal Lateral Postioner system for best image results. This is accomplished by moving the anterior support column out of the line of the X-ray beam.

MORE INFORMATION can be found at innovativemedical.com.

HOSPITAL GOWNS COMBINE COMFORT AND FUNCTION Forget the dreaded and uninteresting hospital gown. PatientStyle is focused on improving the patient experience by designing unique gowns that combine comfort and function.

“Hospital gowns today have been the same for many decades; they do not provide full coverage, are uncomfortable and inadequate for today’s healthcare consumers,” says Dusty Eber, President of PatientStyle. “We have created a hospital gown collection with stylish options for patients of all ages – increasing the sense of comfort and dignity during a hospital stay.”

PatientStyle’s adult gowns are available in many different styles, prints and sizes allowing full coverage and adequate access for nurses and doctors. The collection is made of a soft cotton-rich knit. PatientStyle’s products last for over 100 washes in industrial laundry. PatientStyle also offers a pediatric collection that is made with 100 percent micro polyester.

Hospitals are able to personalize PatientStyle items with logos and insignias, making them ideal for branding opportunities and promotional gifts.

FOR DETAILS, visit www.patientstyle.com

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OR TODAY | May 2014

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NEWS & NOTES

COVIDIEN ANNOUNCES CE MARK APPROVAL FOR PURITAN BENNETT 980 VENTILATOR

IMRIS RECEIVES FDA CLEARANCE FOR NEXT GENERATION VISIUS SURGICAL THEATRE IMRIS Inc. has announced U.S. Food and Drug Administration clearance of the newest generation VISIUS Surgical Theatre that integrates Siemens’ latest highfield MR scanners.

The new core imaging technology, based on Siemens Aera 1.5T(tesla) and Skyra 3.0T technology, helps IMRIS deliver better image quality with higher signalto-noise ratio, faster 3D image acquisition and improved ease-ofuse and workflow during neurosurgical procedures using intraoperative MRI (iMRI).

The addition of these MR systems expands the industryleading 1.5T and 3.0T MRI choices hospitals have when considering the unique, ceiling-mounted IMRIS solution for intraoperative imaging which brings the MRI to the patient during the procedure.

The first installation of this new generation VISIUS Surgical Theatre will be a four-room hybrid operating room suite at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

Covidien has announced that its Puritan Bennett 980 ventilator has received European Economic Area (EEA) CE Mark approval.

The new acute care ventilator from Covidien helps enable patients to breathe more naturally through innovative breath technology.

The Puritan Bennett 980 ventilator system is for patients ranging from neonatal to adult.

The ventilator system was also approved for commercial distribution in the U.S., Japan and Canada and will be available for sale in those countries as well as the EEA. FOR MORE INFORMATION about the Puritan Bennett 980 ventilator, visit www.covidien.com/PB980.

TELEFLEX LAUNCHES SINGLE-USE FIBER OPTIC LARYNGOSCOPE HANDLE Teleflex Inc. has announced the launch of the Rusch DispoLED single-use fiber optic laryngoscope handle.

The handle is the latest addition to Teleflex’s broad single-use anesthesia product portfolio.

The handle features sturdy construction, ergonomic grip, and optimal light output for intubation, WWW.ORTODAY.COM

all designed to inspire clinician confidence during critical procedures. The disposable design helps reduce the risk of cross-contamination and eliminate the hidden costs associated with reusable products.

The Rusch DispoLED Laryngoscope Handle is packaged individually in a preformed tray to protect

the integrity of the light source and preloaded batteries. With a validated 3-year shelf life, it can be safely stored for long periods and is ready to use out of the package.

FOR INFORMATION, visit teleflex.com.

May 2014 | OR TODAY

13

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

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INDUSTRY INSIGHTS AAAHC UPDATE

BY BRUCE E. CUNHA RN, MS, COHN-S

ARE SHARPS INJURIES A THING OF THE PAST? Not Entirely

T

he Needlestick Safety and Prevention Act was signed into law on Nov. 6, 2000, and took effect the following year. It was designed to improve protection from occupational exposure to bloodborne pathogens from accidental sharps injuries in healthcare and other occupational settings. It laid out in greater detail OSHA’s requirement for employers to “identify, evaluate, and implement safer medical devices.”

The Act also mandated additional requirements for maintaining a sharps injury log and for non-managerial healthcare workers to be more involved in evaluating and choosing devices. It was a significant step forward. Yet even now, 13 years after the act became a reality, sharps injuries have not been completely eliminated. It’s been said that every year, healthcare workers experience between 600,000 and 800,000 exposures to blood. (United States Department of Labor-Occupational Safety and Health Administration [USDOL-OSHA], 2001).

As a surveyor for AAAHC, (AAAHC devotes a core chapter to infection prevention and control and safety in its Accreditation Handbook), and as a Manager of Employee Health and Safety, I am particularly concerned with this area of employee wellbeing. So whether your

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Current data suggest that improvements in the design and distribution of equipment are making a positive impact on the incidence of needlesticks. organization is accredited or not, I offer the following guidelines to help you protect the safety of your staff.

TIPS FOR COMPLYING WITH THE OSHA BLOODBORNE PATHOGENS STANDARD: • Assure your bloodborne pathogen exposure control plan is reviewed and updated annually.

• Annually assess any non-safety sharps devices to see if a newer, safety sharps device exists to replace it.

• Make sure the update includes an evaluation by users of any technology that is safer.

• Check that all employees with the potential for blood exposure have been offered hepatitis B vaccine if they have not previously been vaccinated or do not have documentation of a positive hepatitis B titer.

• If you vaccinate an employee for hepatitis B, document that a follow up titer of immunity has been done.

HERE ARE SOME CRITERIA THAT YOU CAN USE IN EVALUATING YOUR FACILITY: • Are there any non-safety hypodermic needles or IV devices being used for patient care?

• Have items like safety scalpel systems been evaluated, and where possible, implemented?

• Are blunted suture needles

available and used in appropriate surgical applications?

• Are sharps containers located so they are easily accessible and not overfilled?

• Are safety devices activated after use?

• When recapping of a sharps is needed, is it done in a way that reduces/eliminates the potential for exposure?

The needlestick law was a landmark achievement for healthcare workers; and current data suggest that improvements in the design and distribution of equipment are making a positive impact on the incidence of needlesticks. But it’s up to all of us to make sure that the law is faithfully implemented and that we remain vigilant until sharps injuries are truly a thing of the past.

ABOUT THE AUTHOR Mr. Cunha is a Registered Nurse, certified as an Occupational Health Nurse, with a Masters Degree in Risk Control.

He has 35 years experience in Occupational Health Nursing and is currently the Manager of Health and Safety for a large Clinical System. Mr. Cunha is an accreditation surveyor for AAAHC.

May 2014 | OR TODAY

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COMPANY SHOWCASE DIDAGE

DIDAGE SALES COMPANY OR Equipment Solutions

D

idage Sales Company has been helping surgery centers and hospitals outfit their ORs since 1990. Customers think of the company as a one-stop shop, where sales consultants will help them find everything they need. The family-oriented, flexible company of 13 employees calls a 15,000-squarefoot warehouse and office in Warsaw, Ind., home. Didage specializes in the sale of new and refurbished operating room essentials, such as OR tables, electrosurgical units and defibrillators. In addition, the company carries and can help customers find just about any kind of equipment used in an OR at a price point that works for the customer.

“We help several surgery centers open every year. Our customers trust us.” says Director of Marketing Angie Tom. Owners Chris and Julie Rankin are as active in the company’s day-to-day operations today as they were when they set up shop 24 years ago. They wanted to provide an alternative to the common equipment salesperson.

Didage takes a consultative approach. “We can steer you toward the right equipment based on the experience we’ve had.”

The company sells equipment from a variety of manufacturers, so Didage salespeople are not biased toward any one brand. “We can tell you what the tried and true is.” Didage’s most popular equipment includes new and refurbished patient monitors, crash carts and tourniquets, as well as refurbished electrosurgical units, operating room tables, and instruments.

Didage’s sister company, Surgical Power, provides customers with orthopedic and power equipment from all manufactures.

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OR TODAY | May 2014

A full-time biomedical technician certifies each piece of refurbished equipment Didage sells. Plus, the company is an official new product dealer for 30 equipment manufacturers. The biomed fully tests every piece of equipment in the Didage showroom and warehouse to ensure that it meets or exceeds manufacturer specifications before it is shipped.

The company takes pride in knowing the equipment that is sold will meet the manufacturer’s specifications. It is not likely for a customer to have an issue with equipment purchased from Didage.

“Our distinguishing factor is our warranty,” Tom says. “There are a lot of companies that do what we do, but many don’t offer a warranty or test the equipment they sell.

They simply ‘spray and pray’ and just hope it works.”

As a testament to the quality of its equipment, Didage offers a one-year warranty standard on everything, unless other arrangements are made.

And on the rare chance a customer has an issue with a piece of equipment they have purchased, “we’ll go in and fix it.”

“We stand behind our products and that keeps our customers coming back.

We can do that for anybody – anything we can do that makes it easier on the purchasing department,” Tom says.

A COMPREHENSIVE APPROACH It’s clear that customers appreciate Didage’s comprehensive approach to equipment sales. “We have lots of repeat business – people have been working with us for 20 years and keep coming back.”

Didage has cultivated a stable of satisfied repeat customers with a straightforward bottom-line approach. “We have helped surgery centers and ORs save hundreds of thousands of dollars.” In the years following the recession, Didage’s business has been consistently on the upswing, because “people are now considering pre-owned equipment. We’ve been quite busy,” Tom says.

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SPECIAL ADVERTISING SECTION

Didage also works with facilities that are adding on or updating their existing equipment. The company will purchase equipment their customers no longer need, offering them a credit toward something newer.

Didage’s no-nonsense approach to matching customers with the equipment best suited to their needs extends beyond the core business. If the trade involves older equipment that isn’t likely to sell, Didage finds a way to donate it. “A lot of equipment, especially disposables, if we didn’t take it [from our customers] they’re just throwing it away.” Didage has always used its resources efficiently, so simply wasting equipment and supplies didn’t feel right, Tom says.

“Now, we keep [unwanted equipment and supplies] at our site and allow anyone who’s going on a mission trip or who works for a non-profit organization to come in and take it for free. If a volunteer sees something in the company’s regular inventory that they need, “we can work with the nonprofit to sell it to them at an affordable price, as close to cost as we can.”

That practice has contributed to Didage’s core strengths as an equipment sales company: to fulfill as many needs as possible for a wide range of customers’ unique situations. Often, purchasing officers will simply send the company a list of all the equipment their facility needs, and Didage will do the rest. The company’s biomed and sales consultants work to match the list with existing inventory, while a procurement manager finds the necessary equipment to fill in the blanks.

“If customers are looking for particular products, most of the time we can find them. We have the ability to work with other trusted dealers to bring it in and refurbish it ourselves. And we’re honest – we’re quick to defer if it’s something outside of our expertise.”

When a procurement officer brings in equipment that is ready for WWW.ORTODAY.COM

refurbishing, it goes through a rigorous process. The equipment is fully tested and repaired, then painted in the company’s on-site paint booth.

Then, Didage takes customization – and customer service – to the next level.

For facilities that want to add a little flair, Didage offers custom upholstery and paint on a variety of equipment.

“We did one retro OR for a surgery center – bright orange upholstery to match the large colorful square patterns on the floor and walls,” Tom says.

A BRIGHT FUTURE Didage has been in business for more than 20 years, and the company is here to stay, Tom says. Didage welcomes visitors at its facility, which has a storefront and a showroom.

Many customers stop in to browse, Tom says. “And we encourage that.”

After all, the company is located in the orthopedic capital of the world.

Warsaw, Ind., is home to three of the five largest orthopedic companies in the U.S. The company’s website (www. didage.com) serves as a virtual showroom. A search function and product photos make it easy for customers to go online and find what they need. The site also allows customers to compare products and request pricing 24 hours a day.

Recent growth has necessitated an expansion in Didage’s sales force.

“We’ve split our territories so we can offer a better level of service with our customers. We’re as busy as we’ve ever been. People are taking preowned equipment seriously.”

But the company won’t let growth affect its commitment to customer service. “People want that personal service,” Tom says. “We always answer the phones here. If you need us, you’ll always get us.”

Case in point: A surgery center customer’s operating table, which had been purchased directly through the manufacturer, stopped working.

The manufacturer had told them the table could not be repaired. The customer “called us in a panic,” Tom recalls. “We had a suitable table here, so we got it all ready for her, and I sent my best guy up to her facility in Michigan.” But instead of installing the loaner table, he repaired the existing table.

“He anticipated what parts were likely to be needed and had them back up and running in less than an hour.

That’s what our guys do – go in and fix problems. So they knew what to expect and could quickly repair it. They have become a repeat customer for us.”

Didage has customers in 44 countries and all 50 states. You can find them at industry trade shows such as the Academy of Orthopedic Surgeons, Ambulatory Surgery Association meetings and AORN. FOR MORE INFORMATION, visit www.didage.com or call 574-268-9098.

May 2014 | OR TODAY

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IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

Q

ACLS CERTIFICATION The director prior to me decided that OR RNs did not need to have Advance Cardiac Life Support certification. The decision gets challenged on a regular basis. Do you require ACLS for OR circulating RNs? A: Our hospital requires it because we do moderate sedation cases. In that case, the RN is responsible for the patient not anesthesia.

A: No, I do not require them to be ACLS certified unless they want to do it on their own.

A: Absolutely! All of our OR RNs and PACU RNs are required to have ACLS. A: We require ACLS and PALS for our Pre-Op, OR and PACU nurses.

A: Yes, if they are circulating for general cases.

A: ACLS is only required for the RNs who do moderate sedation cases in the GI lab and the PACU staff.

A: Yes, and PALS as we have pediatric patients too (ENT mostly).

A: All of our RNs are required to take ACLS as well as PALS. A: We don’t require it for our circulators, unless they provide moderate sedation, but do require it for our RNFAs and PAs. Anesthesia staff are required to have ACLS as they provide all the medications administered to the patient during surgery.

A: Currently, we do not require RNs in the OR to have ACLS. Our Ambulatory, PACU and Endoscopy RNs are required to have ACLS and PALS. Our current management team is very supportive of OR nurses obtaining ACLS certification, but it is not a requirement…yet.

A: We do IV conscious sedation and all of our surgery, PACU and OPS RNs must be certified in ACLS and PALS. A: Our surgery RNs do not do conscious sedation and analgesia. However, it is done in the Cath, GI, ED, Special Procedures and ICU. I know it can be costly to the facility, but consider the alternative if there is no knowledge of the meds, reversal agents or recovery care. We do not have a requirement in surgery. We do have a IV sedation and analgesia competency every year.

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OR TODAY | May 2014

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SUITE TALK

Q

INFECTION PREVENTION PROTOCOLS I was hoping that maybe some of you can help me out with protocols related to infections. When doing total joints, or any procedure, and it is known that the patient has a UTI is the procedure canceled until infection is cleared or do you proceed as usual? Is it policy in your facility that all patients have some type of screening done for MRSA or other infectious diseases? Does every patient or do any patients have to do a pre-shower before surgery with a chlorohexidine-based or other type of wash the night before their surgery? These are a few challenges I am facing and wondering what input any of you can give me.

A: We do have surgeons that will cancel for a UTI. We do MRSA screening on totals and patients do a Hibliclens shower the night before. We are also trialing bottles of foam hibiclens washer for the patients to use in the hospital and to take home. It will last about a week and has great cumulative properties. We are using it on OB right now. We previously trialed SAGE wipes but had to stop using them. It was a product that was left on the skin and it caused too many skin reactions and surgeons cancelling cases.

Q

A: Some of our physicians require either a bath/shower with Chlorhexidine the night before surgery or on the morning of surgery the nurses who prepare the patient for surgery perform a Chlorhexidine skin prep of the whole body followed by an extensive skin prep in the OR. Depending on how extensive the UTI is and if the patient is asymptomatic, the surgeon will usually just treat the UTI and perform the surgery. The antibiotic will be extended beyond the 24 hours post-op. Of course, it is always a physician’s judgment call based on the overall health of the patient.

A: The current recommendation is three showers with Hibiclens before surgery, two days before, one day before and the morning of surgery.

We are now giving out the small packets to the patients at PAT and instructing them about the shower. (The three small packets are cheaper than the small bottle). We also then wipe the area down in pre-op with the wipes. It is the physician’s preference on whether the case is cancelled with a positive urine.

SHIFT START TIMES Can you tell me your OR team shift start time in relationship to your first case start? Do you have orderlies or nursing attendants that set up first cases?

A: Our staff comes in 30-60 minutes before the start time of the first case scheduled in that OR. For example, for bigger cases requiring a longer set-up the staff would come in 60 minutes before the start time. For other cases, the staff would come in 30 minutes before the start time.

We try to flex time as much as possible.

A: At our facility, the scheduled start time is defined as “physician cut time.” To that end, our teams arrive one hour prior to the assigned procedure start time and the patient is generally picked up 30 minutes prior to the scheduled start time. This gives each team 30 minutes to prepare the room and then pick up the patient.

THESE POSTS ARE FROM OR NATION’S LISTSERV. For more information or to join the conversation, visit www.theornation.com.

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May 2014 | OR TODAY

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IN THE OR MARKET ANALYSIS

MARKET ANALYSIS

BY JOHN WALLACE

Wound Therapy

W

ound therapy is a lot more advanced from when you fell down as a child and a kiss from Mom made everything better.

While nothing beats a mother’s love, advances in wound therapy have created a market poised to reach $9 billion by 2020, according to Global Industry Analysts Inc. The transition from traditional wound care to advanced wound care and then active wound care and therapy devices has been steady. The use of simple dressings and bandages gave way to gels, alginates, hydrocolloids and collagen.

Then, skin substitutes and other advanced options became available.

The therapy device market consists of negative pressure wound therapy, hyperbaric oxygen therapy, whirlpool therapy, ultraviolet therapy, ultrasound therapy and others.

The market has grown and factors driving this growth include an aging worldwide population and an increase in chronic diseases such as diabetes and hypertension. Technological advances also contribute to the growth of the wound therapy market, according to RNR Market Research.

“Complex and chronic wounds such as diabetic ulcers, pressure ulcers, and trauma/surgical wounds have emerged to be one of the biggest challenges in healthcare, as they are hard to heal and are a significant drain on resources and nursing time,” according to GIA. “Advanced wound care products are increasingly WWW.ORTODAY.COM

emerging as the standard therapy for treating such slow healing wounds.”

“Substitution of traditional wound management strategies with advanced wound care products is largely due to their effectiveness in managing wounds by preventing accumulation of excess exudate, while maintaining the right level of moisture to promote healing with minimum scarring,” GIA adds.

“These products are increasingly being accepted by hospitals to reduce duration of patient stay and minimize the overall cost of healthcare. Growing knowledge of specifically formulated products and rapid technological innovations are also contributing towards market growth. Additionally, expanding base of aging population and rising prevalence of lifestyle related diseases such as diabetes and obesity that result in chronic wounds which need higher level of care, are also spurring opportunities for the market.”

Some treatments are gaining in popularity among healthcare facilities.

“Active wound care products including engineered tissue and epidermal growth factors are gaining popularity. These products are touted to speed-up the wound healing process, while also requiring relatively less frequent nursing attention,” according to GIA. “Low toxicity and biocompatibility characteristics are enabling active wound care products to emerge as attractive and effective wound care products. Negative pressure wound therapy has emerged as a highly effective solution for advanced wound management by accelerating wound healing by creating negative pressure

on the wound via a foam dressing.”

“A key trend in the advanced wound care market is emergence of combination dressings which are prepared using various available products of wound dressings in different combinations, generally a biological agent and an antimicrobial material,” the GIA report states.

“Apart from their moisture creation and retention capabilities, moist wound dressings have gained widespread usage owing to their ability to offer protection against bacteria and absorb excess wound exudate. Given their better effectiveness than hydrocolloids in managing highly exuding wounds, foam dressings are emerging to be one of the bright spots in the moist wound dressings market. Including an antiseptic agent that helps destroy micro organisms present in the wound, antimicrobial dressings also constitutes a growing segment in the market, with demand mainly spurred by rising prevalence of bacteria which is resistant to antibiotics.”

The United States is the largest section of the global market and the Asia-Pacific region is the fastest growing market with a compound annual growth rate of 11.9 percent, according to GIA. Manufacturers include 3M Healthcare, Coloplast A/S, CONMED Corporation, ConvaTec Inc., Covidien plc, Hollister Wound Care, Kinetic Concepts Inc., Medline Industries Inc., Mölnlycke Health Care AB, Organogenesis Inc., Paul Hartmann AG, and Smith & Nephew Plc. May 2014 | OR TODAY

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IN THE OR PRODUCT SHOWROOM

3M™ KIND REMOVAL SILICONE TAPE 3M™ Kind Removal Silicone Tape features a silicone-based, adhesive technology that delivers reliable fixation and atraumatic removal in one easy-to-use, affordable tape. It provides the adhesion level needed to get the job done, and helps minimize tape-related pain and skin injury.

Features include: • Security: Offers reliable yet pliable fixation, remains in place until you decide otherwise; • Comfort: Removes cleanly, without disrupting fragile skin layers or causing patients undue pain; and • Ease of Use: Can be repositioned and neatly torn by hand.

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OR TODAY | May 2014

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PRODUCT SHOWROOM

ANSELL GAMMEX™ BURN TREATMENT SOLUTIONS Ansell is changing the dressing treatment paradigm with the launch of GAMMEX™ Burn Treatment Solutions. The latest launch features novel, fully customizable solutions for the hard to dress areas in burn and wound care, including the first fully customizable silver antimicrobial barrier glove, featuring Velcro™ closures for adjustable compression and localized wound evaluation, and an outer dressing that offers superb fluid management 2x that of gauze. The line is part of a team therapy approach to burn and wound care, offering efficient, reliable and consistent application across providers. The launch includes four products compatible across treatments: GAMMEX™ Silver Barrier Glove, Silver Finger Dressing, Outer Dressing and Outer Finger Dressing. For more details, visit www.ansell.com/gammexburn.

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May 2014 | OR TODAY

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IN THE OR PRODUCT SHOWROOM

DEVON MEDICAL PRODUCTS EXTRICARE® NPWT SYSTEM The extriCARE® Negative Pressure Wound Therapy (NPWT) System combines powerful pump technology with easy-to-apply dressings to produce wound healing outcomes for patients suffering from various types of wounds, including those related to surgery. Weighing less than one pound, the extriCARE® system provides ease of use for caregivers and patients alike. The system is comprised of the extriCARE® 2400 pump (with pressure settings from 40-140mmHg), disposable 110cc or 400cc canisters that collect wound exudates, and various-sized NPWT dressings that create tight seals around wounds. The extriCARE® system is ideal for acute hospital settings, wound clinics and nursing homes. Visit www.devonmedicalproducts.com.

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OR TODAY | May 2014

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PRODUCT SHOWROOM

INNOVATIVE THERAPIES’ QUANTUM™ Innovative Therapies’ Quantum™ negative pressure wound therapy (NPWT) system is the first fully featured NPWT system with simultaneous irrigation. In a recent pre-clinical trial, Quantum’s simultaneous irrigation was proven to help reduce wound bed bacteria to promote faster wound healing.

Quantum also offers a new form of innovation for wound care – a cost-efficient model in which hospitals pay only for therapy hours used. This revolution in wound therapy helps hospitals gain better control of wound care costs by reducing NPWT associated costs by up to 35 percent, while potentially enhancing care quality. For more information visit itimedical.com.

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May 2014 | OR TODAY

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IN THE OR PRODUCT SHOWROOM

V.A.C.ULTA™ NEGATIVE PRESSURE WOUND THERAPY SYSTEM The V.A.C.Ulta™ Negative Wound Pressure Therapy System is an integrated wound management system that delivers proven V.A.C.® Negative Pressure Wound Therapy and V.A.C. VeraFlo™ Instillation Therapy, which consists of V.A.C.® Therapy coupled with automated, controlled delivery and removal of topical wound solutions. V.A.C.® Therapy, in the absence of instillation, is intended to create an environment that promotes wound healing by secondary or tertiary (delayed primary) intention by preparing the wound bed for closure, reducing edema, promoting granulation tissue formation and perfusion, and by removing exudate and infectious material. For more information, visit www.kci1.com.

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OR TODAY | May 2014

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PRODUCT SHOWROOM

SMITH & NEPHEW’S RENASYSTM EZ MAX Smith & Nephew’s Negative Pressure Wound Therapy (NPWT) portfolio provides innovative technology that is both clinically and cost effective. The RENASYSTM NPWT line offers application versatility – foam, gauze, drains – for a variety of care settings. The revolutionary RENASYS Soft Port replaces traditional plastic tubing with a soft, conformable, compression–resistant channel. The padded feel enhances patient comfort, and works even when twisted, folded or compressed. The PICOTM Single Use NPWT, with its patented, canister-free system, brings NPWT to new areas of use, including closed surgical incisions and discharge transitions.

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May 2014 | OR TODAY

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IN THE OR CONTINUING EDUCATION 392-60C

BY KATHLEEN M. BONCZYK, ESQ. AND MARGI J. SCHULTZ, RN, PHD, CNE, PLNC

CONTINUING EDUCATION 392-60C

SEXUAL HARASSMENT AND RETALIATION The goal of this continuing education module is to update the ability of nurses, dietitians, paramedics and EMTs, fitness professionals, health educators, laboratory professionals, respiratory therapists and social workers to recognize and deal with sexual harassment and retaliation on the job. After studying the information presented here, you will be able to: • Discuss Title VII legislation as it relates to sexual harassment • Describe the standard for retaliation under the law • List steps supervisors and managers should take to deal with complaints of sexual harassment and retaliation

ContinuingEducation.com 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 39 to learn how to earn CE credit for this module.

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D

anielle, a registered nurse and administrator of a 180-bed, skilled nursing facility, closes the door to her office, sits at her desk and removes her glasses. She rubs her throbbing temple and searches for the bottle of aspirin that is buried in her top desk drawer.

Earlier that day, the facility’s receptionist had called Danielle out of a staff meeting to tell her a gentleman in the lobby was demanding to see her immediately. Upon reaching the lobby area, the stranger got up from the leather couch where he had been sitting, immediately walked toward Danielle and asked her name in an abrupt, businesslike voice. After Danielle told him her name, he handed her a stack of documents, encouraged her to have a good day and walked toward the exit.

When Danielle glanced at the first page of the documents that had been handed to her, she saw the word “Summons,” the nursing facility’s legal name and a disclaimer warning her that her employer was being sued. The plaintiff was Brock Alan Pinder, an LPN who

worked on the 3 to 11 shift.

Brock was, in fact, scheduled to work that afternoon.

After faxing the summons and complaint to her company’s legal department, Danielle had a conference call with attorney Jennifer Stephens. Jennifer asked Danielle several questions about Brock’s employment history with the skilled nursing facility. When Jennifer asked Danielle’s opinion as to what kind of an employee Brock was, Danielle answered that he was quick to stand up for himself, especially in situations where he felt he’d been wronged. His manner of coming across could rub his coworkers the wrong way. There’d been one occasion, a year or so ago, when Danielle had to step in and mediate a resolution to a dispute involving Brock and two May 2014 | OR TODAY

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IN THE OR CONTINUING EDUCATION 392-60C

coworkers, Josephine and Nicole.

Thereafter, the problem seemed to resolve, and there had been no hint of ongoing issues between the two women and Brock.

But then, a few months back, Brock complained that he wasn’t getting his fair share of work hours and assignments. He contended that his immediate supervisor gave preferential treatment to his female coworkers when developing the work schedules. He also alleged that he was the one stuck working all the holidays while females were always given these days off to spend with their families. In response to these accusations, Danielle evaluated several months of work schedules and spoke with the scheduling supervisor. In the end, she could find absolutely no evidence of preferential treatment in the way the hours were assigned. She then sat down with Brock. Danielle showed Brock the schedules and addressed all of his concerns in detail. That was that — or so she thought.

Sometime later, Brock complained when an applicant from the outside was hired to work as shift supervisor.

Brock had interviewed for the job, and Danielle knew he wanted it badly.

The director of nursing, however, was seeking a candidate with supervisory experience — someone who could hit the ground running. While Danielle would have enjoyed seeing someone promoted from within, Brock lacked experience. Conversely, the candidate who was selected had years of experience supervising others. She was also pursuing her BSN at the local teaching university.

She seemed to be a good fit for the organization, and Danielle had been pleased with her progress so far.

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OR TODAY | May 2014

Danielle picked up the legal documents once again. In the court complaint, Brock alleged that he had been the victim of sexual discrimination. The complaint outlined his past problems with Josephine and Nicole, his concerns about the way the work schedules were developed and the loss of a promotional opportunity.

Brock complained that in each scenario, he had been discriminated against on the basis of his gender.

He also alleged that he suffered unlawful retaliation after complaining about sex discrimination in the workplace to Danielle and to his immediate supervisor.

Dropping the complaint on her desk, Danielle thought: “Now what?”

SEXUAL HARASSMENT AND THE LAW Sexual harassment is a form of sex discrimination that constitutes an unlawful employment practice in violation of Title VII of the Civil Rights Act of 1964.1 Title VII was passed as part of President Lyndon Johnson’s sweeping civil rights initiatives of the 1960s. This statute prohibits employment-based discrimination on the grounds of race, color, religion, national origin or gender in all aspects of the employment process, from recruiting through termination.

Remedies available under Title VII to a prevailing plaintiff in a sexual harassment lawsuit may include back pay; damages for future loss of earnings; compensation for emotional pain, suffering and mental anguish; reimbursement of attorney’s fees and court costs; and in situations where the person was wrongfully terminated, even job reinstatement.

There are two types of sexual harassment: • Quid pro quo • Hostile environment Quid pro quo is commonly regarded as the more serious of the two forms. It occurs when a supervisor, manager or other agent of the organization who has been conferred managerial authority over the employee abuses his or her power in a way that violates the law. Examples of this form of harassment involve scenarios where an employee is promised a raise in return for conveying a sexual favor or is fired for refusing to engage in a romantic relationship with the authority figure.

Conversely, hostile environment harassment centers on unwelcome sexual conduct that has the purpose or effect of creating an intimidating, hostile or offensive working environment, even if such behavior has no tangible or economic consequences, such as a raise or promotional opportunity. This type of behavior may involve sexually inappropriate jokes, sexual banter or the existence of inappropriate computer screen savers or calendars in the workplace.

The actions of supervisors, executives, coworkers and even customers, vendors and other workplace visitors can ultimately create an inappropriately hostile working environment.

In addition to Title VII, many states and local governments have also passed laws prohibiting sexual harassment and retaliation. For instance, after Title VII was enacted, states such as Pennsylvania, New York, New Jersey, Florida and California enacted legislation barring this behavior. Most of these statutes are modeled after Title VII. In some cases, they afford even more protection for WWW.ORTODAY.COM

CONTINUING EDUCATION 392-60C

the aggrieved person than the federal law does. Thus, a plaintiff could bring a sexual harassment lawsuit under federal as well as state or local law. For example, a complaint could be made up of two counts: the first alleging violations of Title VII and the second asserting claims under the applicable state or local law.

Although the behavior complained of and people involved could be the same, the plaintiff in such a scenario will allege that more than one law has been broken. Consequently, it’s necessary to consult the applicable law in the home jurisdiction to assess the employer’s obligations and the employee’s rights.

The harasser’s conduct must be unwelcome.2 Unwanted sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature constitute sexual harassment when submission to or rejection of this conduct explicitly or implicitly affects a person’s employment, unreasonably interferes with a person’s work performance or creates an intimidating, hostile or offensive work environment.

In contrast to traditional stereotypes that were in play in the years after the law went into effect, the victim and the harasser can be either male or female or any combination of the two. Thus, the target of the harassment could be the same gender as the person who is harassing him or her.

THE ROLE OF THE EEOC People who believe they have been the victims of sex discrimination must file an administrative charge of discrimination with the United States Equal Employment Opportunity Commission before bringing a WWW.ORTODAY.COM

The harasser’s conduct must be unwelcome.2 Unwanted sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature constitute sexual harassment when submission to or rejection of this conduct explicitly or implicitly affects a person’s employment, unreasonably interferes with a person’s work performance or creates an intimidating, hostile or offensive work environment. private lawsuit against the employer.

The EEOC is the governmental agency that interprets and enforces Title VII, as well as several other laws prohibiting workplace discrimination. The EEOC was established in 1965. It has been given statutory authority by the United States Congress to enforce Title VII. There are time limits governing when such charges may be filed, based on whether the complaining party’s rights are covered under Title VII only or under both Title VII and state or local law. In situations where there is no applicable state or local law barring sex-based discrimination, the charge of discrimination must be filed with the EEOC within 180 days from the date of the alleged violation. In other words, suppose the person believes he or she was terminated for rebuffing a supervisor’s sexual advances. The person in question lives in a jurisdiction that has no state or local law prohibiting sexual harassment. In such a case, the deadline to file a charge of discrimination with the EEOC is approximately six months from the termination date. However, this deadline is extended to 300 days if the complaint is also covered by a state or local law prohibiting sexual harassment.3 In any event, if a person believes his or her rights have been violated, it is best to act promptly in

lieu of procrastinating and possibly facing a situation where his or her charge has been time-barred.

During fiscal year 2011, the EEOC received a total of 11,364 charges of sexual harassment, down slightly from 11,717 charges during the prior fiscal year. Of those 11,364 charges, 16.3% were made by male employees.4 Also in fiscal year 2011, the EEOC resolved 12,571 charges of sexual harassment and recovered $52.3 million in monetary benefits on behalf of complaining parties. This figure, however, excludes monies recovered by the EEOC in litigation that was brought on behalf of charging parties by the agency’s attorneys.4 Lawsuits brought by the EEOC remain the exception, not the rule, as most people who sue their employers or former employers do so through the use of private counsel.

RETALIATION Title VII also bars retaliation against people who oppose unlawful sexbased discrimination or harassment.

Accordingly, it is illegal for an employer to coerce, intimidate, threaten, harass or interfere with a person’s rights when the person has spoken out or opposed unlawful discrimination or participated in an employment discrimination proceeding brought by the person in question or someone else. Sex-based May 2014 | OR TODAY

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IN THE OR CONTINUING EDUCATION 392-60C

retaliation is present in situations when an employer initiates some sort of adverse action against an employee who initiates a complaint of sex-based discrimination or sexual harassment in the workplace.

Where the issue of unlawful retaliation is concerned, “adverse action” is conduct that has been taken in an effort to dissuade a person from opposing sex discrimination or from participating in an employment discrimination proceeding. Examples of adverse actions can include terminating, demoting, refusing to hire, or refusing to promote someone who has complained of sexual discrimination.

In years past, employees in certain parts of the country were required to demonstrate that they suffered these types of “ultimate employment action or decision” to prove a retaliation claim under Title VII. However, everything changed on June 22, 2006, the date that the United States Supreme Court ruled on the landmark case of Burlington Northern & Santa Fe Railway Company v. Sheila White, 126 S. Ct. 2405 (2006). Before the White case, there was a split in the appellate courts across the land regarding the appropriate standard for retaliation.

In certain appellate jurisdictions, the plaintiff had to prove that he or she suffered an ultimate employment action or decision to prevail in a retaliation case brought pursuant to Title VII. An analysis of the facts in the White case demonstrates that such is no longer the situation.

THE ‘WHITE’ STANDARD FOR RETALIATION Sheila White was the only female employed in the maintenance of way department at Burlington Northern’s 36

OR TODAY | May 2014

train yard in Tennessee. Shortly after she was hired, White was assigned to operate a forklift. After White began working on the forklift, she complained that her supervisor, Bill Joiner, was making statements that women should not be employed in the maintenance of way department.

In addition, White stated that Joiner made insulting and inappropriate gender-based remarks.

White’s complaints led to an internal investigation, which resulted in Joiner being suspended and required to attend a sexual harassment training session. At the time she was advised of the results of the internal investigation, White was also informed that she was being removed from her job as a forklift operator. White was then assigned to a job performing track laborer duties.

Although there was no change in pay, this new assignment was generally regarded as a less prestigious, more strenuous and dirtier job. Additionally, the forklift operator position was believed to be a job that was better suited to a more senior male.

In response to this involuntary transfer of job duties, White filed an administrative charge of discrimination with the EEOC. After doing so, she was suspended for 37 days without pay for allegedly engaging in insubordination. This suspension was ultimately reversed, and White was reinstated to her job with full back pay. Nonetheless, White sought redress through the courts and eventually sued Burlington Northern. Her complaint alleged that the job reinstatement and suspension constituted illegal acts of retaliation prohibited by Title VII. Following a jury trial, White was awarded $43,500 in damages on her retaliation claim,

as well as attorney’s fees. The jury did not award punitive damages.

The trial court’s determination was appealed, and the case ultimately worked its way up to the United States Supreme Court. The principal issue before the Supreme Court was whether Burlington Northern, which had not fired or demoted White or cut White’s pay or benefits, had engaged in actionable retaliation for her complaints of sex-based discrimination.

In a 9-0 decision, the Supreme Court found that the transfer of White’s forklift responsibilities and her 37-day suspension without pay were sufficiently material and likely to have dissuaded a reasonable employee from making or sustaining a charge of discrimination. Thus, White did not need to prove that she suffered an ultimate employment action, such as involuntary termination. Where the issue of actionable retaliation was concerned, it did not matter that White was reinstated after her suspension or that she received full back pay for the 37 days she was off work. Under the facts of the case involving White, these two actions constituted retaliation prohibited by Title VII. This case gave rise to the White Standard for Retaliation, which is now the law across the land. In accordance with this standard, a retaliation claim could arise in situations that do not involve ultimate employment actions or decisions, such as a refusal to hire, a job demotion, a pay cut or an involuntary termination suffered after the person engaged in protected activity. Something much less than this could ultimately lead to a plaintiff prevailing in a cause of action alleging retaliation.

The White standard involves the following two-prong conjunctive test: WWW.ORTODAY.COM

CONTINUING EDUCATION 392-60C

• The employer’s challenged action would have been material (not trivial) to a reasonable person.

• The conduct likely would have dissuaded a reasonable worker from making or supporting a charge of discrimination.

If, after engaging in protected activity, the answers to these questions are “yes,” then retaliation is present.

All that is left for the plaintiff to do is to make a causal connection between the protected activity and the challenged action.

RETALIATION POST-WHITE Since the White case, there’s a general consensus that it’s easier for a plaintiff to bring a retaliation claim because the complaining party does not need to show that he or she suffered an ultimate employment action or decision. Other acts that do not immediately hit the person in the pocketbook, so to speak, can be tantamount to retaliation. For instance, threats, unjustified negative references, modifications in job schedules, changes in assignments, negative performance evaluations or increased surveillance of an employee who has spoken out against unlawful discrimination may rise to the level of retaliation.

However, that actionable retaliation does not involve petty slights or annoyances, such as a stray negative comment in a neutral or positive evaluation. Generally speaking, the off-hand snubbing of a person, justifiable negative evaluation or refusal to promote will also not equate to retaliation.

There seems to be little question that the White standard is plaintiff friendly. In addition, statistics maintained by the EEOC demonWWW.ORTODAY.COM

strate that the agency has noted a dramatic increase in the amount of retaliation charges since the White decision. During fiscal year 2009, the EEOC received a total of 28,948 charges of retaliation brought under Title VII. In 2011, this figure jumped to 31,429 charges.5 These statistics seem to suggest that employers should anticipate more cases involving retaliation in the years to come, as the filing of an administrative charge with the EEOC is a necessary condition precedent to litigation.

MINIMIZING THE POTENTIAL FOR LEGAL EXPOSURE The best way to avoid a lawsuit is to take measures to prevent one from occurring. Even in situations where the employer is the prevailing party in a lawsuit, the employer still loses.

This is because so much is lost, both quantitatively and qualitatively, in the defense of a lawsuit. Time that could be directed toward running a more efficient organization now needs to be devoted to depositions, responding to interrogatories, and appearing in court. Then there is the issue of court costs and defense attorney fees.

The bottom line is that employment-based litigation is costly, disruptive and time-consuming.

Consequently, it makes good sense for employers to institute effective human resources grievance procedures so employees who believe they have been victimized by unlawful discrimination will step forward and complain, rather than going to the EEOC or plaintiff’s counsel.

Nevertheless, employees are sometimes reluctant to complain about sexual harassment because they fear retaliation for doing so.

However, as there is a possibility that

an employee can lose on a sexual harassment claim, but win a judgment on a claim of retaliation for filing that claim, employers must avoid any actions that could be construed as retaliatory in nature.

They should also implement employee-friendly systems that encourage people to step forward with any concerns of discrimination, including an employee grievance procedure.

Investigations into employee complaints should be prompt, thorough and effective. If someone directly or indirectly invokes the grievance procedure, the investigator should take immediate action. The investigator should meet with the complaining party in a timely manner. Do not allow the problem to fester. Furthermore, this meeting should be conducted in private, away from prying eyes and ears. Each complaint should be dealt with individually, as there is no cookiecutter approach to investigating discrimination complaints. Nonetheless, realize that when a complaint is received, the investigator is dealing with an allegation of discrimination, not a fact. Thus, steps must be taken to protect all parties involved, including the alleged harasser.

In almost all cases, the investigator should meet with the complaining party first. This is an important meeting. Essential facts can be forgotten or embellished as time goes on, so be sure to ask sufficient questions regarding all key matters.

Do not be afraid to ask tough or embarrassing questions. Additionally, avoid asking leading questions or those that simply require “yes” and “no” answers. This is the time for information gathering regarding what has occurred, when it occurred and who witnessed these events.

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IN THE OR CONTINUING EDUCATION 392-60C

Putting the person at ease as much as possible under the circumstances is crucial. Offer the person a drink of water. Ask for permission to take notes. While the meeting’s events must be documented, it is more important to ensure that the person opens up to the investigator and speaks freely. So, if jotting down contemporaneous notes makes the complaining party nervous, put the pen down and document the meeting as soon as it is concluded.

While asking questions, look the person in the eye, but do not stare him or her down. Avoid negative or judgmental facial expressions or body language. At the conclusion of the meeting, advise the complaining party to get back to you with any additional information that comes to mind. Then, while the investigation continues, stay in contact with the complaining party. Long periods of time without any feedback may make the complaining party conclude that the investigation has been dropped, even if it has not. In certain cases, it will take time to speak with the various witnesses and evaluate all the evidence.

As soon as it’s possible, communicate with the alleged harasser. Put him or her on notice that a complaint has been filed and that an investigation has commenced. Then, in no uncertain terms, tell the person that he or she is not to take any action whatsoever against the complaining party that could be construed as retaliation. The last thing the organization needs is for the alleged harasser to have a knee-jerk negative reaction and lash out at the complaining party for exercising the grievance procedure. Thus, it may 38

OR TODAY | May 2014

make sense to separate the alleged victim and harasser while the investigation continues. If this is not possible or practical, monitor the situation closely to guard against retaliation. Gather the necessary information, conduct all interviews and assess the situation based on the evidence provided. Get back to the complaining party and provide him or her with the results of the investigation. Thoroughly document all aspects of the investigation. If the results of the investigation are inconclusive, advise both the complaining party and the alleged harasser of this, and then review the company’s policy on harassment and retaliation with both. If, conversely, the investigation determines that corrective action needs to be taken, including involuntary termination, carry out the decision without delay.

Dealing with discrimination complaints is never pleasant. They can also be time-consuming, mentally draining and tricky. Thus, supervisors and managers with any questions on how to conduct an investigation into these complaints should confer with the organization’s human resources department, legal counsel or outside attorney.

REFERENCES

KATHLEEN M. BONCZYK, ESQ., is an attorney in Florida.

charges.cfm. Accessed November 27, 2012.

1. Title VII of the Civil Rights Act of 1964.

The U.S. Equal Employment Opportunity Commission Web site. http://www.eeoc. gov/laws/statutes/titlevii.cfm. Accessed November 27, 2012.

2. Facts about sexual harassment. The U.S. Equal Employment Opportunity Commission Web site. http://www.eeoc.gov/facts/ fs-sex.html. Accessed November 27, 2012.

3. Filing a charge of discrimination. The U.S. Equal Employment Opportunity Commission Web site. http://www.eeoc.gov/ employees/charge.cfm. Accessed November 27, 2012.

4. Sexual harassment. The U.S. Equal Employment Opportunity Commission Web site. http://www.eeoc.gov/laws/types/sexual_harassment.cfm. Accessed November 27, 2012.

5. Charge statistics FY 1997 through FY 2011. The U.S. Equal Employment Opportunity Commission Web site. http://www. eeoc.gov/eeoc/statistics/enforcement/

MARGI J. SCHULTZ, RN, PHD, CNE, PLNC, is nursing director at GateWay Community College and director of Maricopa nursing at the Maricopa Community College District in Tempe, Ariz. She has worked as a legal nurse consultant and teaches online courses on ethics, leadership and legal nurse consulting.

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CONTINUING EDUCATION 392-60C

HOW TO EARN CONTINUING EDUCATION CREDIT 1.

2.

Read the Continuing Education article.

Go online to ce.nurse.com to take the test for $10. If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at www.nurse.com/unlimitedCE for $44.95 per year.

DEADLINE Courses must be completed by December 15, 2014.

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.

Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test.

5.

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CORPORATE PROFILE

CINCINNATI SUB-ZERO

Q

Please share a little bit about your company’s history and how you achieved success.

Cincinnati Sub-Zero (CSZ), a leading provider of temperature management equipment for over 70 years, serves medical and industrial industries with high quality temperature management products and services worldwide.

Although our products are specific to each of our three divisions, Medical, Industrial and Testing, each division leverages and builds upon the successes of the others.

The Medical Division designs products with both the caregiver and patient in mind. Products are designed for patient comfort and ease of use with innovation and one of a kind products used to manage patient body temperature in the operating room, recovery room, intensive care units, and other areas of hospitals throughout the world. CSZ has delivered patient temperature management

42

OR TODAY | May 2014

systems to healthcare professionals since 1963. Our complete line of hyper-hypothermia products include therapeutic heat therapy and cold therapy units along with a complete line of warming blankets and cooling blankets for body temperature regulation and hyper-hypothermia treatment.

Cincinnati Sub-Zero understands the pressure faced by healthcare professionals today to reduce costs without sacrificing patient safety, comfort, and quality of care. CSZ provides solutions to help meet your needs with a full line of temperature management products.

Q

What are some advantages that your company has over the competition?

At Cincinnati Sub-Zero we put the needs of people first. All of our products are built at our Cincinnati, Ohio facility. You’ll notice the difference in every aspect of our work, from the quality of each product straight through to the variety of products and services that we offer. You’ll be at an advantage when you work with CSZ. We are proud of the quality, design and engineering of each of our products. When you work with Cincinnati Sub-Zero you can

be assured that you will get exactly what you need to deliver top-rate care. We are positively known throughout the healthcare community and our certifications show our commitment to topquality total patient temperature management.

Q

What product or service that your company offers are you most excited about right now?

Right now we are focused on promoting our Hyperthermia system called the Norm-O-Temp along with our Gelli-Roll blanket.

The revolutionary and simpleto-use Gelli-Roll® combines patient temperature management and comfort. It can be used for patient warming or cooling (with the Blanketrol), before, during and after surgery. It is a reusable water blanket encapsulated in Akton® polymer.

The Norm-O-Temp® is a whole body hyperthermia system that allows conductive warming therapy to be administered. It can be used in the operating room, pre-op, recovery, emergency department or any department in need of patient warming therapy.

Here is what one user has to say about the Norm-O-Temp and Gelli-Roll system.

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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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What is on the horizon for your company? How will it evolve in the coming years?

Cincinnati Sub-Zero is a leader in Temperature Management and we are always looking toward the future.

We believe it is vital to our business to listen to the wants and needs of our customers. The feedback our customers provide helps us to improve our product designs and continuous improvement efforts. We will continue to introduce cutting edge temperature management products to improve patient outcomes.

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Please share some company success stories with our readers — one time that you “saved the day” for a customer.

Cincinnati Sub-Zero is very proud of its products and the lives that can be WWW.ORTODAY.COM

saved with when using them. Two stories that can be found on our website (www.cszmedical.com) are about 2 little girls whose lives were saved with our products. Mia Ordway and Avery Fitzgerald were both born with HIE (Hypoxic Ischemic Encephalopathy). Both babies were treated with induced hypothermia and cooled with our Blanketrol III. The treatment was able to help them heal and give them a normal life. Both are healthy toddlers now.

Another story about a life that has been saved with our products is about soccer player, Fabrice Muamba who suffered an on-field cardiac arrest. The 23-year-old midfielder’s

heart stopped for 78 minutes following his collapse and he was rushed to London Chest Hospital for induced hypothermia treatment. Cincinnati Sub-Zero’s products were used to treat Fabrice, he has been blessed with a positive outcome.

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What is your company’s mission statement, or if you don’t have a specific one, what is most important to you about the way you do business?

Cincinnati Sub-Zero’s Mission: Our mission is to deliver worldclass temperature management solutions to our customers right the first time.

May 2014 | OR TODAY

43

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GOING MOBILE: REPLACING COW S

The move to replace computers on wheels with tablets in the OR

S

BY DON SADLER

ince Apple introduced the first iPad in 2010, tablet computers have become increasingly common. Many

people have gone so far as replacing their laptop or desktop computers with tablets.

But is this practical in the operating room environment? Will tablets ever replace the computers on wheels (or COWs) that most surgeons and perioperative nurses rely on to track patient admissions and records as well as nursing and physician documentation?

STILL IN ITS INFANCY The move to replace COWs with tablets in the OR is still in its infancy, notes Andrew Litt, M.D., Chief Medical Officer with Dell Healthcare and Life Sciences.

“Tablets are just now starting to make their way into the operating room, so we’re early in the adoption process,” says Litt.

Ken Jarvis, Director, Health & Life Sciences Industries, Americas Region at Hewlett-Packard, agrees.

“This has been the big issue on their technology plate,” he says about EMRs. Ensuring data security is another obstacle to the widespread adoption of tablets in the OR. “This is especially true with surgeons bringing their own devices into the OR, which can introduce malware and other security breeches into the hospital’s IT system,” says Litt.

“There is a small minority of early adopters using tablets who can pinch and zoom to enter data, but most nurses still want to enter data on a full keyboard and see it on a 24-inch monitor,” he says.

POTENTIAL BENEFITS OF TABLETS Despite some limitations and drawbacks, Jarvis and Litt see incredible potential when it comes to using tablets in the OR.

I think the biggest advantage of tablets in the OR is the fact that they bring data closer to the patient. COWs helped in this regard, but tablets take it several steps further.

– Andrew Litt, M.D., Chief Medical Officer with Dell Healthcare and Life Sciences

“We’re not seeing a huge move toward tablets in the operating room yet,” Jarvis says. “Many hospitals have been preoccupied over the past year with the migration to Windows 7, and Windows 8 is coming up next.”

In addition, many hospital IT departments are still dealing with electronic medical record (EMR) implementation, Litt adds.

50

OR TODAY | May 2014

With the heavy focus at most hospitals on infection prevention, sterilizing tablets and keeping them sterile in the OR environment is another concern.

“Sterile casings need to be developed for tablets so they can be used in the sterile field and kept sterile,” Litt says.

And there is the challenge of a different workflow for data entry, Jarvis adds.

“More hospitals are starting to look at where they can introduce mobile technology to improve patient engagement and streamline the workflow,” says Jarvis.

“I think the biggest advantage of tablets in the OR is the fact that they bring data closer to the patient,” says Litt. “COWs helped in this regard, but tablets take it several steps further. And many patients today, who use WWW.ORTODAY.COM

More hospitals are starting to look at where they can introduce mobile technology to improve patient engagement and streamline the workflow.

– Ken Jarvis, Director, Health & Life Sciences Industries, Americas Region at Hewlett-Packard

smartphones and tablets in their everyday lives, expect this kind of mobile technology from their healthcare facilities.”

Also, many ORs have space limitations.

“There’s more and more technology that needs to fit into the OR, but many ORs just aren’t built for all of it,” Litt says. “Tablets offer an opportunity to make ORs much more efficient.”

In an interview with TabTimes, Dr. Felasfa M. Wodajo, MD, an assistant professor of orthopedic surgery at the Virginia Commonwealth University School of Medicine’s Inova Campus and Georgetown University Hospital, described several different ways he uses an iPad in the operating room.

“For me, the most important use in the operating room is for reviewing imaging studies,” he WWW.ORTODAY.COM

stated in the interview. “Traditionally you look at a CD-ROM at a PC workstation, and once you are scrubbed you can’t easily go back and change the images. With the iPad you can continually change which slices you look at wherever you are.”

Wodajo also transfers photos he has taken with a digital camera during surgery to his iPad so he can share them with the patient’s family and friends in the waiting room. He believes that surgeons are just scratching the surface of the potential of using tablets in the OR. In particular, he is interested in the possibility of using the iPad’s built-in sensors, like the accelerometer and gyroscope, to create new assistive surgical tools.

In an interview with The SmartVan, Daniel Schwartz, the medical director at QxMD, a software company that creates

mobile apps for medical professionals, described another practical use of tablets in the OR: for documenting the surgical safety checklist.

“We have actually implemented the checklist into a full-featured tool so that people can actually run through the checklist and track it electronically as they are in the operating room,” Schwartz stated in the interview. “This is a really practical example about how we hope people will use these tools at the point of care to improve patient outcomes. The whole idea of having it on a tablet device is that the number of these tools is increasing exponentially.”

“The surgical checklist is the perfect place to bring an IT, rather than a manual, approach to standardized procedures,” adds Litt. “This is an opportunity for tablets in the OR that hasn’t been widely explored yet.”

May 2014 | OR TODAY

51

THE DELL VENUE 11 PRO’S enhanced security features — including multi-factor biometric access authentication, like smartcard and fingerprint readers — meet stringent HIPPA compliance standards.

“This gives OR staff the peace of mind to easily enforce and adhere to some of the most rigorous security regulations.”

– Andrew Litt, M.D.

CULTURAL AND WORKFLOW CHANGES The move away from COWs to tablets in the OR is about much more than just devices or software — it’s about cultural and workflow changes, says Litt.

“It will require a different way of thinking on the part of all OR personnel,” he explains.

Jarvis suggests that hospitals develop an overall mobility strategy that details how mobile devices like tablets will be used to optimize the OR environment.

“This involves determining how tablets will be used to improve productivity, efficiency and patient engagement. Hospitals need to decide where, when, why and how they will use mobile technology,” he says.

Christine Kennedy RN, BSN, MA,CNOR, the Nursing Informatics Coordinator with Lawrence and Memorial Hospital in New London, Conn., suggests 52

OR TODAY | May 2014

that a good first step for OR personnel considering transitioning from COWs to tablets is to ask their IT or IS department to request that a vendor bring some tablets in to try them out.

“This will answer a lot of questions right out of the gate, and you won’t have to play a guessing game,” says Kennedy.

“In addition, IT and IS will be familiar with all the factors that will come into play in choosing a device, like ergonomics, the weight of the device, how it will be carried around, how it will be cleaned, etc.”

Two tablets that are currently being used in the OR environment are the HP EliteBook Revolve and the Dell Venue 11 Pro tablets. According to Jarvis, the HP EliteBook Revolve allows surgeons and OR nurses to access, collect and verify information immediately.

“This helps improve the accuracy of patient records and the overall

patient experience,” Jarvis says.

Meanwhile, the Dell Venue 11 Pro’s enhanced security features — including multi-factor biometric access authentication, like smartcard and fingerprint readers — meet stringent HIPPA compliance standards.

“This gives OR staff the peace of mind to easily enforce and adhere to some of the most rigorous security regulations,” says Litt.

In an interview with OR Manager, Dr. Keley John Booth, MD, predicted that tablets and smartphones will start to replace COWs and even WOWs (or wireless computers on wheels).

“Tablet devices are going to allow us to do everything a WOW can do on a lightweight platform,” he said in the interview. “We are going to see leaps to the point where mobile technology becomes a mainstay.”

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SPOTLIGHT ON: JOYCE P. MILLER, DNP, RN

BY MATT SKOUFALOS

A PASSION FOR CARING Nurse shares lessons on communication, technology and trust

E

ven after 40-plus years, Joyce P. Miller, DNP, RN, couldn’t see herself in any other profession than nursing.

“I have always wanted to be a nurse,” she said, “even when I was in high school. I’m not sure where it came from, but there was always this passion to care for people.”

Since Miller attended nursing school in the 1970s, her career included a 38-year turn at the Mayo Clinic in Rochester, Minn., with

WWW.ORTODAY.COM

more than 25 years in the operating room. She then transferred into a teaching role at Augsburg College in Minneapolis, Minn.

“I remember not knowing much about the operating room when I first applied,” she said. “I just knew that I needed a change … and I remember thinking ‘What a tremendous opportunity and what a tremendous learning curve.’ ” One of the things Miller observed during her time working in the hospital was the need for families to get a greater degree of clarity about what happens in the operating room.

She recalls hearing family members of surgical patients say that the OR is “kind of like this mystery place” for them. Comments like that prompted her to began a pilot program with five orthopedists on staff to become a nurse communicator.

“That was a really unique piece of perioperative nursing that most people don’t think about,” Miller said. “We provided updates when the patients went into the operating room. For a couple years I continued to grow the program and now it’s a thriving program, and very, very well-received. Families love it.”

May 2014 | OR TODAY

57

“You really have to take a look at the person as a holistic human being.”

“We can’t do a cookie-cutter approach to care; every patient isn’t the same; every person needs something different.”

Providing that depth of communication to families of patients is important, Miller said, not only because the complexity of their cases is ever-increasing, but also because of the speed with which they are admitted to and released from the hospital.

“I think a big piece of nursing is really caring for the patient and understanding the patient well enough to say, ‘What makes you heal, what makes you feel better?’ ” Miller said. “The complexity of their illnesses; their acuity level is so much higher, and nurses really need to be educated to know that it’s more than the disease.”

“You really have to take a look at the person as a holistic human being,” she said. “We can’t do a cookie-cutter approach to care; every patient isn’t the same; every person needs something different. To really help them and provide care that’s 58

OR TODAY | May 2014

unique to that individual is really tough to do when you’re taking care of multiple patients.”

In addition to offering differentiated care, Miller said, nurses should be approaching the delivery of care with an eye toward global health and wellness, “because it’s not just the illness” that providers should be treating.

At Augsburg College, where Miller is an assistant professor, students can attend master’s and doctorate-level courses in transcultural nursing, where environmental issues weigh more heavily on professionals’ decision-making than in the hospital setting.

“How do you discharge a patient who’s homeless?” Miller said. “It’s great to think about [how] you need this medication, but realistically, how can you afford this medication? And then the doctors wonder why they’re noncompliant.”

Miller emphasizes that nurses should work foremost on developing a rapport of trust with their patients rather than speaking to them from a position of authority. Without trust and an open dialogue, she said, nurses might not have an accurate concept of how likely a patient is to succeed with a given course of care.

“Physicians will see a patient, and they’ll get out their little book and say, ‘Yep, this is the best diagnosis, the best treatment for this,’ and say, ‘This is what you need to do,’ ” Miller said. “But until you talk to the patient and understand what else do they do, how does that complement or not complement what the physician is recommending for them?”

“I say to the nurses: your patients are the lessons you need to learn from, and they know what helps them.” Miller added. “Is this something that they realistically can do, and if not, what is it that would help?”

WWW.ORTODAY.COM

For an example, Miller cites a pair of health commons projects in which she participates. One serves the homeless community, and the other caters to the needs of the significant Somali population in her area.

She tells the story of a Somali woman who came to the commons looking for some clarity on her prescriptions — she had been issued 18 bottles of blood pressure medication from various trips to the clinic. Together with a Somali physician volunteer, Miller said, they worked out the best course of action for her care.

“When I talk about healthcare and the complexity of care, it’s really understanding and making sure that that patient understands, and is going to do the follow-up,” she said.

“Language barriers make it even more complex because people don’t want to be rude, and they want to be polite; ‘The physician knows so I’m just going to nod and say yes.’ ” Technology and patient care can clash just as easily as any language barrier, Miller added. Although electronic medical records are convenient, portable (and federally mandated), she says they can threaten to remove nurses from “the caring aspect” of patient interaction.

“Sometimes the hospitals design the computer so that the physician is facing the computer instead of looking at you,” Miller said. “So, as a nurse, you need to really focus on that care and that relationship with the patient. But I think it’s so easy and people get into that little routine of click, click, click, task, task, task, that they sometimes forget how important it is to build that relationship with that patient.”

“Some of those healing practices, we’ve got to make sure we still do them,” she said; “that we take them back; that we don’t give them away because of technology or the task versus the care.”

WWW.ORTODAY.COM

Joyce Miller and Hib a Sharif, a commun ity outreach coordinator for Fa irview Health Service s, attend a conference in Albuq uerque, N.M.

Joyce Miller, DNP, RN, attended nursing school in the 1970s and after a 38-year turn at the Mayo Clinic in Rochester, Minn., she transferred into a teaching role at Augsburg College in Minneapolis, Minn.

Augsburg College Assistant Professor Joyce Miller, DNP, RN, consults with a stu dent in the nursing progra m at the Rochester, Minn., bra nch of the College.

May 2014 | OR TODAY

59

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61

OUT OF THE OR HEALTH

BY MARILYNN PRESTON

THE ART OF MAKING CHANGE: PART TWO Did you make any New Year’s Resolutions this year?

How’s it going?

Wait! Don’t hang up.

When you make a New Year’s Resolution, you are asking yourself to develop a new habit. Your choice: detox from processed foods; bike to work; walk the stairs instead of taking the escalator.

But new habits take time to take over, more time than you think, if you think about it at all. And if you’re not thinking about what’s involved in making change happen, then it’s no wonder you’ve forgotten what your 2014 resolutions even were. “I failed before; I’ve failed again; what am I missing?”

Welcome, Dear Readers, to the off ramp of the Wheel of Failure: “The Art of Making Change” is a continuation of last month’s column that invited you to tear up your list of New Year’s Resolutions and begin again.

In Jeremy Dean’s compelling book, “Making Habits, Breaking Habits: 62

OR TODAY | May 2014

Why We Do Things, Why We Don’t, and How to Make Any Change Stick,” he assures us that new habits can be formed, but how long it takes varies greatly. On average, it takes 66 days for a new habit to take over your life.

Two months or more of everyday attention, writing it down, keeping focused, telling a friend, working with a coach or an “accountability partner.”

Scientists who study the psychology of self-control are so certain about this remote-control reality we all live in, they have given it a name.

It’s called “automaticity,” and learning to move through it and act from a place that is more authentic to your personal vision of health and wellness paves the way for successful change.

Authentic, long-lasting change happens more often when you first create a visualization, a detailed mental picture of who you are, where you are, what you feel when you see yourself living a healthier, happier life.

Why so long? Because neuroscientists know the brain has a mind of it’s own. It resists change and would rather nap in front of the TV. When you mindfully decide to let go of an old habit and replace it with something less fried and sugary, something better for your sleep, digestion and overall health, you wake up to a new understanding of what drives your habits.

“Acting without thinking drives our habits,” reports Dean.

And so does: ACTING ON WHAT YOU VALUE. Authentic, long-lasting change happens more often when you first create a visualization, a detailed mental picture of who you are, where you are, what you feel when you see yourself living a healthier, happier life.

“I see myself with my husband, hiking in Florida and camping over night with our grandchildren. I love WWW.ORTODAY.COM

HEALTH

them to bits and they love being with me. I feel fit, strong and safe ... ” What you value will express itself in your personal wellness vision. Make it specific; make it true. You can make this a DIY project, or recruit a close friend, or consult with a local wellness coach. As Obamacare catches on, they’ll be more and more available. And affordable. I hope.

SET GOALS, STAY POSITIVE, BE PATIENT. Once your wellness vision is created, you have a target to aim for. Next, you’ll want to create the small, realistic goals that will get you there: week-by-week. Change is not linear. Expect setbacks and delays but avoid despair.

In fact, stay very, very positive. That’s what all the research shows. Don’t focus on what you didn’t do; celebrate what you did do. Beating yourself up – the selfie of trash talking – is counterproductive to lasting change.

Keep in mind the 66 days it takes for a new habit to take hold. An exercise habit takes even longer. A recent research study – handpicked by me to prove my point – shows that people who write down a detailed, step-by-step plan are 50 percent more likely to achieve their goals.

Fifty percent is huge!

KEEP A JOURNAL. Writing down your detailed game plan and keeping track of your accomplishments is what puts you in the moment. That’s how we break free from the limitations of “automaticity.”

To support the lifestyle change you’re making, it helps to write down – every day – three things you’re grateful for. Every night, write down three things you did well that day. (Sounds hokey, but it works.)

Now you know a few new things about how change happens. The rest, is up to you.

MARILYNN PRESTON 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.

WWW.ORTODAY.COM

May 2014 | OR TODAY

63

OUT OF THE OR FITNESS

BY CAMERON HUDDLESTON, KIPLINGER PERSONAL FINANCE

THIS IS A GOOD TIME TO SAVE MONEY ON GYM MEMBERSHIPS

A

s always, the No. 1 New Year’s resolution for 2014 was to lose weight, according to the University of Scranton Journal of Clinical Psychology. Spending less and saving more also rank among the top five resolutions. The good news is that many people can do both by getting a gym membership for less.

Gyms know many people want to trim down and tone up, says Trae Bodge, senior editor for deal and coupon site RetailMeNot. “In response, they’re offering a lot of great deals,” Bodge says.

In addition to limited-time offers, there are several other ways you can save money on gym memberships: • Take advantage of free trials. You can get a free day pass at many gyms any time of the year, Bodge says. However, several national fitness chains offer lengthier free trials to capitalize on weight-loss resolutions. For example, 24 Hour Fitness has a free three-day pass, Gold’s Gym and Anytime Fitness

64

OR TODAY | May 2014

are offering free seven-day trials, and Snap Fitness will send you a free 30-day pass if you sign up online (and pay $8.95 for shipping and handling).

Bodge says you should take advantage of free passes at several gyms to find the one that suits you best so you don’t waste money signing a contract with a facility you don’t try out first.

• Don’t be afraid to negotiate. If you take advantage of free trials at several gyms but find that your favorite isn’t offering the best membership deal, let the manager know what other gyms you’ve visited are offering. Bodge says gyms want your business, so they may be willing to match a competitor’s price.

• Let your employer or insurance company foot the bill. Several companies offer employees a reimbursement for gym memberships or have on-site gyms that employees can take advantage of for free, Bodge says. Check with your human resources department to see if your employer offers this perk – and don’t pass it up.

Otherwise, check with your health

insurance company to see if it offers fitness or weight-loss reimbursement.

Aetna and Blue Cross Blue Shield are among the insurers with fitness reimbursement programs.

And some insurers, such as Kaiser Permanente, offer discounts for memberships at participating fitness clubs.

• Opt for a month-to-month membership. If you’re just starting a fitness routine, Bodge says you’re better off paying month-to-month rather than locking yourself into a long contract for two reasons. At many gyms, it will cost you less to pay on a monthly rather than annual basis, and if you don’t stick to your fitness routine, you won’t throw away money on a membership you’re not using.

• Look for coupons. Occasionally, fitness club chains offer coupons.

For example, RetailMeNot has a coupon code for 50 percent off the membership fee and the first month free at Curves. And if you want to exercise at home, early in the year is the best time to find discounts on fitness equipment and DVDs, Bodge says.

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FITNESS

• Join with a friend. Smaller, locally-operated gyms often offer two-for-one membership deals but don’t actively promote them, Bodge says. Ask whether you can get a discount if you join with a friend.

• Exercise at off-peak hours. Some small gyms and 24-hour fitness clubs offer discounted rates if you exercise at off-peak hours, such as late at night. However, like twofor-one deals, this discount often isn’t advertised but is worth asking about, Bodge says.

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• Check into a la carte pricing. If a gym offers several services, facilities and types of training equipment but you only plan to, say, run on a treadmill, ask whether you can pay for just that.

• Ask about perks. If you sign up for the lowest membership level but commit for a year, Bodge recommends asking the gym to throw in a free perk, such as access to a personal trainer or massages.

May 2014 | OR TODAY

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OR TODAY | May 2014

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OUT OF THE OR NUTRITION

MISCONCEPTIONS

EXPOSED

Multivitamins and Nutritional Supplements

H

ow often do you eat a cup of sauteed spinach? How about three servings of fatty fish, like salmon, per week? Probably not very often, but those are examples of foods and portions that are packed with the recommended amounts of essential nutrients. Research shows that Americans aren’t making the nutrition grade and, therefore, can lack important vitamins and minerals like folic acid, vitamin E, vitamin K and even vitamin C. “Even if you follow a healthy diet, a busy lifestyle can make it difficult to obtain the recommended amounts of vitamins and minerals from food alone,” says Elizabeth Somer, a registered dietician and author of several books, including “The Essential Guide to Vitamins and Minerals.”

Data on dietary intake from the National Health and Nutrition Examination Survey, which used the USDA’s Healthy Eating Index to compare what people say they eat to recommended dietary guidelines, found that children and adults scored 56 points out of a possible 100 (equivalent to an “F” grade), while seniors fared only slightly better at 65 points (equivalent to a “D” grade).

The American Heart Association agreed with those findings in its 2013 report on heart disease and stroke, concluding that poor diet and lack of exercise are two of the main factors contributing to the high prevalence of heart disease in the U.S. One easy way to maintain good nutrition is to enhance your diet with supplements; however, the frequency of new studies combined

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with the staggering number of supplements available makes it increasingly confusing to know what’s right.

Somer puts nutrition news in context, provides the facts for common misconceptions and offers realistic tips to meet daily nutrition needs: MISCONCEPTION 1: IT’S REALISTIC TO OBTAIN ALL ESSENTIAL NUTRIENTS FROM FOOD. Even experienced nutritionists have a hard time designing a diet that provides all the essential nutrients for one day and busy Americans often struggle to follow a highly regimented diet. That’s not to say it’s impossible but the best approach is to focus on eating nutrient-rich foods as much as possible – like dark leafy greens (good source of lutein for eye health), colorful fruits, whole grains, healthy proteins and fats (such as salmon, which is a great source of omega-3 fatty acids DHA and EPA) – and fill gaps in nutrition with a daily multivitamin. “Another supplement I always recommend is fish oil,

or a vegetarian source from algae, because DHA and EPA benefit eye, heart and brain health,” says Somer.

MISCONCEPTION 2: MULTIVITAMINS HAVE NO HEALTH BENEFITS. Although recent studies report that vitamin and mineral supplements do not lower one’s risk of heart disease or cancer, these supplements are still proven to be beneficial to one’s health. “If a study found that people who drank water had no lower risk for dementia, would you stop drinking water?” asks Somer. “Of course not, because water, like essential vitamins and minerals, is crucial to health and there is no controversy over its importance for human nutrition.”

MISCONCEPTION 3: MULTIVITAMINS ARE A WASTE OF MONEY. Multivitamins are a relatively inexpensive tool to achieve proper nutrition. “No reputable health expert will argue that supplements can or should replace a good diet and a healthy lifestyle,” says Somer.

“However, multivitamins and nutritional supplements are one factor in a pattern of living that is known to maintain overall well-being. Think of multivitamins as an insurance policy for optimal nutrition – they’re meant to supplement, not replace, a healthy diet.”

May 2014 | OR TODAY

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OUT OF THE OR RECIPE

BY FAITH DURAND

PANNA COTTA PURE HEAVEN ... AND SO EASY TO MAKE

P

anna cotta may just be the perfect dessert: It’s easy, quick, practically foolproof and accommodating to many dietary adjustments, being naturally gluten-free and adaptable to dairyfree and vegan diets.

It also happens to be luscious and perfectly creamy, in a way that belies its utter simplicity.

Below, I’ll walk you through making panna cotta, step by step. People think it’s some laborious restaurant dessert involving cheesecloth and a chinois, but it’s actually easier than making Jello out of a box.

But there I go again about how easy this is. Let’s get back to how it tastes, shall we?

It’s a very basic pudding that is made of dairy thickened with gelatin. It originated in Italy and its name literally means “cooked cream,” since the earliest versions were made of thick cream, sometimes thickened with fish bones.

You can eat it straight out of a cup, but it’s often unmolded onto a plate and drizzled with sweet sauce and garnished with fruit. A bite of panna cotta is remarkably creamy, melting in the mouth without a trace of grittiness or lumps.

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OUT OF THE OR RECIPE

This tutorial will teach you how to make the most basic vanilla panna cotta, flavored with vanilla extract and a pinch of salt. You only need a few ingredients (milk, cream, gelatin, flavorings). I often don’t even use milk and cream but half and half (see my note on that below). The goal with panna cotta is to calibrate the amount of gelatin to the dairy and its fat so that you achieve a firm set that is still delicate and wobbly.

As with any other elemental recipe, you could argue for days over the pieces. You might like your panna cotta a touch sweeter, or with less fat in it.

This recipe is my idea of a very good basic panna cotta. It’s not too fatty, and not too sweet, but still rich. I included a touch of extra gelatin to make it extra-foolproof, and so that you can unmold it onto a plate.

But it shouldn’t be rubbery – it’s wobbly and velvety smooth.

For this recipe you should use plain, unflavored gelatin, which is usually found in the grocery store aisle with the baking supplies and Jello. I use granulated gelatin, which is the most common form of gelatin in the U.S. (as opposed to gelatin sheets).

What if you don’t eat gelatin? Gelatin is an animal product and not vegetarian. You can substitute agar agar or another vegetarian gelatin substitute. I don’t give precise substitutions because if you’re using a vegetarian gelatin you may also be switching up the milk and cream for an alternative dairy, and I haven’t tested the permutations of agar agar with soy, coconut or almond milk, or in all the various combinations.

Now, shall we make some pudding? This is a lot of conversation for what ends up being about 5 minutes at the stove – it’s so easy!

Oops there I go again. Let’s get started!

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BY FAITH DURAND

PANNA COTTA

Makes six 4-ounce puddings.

• cooking spray 1 1/2 cups whole milk (see Ingredient Notes) 3 teaspoons powdered gelatin 1/3 cup sugar 1 1/2 cups light or heavy cream 1 teaspoon pure vanilla extract • pinch salt

EQUIPMENT: • six 6-ounce ramekins • paper towels • 2-quart saucepan • whisk • large bowl • thin knife DIRECTIONS: Lightly

grease the ramekins: Spray the ramekins with cooking spray, then use a paper towel to wipe out most of the oil, leaving only a light residue.

cool down. The milk should get hot, but not so hot that you can’t leave your finger in the pot for a few seconds.

The gelatin will dissolve quickly as the milk warms; it melts at body temperature so this step should go quickly.

Check to make sure the gelatin is dissolved: After about 2 minutes of warming, rub a bit of the milk between your fingers to make sure it’s smooth. Or dip a spoon in the milk and check the back for distinct grains of gelatin.

Dissolve the sugar: Stir the sugar into the milk and continue warming until it dissolves as well. It shouldn’t take more than 5 minutes total to dissolve both the gelatin and sugar. Again, never let the mixture boil.

Bloom the gelatin: Pour the milk into the saucepan and sprinkle the powdered gelatin evenly over top. Let soften for 5 minutes or until the surface of the milk is wrinkled and the gelatin grains look wet and slightly dissolved.

Remove the saucepan from the heat. Whisk in the cream, vanilla, and a pinch of salt. Divide the mixture evenly between the prepared ramekins and put in the refrigerator to chill. If serving straight from the cups, without unmolding, chill for 1 to 2 hours. If you want to unmold the panna cotta, chill for at least 4 hours or overnight.

Dissolve the gelatin over low heat: Set the saucepan over low heat and warm the milk gently, stirring or whisking frequently. The milk should never boil or simmer; if you see steam remove the pot from the stove and let it

Prepare to unmold: Fill a large bowl partway with warm to hot water. Wipe a dessert plate with a damp paper towel (a damp plate lets you reposition the panna cotta more easily if it doesn’t fall in the right spot).

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RECIPE

Release the panna cotta edge from the cup: Run a thin knife carefully around the sides of a ramekin. Don’t slide the knife all the way into the cup; just release the top edge of the pudding from the edge of the cup. Dip the ramekin in the warm water up to its rim, and hold it there for about 3 seconds.

Invert the ramekin over the plate and shake gently to help the panna cotta fall out, or press gently on one side to help nudge it out. It should fall out on the plate easily.

(If it does not, return to the warm water bath in increments of 2 seconds.) Reposition on the plate if desired. Serve immediately, or refrigerate, lightly covered, for up to 5 days. The gelatin gets stronger as it sits, so this will be a bit rubbery by days 4 or 5, but you can mitigate this by letting the panna cotta sit at room temperature for about half an hour before serving.

INGREDIENT NOTES I usually prefer to use half and half as a base for panna cotta, instead of milk and cream, because the milk and cream in half and half has been homogenized. This means that the panna cotta won’t separate into layers of lighter and heavier fat levels, as often happens when using milk and cream.

However, you can use any combination of milk, cream, coconut milk, soy milk, almond milk – really any creamy liquid – to make panna cotta.

But the less fat in the panna cotta, the softer it will be. A panna cotta made with all soy milk, for instance, will set very softly. I wouldn’t recommend trying to unmold it unless the proportion of gelatin was increased.

If you want to play with the flavors, try scraping a vanilla bean into the warmed milk, instead of using extract. Or add lemon or WWW.ORTODAY.COM

almond extracts, or stir in a handful of chopped chocolate at the very end for a stracciatella effect. You can substitute espresso or pureed fruit for some of the milk. Just a few ideas – the possibilities are endless!

TROUBLESHOOTING PANNA COTTA MY PANNA COTTA IS STILL LIQUID! Perhaps the gelatin didn’t melt all the way, or you accidentally boiled the mixture. (Boiling destroys gelatin’s thickening power.) It may also have not set long enough.

My panna cotta has two layers! See my note above about milk and cream.

If you are using non-homogenized milk, as I did in this tutorial, this is especially likely to happen. I don’t find that it really affects the eating experience, but to reliably avoid this, use half and half instead of milk and cream.

SERVING PANNA COTTA: A FEW SUGGESTIONS Panna cotta is such an easy dessert to make, and finishing it off can be very simple too. Here are a few ways I like to serve it.

• Garnish with fresh fruit.

• Drizzle with chocolate or caramel sauce.

• Warm some raspberry or strawberry jam and drizzle over top.

• Sprinkle chopped nuts or grated chocolate on top.

• Dollop a spoonful of store-bought lemon curd on the pudding.

FAITH DURAND is executive editor of TheKitchn.com, a nationally known blog for people who love food and home cooking. Submit any comments or questions to kitchn@apartmenttherapy.com.

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OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTEST • MAY •

We can’t fix stupid, but we can sedate it!

National Nurses Week

OR Today wants to know how you’ll be celebrating National Nurses Week this year.

The week-long celebration will be May 6-12. Send in your photos and details of how you or your team is spending the week. So, catch yourself or your team in the act of planning, decorating, or celebrating!

Because this is a very SPECIAL week, we will be sending all of our photo submissions a prize pack that includes “Nurse Pill”, the newest addition to our OR Today team!

And, of course, the winner wins lunch for the team!

THE WINNER GETS LUNCH FOR THE ENTIRE TEAM!

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NATIONAL NURSES WEEK RECOGNIZES NURSES’ LEADERSHIP, MAY 6-12 Patients often recognize that a nurse is the healthcare professional with whom they and their families have the most direct contact. But they might not realize that nurses also are leaders in improving the quality of care and expanding access to care. That’s why May 6-12 is celebrated as National Nurses Week, an annual opportunity for communities to recognize the full range of nurses’ contributions.

This year’s theme, “Nurses: Leading the Way,” recognizes nurses as leaders at the bedside, in the boardroom, throughout communities and in the halls of government. The public holds nurses in high regard and trusts them to advocate for patients.

Beginning with National Nurses Day on May 6, nurses are being honored as leaders who improve the quality of healthcare. Nurses practice in diverse roles, such as clinicians, administrators, researchers, educators and policymakers.

MORE INFORMATION visit www.nursing-

world.org/NationalNursesWeek.

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OR TODAY | May 2014

PINBOARD

OR TODAY

CONTEST WINNER OR Today is happy to feature the winner for the Spring Into Action contest!

What is your goal or your team’s goal for 2014?

“Spring Cleaning P&Ps.”

Mariam Lamb, Nurse Supervisor, hard at work “spring cleaning” all the P&Ps for the Melissa Waibel Guam Surgicenter

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BUZZY ENTREPRENEUR TURNS DOWN SHARKS

Pain researcher and Buzzy CEO Amy Baxter, MD, nixed a deal with ABC’s “Shark Tank” on Feb. 28, but since the episode aired, demand for her needlenumbing invention has exploded, bumping sales 13,225 percent over the same period last year. Just as the Sharks suggested, business-to-business healthcare companies have already reached out.

“I am grateful to the Sharks for allowing me to bring the issue of needle phobia to light on national television,” said Baxter. “Now people know there is a real solution for pain and fear.”

Medical professionals are beginning to recognize they can intervene – 1,200 hospitals use Buzzy.

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Thank you to all who submitted!

Look for your chance to win in our OR Today Magazine monthly contests!

ALLERGIES REGARDLESS OF WHERE YOU LIVE

In a nationwide study to examine the prevalence of allergies from early childhood to old age, scientists from the National Institutes of Health report that allergy prevalence is the same across different regions of the U.S., except in children 5 and younger. Among children aged 1-5, those from the Southern U.S. displayed a higher prevalence of allergies than their peers living in other U.S. regions. These Southern states include Texas, Oklahoma, Louisiana, Arkansas, Tennessee, Kentucky, Mississippi, Alabama, Georgia, West Virginia, Virginia, North Carolina, South Carolina and Florida.

FOR MORE INFORMATION on environmental health topics,

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May 2014 | OR TODAY

75

INDEX ALPHABETICAL 3M Healthcare………………………………………………… 5, 22

EIZO Nanao Technologies……………………………… 67

OR Specific……………………………………………………… 73

AAAHC…………………………………………………………………14

Enthermics Medical Systems…………………………… 4

Palmero Health Care……………………………………… 68

Ansell Healthcare Inc.……………………………………… 10

GelPro……………………………………………………………………41

Piedmont Medical, Inc…………………………………… 63

BEMIS Healthcare………………………………………………31

Government Liquidation…………………………………IBC

Polar Products………………………………………………… 78

BOSS Instruments………………………………………………18

Healthmark Industries…………………………………… 46

Ruhof Corporation…………………………………………… 2-3

Bryton Corporation……………………………………………19

Innovative Medical Products, Inc………………… BC

Sage Services…………………………………………………… 66

C Change Surgical…………………………………………… 65

International Medical Equipment.……………………61

Select Surgical Technologies…………………………… 9

Cables and Sensors………………………………………… 68

Kapp Surgical Instrument, Inc.…………………………14

Serim Research Corporation………………………… 54

Checklist Boards Corp.…………………………………… 65

KTW Group…………………………………………………………61

Spectrum Surgical Instruments Corp.……………41

Cincinnati Sub-Zero…………………………………… 42-45

Lumalier Corporation……………………………………… 40

STERIS Corp.…………………………………………………… 70

Cygnus Medical………………………………………………… 53

McGan Technologies……………………………………… 77

Surgical Power………………………………………………… 66

Dan Allen Surgical…………………………………………… 60

MD Technologies……………………………………………… 55

SurgiDat Corp…………………………………………………… 54

Didage Sales Company, Inc.…………………… 16-17, 19

MedWrench……………………………………………………… 78

TBJ, Inc.……………………………………………………………… 30

Ecolab Inc., Professional Products Div.………… 47

Mobile Instrument Service & Repair……………… 6

INDEX CATEGORICAL ACCREDITATION AAAHC…………………………………………………………………14 ANESTHESIA Checklist Boards Corp.…………………………………… 65 APPAREL Healthmark Industries…………………………………… 46 ASSOCIATIONS AAAHC…………………………………………………………………14 AUCTIONS Government Liquidation…………………………………IBC BEDS Innovative Medical Products, Inc………………… BC Piedmont Medical, Inc…………………………………… 63 CARDIAC SURGERY C Change Surgical…………………………………………… 65 CABLES/LEADS Sage Services…………………………………………………… 66 CLEANING SUPPLIES Ruhof Corporation…………………………………………… 2-3 CLAMPS Innovative Medical Products, Inc………………… BC CS Spectrum Surgical Instruments Corp.……………41

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OR TODAY | May 2014

DISPOSABLES Government Liquidation…………………………………IBC Kapp Surgical Instrument, Inc.…………………………14 Sage Services…………………………………………………… 66 EDUCATION Spectrum Surgical Instruments Corp.……………41 ENDOSCOPY Ecolab Inc., Professional Products Div.………… 47 Government Liquidation…………………………………IBC International Medical Equipment.……………………61 Kapp Surgical Instrument, Inc.…………………………14 MD Technologies……………………………………………… 55 Mobile Instrument Service & Repair……………… 6 OR Specific……………………………………………………… 73 Ruhof Corporation…………………………………………… 2-3 Spectrum Surgical Instruments Corp.……………41 TBJ, Inc.……………………………………………………………… 30 GEL PADS Innovative Medical Products, Inc………………… BC GENERAL Checklist Boards Corp.…………………………………… 65 Didage Sales Company, Inc.…………………… 16-17, 19 GelPro……………………………………………………………………41 Government Liquidation…………………………………IBC International Medical Equipment.……………………61 KTW Group…………………………………………………………61 Lumalier Corporation……………………………………… 40 Select Surgical Technologies…………………………… 9 Surgical Power………………………………………………… 66

HAND/ARM POSITIONERS Innovative Medical Products, Inc………………… BC HEALTHCARE STAFFING/MANAGEMENT SurgiDat Corp…………………………………………………… 54 HIP SYSTEMS Innovative Medical Products, Inc………………… BC INFECTION CONTROL/PREVENTION 3M Healthcare………………………………………………… 5, 22 BEMIS Healthcare………………………………………………31 Ecolab Inc., Professional Products Div.………… 47 Government Liquidation…………………………………IBC Palmero Health Care……………………………………… 68 Ruhof Corporation…………………………………………… 2-3 Spectrum Surgical Instruments Corp.……………41 INSTRUMENTS Government Liquidation…………………………………IBC Spectrum Surgical Instruments Corp.……………41 INTERNET RESOURCES MedWrench……………………………………………………… 78 KNEE SYSTEMS Innovative Medical Products, Inc………………… BC LAB KTW Group…………………………………………………………61 LASER Checklist Boards Corp.…………………………………… 65

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INDEX CATEGORICAL LATEX FREE Ansell Healthcare Inc. …………………………………… 10

Spectrum Surgical Instruments Corp. …………41 STERIS Corp. ………………………………………………… 70

LEG POSITIONERS Innovative Medical Products, Inc ……………… BC

STRETCHERS Piedmont Medical, Inc ………………………………… 63

OPHTHALMICS Ecolab Inc., Professional Products Div.……… 47

SURGEON COOLING Polar Products ……………………………………………… 78

OR TABLE ACCESSORIES Bryton Corporation …………………………………………19 Innovative Medical Products, Inc ……………… BC

SURGICAL AAAHC ………………………………………………………………14 BOSS Instruments ……………………………………………18 Checklist Boards Corp. ………………………………… 65 Dan Allen Surgical ………………………………………… 60 Ecolab Inc., Professional Products Div.……… 47 EIZO Nanao Technologies …………………………… 67 Kapp Surgical Instrument, Inc. ………………………14 KTW Group ………………………………………………………61 Lumalier Corporation …………………………………… 40 MD Technologies …………………………………………… 55 Select Surgical Technologies ………………………… 9 Surgical Power ……………………………………………… 66

ORTHOPEDIC OR Specific …………………………………………………… 76 Surgical Power ……………………………………………… 66 OTHER Select Surgical Technologies ………………………… 9 PATIENT AIDS Innovative Medical Products, Inc ……………… BC PATIENT MONITORS Cables and Sensors ……………………………………… 68 EIZO Nanao Technologies …………………………… 67 POSITIONING AIDS Innovative Medical Products, Inc ……………… BC POSITIONERS/IMMOBILIZERS Innovative Medical Products, Inc ……………… BC RADIOLOGY Checklist Boards Corp. ………………………………… 65 Ecolab Inc., Professional Products Div.……… 47 EIZO Nanao Technologies …………………………… 67

SURGICAL GLOVES Ansell Healthcare Inc. …………………………………… 10 SURGICAL GRAFTS Select Surgical Technologies ………………………… 9 SURGICAL SUPPLIES Cincinnati Sub-Zero ………………………………… 42-45 Cygnus Medical ……………………………………………… 53 Government Liquidation ………………………………IBC Ruhof Corporation ………………………………………… 2-3 SURPLUS MEDICAL Government Liquidation ………………………………IBC

REFURBISHED EQUIPMENT Piedmont Medical, Inc ………………………………… 63

SUPPORTS Innovative Medical Products, Inc ……………… BC

REPAIR/SERVICE International Medical Equipment. …………………61 Piedmont Medical, Inc ………………………………… 63 Spectrum Surgical Instruments Corp. …………41

TEMPERATURE MANAGEMENT C Change Surgical ………………………………………… 65

SHOULDER RECONSTRUCTION Innovative Medical Products, Inc ……………… BC SIDE RAIL SOCKETS Innovative Medical Products, Inc ……………… BC SOFTWARE SurgiDat Corp ………………………………………………… 54 SPINE OR Specific …………………………………………………… 73 STERILE PROCESSING TBJ, Inc. …………………………………………………………… 30 STERILIZATION Lumalier Corporation …………………………………… 40

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TEST INSTRUMENTS McGan Technologies …………………………………… 77 TEST STRIPS Serim Research Corporation ……………………… 54 ULTRASOUND Ecolab Inc., Professional Products Div.……… 47 VIDEO Ecolab Inc., Professional Products Div.……… 47 EIZO Nanao Technologies …………………………… 67 WASTE MANAGEMENT BEMIS Healthcare ……………………………………………31 WARMERS Enthermics Medical Systems ………………………… 4

May 2014 | OR TODAY

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