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CONTENTS

features

OR TODAY | July/August 2014

42 CORPORATE PROFILE

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HOW TO AVOID BURNOUT IN THE OR

OR nurses and surgical techs experience a great deal of stress at work. We take a look at how to manage that stress to avoid a burnout or meltdown.

SPOTLIGHT ON

Colleen Berry has found the perfect job. It allows her to use her artistic talents as part of of her nursing career while helping patients who are recovering from life-altering illnesses.

OR Today (Vol. 14, Issue #7/8) July/August 2014 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. 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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July/August 2014 | OR TODAY

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

EDITOR

John Wallace | jwallace@mdpublishing.com

ART DEPARTMENT Jonathan Riley Yareia Frazier Jessica Laurain

ACCOUNT EXECUTIVES

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

26 INDUSTRY INSIGHTS

11 News & Notes 16 AAAHC Update 18 Surgical Services Summit

Jayme McKelvey | jayme@mdpublishing.com

CIRCULATION Bethany Williams

ACCOUNTING Sue Cinq-Mars

WEB SERVICES Taylor Martin Michelle McMonigle

IN THE OR 20 24 26 32

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 60 Health 62 Fitness 64 Nutrition 68 Recipe 72 Pinboard 80 Index

OR TODAY | July/August 2014

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INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

EIZO EXPANDS LARGE MONITOR SYSTEM OFFERINGS

IZO Inc. has expanded its FDA 510(k)cleared large monitor system with the addition of the RadiForce LS580W monitor and LMM0802 large monitor manager for interventional radiology and surgical suites. In 2011, EIZO received FDA 510(k) clearance from the U.S. Food and Drug Administration for the RadiForce LS560W monitor and LMM56800 large monitor manager. With the introduction of the monitor’s successor model, the RadiForce LS580W and the LMM0802 large monitor

manager as an alternative component, EIZO’s FDA-cleared large monitor system now offers additional options to medical professionals while continuing to provide a high level of customer assurance. In the operating room and interventional suite, essential information such as X-ray, endoscopic images, and EP (electrophysiology) is typically displayed using several different monitors. The RadiForce LS580W is a large 58-inch widescreen monitor with 4K ultra HD display for viewing a

variety of essential medical information on a single screen. This allows users to view important information consistently and conveniently in one location. With the

LMM0802 large monitor manager, users can scale and position several source video windows to suit their preferences and working conditions.

ENCOMPASS GROUP EXPANDS ANTI-EMBOLISM STOCKINGS SIZE OFFERING Encompass Group LLC has announced more size options for the Albahealth EssentialCARE Anti-Embolism Stockings. “With proper sizing and application of anti-embolism stockings being the key to comfortable and effective DVT prevention therapy, a vast size offering is imperative. To further support proper sizing and address our customer needs, EssentialCARE Anti-Embolism Stockings product line now features 12 additional sizes,” said Jennifer Woody, senior marketing manager for Albahealth. “We now offer 32 sizes from small through 3XLarge in multiple lengths, so we can accommodate the majority of the patient population.” Features of EssentialCARE AES include: color-coded heel positioner for proper heel and ankle placement and easy size identification, moisture management to move fluids and body oils from skin to surface of the fabric quickly to speed drying and for better laundering, two-way stretch fabric allows stocking to conform to shape of limb, and premium elastic top keeps stocking in place without causing tourniquet effect.

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July/August 2014 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

OLYMPUS RECEIVES BREAKTHROUGH INNOVATION TECHNOLOGY AWARD Olympus has announced that its Endoeye Flex 3D articulating videoscope was one of 16 medical innovations on display in front of thousands of healthcare providers and experts at the at the Premier Inc. 2014 Breakthroughs Conference and Exhibition. Olympus’ 3D Imaging System was showcased during the conference’s sixth annual Innovation Celebration, which recognizes advances in healthcare while highlighting industry suppliers committed to innovation and improving patient outcomes. Olympus’ Endoeye Flex 3D is the world’s only articulating HD 3D videoscope. The system’s 3D visualization provides depth perception and a precise spatial view of anatomy that cannot be achieved with traditional 2D systems, producing bright, natural 2D and 3D images in a lightweight and ergonomic design. It also delivers up to 100 degrees of articulation in all directions, enabling observation and therapy in the entire peritoneal cavity — and with a level visual horizon.

When compared with traditional 2D surgical systems, the Endoeye Flex 3D delivers value to surgeons and patients by reducing surgical errors and improving the speed, accuracy and precision of surgical tasks. Olympus’ 3D system also provides surgeons with real time tactile feedback, which is lost when using robotic alternatives.

Award winners were announced during the Innovation Celebration held at the Henry B. Gonzalez Convention Center in San Antonio, Texas. • FOR MORE INFORMATION or to evaluate the Olympus Endoeye Flex 3D system, contact your Olympus representative or call 800-548-5515.

CONNEXALL GRANTED U.S. PATENT FOR PATIENT FALL PROTECTION Connexall has been granted a patent by the U.S. Patent and Trademark Office for Preemptive Notification of Patient Fall Risk Condition. Connexall has collaborated with Stryker to achieve a patent on this innovative application of technology which greatly reduces the risk of patient falls and resulting injury. Most hospitals have established protocols that identify a minimum “safe” bed configuration for each patient fall risk level. For example, a high fall risk protocol may dictate certain settings related to the bed height, position of the railings, brake settings, etc. The now-patented technology involves the Connexall system receiving the patient’s fall risk level from the hospital’s electronic medical record system, and the ongoing real-time state of the patient’s bed configuration from Stryker. Connexall then actively evaluates both data streams to determine if the current bed configuration falls outside of the set protocol, and therefore presents a heightened patient fall risk condition that needs immediate attention by the caregiver. The resulting notification to the caregiver ensures that they can return to the room and proactively restore the bed to the proper configuration to avert the potential of a patient fall. •

OR TODAY | July/August 2014

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NEWS & NOTES

THE JOINT COMMISSION ADDRESSES UNSAFE INJECTION PRACTICES Since 2001, at least 49 outbreaks have occurred due to the mishandling of injectable medical products, according to the Centers for Disease Control and Prevention. In spite of this, adverse events related to unsafe injection practices and lapses in infection control practices are underreported, and it remains a challenge to measure the true frequency of such occurrences. To raise awareness of the issue, The Joint Commission released a Sentinel Event Alert, “Preventing Infection from the Misuse of Vials.” The free publication was written to educate healthcare organizations and healthcare workers on the risks of misusing vials of injectable medical products. The alert describes the factors that contribute to the misuse of vials and recommends strategies for improvement. The misuse of vials primarily involves the reuse of single-dose vials, which are intended to be used once for a single patient. Single-dose vials typically lack preservatives; therefore, using these vials more than once carries substantial risks for bacterial contamination, growth and infection. For multiple-dose vials, one survey of healthcare practitioners found that 15 percent reported using the same syringe to re-enter a vial numerous times for the same patient, and of that 15 percent, 6.5 percent reported saving vials for use on other patients. Patients exposed to these types of vial misuse have become infected with the hepatitis B or C viruses, meningitis, and other types of infections. According to the CDC, adverse events caused by this misuse have occurred in inpatient and outpatient settings. Much of the information and guidance provided in The Joint Commission’s periodic Sentinel Event Alerts is drawn from its Sentinel Event Database. The database includes detailed information about adverse events and their underlying causes. A complete list and text of past issues of Sentinel Event Alert can be found on The Joint Commission website. •

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HEALTHMARK INDUSTRIES INTRODUCES COOL SOLUTION FOR WORK ENVIRONMENTS On recent field visits in the sterile processing and OR areas of various hospitals, staff members revealed that one challenge they face is being uncomfortably hot in their work environments. Shifts can be long and especially hot while wearing necessary PPE. With this in mind, Healthmark worked to deliver a solution and is pleased to be launching its Cool Aids cooling products. OSHA specifies that Personal Protective Equipment (PPE) standard at 1910.132(d) requires every employer in general industry to conduct a hazard assessment to determine appropriate PPE to be used to protect employees from the hazards identified in the assessment. Keeping cool underneath PPE is important to employee comfort because it helps them effectively perform their tasks. Cool Aids are designed to manage body temperature from the head, neck, chest and core body. They are available in beanies, skullcaps, neck wraps and vests. The combination of unique fabrics creates an evaporative temperature management system. The products provide cool comfort for hours, and may be used multiple times. The vest is designed with cooling inserts that are refrigerated before each use. • ADDITIONAL INFORMATION about Cool Aids is available at http://hmark.com/coolaids.php or by calling at 800-521-6224.

July/August 2014 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

MEDLINE UNVEILS INTUITIVE SOLUTION FOR ORTHOPEDIC FOOT AND ANKLE SURGERY SPAN-AMERICA’S SLEEP SURFACE EXPANSION KIT PROVIDES A NEW DIMENSION IN CAREGIVING Span-America Medical Systems Inc. introduces a 42-inch expander kit for its Rexx and Advantage models following the recent introduction of its premium Encore bed with advanced caregiving features such as on-board ReadyWide sleep surface expansion. Engineered for easy attachment and sturdy support, the new expanders allow the Q-Series beds to provide increased user comfort and an added level of safety during repositioning. Published studies indicate that a wider sleeping surface can reduce the risk of falls, particularly in residents accustomed to sleeping on a common consumer product. Installation of the expanders is intuitive. The expander units attach and detach without tools following removal of the corner mattress retainers. A spring-loaded latch fastens the expander units securely to the underside of the head, knee and foot decks. The kit includes form-fitted molded foam storage units to support long-term use. Span’s half-head assist rails – in molded plastic or steel – are fully compatible, fitting to the expander unit before it is attached to the deck. •

OR TODAY | July/August 2014

For ambulatory surgery centers looking for more efficient and simplified ways to perform orthopedic foot and ankle surgeries and help reduce errors, the Medline Unite Cannulated Screw System is available for use in corrective procedures and fracture repairs. Medline launched the newly designed system of implants and instrumentation at the Ambulatory Surgery Center Association’s 2014 annual meeting in Nashville, Tenn. Medline Unite is a unique system in which the implants and instrumentation are not only color coded so staff can easily match the size of the screws with the corresponding instruments, the contents of the tray system are organized in the order in which each item is used by staff during the procedure. This intuitive design makes the procedure more efficient for the surgical staff and surgeon and reduces the likelihood of errors. The implants are made of an advanced titanium alloy, which meets the stringent standards of the International Organization for Standardization. FOR MORE INFORMATION about the Medline Unite Cannulated Screw System, visit www.medline.com.

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9975-477-008

INDUSTRY INSIGHTS AAAHC UPDATE

BY SANDRA JONES, CASC, LHRM, CHCQM, FHFMA SVP AND COO

THE OR DIRECTOR’S ROLE IN GOVERNING BODY OVERSIGHT

hile some surgical facilities are part of a complex hospital system or a corporation with several layers of management and medical staff, many ASCs remain unaffiliated with a larger institution and have a very flat organizational structure. As a result, the OR director may be the same person who is the administrator, the ex-officio member of the governing body and the immediate liaison with the medical director. The flat organizational structure can streamline medical staff and governing body activities. Yet, this can sometimes lead to lack of clarity in documenting governing body action. Learning regulatory and accreditation requirements for governing body activities can help the director plan communication and documentation.

Whether a facility is large or small, the governing body has a duty to oversee the business, obtain clinical input from nurses and medical staff members, and provide a safe environment for the patient and the staff. Becoming familiar with your organizational structure, bylaws, and minutes may be the initial step to learning how the governing body reviews and acts to perform oversight – essential to successfully meet surveys by state or accreditation surveyors. Finding evidence of your organization’s governing body activities should not be a challenge. For a small surgery center with a few physicians handling all committee and governing body activities, versus one with dozens of physicians serving on committees and governing body, the responsibilities are not different. Regardless of the complexity of the organization, the same regulations apply. 16

OR TODAY | July/August 2014

One way to prepare yourself for compliance is to read your medical staff and governing body bylaws or an agreement for management and operations. Which document you have defining governing body responsibilities will depend upon your legal structure and organizational affiliations. Medicare §416.41 Condition for Coverage Governing Body and Management states: “The ASC must have a governing body that assumes full legal responsibility for determining, implementing, and monitoring policies governing the ASC’s total operation. The governing body has oversight and accountability for the quality assessment and performance improvement program, ensures that the facility policies and programs are administered so as to provide quality healthcare in a safe environment, and develops and maintains a disaster preparedness plan.”

Reading the Interpretive Guidelines assists in understanding what surveyors will look for in documentation of activities. The guidelines include statements such as: Delegations of governing body authority should be documented in writing. The governing body is not only responsible for adopting formal policies and procedures that govern all operations within the ASC, but also must take actions to ensure that these policies are implemented. The guidelines also list some items that surveyors may look for. What are typical items on the governing body’s meeting agenda and how often do they meet? Where is evidence of how the governing body monitors internal compliance with and reassesses the ASC’s policies? Is there any evidence of data collected and submitted to the governing body related to specific ASC policies? Let’s stop here for a minute and cite an example of governing body activity. You would have a policy on how instruments are processed. The governing body approves the policy. You implement it. You collect data that shows you have monitored the implementation and performance of the staff. You report to the governing body your findings. Perhaps the governing body members asked if AAMI or another national organization’s standards are being followed. Maybe there is a question and WWW.ORTODAY.COM

AAAHC UPDATE

discussion about training of staff and availability of reference materials. When minutes contain such comments, demonstrating your governing body is active in oversight, quality assessment, and the administration of policies to provide quality healthcare in a safe environment, your governing body’s participation is documented. The Interpretive Guidelines for §416.41 state, “The governing body is responsible for establishing the ASC’s policies, making sure that the policies are implemented, and monitoring internal compliance with the ASC’s policies as well as assessing those policies periodically to determine whether they need revision.” The preceding paragraph

gives an example of meeting this responsibility. One great thing about digital documents is that you can do a word search. Use word search to focus your learning of regulations and inspection expectations. Search the CMS Appendix L document and accreditation standards for the words “governing body.” Read all the areas that mention governing body and make notes of the expected activity. Think about how your minutes, sign off on forms or reports, and on-going QAPI activities help you document actions, involvement and oversight by your governing body. How do the minutes differentiate between reports, input, recommendations and actions? How does

your documentation clarify the governing body’s oversight? Regardless of the layers of committees and management, your knowledge gained by understanding governing body responsibilities will help you prepare QAPI activities, recommendations, reports and minutes. ABOUT THE AUTHOR Sandra Jones is a licensed risk manager and certified in ASC administration and quality management. She is a board member and surveyor for AAAHC, a past board member of the ASC Association, and past President of the MGMA ASC assembly. Sandra oversees a team of vice presidents who provide regulatory compliance and operational oversight to over 90 surgery centers.

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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July/August 2014 | OR TODAY

INDUSTRY INSIGHTS SURGICAL SERVICES SUMMIT

BY JOHN WALLACE

INAUGURAL SURGICAL SERVICES SUMMIT SET FOR VEGAS

as Vegas is the place to be this December for perioperative leaders from throughout North America.

The 2014 Surgical Services Summit, presented by OR Today magazine and DecisionHealth, is set for Dec. 7-9 at Green Valley Ranch. The two organizations, combined, have more than 37 years of experience meeting the needs of perioperative professionals. The inaugural Surgical Services Summit will bring together perioperative leaders in an environment that fosters solution-making for prevailing challenges, regulations and culture changes facing the surgical suite and the professionals called on to manage the business decisions and patient care within the OR. Value-based care is causing disruptive changes in the surgical setting and leaders are being called upon to deploy cost-aligned, qualityfocused practices and strategies. The Surgical Services Summit offers a unique opportunity to learn from standard-bearers, network with influential leaders, hone management skills, discover new resources and services, and deliver solutions to improve a facility’s performance. “I am delighted to announce the 2014 Surgical Services Summit, a 18

OR TODAY | July/August 2014

Surgical Services Summit will be held at Green Valley Ranch in December.

high-level networking and learning environment for the leaders and managers tasked with running the business operations and patient safety in the surgical suite,” says Carol Brault, Vice President, Acute Care Group, DecisionHealth LLC. Brault says the Surgical Services Summit will offer educational sessions and networking that will empower today’s professionals to overcome challenges. “Today, facing the impact of declining reimbursements, reductions in elective surgeries, and

penalties tied to quality, perioperative leaders are pivoting to new strategies that will enable you to manage better under LEAN principles and consistent standards of practice,” she says. “In addition, top imperatives, including safety, reducing errors, preventing readmissions and ensuring each patient has a positive surgical experience, must be addressed in order to thrive in the era of value-based care.” “With these educational needs in mind, and the requirement to shift WWW.ORTODAY.COM

SURGICAL SERVICES SUMMIT

NO MORE

Wheel obstructions skills and work processes, the concept of the first annual Surgical Services Summit was born. I am delighted to invite you to join us in Las Vegas for this groundbreaking opportunity,” Brault adds. Continuing education in the classroom setting is just one advantage of attending the event. The networking opportunities are another reason to be in Vegas this December. “The Summit will draw leaders from all over the nation, in hospitals and surgery centers, who have large budgetary oversight and responsibilities. The Summit will provide you an exceptional opportunity to network and interact with key leaders actively seeking to improve their systems, equipment, workflow, processes and the safety of their patients, all in an intimate setting and smallconference feel,” Brault says. FOR INFORMATION, or to register, visit surgicalservicessummit.com/.

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July/August 2014 | OR TODAY

IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

H&P FOR SURGERY Can anyone share what your practice is doing for the update of history and physicals for surgery according to The Joint Commission guidelines? I have always followed that history and physical must be within 30 days of date of surgery and updated within 24 hours. Therefore if an H&P was dictated within 24 hours it did not need an update. I have recently been told that it must be updated after admission even if dictated within 24 hours. A: I am not sure why anyone would think an H&P performed within the last 24 hours would need an update unless there was a change in the patient’s condition within that time. The standards and regulations do not identify any further requirement than that. A: The standard is in Provision of Care, standard PC.01.02.03. For a medical history and physical examination that was completed within 30 days prior to registration or inpatient admission, an update documenting any changes in the patient’s condition is completed within 24 hours after registration or inpatient admission, but prior to surgery or a procedure requiring anesthesia services. The key words here are after registration or inpatient admission and prior to surgery or a procedure requiring anesthesia. A: Were you given any supporting data? I have not heard this. I would ask for documents that support them needing to be updated even if dictated within 24 hours. A: All H&Ps must be updated the day of surgery, no matter if they were done two weeks prior or the day before surgery.

OR TODAY | July/August 2014

A: Yes, all H&Ps must be updated the morning of the procedure. We learned this during our last TJC survey (3 years ago). A: Ditto …. this is how the standards were interpreted to us and the reason our doctors resign all their H&Ps in pre-op holding even if they dictated them the night before. A: H&Ps must be written within 30 days of procedure and updated within 24 hours (date, time, and MD signature). If the H&P is not within 30 days we have them write a new one. A: We are accredited by The Joint Commission so we follow their standards. I would check with your quality department to see the standard and how your hospital is following it. A: At our last survey we asked for clarification on this issue and were told that the standard requires the H&P to be updated within 24 hours prior to receiving anesthesia or sedation. That is an inclusive 24 hours and unless the patient’s condition changes, it is not required again immediately prior to the procedure. If your hospital policy requires a repeat update, then you must follow your policy.

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SUITE TALK

DAY OF SURGERY PREP PROCESS I am working on a project to reduce the amount of time patients wait in prep and holding prior to surgery. My goal is to reduce patient anxiety and enhance their surgical experience. I know from some time observations that there are 35 minutes of hands on patient care (including RN assessment, IV start, vital signs, etc.) to be completed prior to surgery. The remaining time the patient spends just waiting. One of my biggest challenges has been the availability of an anesthesiologist to perform their assessment and obtain consent. Our current staffing model has anesthesiologists supervising 3-4 CRNAs. They only perform assessment and obtain consents on patients of their assigned CRNAs. This can cause a 30-40 minute wait for an anesthesiologist. Is this a typical staff model? Do you have an anesthesiologist(s) assigned to prep and holding to just perform their assessments and obtain consents for all patients. A: Our format is that whomever the CRNA is assigned to the surgical procedure is the CRNA who comes to pre-op/post-op to assess or discharge their patients. This process moves the patients along very well. Also, our unit is a patient- and family-centered care unit so their family members/loved ones come and go freely, we have movies if they wish to watch a movie, and our satisfaction scores are very good. A: At my former place of employment, we had sufficient surgeries to have an MDA assigned to pre-op holding/PACU to assess, consent and perform the discharge evaluation. It was very efficient.

UNIVERSAL TRACKING I am curious how others are handling this with the screw trays in orthopedics. When the replacement screws arrive in a sterile pack, technically you cannot open them to put them in the tray as replacements, as it says on the package that they cannot be reprocessed. Is everyone doing away with screw sets now and bringing all the different components in the OR Room? To me this is the only way to be able to track the screws. A: Generally our screws come in non-sterile packages that we use in our screw racks. Sometimes special plates come in that are sterile and we leave them sterile until they are used. Occasionally they are opened to see if they are the “correct fit.” If they aren’t used then we place them back in the tray, which we resteril-

ize, with the other plates. I guess the bottom line is to check with your vendor and see if the screws are available unsterile. A: We handle our plates and screws in the same manner.

THESE POSTS ARE FROM OR NATION’S LISTSERV FOR MORE INFORMATION OR TO JOIN THE CONVERSATION, VISIT WWW.THEORNATION.COM.

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July/August 2014 | OR TODAY

ACTION is a registered trademark of Action Products, Inc. ÂŠ 2014 Action Products, Inc.

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July/August 2014 | OR TODAY

IN THE OR MARKET ANALYSIS

BY JOHN WALLACE

MARKET ANALYSIS Patient Positioners

Patient positioners play an important role in healthcare from the prevention of pressure ulcers to assisting with surgeries and recovery. These devices can also be vital when it comes to robotic surgery procedures.

Since the Centers for Medicare and Medicaid Services (CMS) deemed pressure ulcers an event that should never take place, the market has grown for patient positioners that can reduce pressure on the skin. An aging U.S. population is another factor that could impact the market, according to Earl Cole, Vice President of Innovative Medical Products Inc. Innovative Medical Products manufacturers patient positioning devices for orthopedic surgical procedures. The company is focused on developing and marketing innovative products to benefit and improve efficiency in the operating room and hospital clinics where patient stability and positioning are 24

OR TODAY | July/August 2014

required. Its primary focus has been in orthopedics, anesthesiology, radiology and home healthcare. “The real market growth in positioners could come from the demographics,” said Cole. “As baby boomers age more and enter their 70s, there will be a big surge in total hip replacement procedures and, therefore, an acute need for more positioners.” “As our population ages but still remains active, joint injuries are occurring more than ever,” Cole added. “Sports medicine utilizes an array of patient positioners including distraction devices for smallincision, arthroscopic procedures. For example, knee surgery, probably the most frequent consequence of

sports-related injuries, relies more and more on distraction devices than on manual manipulation of the limb to distract the joint. Joint distraction positioners provide more accuracy for the surgeon and better surgical outcomes – two attractive benefits why these devices are in demand.” An increase in the number of robotic surgery systems along with the techniques and procedures they allow has spurred growth in the patient positioner market. These more specific procedures require more specific positioners. The need for more precise movements during surgery also adds to the need for patient positioners. “Robotic surgery and stable positioning go hand in hand,” Cole said. “You want the patient to be as stable as possible, so when the robot is doing its job, it can be as accurate as possible. Robotics are being used more and more in arthroscopic procedures. Smaller incisions mean less recovery time for the patient, which increases the popularity of this procedure. More arthroscopies require positioning solutions that WWW.ORTODAY.COM

MARKET ANALYSIS

provide the most stability.” Span-America manufactures and markets a comprehensive selection of pressure management products for the medical market, including patient positioners. Earlier this year, Span-America Medical Systems Inc. reported net income for the second quarter of fiscal 2014 was down compared to the second quarter of fiscal 2013. Net sales for the second quarter of fiscal 2014 were $14.7 million compared with $16.6 million in the second quarter of fiscal 2013. “Span-America’s second quarter sales and earnings were below the second quarter of last fiscal year due primarily to lower sales of consumer bedding products and M.C. Healthcare product lines,” stated Jim Ferguson, president and chief executive officer of Span-America. “As we expected and previously announced, sales of consumer bedding products were down due to the loss of a large retail customer that selected a different supplier in a routine competitive bidding process for their everyday consumer bedding products. M.C. Healthcare’s sales to the provincial government in WWW.ORTODAY.COM

British Columbia were down $1.1 million compared with the same quarter last year due to changes in governmental budget allocations and restrained government spending.”

made the devices more reliable. “Healthcare providers have accepted patient positioners because they do what they’re supposed to do – provide stability for the patient during sur-

Earlier this year, Span-America Medical Systems Inc. reported net income for the second quarter of fiscal 2014 was down at $14.7 million compared with $16.6 million in the second quarter of fiscal 2013.

Ferguson said he expects the sale of medical products to increase. “We expect modest growth in medical and industrial sales in the second half of fiscal 2014,” Ferguson said. The company is optimistic about the future because of market trends. “We are encouraged about future sales opportunities for our medical and custom products based on the activity that we are currently seeing in our markets,” concluded Ferguson. Cole, of Innovative Medical Products, is also optimistic about the future of the patient positioner market because advances have

gery,” Cole said. “Before that, when performing hip replacements, for example, the surgical team would literally use tape and straps, or later, the beanbag, to keep the patient in the lateral position. But these efforts could never do the job, as there was most always patient movement. Patient positioners, on the other hand, provide the stability required.”

July/August 2014 | OR TODAY

IN THE OR PRODUCT SHOWROOM

STELLAR® POSITIONING PRODUCTS ENCOMPASS GROUP The Pillow Factory Stellar® Positioning Products are the perfect balance of function and comfort. All are covered in attractive blue, technologically advanced, Comfort Care™ fabric for an ultra-soft, breathable surface that is fluid-resistant and easy to wipe clean. They are filled with recycled polyester fiberfill. Stellar Positioning Products are available in a variety of styles, including wedges, bolsters, full-body, and an Encompass patented 3-in-1 Convertible Positioner. They can be used to elevate, prop, and support patients – providing ideal comfort during rest and recovery. For more information, contact Encompass Group, LLC at info@encompassgroup.net, 800-284-4540 or www.encompassgroup.net.

OR TODAY | July/August 2014

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PRODUCT SHOWROOM

HUMBLES TRENWRAP™ INNOVATIVE MEDICAL PRODUCTS The Humbles TrenWrap™ positioning pad system securely anchors a patient wherever desired on the operating table prior to positioning in Trendelenburg for robotic and laparoscopic surgeries. The system’s Pre-Load™ Rail Clamps secure the straps of the positioning base pad, locking the pad tightly in position to the OR table’s side rails. The TrenWrap™’s proprietary Phase 4™ adhesive material applies directly to the patient’s skin, affixing the patient to the TrenWrap™ positioning pad system. In accordance with AORN guidelines, the TrenWrap™ system eliminates tucking sheets under the patient to hold the patient’s arms in place during surgery.

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July/August 2014 | OR TODAY

IN THE OR PRODUCT SHOWROOM

AKTON速 POLYMER POSITIONERS ACTION PRODUCTS Exclusive Akton速 polymer support surfaces and positioners from Action Products have set the standard for over 40 years. The reusable line of pads and positioners has a 360属 stretch to allow for maximum pressure and shear qualities. Based on clinical engineering, Action速 brand products are known in the industry for their optimal effectiveness in redistributing heat, weight and pressure. With an expansive selection, Action has your pressure management plan covered from neonatal to bariatric patients. Why trust your zero tolerance goals to anyone else? Take advantage of our education on our free CE, nurse advice line, YouTube and informative blog.

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PRODUCT SHOWROOM

BUTTERFLY BEAN BAG POSITIONER DAVID SCOTT COMPANY David Scott Company created the Butterfly Steep Trendelenburg Gel Bean Bag Positioner in conjunction with a leading Boston-based Harvard Medical School surgeon. The polyurethane positioner is designed as an aid in securing patients when in steep Trendelenburg and is ideal for robotic surgery. This is the only steep Trendelenburg positioner that offers an integral gel layer for pressure management attributes, comfort and patient safety. The positioner has wings that support and cradle the patient around the upper arm and shoulders. These wings can be molded into the shoulders to secure the patient without the need for shoulder supports. The Butterfly has six individual, replaceable securing straps that anchor it to OR table side rails and offers IV access to the forearm, while the lower wings protect the patientâ&#x20AC;&#x2122;s hands.

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NI-25341

IN THE OR CONTINUING EDUCATION 683

BY VICKI GEORGE, RN, PHD, FAAN, AND BARB HAAG-HEITMAN, RN, PHD, PHCNS-BC

PEER REVIEW IN NURSING

An Evidence-Based Approach

OR TODAY | July/August 2014

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CONTINUING EDUCATION 683

ou may have heard of peer review in nursing, but do you really know what it is? Do you know how it can be applied to your practice to enhance safety and high-quality outcomes? Peer review includes using evidence-based practice and professional standards to evaluate the nursing practice of a peer (i.e., a nurse of the same rank or standing). For example, one nurse may review a peer at the bedside to ensure that the peer is following evidence-based protocols for preventing ventilator-associated pneumonia This type of peer review has had a significant impact on the quality and safety of care, with a reduction in VAP and related costs.1 ContinuingEducation.com guarantees this educational activity is free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See page 39 to learn how to earn CE credit for this module.

The goal of this CE program is to inform nurses about the evidence-based peerreview process in nursing. After studying the information presented here, you will be able to: • Describe the role of peer review in professional practice • Discuss role of peer review in creating and sustaining quality and safety outcomes • Explain evidence-based practice principles for nursing peer-review activities in a contemporary model of nursing practice

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Peer review is essential for being a part of a profession, but few healthcare organizations have meaningful nursing peer-review processes. Nursing has lagged behind other professional groups, especially physicians, in creating a peerreview agenda. Authentic nursing peer review requires that all nurses use evidencebased standards, regardless of role or practice setting. FOR SAFETY’S SAKE Nursing peer review looks at present practice and allows the correction or mitigation of errors during an episode of care. This contrasts with the retrospective, error-based peer review system that many healthcare disciplines use to try to ensure patient safety and quality care. The latter system, which looks back at errors and often assigns blame, is ineffective and has plagued healthcare for many years. Although the focus on quality appears evident in traditional peer-review processes, the outcomes are not consistent or sustainable. For example, wrong-site surgery still occurs in U.S. hospitals and clinics an estimated 40 times a week despite the use of the universal protocol and other safety checklists.2 Safety checklists and protocols provide the structure for error prevention,

but most practice environments do not have a process to create a culture of safety using real-time peer-to-peer feedback. Many healthcare dollars are spent on quality improvement education programs and workshops. Facilities rely too heavily on manager-designed and educator-led annual skills days and competency checklist approaches to ensure quality. Most of these programs do not develop or measure the professional behaviors and judgments necessary to prevent errors at the point of care. Effective peer review is necessary to create cultures of safety. A sustainable improvement in clinical practice is possible with peer review that is embraced by the nursing governance structure and implemented at the unit level. Locating peer review at the point of service acknowledges that to improve safety and prevent harm, practitioners must work together to prevent and intercept errors in real time. The nuclear and aviation industries have demonstrated the value of real-time peer-topeer review. Both industries have improved safety by using prospective peer-to-peer review to anticipate and prevent errors.3 For healthcare to have a similar safety record, peer review must move away from retrospective data reviews and July/August 2014 | OR TODAY

IN THE OR CONTINUING EDUCATION 683

root cause analyses by quality departments and toward a systematic approach using real-time peer review by clinicians at the point of care. Registered nurses are in an ideal position to create safer environments for patients: RNs constitute the largest healthcare occupation in the U.S., with 3.1 million jobs,4 most directly involved in patient care. Nurses need to create a systematic peer-to-peer model for nursing that can accelerate improvement in patient safety and quality outcomes. PROFESSIONAL DIMENSIONS The American Nurses Association published its Guidelines for Peer Review in 1988 to support peer review as an essential part of a quality assurance system and to help ensure self-regulation of the discipline of nursing.5 However, most healthcare organizations do not have evidence-based peer-review processes for nurses in all settings and levels. Peer review is an essential element that defines all professional disciplines and, therefore, is not optional for any practicing professional. Nursing can use peer review to systematically assess, monitor and make judgments about peers’ quality of nursing care as measured against professional standards and evidence-based practice. The primary focus of peer review is the quality of nursing practice. The authors of the early ANA peer review guidelines recognized that the quality, quantity and cost of care were closely related and that what happened in one of these dimensions affected the other.5 Nursing peer review is based on the belief that in a self-regulating professional practice model (e.g., shared governance), the clinical accountability for nursing care rests 34

OR TODAY | July/August 2014

solely with the clinical practicing nurse. At the core of quality and safety is the essential role of the direct care nurse to maintain accountability for clinical practice standards, advocate for the patient to receive quality and safe care, and ensure the quality of the nurse and nursing care using peer credentialing and peer review.5 The result of nurses’ peer review is a sustainable improvement in quality nurse-sensitive indicators, such as falls, pain and patient satisfaction, and in safety outcomes along with practice advancement and professional development. Evidence-based practice should provide the foundation for all peer review. Nursing peer review uses evidence-based principles (discussed later in this module) and demands effective communication, collaboration and engagement of all nurses. Confusion exists about the differences between peer review, peer evaluation and annual performance reviews. As nurses begin designing peer review, these differences need to be clear. Professional peer review is conducted within the professional practice model using an organized and principled approach for reviewing the quality of the care and the quality of the nurse.6 The annual performance review is a human resource/ management function performed by managers with direct reports to focus on an employee’s goals and contributions to an organization’s success.6 Managers can often request a peer evaluation, or input by nurses, about another nurse’s performance as part of the annual performance review. Often, this type of peer evaluation is anonymous even though anonymous feedback is not evidence based. An evaluation done by a peer in this type of 360-degree process is not peer review.

PEER-REVIEW PRINCIPLES Peer review involves the following principles:5 Principle No. 1: A peer is someone of the same rank. Clear definitions of peer groups are essential to creating effective peer- review processes. The role held by a nurse defines his or her rank and subsequent peer group(s), not the capability of a nurse to care for a patient as part of a work assignment. For example, a unit educator who takes a direct care assignment 50% of the time is both an educator and a direct care nurse. The nurse in this situation belongs to each group of like rank and, therefore, must participate in peer review for both roles. Note that managers are not peers with direct care nurses even though they have practiced as direct care nurses.7 Peer groups include: • Direct care nurse to direct care nurse • APN to APN • CNS to CNS • Educator to educator • Manager to manager • Director to director • Nursing administrator to nursing administrator Principle No. 2: Peer review is practice focused. Peer review incorporates role-specific evidencebased practices along with specific quality and safety outcome measurements. Peer review provides the structure and process to ensure that the peer group sanctions the use of new nursing standards and innovative approaches to care. Peer review should not be confused with peer evaluation by the manager during an annual performance review or 360-feedback evaluation from a peer group.6 Principle No. 3: Feedback is timely, routine and a continual expectation. To continually ensure quality outcomes, nursing peer WWW.ORTODAY.COM

CONTINUING EDUCATION 683

review needs to be timely, continuous and a routine expectation in daily practice, as in each handoff of care. Continuous quality improvement demands that organizations create structures and processes that support dynamic feedback to all healthcare providers, especially at the point of care. Nurses need to develop new models of peer review that move beyond traditional static processes, such as retrospective chart audits, to “just-in-time” chart review and patient rounding by peers during patient handoffs between shifts. This allows for immediate changes in practice to improve patient outcomes with a focus on improving care. The improvement seen in team care should be reflected in the improved clinical outcomes for patients. Principle No. 4: Peer review fosters a continuous learning culture of patient safety and best practices. Peer review in a learning organization and a just culture helps nurses feel safe to explore innovation. For example, nurses in some organizations have moved away from the traditional skills day for competency assessment and now use simulation or real-time performance-based validation.5 A continuous learning culture shifts the focus from individual learning to organizational learning and helps foster a common commitment to achieve and sustain quality and safety outcomes. Direct care nurses report that they feel a sense of teamwork and support from the nurses they work with when feedback is given properly, and they report that it “can make you feel more secure at work.”7 Even less favorable feedback can be viewed as having someone “watch your back.”8 As one nurse said, it makes “me feel secure; someone is watching over me.”8 In a continuous learning WWW.ORTODAY.COM

culture, peers often question one another about the effectiveness of nursing practice. Nurses working to reduce VAP, for example, helped one another understand alternatives to VAP prevention when the patient could not tolerate having the head of the bed elevated as per the standard protocol. As a result of peers’ questioning each other, more timely modifications to advance practice can be made without fear of retribution. Nursing peer review can provide an effective systems-centered approach to reducing errors in healthcare, as realized in other high-risk industries, such as aviation and nuclear power.3 Principle No. 5: Feedback is not anonymous. Positive nurse relationships emerge from focused and skillful dialogue. The Code of Ethics for Nurses outlines a nurse’s duty to use respectful communication with an open exchange of views that preserve practice integrity and safety.9 Many staff nurses call anonymous feedback “pal review,” especially when it is collected by the manager and communicated to the nurse during an annual performance evaluation.5 This form of feedback does not help create teamwork or promote professional growth and patient safety. Principle No. 6: Feedback incorporates the developmental stage of the nurse. Decades of research indicate that nursing practice develops along a novice-to-expert continuum.10,11 Peer review that measures the progress of the clinician from novice to expert can encourage professional growth.10 Continuous feedback should give consideration to the experience and developmental stage of the nurse.12 Although expert nursing practice is highly valued, we know very little about how to promote it. Nurses

should be knowledgeable about and use the characteristics of practice for each of the stages of novice to expert. The theory of novice to expert described by Patricia Benner, RN, PhD, FAAN,10 recognizes that years of service alone will not guarantee progression to the expert stage and that many nurses do not reach the level of expert practice, inferring that antecedents to expert practice are missing in their development.10 Peer review can create the type of reflective practice that measures the nurse’s development along the novice-toexpert continuum. DOMAINS OF PEER REVIEW There are three contemporary domains of peer-review practice: practice advancement, role actualization, and quality and safety. A comprehensive peer-review program includes activities in each domain.5 The focus of each domain’s peer review activities is presented below:

Figure 1: The Domains of Peer Review © Haag-Heitman & George 2010

Domain of practice advancement: Many organizations use clinical and career ladder programs to recognize and differentiate nursing practice. July/August 2014 | OR TODAY

IN THE OR CONTINUING EDUCATION 683

Historically, these programs rarely use true peer review that involves nurses at the same level reviewing and determining one another’s advancement. Generally, the manager, not the staff, determines a nurse’s advancement on career ladders; thus, it is not a true peerreview process. Typical criteria in clinical ladders include continuing education, committee participation, work experience, certifications, academic degrees, community service and performance appraisal scores,11 often involving elaborate portfolios. While many programs claim to use Benner’s9 work as a framework, most programs’ criteria for advancement do not correlate with Benner’s developmental criteria, which is measured solely by exemplars from practice. Often participation in clinical advancement programs is low because of what nurses consider unrealistic expectations, time-consuming processes and inconsistencies in the program’s administration. The elements of the portfolio often used to develop clinical ladders may lend themselves more to the domain of role actualization, as evidenced below. Benner’s model of practice along the novice-to-expert continuum requires clinical narratives from a nurse’s practice (accounts of a patient-nurse interactions) to determine practice stages.11,12 A practice-based advancement program that uses staging on the novice-to-expert continuum allows for the differentiation of practice levels for direct care nurses. This process also acknowledges that critical-thinking skills develop throughout the experiential learning process and can be demonstrated in clinical narratives. Using clinical narratives in the credentialing process allows for differentiating practice beyond 36

OR TODAY | July/August 2014

skills-based measurements and more fully defines the comprehensive nature of nursing practice. Peer feedback promotes learning throughout a nurse’s career and helps expand a nurse’s capacity for self-direction and self-assessment. Therefore, giving and receiving peer-to-peer feedback must extend beyond orientation to throughout one’s career to encourage development along the novice-to-expert continuum. Some organizations are beginning to use new peer-review approaches to competency assessment. Peers define the competencies needed and validate performance in real time or in simulation labs with actual situations. This shift incorporates the following principles: • Moving from traditional psychomotor skills to an interpretation of interpersonal and critical-thinking skills • Discovering that the most accurate way of assessing competency is at the point of care at bedside or in simulation labs • Recognizing that peers are an essential source of learning5 Supporting the changing developmental needs of all nurses can help expand their practice and help them work to the full extent of their education and training, as recommended by the Institute of Medicine.12 Domain of role actualization: Nurses use evidence-based practices to promote better outcomes. Continually extending nursing knowledge and skills promotes effective practice and role development. Peer review plays an essential role in promoting continuous learning, practice development and nursing role autonomy. In the Guide to the Code of Ethics for Nurses,9 the concept of professional growth also moves beyond minimal standards of nursing skills, often called “baseline

competencies,” toward an ideal of practice based on professional credentialing and privileging.13 (Privileging involves the formal assessment of knowledge, skills and attitudes required to perform an aspect of care or a specific procedure.) Peer-to-peer feedback is expected throughout orientation and socialization to new roles. Once formal orientation is over, however, most organizations abandon daily feedback, to the detriment of the profession and organization. Protecting nurses’ role autonomy and the stature of nursing requires peer review to foster professional development and ensure role competency. Although widely used to define proficiency, competency is the rock-bottom level of acceptable practice.9 Therefore, is it time to move away from the minimalist concept of competency and to use peer review for professional credentialing and privileging. Staff must have accountability for appropriate credentialing of applicants to the nursing staff since the exercise of the clinical nurse role is a privilege, not an obligation.14 Because most nurses work in direct care, most credentials are clinical. This means that direct care nurses need to play a significant role through the shared governance structure in setting goals for required role accomplishments. In reviewing peers’ credentials and in privileging clinical advancement programs or ladders, nurses incorporate the obligations of membership to the nursing discipline and develop the criteria for approval, such as academic preparation, advanced degrees, licensure, experience, certifications and other factors indicating adequate preparation. In addition, they can reward nurses for community service and other goals WWW.ORTODAY.COM

CONTINUING EDUCATION 683

of practice set by the governance structure. Shared governance bylaws should always define the credentialing and privileging and peer-review processes for nursing.15 These same principles, although not usually defined in a clinical ladder, can also apply to nurses in roles other than direct care, such as educators, managers and advanced practice nurses. Domain of quality and safety: The number of quality and safety initiatives has grown across all practice settings along with the demand for measuring and reporting outcomes. Each nursing department’s strategic initiatives are used to determine nursing priorities and as a focus for peer review. Peer review helps ensure established outcomes by using peer-to-peer feedback that includes prompt corrective action to prevent undesired outcomes. Outcomes are best achieved when peer review takes place in a just culture that prevents individualfocused blame for bad outcomes. A summary of practices that integrate a peer-review component to promote quality and safety outcomes follows: • New skill-based practice changes are ideally adopted using direct observation in patient care areas between peers at change of shift or handoff.3 • Regulatory or practice standard documentation can be improved using a real-time or open-chart review process between peers. This is in contrast to the traditional retrospective and static chart audit process commonly used and reported to the manager. • Nurse-sensitive quality measures should be used to establish priorities for peer-review direct feedback activities at the unit level. The improvement in practice resulting from nurses’ monitoring, and sometimes correcting or WWW.ORTODAY.COM

educating, one another through peer review helps achieve desired outcomes and improve patient care in real time. • Incident-based peer review that focuses on one episode of care that resulted in quality/safety concerns is retrospective, eliminating the ability to influence the clinical outcome in real time Organizational learning to correct systems issues is possible using the governance structure to examine a “near miss” or sentinel event. This also can be done in an interprofessional way using a root cause analysis, provided each discipline is careful to bring the systems changes identified back to its own discipline’s practice framework. One discipline should not decide the practice of another. PEER-REVIEW EDUCATION The ANA calls for education of all nurses on the benefits of peer review and maintains that feedback to the nurse under review is more effective when verbal and written communication are combined.5 But the ANA has not specified the education necessary for peer review and peer feedback. Without training on giving and receiving feedback, raters often inflate or deflate the rating of a peer. Education that incorporates the principles above can help nurses accept peer review and reduce misconceptions about it. Nursing education about peer review ideally begins in undergraduate education. The concept of peer review becomes an expectation and a standard of practice. Quality in performance and self-regulation is a hallmark of a mature profession, and peer review is how a professional holds itself accountable to society. Therefore, a national call to action involving

nursing peer review is essential. Now the only focused action on peer review is in the American Nurses Credentialing Center’s Magnet Program. To earn the Magnet designation, a hospital must have nursing peerreview processes in place.16 More education is needed so that nurses understand the need for peer review at all levels to ensure accountability, competence and autonomy. Shifting clinical peer review from a management-led to a staff-led approach within the shared governance structure requires all levels of nurses to be committed, resilient, flexible, visionary and creative. Clinical nurses can no longer ignore the essential role that peer review plays in improving quality and safety outcomes. Nursing can take action to develop peer-review standards grounded in evidence-based practice, the novice-to-expert-continuum and the day-to-day, shift-to-shift focus on improving outcomes. VICKI GEORGE, RN, PHD, FAAN, AND BARB HAAG-HEITMAN, RN, PHD, PHCNS-BC, are managing partners and consultants for Nursing Consulting Partners LLC. REFERENCES 1. Fields L. Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit. J Neurosci Nurs. 2008;(40)5:291-298. 2. Boodman SG. The pain of wrong site surgery. Washington Post. June 20, 2011. 3. Hudson DW, Holzmueller CG, Pronovost PJ, et al. Toward improving patient safety through voluntary peer-to-peer assessment. Am J Med Quality. 2012;27(3):201-209. 4. Occupational outlook handbook: registered nurses. U.S. Bureau of Labor Statistics Web site. http://www.bls.gov/ooh/healthcare/registered-nurses.htm. Accessed February 18, 2013. 5. Haag-Heitman B, George V. Nursing Peer Review: Strategies for Successful ImplemenJuly/August 2014 | OR TODAY

IN THE OR CONTINUING EDUCATION 683 tation. Burlington, MA: Jones &

2nd ed. Dubuque, IA: Kendall

12. Haag-Heitman B. Sup-

Clin Nurs. 2001;9(2):273-281.

Bartlett; 2011.

Hunt Publishing Co.: 2010.

porting transitions in clinical

15. Porter-O’Grady T. Creden-

6. George V, Haag-Heitman B. Dif-

9. American Nurses Association.

practice. J Perinat Neonat Nurs.

tialing. privileging and nursing

ferentiating peer review and the

Code of Ethics for Nurses: Inter-

2012;26(1):5-7.

bylaws: assuring accountability. J

annual performance review. Nurs

pretation and Application. Silver

13. Schmidt L, Nelson D, Godfrey

Nurs Admin. 1985;15(12):23-27.

Leader. 2012;10(1):26-28.

Spring, MD: Author; 2008

L. A clinical ladder program

16. American Nurses Credential-

7. George V, Haag-Heitman

10. Benner P. From Novice to

based on Carper’s fundamental

ing Center. Application Manual

B. Nursing peer review: the

Expert. Menlo Park, CA: Addison-

patterns of knowing in nursing. J

Magnet Recognition Program.

manager’s role. J Nurs Manage.

Wesley; 1984.

Nurs Admin. 2003;33(3):146-152.

Washington, DC: American Nurs-

2011;19(2):254-259.

11. Haag-Heitman B. Clinical Prac-

14. Vuorinen R, Tarkka MT, Mere-

8. Fiddler M, Marienau C, Whita-

es Credentialing Center; 2008.

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toja R. Peer evaluation in nurses’

ker U. Assessing Learning: Stan-

to-Expert Theory. Gaithersburg,

professional development: a pilot

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MD: Aspen; 1999.

study to investigate the issues. J

CLINICAL VIGNETTE

A recent chart audit on an adult med/surg unit indicated that most nurses use the dorsal gluteal buttock for IM injection. But recent nursing literature suggests that the ventral gluteal (VG) site is preferable for IM injection because it is located away from major nerves and muscles, providing better access to muscular tissue and offering faster medication uptake. The current nursing policy already indicates the VG site is the preferred site.

A nurse who has participated in peer review at another hospital says that peer review: A. Is already used in most hospitals B. Is already a regular part of nursing C. Is unique to healthcare D. Improves patient safety

3. Correct Answer: A — Nursing peer review looks at present practice and allows the correction or mitigation of errors during an episode of care. 2. Correct Answer: C — The change in practice is based on evidence found in a review of the literature. 1. Correct Answer: D — Practice changes are ideally adopted using direct observation in patient care areas between peers at change of shift or handoff, i.e., peer review.

Using the VG site for IM injections is based on: A. The nurse manager’s preferences B. Tradition C. Evidence D. Joint Commission standards

The nurses on the med/surg unit understand that: A. Peer review allows the correction or mitigation of errors during an episode of care. B. Nurse-sensitive quality measures aren’t part of peer review. C. Peer review, peer evaluation and annual performance reviews are identical. D. The retrospective system of peer review has proven effective.

4. Correct Answer: D — Sustainable improvements in safety outcomes are one result of nursing peer review.

Which would be the most helpful to ensure universal adoption of the VG site for IM injection? A. A large-scale mandatory educational program B. The inclusion of VG as a competency in the annual education skills day C. A computer-based education module D. Peer review at the unit level

CONTINUING EDUCATION 683

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

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.

All users must complete the check out process to complete the process. You will be able to view a certificate on screen and print or save it for your records.

ACCREDITED ContinuingEducation.com is accredited as a provider of continuing nursing education by the American Nurses Credentialing Centerâ&#x20AC;&#x2122;s Commission on Accreditation. Accredited status does not imply endorsement by the provider or ANCC of any commercial products displayed in conjunction with this activity. ContinuingEducation.com is also accredited by the Florida Board of Nursing (provider no. FBN 50-1489) and the California Board of Registered Nursing (provider no. CEP13213).

ONLINE Nurse.com/CE You can take this test online or select from the list of courses available. Prices subject to change.

QUESTIONS Questions or for a complete listing of our courses Phone: 800-866-0919 Email: ce@nurse.com

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LET’S GEL INC. T

hanksgiving has special meaning for Robb McMahan and his wife, Lisa. In 2002, Robb completed the tile floor in their kitchen. Lisa had spent the day preparing a family feast. Everything appeared to be great, but as much as Lisa enjoyed cooking for her family she was suffering leg and back pain after standing on the hard tile floor for hours. Lisa ventured to a home improvement store where she bought some foam mats. They were small and did not match the décor of the couple’s kitchen. They helped with Lisa’s leg and back pain, but they were not durable. Robb, an engineer who had used his creativity in the past to develop everything from notebook computers to wheelchairs, decided he could solve the dilemma himself. After countless late nights and hundreds of prototypes, Robb finally developed an innovative patentable mat design utilizing soft, shock-absorbing polymer gel as the cushioning element. Fast-forward twelve years and Robb is the founder and CEO of Let’s Gel Inc. Let’s Gel Inc., an Austin, Texasbased privately held corporation, is the leading manufacturer and provider of innovative ergonomic flooring products in the home, medical, and commercial flooring categories. 42

OR TODAY | July/August 2014

Robb and Lisa McMahan, Founders of Let’s Gel, Inc.

The success of the company in the residential market led to an expansion into other areas. “We are the only company in the world that manufactures floor mats with gel. Gel is a proven energy rebounder. It offers the highest level of support. We have also invested thousands of dollars researching our mat technology,” Robb says. Robb explains how the company expanded from the residential market into the medical industry. “The way we got into this business wasn’t some genius move on my part. We constantly had hospitals contacting us about buying mats,” Robb says. “We had a surgeon, Dr. Jamie Landman, M.D., contact us and he basically said ‘I absolutely love your product. It is wonderful. I won’t do a surgery without it. I want to do a

study on your mat. Will you guys supply me with mats to do a study?’ We said, ‘Yes, absolutely.’ ” “We did the study with him and through feedback from Jamie we actually made some modifications to the mat,” Robb says. “We are the first and only manufacturer of ergonomic flooring with gel,” he adds. “Our mats have antimicrobial and anti-bacterial properties. The top surface provides the necessary friction level for use with damp or dry surgical booties. They are compatible with hospital grade quaternary cleaners and are NFPA 260 and Cal 117 compliant. GelPro mats are also certified by the National Floor Safety Institute for high-traction and are proudly made in the USA.” “The medical mat is a little more cushioned. It is 50 percent thicker than our standard mat that we sell in the residential marketplace,” Robb says. “It’s a little more cushioned because what we found is that a lot of the surgeons and a lot of the surgeries, particularly the orthopedic surgeries, tend to go for a pretty long time. Some of these surgeries go four to eight hours. With feedback through this study, we actually modified the product and made the product better.” In short, Robb says the healthcare industry came to him and they worked together to create a remedy. “What happened is the medical market came to us and said, ‘Hey, there’s not a good solution out there WWW.ORTODAY.COM

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and we’d really like to work with you to develop a solution.’ So that’s what we’ve done and I would say we are the leaders in the space right now,” Robb says. “We sell to a lot of hospitals direct and we have a growing distribution.” According to the randomized control study conducted by Columbia University’s School of Medicine and led by Dr. Landman, director of minimally invasive urology, it was concluded that the Let’s Gel products improved surgeons’ comfort and ergonomics during minimally invasive procedures, reducing the number of stretches and postural changes. Surgeons benefitting most from the use of comfort mats include vascular, transplant, orthopedic, and also scrub technicians. Robb says it is easy for people to understand how the mats benefit people in healthcare facilities. He compares it to a shopping trip to the mall. After walking on the hard floor in the mall and then stepping onto a carpet or padded surface relief can be felt almost instantly. “The key thing about the medical industry is that it really is not that different from anybody who stands on a really hard surface for a long period of time,” Robb says. “If you are standing on a very hard floor for an extended period of time you start having pain in your lower back first and then you have pain in your legs and in your feet. The primary benefit in the medical space is even more profound than it is on the residential side because these guys are doing something that is very important and very precise and very intricate. It’s a challenge to focus on what you are doing if you are in pain.” “Basically what the mat does is it allows surgeons to stand in a more WWW.ORTODAY.COM

GelPro Medical Mat in Columbia Blue

comfortable position for a longer period of time and have their focus on the work that they are doing as opposed to focusing on the pain they are experiencing from standing,” Robb points out. “As someone who has had knee surgery, and other surgeries in my life, I certainly want my surgeon to be pain free and focused on treating me.” The entry into operating rooms was a big success, but the need for Let’s Gel products did not stop there. Nurses and other hospital personnel soon began to contact the company for comfort solutions.

“We started out in the operating room and that is a product that uses primarily gel, it is a dual core technology but it uses gel as the primary cushioning element. As we started getting very successful in the operating room space, we had other areas of the hospital approach us,” Robb says. Soon mats were placed at nurse stations and pharmacies as well as other areas of the hospital. These mats are the NewLife Eco-Pro Anti-Fatigue Mats. They are ergonomically designed to provide the perfect balance of premium July/August 2014 | OR TODAY

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GelPro Medical Mats are scientifically engineered with gel plus foam technology to provide all-day comfort in operating rooms.

comfort and optimal support. The company’s proprietary Cellulon Polyurethane Technology stands up to the tough demands of commercial environments while providing lasting comfort that won’t bottom out over time. Manufactured in the USA, this eco-friendly line of anti-fatigue mats is certified by the National Floor Safety Institute for its high traction bottom surface. “Our Continuous Comfort mat line are mats made from polyurethane foam and offer the standing professional top ergonomic support for non-sterile applications,” Robb says. “The mats are made using BioFoam, which is a renewable plant-based resource. This mat is ideal for areas that have long counters such as pharmacies and nurses’ stations. Continuous Comfort mats are available in virtually any length, and can be custom made for a variety of applications.” COMFORT IS KEY “It is extremely durable, but the great thing about the polyurethane 44

OR TODAY | July/August 2014

mats is that they have what we call a very high-energy return factor,” he adds. “They are very springy and very bouncy. So, they are super comfortable to stand on and they are great for walking back and forth on.” It turns out that Robb and Lisa are not the only ones that are thankful for Let’s Gel Inc. The company receives mail and email messages praising their products on a daily basis. “Overall what we want to do is improve the health and well being of individuals who find it necessary to stand for long periods of time,” Robb says. “What has shocked me are the letters and emails we get back from customers even on the residential side.” Customers thank Robb and Lisa for allowing them to live a normal life, the praise the mats for helping them be able to cook for their family or just to be able to enjoy cooking like they did before back and leg pain forced them to exit the kitchen. “The bottom line is that our floor mats are the most comfortable floor mats in the world and they do a

better job of pain relief than anybody else’s,” Robb says. “All of our customer surveys that we do, all of the responses, the aesthetics are up there in the top three but number one every single time is comfort and pain relief.” Doctors, nurses and hospital employees are also thankful for Let’s Gel Inc. “On the medical side, we’ve never had a complaint or a mat returned,” Robb says. Let’s Gel continues to grow and Robb says new products will soon be introduced. “We have several innovative products that use our gel technology that will be released in the near future,” Robb says. “Many of these products will be used in the medical field both for healthcare professionals and by patients.” FOR MORE INFORMATION, visit www.gelpromedical.com or www.gelpro.com.

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RE JUST AS IMP ORTANT AS PATIENT C ARE By D on Sadler

Every job involves a certain amount of stress. But it’s probably safe to say that OR nurses and surgical techs experience more stress in their jobs than people in most other professions. ...

heir hours are often long and grueling, and the stakes associated with performing their jobs are literally life and death. In this type of environment, it’s not a matter if, but when, they will experience stress. The question is: What can they do to manage this stress and keep it from eventually leading to job burnout? “OR nursing can be very demanding, both physically and mentally,” says Caroline Doughty, RN, circulator, scheduler and charge nurse in the OR at Atlanta Medical Center. “I have gone home very tired and mentally drained after a shift. When you work in this manner for several months on end, it can make you rethink your career choice.” “In the OR nursing world, it’s hard to avoid stress and burnout,” adds Linda Park, RN, BSN, who works at All Children’s Hospital in St. Petersburg, Fla. “There’s always going to be a shortage of nursing staff, so you just have to deal with that aspect of the job. As nurses, we tend to put others’ needs before our own and forget that we need rest, too.”

DEALING WITH COMPASSION FATIGUE Phyllis Quinlan, PhD, RN-BC, is a consultant and personal coach who has worked with a number of different types of professional caregivers, including OR nurses and surgical techs. She says that stress management is at the top of the list of concerns for the OR nurses and surgical techs she has worked with. “I’m trying to raise awareness of what I call ‘compassion fatigue,’ ” says Quinlan. “This is the physical, intellectual and spiritual exhaustion experienced by many OR nurses and surgical techs that they may not even be aware of. But it comes through in their speech, behavior and, ultimately, their job performance.” For OR nurses and surgical techs, compassion fatigue can manifest itself in many different forms, she says. These include feelings of detachment from your patients, a difficulty in relating to patients and coworkers, and going through the motions of your job in a robotic way,

Caroline Doughty

is a RN, circulator, scheduler, charge nurse in OR, at Atlanta Medical Center. 48

OR TODAY | July/August 2014

without any real compassion or emotion, she says. “Others might start to view you as cold and distant,” says Quinlan. “They might ask you if something’s wrong, but professional caregivers are often hesitant to acknowledge that they need care themselves.” Marla Packer-Perdunn, RN, who works at the Centers for Specialty Care in Deptford, N.J., can relate to this. “Yes, I have experienced burnout — I

Phyllis Quinlan, PhD, RN-BC

“I’m trying to raise awareness of what I call ‘compassion fatigue’. This is the physical, intellectual and spiritual exhaustion experienced by many OR nurses and surgical techs that they may not even be aware of” — Phyllis Quinlan

think at some point everyone does. We work in healthcare, which is a caring profession that sometimes is not sensitive to the needs of its employees,” Packer-Perdunn says. “We can become blasé to our surroundings and numb to the suffering of others,” she adds. “Personally, I find that I become very short and impatient with people when I’m feeling stressed and burned out.” To resolve her burnout, Packer-Perdunn says she took a close look at what was missing in her life. “I had given up my favorite hobby, karate, which was the one thing in my life that I looked forward to every day. So I decided to find a studio and resume my training. This has helped me resolve my feelings of anger, loneliness and solitude,’” she says. “I volun have made new friends and volunteer at the studio to help teach the children’s classes, which brings me a sense of fulfillment and joy.”

MINIMIZE AND MANAGE STRESS Kathy Kaehler, a better living expert and the author of several books on fitness and nutrition, emphasizes that it’s impossible to eliminate stress in your job or your life. “Rather, your goal should be to minimize and manage your stress so it doesn’t eventually lead to job burnout,” Kaehler says. Two of the most important keys to managing stress and avoiding burnout, says Kaehler, are exercising regularly and eating right. “This isn’t a real news flash to anyone, but there’s a big difference between knowing you should exercise and eat right and actually doing it,” she says. For starters, she says you need to make an “appointment” with yourself every day to exercise. “Nurses and surgical techs work long hours so it might not always be realistic to work out an hour or longer every day,” WWW.ORTODAY.COM

Kathy Kaehler

is a better living expert and the author of several books on fitness and nutrition.

“Coming into the OR was excitexcit ing, but I think I overextended myself in the beginning. I learned a lot but started to feel very negative negatively about coming to work,” she says. “I knew I had to make some chang changes or I would run myself away from a job I really liked.” So Doughty decided to take on the OR personnel schedule. “This was an outlet that benefitted the department and me. It gets me off the floor occasionally and allows me to use my talents in a different manner, while giving me a break and making my job more manageable,” she says.

she acknowledges. “Instead, strive for shorter bouts of exercise — even five minutes can make a difference, because exercise has a cumulative effect.” For example, you can take five minutes here and there to do some plank exercises or jumping jacks or walk up and down a flight of stairs. “This will have a tremendous ripple effect throughout your day when it comes to reducing stress and helping stay calm,” says Kaehler. Planning is also the key to better nutrition, Kaehler adds. After spending years flying cross-country each week from her home in California to appear as a guest on “The Today Show” in New York, she found herself getting into bad eating habits. So she started what she calls Sunday Setup, when she does all of her food preparation for the week on Sundays so it’s easier to make healthy food choices all week long. WWW.ORTODAY.COM

A CHANGE OF SCENERY Sometimes, a change of scenery can help OR nurses and surgical techs better manage their stress and avoid burnout. Park says she experienced burnout at her previous job. “There was no support for the staff,” Park says. “I think a lot of nurses go through burnout because of the politics in the workplace.” This prompted her to take a different track in her nursing career and pursue travel nursing. “I knew that I still wanted to do OR nursing, but I felt like a change of scenery would help, and travel nursing was something I always wanted to do,” she says. “So I made the big jump and decided to pursue it.” Doughty, who transitioned into the OR after managing the ICU, also decided to try something different to manage her stress and avoid burnout.

LET GO OF CONTROL Quinlan encourages the OR nurses and surgical techs she works with to understand that they can’t control everything. “Control is an illusion,” she says, “especially in the OR, where things can change on a dime. So you have to be willing to be adaptable. Be open to whatever the day or night brings, instead of being resistant and inflexible if everything doesn’t go the way you planned.” Packer-Perdunn advises OR nurses and surgical techs who are feeling overly stressed and burned out to do a little soul searching. “Look deep inside yourself and try to find out what is the missing factor in your life,” she says. “This is a difficult thing to do objectively.” And Park stresses the importance of taking time for yourself to relax, and scheduling some “me” time in your calendar. “Or try something new like I did. Sometimes, a change of scenery can get you excited about your job again and help you see things from a new perspective,” Park says.

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SPOTLIGHT ON: COLLEEN BERRY

the

OF CARING By Matthew N. Skoufalos

ll her life, Colleen Berry has had a passion for art and aesthetics. A Florida native, Berry got her start in nursing at the Mayo Clinic in Jacksonville, Fla. She spent a couple years in orthopedics and neurosurgery before returning to school to earn a nurse practitioner degree. As her medical career advanced, Berry always felt divided between two worlds; as though half of her still belonged in art school.

the

OF CARING It wasn’t until Berry moved to Denver with her husband, Jackson, in 2013 to join the practice of Dr. Lisa Hunsicker at Revalla Plastic Surgery that she got the chance to use her artistic talents as part of of her nursing career — and to help patients recovering from life-altering illnesses. Berry was drawn to Revalla by Hunsicker’s work with breast cancer patients, particularly a reconstructive procedure called direct-to-implant surgery that Berry said helps alleviate discomfort and decrease recovery time for women undergoing double mastectomy.

“[Doctors] used to do tissue expanders, and over a period of multiple surgeries [patients] would have their breasts reconstructed,” Berry said. “These women would come in every couple weeks and have saline injected into the tissue expanders, and then that would take a couple months, and then they would have another surgery to put the permanent implants in.” Instead of using the traditional approach of tissue expanders in such patients, Berry said, Hunsicker performs a single-stage procedure during which the mastectomy and

t to determine what

ting with each patien

d deal of time consul Colleen spends a goo desired outcome. color will provide the

implant surgeries are performed immediately after one another. Berry said the difference in outcomes for patients is “slim to none,” and that opinion is based on more than a decade of data as well as anecdotal responses. “This works so well for women because they have to deal with the cancer diagnosis, then a mastectomy, and then they wake up with no reconstruction,” Berry said. “It takes a toll on their psyche.” By comparison, she said, patients undergoing the direct-to-implant procedure come out of anesthesia with fully reconstructed breasts.

size, shape and

“These patients take about six weeks out of their life and then they’re done,” she said. “It’s more of a speed bump in their life. They’re back to normal and back to life.” The direct-to-implant procedure has also helped save the lives of a few traditional cosmetic surgery patients as well, Berry said. She related the story of one 26-year-old patient who came in seeking a breast augmentation and discovered a cancer diagnosis during a requisite, pre-surgery mammogram. The patient opted for the mastectomy and the direct-to-implant procedure, and “had the same recovery and same restrictions that someone did for a regular breast augmentation,” Berry said. Aside from contributing to the health outcomes of women in need of cosmetic and reconstructive surgery, Berry said, she loves working in her chosen specialty because of the visible emotional component to her work. It’s a sensitive issue to speak with people about making intimate changes to their bodies, she said; many of the women seen in the practice just want to look and feel the same as they did pre-operatively.

The patient experiences little to no discomfort during the procedure, and it typically requires a few hours per treatment. Patients usually receive two to three treatments to create the desired 3-D effect.

I use my art background on top of my nursing background to really give these women the best outcome that’s possible. I feel with the tattoos you’ve either got the art background and the natural talent for it or you don’t. It was really just a natural transition for me.

— Colleen Berry

“There is a question about getting to choose your size,” Berry said. “We ask, ‘If you could wave your magic wand’,” and make changes, “and these end up looking very similar to your [original] breasts; as similar as they possibly can.

“A lot of women want to hang onto that,” she said. “They don’t want to feel like they’ve had cancer; they don’t want to feel like they’ve had surgery. It gets you to [go from] having a cancer diagnosis to being

totally cancer-free, and you get to keep all your body parts.” Berry is also a key component of the road to recovery for those of Hunsicker’s patients who undergo a non-nipple-sparing mastectomy.

Flesh-toned inks are sele cted and mixed accord ingly, in the same way palette when painting. an artist chooses colo Deeper and lighter hue rs to have available on s overlap to create the their 3-D effect in which Col leen specializes.

Some will opt for a temporary tattoo, an adhesive prosthetic, or a 3D nipple tattoo, which Berry performs. The procedure takes three sessions to complete, “just to make sure we’ve got all of the detail involved,” Berry said. She brings her understanding of shading, lighting and color, all honed throughout a life of artistic pursuits, into the clinical setting. “I was always involved in art classes, drawing, photography,” Berry said. “I actually wanted to be a tattoo artist. I ended up going back to school, learning how to use the tattoo machine, all the tattooing guns and colors. I had to do that entire advanced training and then I had to go back for more advanced training for nipple areolas themselves. “I use my art background on top of my nursing background to really give these women the best outcome that’s possible,” she said. “I feel with the

tattoos you’ve either got the art background and the natural talent for it or you don’t. It was really just a natural transition for me.” Berry, who also provides permanent makeup for chemotherapy patients, said that the entire experience of working with cosmetics has challenged her fundamental understanding about aesthetics. Even after completing the 3D tattoos, she said, most patients tell her they don’t care if anyone sees the finished product; they just want to draw their own eyes away from their scars “and back to something that looks normal for them.” “I feel like what I’ve learned the most is that people want what they look like,” she said. “They want to look how they did; not necessarily better, but how they used to look. I can tell them, ‘I’ve got all these ideas for you,’ and they show me a picture and say, ‘This is what I want to look

like.’ Everyone’s beauty is reflected to them differently.” “I’ve always thought about beauty and appearance as very personal,” Berry said. “This, to them, is the finishing touch. This is the high-five, ‘My cancer is over, and I’m back to normal [moment],’ ” she said. Berry still pursues her own artistic passions on the weekends; she enjoys acrylic painting and charcoal drawings, and says she’s “still exploring Denver” with her husband and their two rescue dogs, Walt and Babs. “Nurses should know that there’s so much out there,” she said. “If you feel like you’ve got something to offer, you should really pursue it. It took me this long to figure out that I could mesh my love of art and aesthetics and things with my love of nursing. “I’m very lucky to have discovered this at this point in my life,” Berry added.

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OUT OF THE OR HEALTH

THE VALUE OF DIET SODA STILL STIRRING DEBATE

he debate surrounding the weight loss benefits of drinking diet soda – or more specifically, its artificial sweetener content – is a hot one. Some experts argue that drinking diet soda instead of its sugar-sweetened counterpart can cut calories and support weight loss. Yet, emerging research indicates that diet soda is not conducive to weight control. The U.S. Department of Agriculture Dietary Guidelines reflects this, recommending that non-caloric sweeteners may reduce the intake of added sugar, yet still questioning their effectiveness as a weight management strategy. A 2005 study by researchers at the University of Texas Health Science Center found that the more diet soda a person drank, the higher the risk

60 OR TODAY | July/August 2014

for becoming overweight or obese. For each diet soda the study participants drank per day, their likelihood of becoming overweight was increased by 65 percent, and obese by 41 percent. The same university conducted another study in 2011, which included 474 participants, aged 65 years or older, from the San Antonio Longitudinal Study of Aging, and found that over a 10-year period diet soda drinkers as a group had 70 percent greater increases in waist circumference than non-diet soda drinkers. And high diet soda consumers (two or more per day) had waist circumference increases that were 500 percent greater than non-diet soda drinkers. WHY DIET SODAS MAY WORK AGAINST YOU One reason diet sodas may be ineffective for weight control is because of the disconnect between

the taste of artificial sweeteners and their lack of calories. Upon tasting artificial sweeteners, the brain anticipates the body will need to digest calories, but because artificial sweeteners do not deliver energy the body is simply thrown off. This was backed by a study published in Behavioral Neuroscience, which found that when rodents consumed yogurt with non-caloric sweetener they consumed more calories, gained more weight, and put on more body fat compared to rats given yogurt sweetened with sugar. A study in a 2012 issue of Physiology and Behavior also found that diet soda drinkers’ brain receptors undergo a greater activation from the taste of sweetness, suggesting that regular consumption of diet soda may alter the brain’s normal reward processing that accompanies the taste of sweetness; in other words, the brain may experience a magniWWW.ORTODAY.COM

HEALTH

fied response to the sweet-tasting drink, which may spur an increased desire for food. OTHER HEALTH CONCERNS Aside from weight gain, artificiallysweetened beverages appear to play a role in increasing other health risks. Daily diet soda consumption was linked with vascular risk factors and events, such as stroke, heart attack and death, according to a 2012 study in the Journal of General Internal Medicine.

And while both sugar-sweetened and artificially sweetened beverages were associated with type 2 diabetes risk in women, the diet beverages carried the greatest risk, found a 2013 study published in the American Journal of Clinical Nutrition. HERE’S WHAT TO DO Approximately 20 percent of the American population consumes diet beverages on any given day, according to the U.S. Centers for Disease Control and Prevention. Given the

growing body of evidence linking diet sodas to health problems, it might be a good idea to cut out this drink, which provides no nutritional benefits. Instead, opt for water, unsweetened iced tea or coffee, or sparkling water with a splash of 100 percent fruit juice. REPRINTED WITH PERMISSION from Environmental Nutrition, a monthly publication of Belvoir Media Group, LLC. www.EnvironmentalNutrition.com.

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OUT OF THE OR FITNESS

BY CAMERON HUDDLESTON, KIPLINGER PERSONAL FINANCE

AQUATIC EXERCISE A SAFE, GENTLE AND EFFECTIVE WAY TO WORK OUT

hen you’re struggling with joint pain, gravity can make exercise an unpleasant experience. But exercising in water, also known as aquatic therapy, can change all that.

“It enables you to do many of the same exercises you’d do on land without applying the same force on your joints,” says Gayle Olson, a certified athletic trainer at the Sports Performance Center at Harvardaffiliated Massachusetts General Hospital, Boston. WHY IT HELPS Aquatic therapy has many benefits. “One of the things people love about it is the feeling of buoyancy. It takes pressure off your body, and that brings immediate relief to painful areas,” explains Olson. Buoyancy is just part of the magic. The water provides resistance to your body, which helps you build muscle and bone strength. And the 62

OR TODAY | July/August 2014

warmth of the water encourages you to move, which has a helpful side effect: Repetitive movement pumps a natural lubricant called synovial fluid into the joints.

to help keep you stable in the water. After floating for a few moments to get used to the water, often with the help of a small flotation device (think pool noodle), you’ll begin a workout.

“ One of the things people love about it is the feeling of buoyancy. It takes pressure off your body, and that brings immediate relief to painful areas.” — Gayle Olson

Another plus of aquatic therapy is that it’s a safe exercise: Not only is it gentle on arthritic joints, which can help prevent further injury, but it also poses less danger from falls compared to land exercise. “If you fall during aquatic therapy, you just get wet, not hurt,” says Olson. HOW IT WORKS A typical aquatic therapy class takes place in a large pool and lasts for 30 to 60 minutes. If you’re disabled or have a balance problem, you’ll be encouraged to bring a partner along

The types of exercises you can do in the pool vary. “You can move your arms to work on improving posture, do combination movements for a good core muscle workout that helps your back, or do balance activities. You can also do an aerobic workout by marching, walking, running, jumping, and swimming,” says Olson. You can also work out with special weights that float. WHERE TO FIND IT If you’re interested in taking an aquatic WWW.ORTODAY.COM

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therapy class, Olson recommends looking at the local YMCA, fitness center, senior center, or hospital. But don’t expect insurance to pay for it. “Medicare and other insurers rarely cover the costs, although some insurance plans offer a reimbursement if you participate in a fitness activity,” says Olson. You may be able to get coverage for aquatic therapy if your doctor prescribes it as physical therapy. And many physical therapy groups offer therapy in a pool. Olson says to look for either a group-based rate of up to $15 per class or a personal trainer fee of $35 to $60 per half-hour. That can be an expensive way to exercise. So Olson advises that you go and watch a class or training session first, before you jump in. Just about anyone can take an aquatic therapy class. It’s helpful to people who have chronic pain from arthritic joints or fibromyalgia and for people who are disabled. It’s also considered safe for people who have balance problems or disability from multiple sclerosis, Parkinson’s disease, or stroke. Can’t swim? Usually that’s not a problem; you can wear a life vest. Olson also recommends the therapy for people who are recovering from surgery, once wounds have healed. But aquatic therapy isn’t right for people with open wounds, infectious disease, seizure disorders, or incontinence.

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Pumps Come Patient Ready with a One Year Warranty

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594A

July/August 2014 | OR TODAY

OUT OF THE OR NUTRITION

BY SHARON PALMER, R.D.

WHEN IT COMES TO ADDED SUGARS, THINK SPRINKLE, NOT SCOOP

aybe you’ve sworn off refined “white” sugar and think that sweetening a latte with, say, agave nectar, is better because, “it’s natural.” Truth is, most health experts agree that the best move you can make when it comes to added sugars (those added to foods by consumers or manufacturers) is to eat less of them. All of them.

The American Heart Association recommends limiting added sugars to 100 calories per day (6 teaspoons) for women and 150 calories a day (9 teaspoons) for men. But Americans’ average per capita daily sugar consumption is a whopping 28 teaspoons. Too much sugar can increase risk for obesity, heart disease and diabetes. You don’t have to ditch sugars all together. Get to know the types you’re seeing, learn how to spot added sugars on labels, and then sweeten sparingly. Here’s help:

GRANULATED SUGAR (A.K.A., SUGAR, TABLE SUGAR) Granulated sugar is composed of 50 percent glucose and 50 percent fructose. This pure white sugar has been processed and therefore it has few minerals and antioxidants.

PER TEASPOON: 16 calories, 4 g carbohydrate

AGAVE NECTAR This sweetener has a glycemic index (measure of how high a food raises blood-glucose levels after eating) that’s significantly lower than that of table sugar; it’s also up to 90 percent fructose. Agave is good for giving smoothies and iced drinks a touch of sweetness.

OR TODAY | July/August 2014

PER TEASPOON: 21 calories, 5 g carbohydrate

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NUTRITION

HONEY Delivers slightly more fructose than glucose. Honey’s antioxidant quantity varies greatly based on type; buckwheat honey typically delivers the most. Honey provides a delicate, sweet flavor to dressings, marinades and slaws.

MOLASSES About 50 percent each glucose and fructose, dark molasses has the highest antioxidant levels of all sweeteners (per serving). It’s great for adding a hint of sweetness to baked beans, homemade BBQ sauces and ginger cookies.

PER TEASPOON: 21 calories, 5 g carbohydrate

PER TEASPOON: 19 calories, 5 g carbohydrate

MAPLE SYRUP A go-to for drizzling over pancakes and waffles, maple syrup is about 50-50 glucose and fructose (depending on grade) and contains small amounts of polyphenols – antioxidants that help quell inflammation.

TURBINADO (RAW SUGAR) Like granulated sugar it’s 50 percent fructose and 50 percent glucose. The brown color comes from small amounts of molasses that haven’t been stripped out. It’s best for topping cookies for a sugary crackle.

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PER TEASPOON: 17 calories, 4 g carbohydrate

PER TEASPOON: 18 calories, 5 g carbohydrate

July/August 2014 | OR TODAY

OUT OF THE OR NUTRITION

GLOSSARY Glucose is a so-called simple sugar found in all foods with carbohydrate. A label’s “sugars” designation includes both natural and added sugars. Fructose, a simple sugar, is found naturally in fruit (and honey and agave nectar). When isolated from whole foods (and eaten in excess), fructose could present unique health risks, say some health experts. HIDDEN IN PLAIN SIGHT Added sugars lurk in many processed foods. And although more and more food companies are ditching highfructose corn syrup, their products aren’t necessarily sugar-free. In fact, they may contain just as much sugar as before, just in a different form. Here’s how to find out:

READ THE NUTRITION FACTS PANEL Under a food label’s “sugars” designation, both natural and added sugars are included. Natural sugars (such as lactose in milk and fructose in fruit) are not usually a problem because they come in small doses and are packed with other nutrients, which helps slow absorption.

CHECK THE INGREDIENT LIST All of the following are aliases for added sugar. The higher up on the list they appear, the more sugar is in the product. Dextrose, fructose, honey, invert sugar, raw sugar, malt syrup, rice syrup, sucrose, xylose, molasses,

corn sweetener, fruit juice concentrate, high-fructose corn syrup, brown sugar, corn syrup, glucose, lactose, maltose, sucrose, evaporated cane juice, agave nectar, cane crystals, cane sugar, crystalline fructose, barley malt, beet sugar, caramel.

COMPARE PRODUCTS Determine how much unhealthful added sugar your product contains by comparing it to a comparable sugar-free product, such as strawberry yogurt to plain yogurt, or canned peaches in syrup to canned peaches in juice. EATINGWELL is a magazine and website devoted to healthy eating as a way of life. Online at www.eatingwell.com.

Enjoy your Independence! Demand your freedom! When you decide to use DisCide! The disinfectant that kills over 21 microorganisms in 1 minute or less! HOW DID YOUR DISINFECTANT RATE? Visit EPA website for more info http://www.epa.gov/oppad001/atp-product-list.pdf

As shown on the EPA’s list, Palmero Health Care’s DisCide Ultra Disinfecting Towelettes and DisCide Ultra Disinfecting Spray ACHIEVED the Agency’s stringent efficacy performance standards against Staphylococcus aureus, Pseudomonas aeruginosa, and Mycobacterium BCG (tuberculosis bacteria) and are confirmed as an efficacious hospital disinfectants.

160 count, 6" x 6¾" towelettes 60 count 10.5 X 10.5

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Request a free sample www.palmerohealth.com of DisCide Ultra! http://www.palmerohealth.com/requestSamples 800-344-6424

OR TODAY | February 2013

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Select a Safe Place for your MIS Instruments DDLP-1123

Full Size Double Decker Lap Tray Combine the Laparoscopic Insert with the graduated Secur-It™ holders (3, 5 & 10 mm slots) to accommodate up to 15 lap instruments. Use an optional silicone cushion mat to protect instruments in the bottom - doubling up on available storage space. Or easily install the single width Secur-Its™ to hold additional cannulated instruments. These trays are made of tough, lightweight and corrosion resistant anodized aluminum. 23” x 11” x 8”h.

Bariatric Laparoscopic Tray

52527

This tray is large enough to accommodate the very long instruments used in bariatric surgeries (max length 65cm). The system is made of tough, lightweight and corrosion resistant anodized aluminum. The laparoscopic Insert with the graduated Secur-It™ holders (3, 5 & 10 mm slots) is designed to accommodate up to 15 lap instruments. The double-decker design holds twice the number of instruments in the same amount of space. 25.6” x 10.7” x 7.7”h

31127 DV

Robotic Arm Sterilization Case Manufactured of tough but lightweight anodized aluminium, this tray is conﬁgured to accommodate and secure robotic instrumentation for safe steam sterilization, transport and storage. The graduated Secur-Its™ safely hold and protect up to 8 instruments. The kit includes: 2 each 10”, 15 position universal brackets. 27” x 11” x 3.5”h.

healthmark INDUSTRIES CO. health care products 800-521-6224 www.hmark.com

OUT OF THE OR RECIPE

BY DIANE ROSSEN WORTHINGTON

SUMMER CHOPPED SALAD WITH BASIL VINAIGRETTE

OR TODAY | July/August 2014

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RECIPE

rowing up in Los Angeles, I had the opportunity to enjoy just about every version of the famous Brown Derby Cobb salad that was offered. You can still find the original Cobb salad, named after Bob Cobb, the owner of the Brown Derby, at any number of California restaurants. In fact, this salad has become a national favorite in restaurants across the country. Chopped iceberg lettuce is the basic ingredient, along with blue cheese, cooked chicken, crisp, crumbled bacon, diced avocado and tomato garnishes. Sometimes it comes mixed and other times it is presented with a pretty design of all of the ingredients on top.

Chefs love to create their own signature versions of this classic, and so can you. Some other flavor additions or substitutions you might consider include sweet red or orange bell peppers, cucumbers, provolone, feta cheese or even olives. Another favorite of mine is to chop up chilled

grilled vegetables and top with some goat cheese. This reinterpreted recipe is a family favorite when it’s just too hot to cook. Take the freshest greens, add perfectly ripe chopped tomatoes, raw sweet corn, a sprinkling of sliced hearts of palm and toasted pista-

chios, and dress with a peppery basil vinaigrette. For a more substantial main course salad, add cooked chicken or seafood. Begin with bowls of your favorite chilled soup for an al fresco light lunch or dinner. Don’t forget some crusty French or Italian bread and small bowls of fruity olive oil for dipping. DIANE ROSSEN WORTHINGTON is an authority on new American cooking. She is the author of 18 cookbooks, including “Seriously Simple Holidays,” and also a James Beard award-winning radio show host. You can contact her at www. seriouslysimple.com

SUMMER CHOPPED SALAD WITH BASIL VINAIGRETTE Serves 4-6.

DRESSING: 1 shallot, finely chopped 1 1/2 tablespoons balsamic vinegar 2 teaspoons fresh lemon juice 1 teaspoon whole grain Dijon mustard 1/3 cup olive oil •

1/4

Salt and freshly ground black pepper cup packed coarsely chopped basil leaves

SALAD: 1/2 pound of fresh mixed salad greens, finely 1 1 1/4 1 1/4 1

chopped large ripe tomato, coarsely chopped (14.5 ounce) jar hearts of palm, rinsed and sliced European cucumber, finely chopped fresh ear of white or sweet yellow corn, husked and kernels cut off (see note) cup shelled and chopped pistachio nuts, toasted (see note) avocado, peeled and sliced, for garnish

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DIRECTIONS: In a food processor, combine the shallot, vinegar, lemon juice and mustard, and process to combine. Slowly add the oil, whisking to incorporate. Add the salt and pepper and basil, and pulse until well blended. Taste for seasoning. Combine all salad ingredients into a large salad bowl. Add dressing and toss until all vegetables are well coated. Transfer to serving plates and garnish with avocado slices. Sprinkle freshly ground pepper on the salad if desired, and serve. Note: To remove the corn kernels from the cob, break the husked corncob in two. Hold each half vertically, resting on the blunt end for stability, and slide a chef’s knife down the sides, releasing the corn kernels. To toast the pistachios, place on baking sheet in 350 F oven and toast for 3 to 5 minutes. Cool.

July/August 2014 | OR TODAY

FINALLY FINALLYREFURBISHED REFURBISHED ANESTHESIA ANESTHESIAEQUIPMENT EQUIPMENT ATAT PRICES PRICESTHAT THATWON’T WON’T LEAVE LEAVEYOU YOUFEELING FEELING KNOCKED KNOCKEDOUT. OUT. Save % 40-60

We offer depot repair on several patient monitors at a fraction of the cost of OEM. If you are a do it yourself tech, we have a large quantity of parts In stock.

Doctors Depot

800.979.4993 | doctorsdepot.com aaron@doctorsdepot.com

Dräger Fabius Tiro

Datex-Ohmeda Aestiva 5

• Compact, space-saving design

• Includes 7900 Smartvent (Optional PSV Pro Software)

• High performance ventilation w/all major modes • CLIC Absorber systems • Intelligent safety features for enhanced patient protection • Standardized Dräger user interface for easy and intuitive operation

Mindray A5 • 15” Touchscreen • VCV, PCV-VG, PS, SIMV-VC, and SIMV-PC Ventilation Modes • Heated Absorber • Data output compliant with most EMR systems

• Option: S5 Anesthesia Monitor (as shown in picture)

100%

satisfaction or your money back All refurbishing done inhouse by Factory trained and certified technicians.

GE Datex-Ohmeda S5 ADU Carestation • • Several configurations available. • Includes 12” Screens • Complete S5 Monitoring System • Ohmeda ADU certified technician in-house

GE Avance • Complete patient monitoring capabilities: respiratory gas, hemodynamic and adequacy of anesthesia. • Our state of the art electronic gas mixer with pneumatic back-up control. • Advanced Breathing System(ABS) • All modes of ventilation available.

Dräger Fabius GS and Fabius GS Premium

GE Aespire 7100/7900

• Fully upgradeable to add new technologies as your needs change.

• Includes Ventilator modes: Pressure Support, SIMV, Volume and Pressure Control.

• 7100 Ventilator features volume and pressure control modes with Electronic PEEP.

• Can be integrated with your hospital information system.

• Heated Absorber

• Pressure waveform for visual reference on a breath-by-breath basis

• Low circuit volume contributes to a fast response well suited for low flow cases - 2.7 L in vent mode, 1.2L in manual mode.

• CLIC system for Soda Sorb

• Smart Alarms direct user to specific problems and affected parameters

GE Aisys • VC, PC, PS w/Apnea Backup, SIMV Volume and Pressure, Electronic PEEP, PCV-VG, PCV-PG.

• Color display

• 7900 Smartvent includes PSV Pro SW

• Advances Breathing System(ABS)

ORToday_halfpage_2014_FINALD.pdf

1/24/14

4:16 PM

cooler than ever Introducing CoolOR® The NEW cooling vest system designed specifically for operating rooms!

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

• Portable • Convenient • Easy-to-use

MADE IN THE U.S.A.

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Neoprene gasket seal with secure stainless steel compression latches.

NO ELECTRICAL CORDS Rechargeable lithium ion battery offers increased mobility with over six hours per charge. All electrical components are UL Listed.

*heel strap kit optional

Plenty of Benefits Calzuro is durable with a 1½ inch heal offering hours of comfort, a slip resistant sole, and the ability to easily disinfect Calzuro in an autoclave, bleach, or in the wash machine.

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July/August 2014 | OR TODAY

OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTEST • JULY •

Add this to your Summer Reading List

Where in the World?? ORToday is everywhere you are!

Take a pic of yourself wearing your OR Today T-shirt or holding a copy of OR Today and send it in! Each submission gets a $5 Starbucks gift card! Plus, the most creative entry receives lunch for their team! Send pics to social@mdpublishing.com or post on our ORToday Facebook page!

THE WINNER GETS LUNCH FOR THE ENTIRE TEAM!

Starbucks Gift Card

{

EACH SUBMISSION WINS A STARBUCKS GIFTCARD

Win Lunch!

Join the community! 72

OR TODAY | July/August 2014

“The world begins anew, starting now,” opens Monica Byrne’s debut, “The Girl in the Road” (Crown Publishers; 2014). Byrne fiction is sure to appeal to fans of Margaret Atwood and David Mitchell and establish her as an important new literary voice. Byrne’s debut, set between futuristic India and Africa, follows the parallel journeys of Meena and Mariama, two woman from separate times and separate countries both fleeing their traumatic pasts for Ethiopia. As Meena embarks on a harrowing journey from India across the Trail, a mysterious and majestic energy-harvesting bridge that spans the Arabian Sea, and Mariama travels by caravan from West Africa, their fates intertwine in ways that are profoundly moving and shocking to the core. Powerfully influenced by Byrne’s own background in science and her travels to Ethiopia, India, and the South Pacific, “The Girl in the Road”is an exploration of our need to come to terms with our histories and to understand and convey emotional truth.

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OR TODAY

CONTEST • AUGUST •

WHAT WOULD NURSE PILL SAY?

GET MOTIVATED No matter what you do for a living, the key to success is motivating yourself. Here is a sneak peek at some tips on self-motivation:

OR Today wants to know what you think Nurse Pill would say in the OR! Give us your best or funniest scenario.

{

We may encounter many defeats but we must not be defeated. – Maya Angelou

EACH SUBMISSION WINS AN OR TODAY PRIZE PACK THE WINNER GETS LUNCH FOR THE ENTIRE TEAM!

Check out last month’s winners!

• Realize that YOU are in control. You cannot control the outside world, but you can control your emotional reaction to it. • Adopt a positive vocabulary. Use strong adjectives (e.g., “fantastic”) to describe what’s good and weak words (e.g., “annoying”) to describe what’s not. • Condition your mind. Train yourself to think positive thoughts while avoiding negative thoughts. • Avoid negative people. They drain your energy and waste your time, so hanging with them is like shooting yourself in the foot. • Seek out the similarly motivated. Their positive energy will rub off on you, and you can imitate their success strategies. • Have goals — but remain flexible. No plan should be cast in concrete, lest it become more important than achieving the goal. • Act with a higher purpose. Any activity or action that doesn’t serve your higher goal is wasted effort — and should be avoided. • Take responsibility. If you blame (or credit) luck, fate, or divine intervention, you’ll always have an excuse. • Stretch past your limits. Walking the old, familiar paths is how you grow old. Stretching makes you grow and evolve. — Adapted from “Business Without the Bullsh*t: 49 Secrets and Shortcuts You Need to Know” by Geoffrey James. For more information, please visit www.geoffreyjames.com.

Piedmont Henry Hospital Nurses WWW.ORTODAY.COM

WWFD: What Would Florence Do? July/August 2014 | OR TODAY

STAY CONNECTED WITH OR TODAY Take a pic of yourself wearing your OR Today T-shirt or holding an OR Today magazine and send it in! ENT

# E R E H W HE I N T D? RLy is WO a OR Tod e wher every ! u yo are

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+ +

= WIN

Each submission gets a $5 Starbucks gift card! + Plus, the most creative entry receives lunch for their team! Send your photos to social@mdpublishing.com or post on our OR Today Facebook page!

Join the community!

July/August 2014 | OR TODAY

Your Medical Product Support Network. Reasons to join MedWrench: 1. Get ANSWERS to tough medical equipment issues. 2. SHARE knowledge by providing solutions to others. 3. STAY CURRENT with new products and equipment news. 4. Find QUALITY vendors and service providers. Â 5. Create your own MY BENCH for quick access to product resources.

FREE to join! www.MedWrench.com

OR TODAY | July/August 2014

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Professional Comfort for Surgeons, Nurses & Technicians

STAND IN COMFORT

Easy-to-clean

TOP SURFACE •Provides necessary friction with damp or dry surgical booties •Compatible with hospital grade quaternary cleaners •NFPA 260 and CAL 117 compliant

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Multiple sizes 100% GELPRO GEL

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Antimicrobial and antibacterial surfaces Made in the USA

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July/August 2014 | OR TODAY

DECEMBER 8-9, 2014 GREEN VALLEY RANCH RESORT SPA CASINO LAS VEGAS NV

The Surgical Services Summit has been approved for 10 nursing contact hours through the Commonwealth Education Seminars!

Co-Sponsored by TAKE GOOD CARE: NURSES • SURGICAL TECHS • NURSE MANAGERS

PREPARE FOR THE NEW

2014 SURGICAL SERVICES SUMMIT

IMPROVING QUALITY, PATIENT EXPERIENCE & FINANCIAL PERFORMANCE

Conference Overview The 2014 Surgical Services Summit brings together Perioperative leaders across the surgical suite to address the main challenges, regulations and culture changes facing professionals called on to manage the business of the surgical suite and the care for patients entering their facility. The era of value-based care is causing disruptive changes in the surgical setting, requiring todayâ&#x20AC;&#x2122;s leaders to deploy new practices and strategies. The Summit offers you a unique opportunity to network with influential leaders who are actively seeking services and solutions to improve performance at their facilities.

See you in Vegas!

INDEX ALPHABETICAL AAAHC…………………………………………………………………17

Decision Health…………………………………………… 78-79

MD Technologies……………………………………………… 58

Action Products……………………………………………… 22

Didage Sales Company, Inc.…………………………… 23

MedWrench……………………………………………………… 76

AIV Inc.……………………………………………………………… 63

Doctors Depot.………………………………………………… 70

Mobile Instrument Service & Repair…………… 30

Allen Medical Systems……………………………………… 6

EIZO Nanao Technologies……………………………… 58

Palmero Health Care……………………………………… 66

ARON Works…………………………………………………… 58

Encompass Group, LLC…………………………………… 23

Polar Products……………………………………………………71

Arthro Plastics Inc.………………………………………………71

Fluke Biomedical………………………………………………… 5

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

BEMIS Healthcare…………………………………………… 40

GelPro…………………………………………………… 42-45, 77

Sage Services…………………………………………………… 75

Bryton Corporation……………………………………………51

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

Select Surgical Technologies……………………………41

C Change Surgical…………………………………………… 76

Healthmark Industries…………………………………… 67

SIPS Consults, Corp.………………………………………… 23

Censis Technologies, Inc. ……………………………… 10

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

SMD Wynne Corp.………………………………………………71

Cincinnati Sub-Zero………………………………………… 82

Innovative Research Labs, Inc.…………………………19

Stryker Sustainability Solutions……………………… 4

Clorox Professional Products……………………… 9, 31

Jac-Cell Medic.……………………………………………………61

Surgical Power………………………………………………… 77

Cygnus Medical……………………………………………………51

Jet Medical Electronics…………………………………… 63

Tenacore Holdings, Inc.…………………………………… 59

Dan Allen Surgical…………………………………………… 50

Key Surgical……………………………………………………… 57

David Scott Company.…………………………………… 22

Lumalier Corporation…………………………………………15

INDEX CATEGORICAL ACCREDITATION AAAHC…………………………………………………………………17 ANESTHESIA David Scott Company.…………………………………… 22 Doctors Depot.………………………………………………… 70 Innovative Research Labs, Inc.…………………………19 SMD Wynne Corp.………………………………………………71 APPAREL Healthmark Industries…………………………………… 67 ARTHROSCOPIC SURGERY Arthro Plastics Inc.………………………………………………71 ASSOCIATIONS AAAHC…………………………………………………………………17 AUCTIONS Government Liquidation…………………………………IBC BEDS Innovative Medical Products, Inc………………… BC BIOMEDICAL Innovative Research Labs, Inc.…………………………19 Jac-Cell Medic.……………………………………………………61 CARDIAC SURGERY C Change Surgical…………………………………………… 76 CABLES/LEADS Sage Services…………………………………………………… 75 CONSULTING/LEADERSHIP PLACEMENT ARON Works…………………………………………………… 58

OR TODAY | July/August 2014

CLEANING SUPPLIES Encompass Group, LLC…………………………………… 23 Ruhof Corporation…………………………………………… 2-3 CLAMPS Innovative Medical Products, Inc………………… BC CARTS David Scott Company.…………………………………… 22 DISPOSABLES Government Liquidation…………………………………IBC Sage Services…………………………………………………… 75

GENERAL David Scott Company.…………………………………… 22 Didage Sales Company, Inc.…………………………… 23 GelPro…………………………………………………… 42-45, 77 Government Liquidation…………………………………IBC Innovative Research Labs, Inc.…………………………19 Lumalier Corporation…………………………………………15 Select Surgical Technologies……………………………41 SIPS Consults, Corp.………………………………………… 23 Surgical Power………………………………………………… 77 HAND/ARM POSITIONERS Innovative Medical Products, Inc………………… BC

ELECTROSURGERY Fluke Biomedical………………………………………………… 5

HIP SYSTEMS Innovative Medical Products, Inc………………… BC

ENDOSCOPY Government Liquidation…………………………………IBC Innovative Research Labs, Inc.…………………………19 MD Technologies……………………………………………… 58 Mobile Instrument Service & Repair…………… 30 Ruhof Corporation…………………………………………… 2-3 SIPS Consults, Corp.………………………………………… 23 Tenacore Holdings, Inc.…………………………………… 59

INFECTION CONTROL/PREVENTION BEMIS Healthcare…………………………………………… 40 Clorox Professional Products……………………… 9, 31 Encompass Group, LLC…………………………………… 23 Government Liquidation…………………………………IBC Palmero Health Care……………………………………… 66 Ruhof Corporation…………………………………………… 2-3 SMD Wynne Corp.………………………………………………71

EMPLOYMENT SIPS Consults, Corp.………………………………………… 23

INFUSION PUMPS AIV Inc.……………………………………………………………… 63

FALL PREVENTIOM Encompass Group, LLC…………………………………… 23

INSTRUMENTS Government Liquidation…………………………………IBC Mobile Instrument Service & Repair…………… 30

FLUID CONTROL Arthro Plastics Inc.………………………………………………71 GEL PADS Innovative Medical Products, Inc………………… BC

INTERNET RESOURCES MedWrench……………………………………………………… 76

WWW.ORTODAY.COM

INDEX CATEGORICAL KNEE SYSTEMS Innovative Medical Products, Inc ……………… BC LEG POSITIONERS Innovative Medical Products, Inc ……………… BC OR TABLE ACCESSORIES Action Products …………………………………………… 22 Bryton Corporation …………………………………………51 Innovative Medical Products, Inc ……………… BC ORTHOPEDIC Surgical Power ……………………………………………… 77 PATIENT AIDS Innovative Medical Products, Inc ……………… BC PATIENT MONITORS EIZO Nanao Technologies …………………………… 58 Jet Medical Electronics ………………………………… 63 PATIENT WARMING Encompass Group, LLC ………………………………… 23 PATIENT POSITIONING Action Products …………………………………………… 22 David Scott Company. ………………………………… 22 POSITIONING AIDS Innovative Medical Products, Inc ……………… BC POSITIONERS/IMMOBILIZERS Innovative Medical Products, Inc ……………… BC RADIOLOGY EIZO Nanao Technologies …………………………… 58 REPAIR/SERVICE AIV Inc. …………………………………………………………… 63

Kapp Surgical Instrument ………………………………14 Lumalier Corporation ………………………………………15 MD Technologies …………………………………………… 58 Mobile Instrument Service & Repair ………… 30 Select Surgical Technologies …………………………41 SMD Wynne Corp. ……………………………………………71 Surgical Power ……………………………………………… 77 SURGICAL EQUIPMENT Arthro Plastics Inc. ……………………………………………71 Mobile Instrument Service & Repair ………… 30 SURGICAL GRAFTS Select Surgical Technologies …………………………41 SURGICAL SUPPLIES Action Products …………………………………………… 22 Cincinnati Sub-Zero ……………………………………… 82 Cygnus Medical …………………………………………………51 David Scott Company. ………………………………… 22 Government Liquidation ………………………………IBC Key Surgical …………………………………………………… 57 Ruhof Corporation ………………………………………… 2-3 SURPLUS MEDICAL Government Liquidation ………………………………IBC SUPPORTS Innovative Medical Products, Inc ……………… BC TEMPERATURE MANAGEMENT C Change Surgical ………………………………………… 76 TEST INSTRUMENTS Fluke Biomedical ……………………………………………… 5 TRADE SHOWS Decision Health ………………………………………… 78-79

SHOULDER RECONSTRUCTION Innovative Medical Products, Inc ……………… BC

ULTRASOUND AIV Inc. …………………………………………………………… 63 Tenacore Holdings, Inc. ………………………………… 59

SIDE RAIL SOCKETS Innovative Medical Products, Inc ……………… BC

VIDEO EIZO Nanao Technologies …………………………… 58

STERILE PROCESSING Key Surgical …………………………………………………… 57

WASTE MANAGEMENT BEMIS Healthcare ………………………………………… 40

STERILIZATION Clorox Professional Products …………………… 9, 31 Lumalier Corporation ………………………………………15 SIPS Consults, Corp. ……………………………………… 23 SUCTION MATS Arthro Plastics Inc. ……………………………………………71 SURGEON COOLING Polar Products …………………………………………………71 SURGICAL AAAHC ………………………………………………………………17 Allen Medical Systems …………………………………… 6 Arthro Plastics Inc. ……………………………………………71 Censis Technologies, Inc. …………………………… 10 Clorox Professional Products …………………… 9, 31 Dan Allen Surgical ………………………………………… 50 David Scott Company. ………………………………… 22 EIZO Nanao Technologies …………………………… 58

WWW.ORTODAY.COM

July/August 2014 | OR TODAY

c i n c i n n a t i

s u b - z e r o

Gelli-Roll® & Norm-O-Temp® The Norm-O-Temp® and Gelli-Roll® combined offer a whole body warming system that can be used in pre-op, the Operating Room, recovery, or the Emergency Department for conductive warming. The Gelli-Roll® is a reusable water blanket that provides patient warming and comfort. It allows for the caregiver to have complete access and is easy to clean with disinfectants.

“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

www.cszmedical.com Phone: 513-772-8810 Toll Free: 800-989-7373 Fax: 513-772-9119

Enhanced Humbles LapWrap Positioning Pad ®

Now even more secure with two-way performance! Anesthesiologist Frank Humbles, M.D. knows the importance of patient positioning. The Enhanced Humbles LapWrap®. • Positions patients arms while allowing easy access for leads and IV’s • Secures patient to OR table • Is dual sided for increased flexibility • Optional extensions can be attached for the extremely obese

Designed to meet

The operative word in patient positioning.

AORN

recommendations

www.impmedical.com

Now you can secure your patient in place. Loop the LapWrap® tab around the side rail of the OR table.

Bariatric Patients are no problem. The LapWrap’s® tab configuration also makes positioning bariatric patients easier.

Keep arms securely positioned. Designed to prevent tissue injury. Arms stay where you put them during the procedure.

Adaptable to all size patients. Use the optional extensions to secure the extremely obese.

The LapWrap® was designed to meet AORN recommendations in “Recommended practices for positioning the patient in the perioperative practice setting” to prevent tissue injury and ischemia that may be caused by tucking a patient’s arms at his or her side.

For more info or to order call 1-800-467-4944 US Patent No. 8,001,635