OR Today - September 2014 by MD Publishing

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CONTENTS

features

OR TODAY | September 2014

PIECING TOGETHER A WINNING TEAM

Well-trained, top-notch OR nurses are in high demand today, which makes it critical that hospitals devise a plan for how they will recruit and retain their OR nursing staff and build their OR nursing teams.

CORPORATE PROFILE

Healthmark Industries is a family-owned healthcare supplier business founded about 50 years ago. The company offers a variety of products and services, including continuing education opportunities.

SPOTLIGHT ON

After 33 years in perioperative practice, Donna Watson, RN, MSN, CNOR, FNP, continues to make a difference as the Director of Societies and Patient Advocacy Programs for Covidien.

OR Today (Vol. 14, Issue #9) September 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. ÂŠ 2014

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September 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

66 INDUSTRY INSIGHTS 10 News & Notes 16 ASC Update 20 AAAHC Update

Jayme McKelvey | jayme@mdpublishing.com

CIRCULATION Bethany Williams

ACCOUNTING Sue Cinq-Mars

WEB SERVICES Betsy Popinga Taylor Martin

IN THE OR 24 29 30 38

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 66 68 72 74 78

Health Fitness Nutrition Recipe Pinboard

80 Index

OR TODAY | September 2014

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INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

RUHOF INTRODUCES NEW PRODUCT

uhof has announced a new single-use cannulated instrument cleaning device. The CS/SPD Pull Thru is an instrument cleaning device, which can be effectively used to clean the hard-to-reach narrow lumen channels of laparoscopic and cannulated instruments in a single pass. The CS/SPD Pull Thru is designed to clean instruments with lumens from 3 mm to 15 mm. It may be used with Ruhof’s multi-tiered enzymatic detergents for more effective cleaning. The unique four-wiper design of the CS/SPD Pull

Thru provides a complete circumferential seal in the lumen channel, thereby removing almost all residue in a single pass. The 360 degree seal creates a vacuum which draws detergent through the lumen removing residue from crevices or other areas of minor damage in the lumen. The vacuum also ensures the lumen is completely filled with detergent to attack and remove bioburden. The single pass cleaning action significantly reduces cleaning time while improving the overall efficacy of the cleaning process. •

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MEDLINE RENEWS FIVE-YEAR DEAL WITH SURGICAL CARE Surgical Care Affiliates has renewed its prime vendor agreement for distribution services with Medline Industries Inc. The five-year agreement will deliver significant cost savings by driving distribution and supply chain efficiencies and reduced product cost. The agreement is expected to be worth approximately $175 million over the course of the deal. As of March 31, 2014, SCA operated a national network of 175 ambulatory surgery centers and surgical hospitals in 34 states. “Medline consistently helps us provide better, more efficient service to our physicians and patients,” said Chris Klassen, vice president of Supply Chain for SCA. “Medline’s manufacturer-direct model and supply chain efficiencies help reduce our costs and at the same time enhance our service levels and improve our profitability in a period when all healthcare providers are facing significant economic challenges.” Medline will provide a broad array of its Medline brand medical and surgical products, as well as other national brand supplies at significant savings directly to SCA facilities from its more than 40 distribution centers throughout the country. Medline will also deliver cost savings and efficiencies to the hospital by implementing product standardization and utilization solutions, as well as providing enhanced reporting capabilities to help the health system better monitor and control costs. • 10

OR TODAY | September 2014

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NEWS & NOTES

AAAASF WELCOMES NEW PUBLIC RELATIONS AND MARKETING MANAGER

The American Association for Accreditation of Ambulatory Surgery Facilities Inc. (AAAASF) welcomes Kim Kubiak to its management team. Kubiak has been named the organization’s public relations and marketing manager. Kubiak has spent more than 25 years in the public relations, media and healthcare industries. She will serve as media liaison and manage day-to-day marketing and other public relations initiatives. AAAASF was established in 1980 to develop an accreditation program to standardize and improve the quality of medical and surgical care in ambulatory surgery facilities while assuring the public of high standards for patient care and safety in an accredited facility. Today, more than 2,000 ambulatory surgery facilities are accredited by AAAASF, the largest not-for-profit accrediting organization in the United States. • FOR MORE INFORMATION, visit www.aaaasf.org.

WELCH ALLYN EXPANDS CONNEX VITAL SIGNS MONITOR WITH CUSTOMIZABLE SCORING APP Welch Allyn has announced a new scoring app for its Connex Vital Signs Monitor (VSM). The ability to score patient data on the Connex VSM multiparameter device using the hospital’s protocols enables healthcare professionals to evaluate multiple parameters in a single score, which can include patient vitals and manually entered assessments and measurements. The Connex Scoring App can help track signs of patient deterioration at the bedside using the hospital’s own Early Warning Score (EWS) protocols to determine the likelihood of adverse events. The new app uses a point-of-care calculator to automate and color code customizable bedside scoring protocols for any type of clinical issue, as well as facility-determined interventions, to help providers make informed patient care decisions quickly. The Scoring App can be used for more than EWS. Hospitals can configure it to match other scoring protocols such as sepsis scores, fall risk assessments, pressure ulcer risk scores and any other calculations that need to be done quickly at the bedside and provide care guidance right on the device. For example, this guidance can help clinicians recognize factors such as when the patient may require continuous monitoring using features such as Microstream end-tidal carbon dioxide technology from Covidien; contact-free motion, heart rate and respiratory rate surveillance from EarlySense; or acoustic respiration from Masimo. WWW.ORTODAY.COM

The Connex Scoring App builds on the device parameters and customizable data fields of the Connex VSM, which also captures automatic measurements such as heart rate, blood pressure, temperature and pulse oximetry (SpO2). Standard manual parameters include fields such as respiration, height, weight and pain level, but can be expanded to allow capture of nearly any data the hospital would like to document at the point-of-care, such as consciousness level, intakes and outputs, or other details used in the hospital’s score. When used as part of the Welch Allyn Connex Clinical Surveillance System (CSS) the device can wirelessly transfer the data to a wide range of electronic medical record (EMR) systems. Medical charting is automated and data becomes immediately available to clinical staff to help improve decision-making and patient outcomes. As part of the Welch Allyn Connex CSS, the vitals documentation process becomes automated — reducing manual steps and potential delays and the errors that go with them. The addition of the Connex Scoring App allows users to document accurate patient data from the bedside — giving clinicians instant access to patient data anytime, anywhere and allows them to identify abnormal vital signs more quickly. It also allows for remote device configuration, sent directly to the Connex VSM via the hospital’s network, to help quickly deploy new device settings and protocols without investing in a new device. • September 2014 | OR TODAY

INDUSTRY INSIGHTS

IMP INTRODUCES NEW DE MAYO ANKLE DISTRACTOR The new De Mayo Ankle Distractor, from Innovative Medical Products, gives surgeons a better approach to the surgical site while distracting the joint space to insert the surgical scope and instruments. The ankle distractor is part of IMP’s Innovative Sports Medicine line encompassing a full range of positioning devices for the arthroscopic surgical repair of sportsrelated injuries of the shoulder, elbow, knee and ankle. The line employs the same type of positioning technology IMP has successfully developed for total joint replacement. The IMP solution is unlike other ankle distractors by reducing the counter pressure placed against the thigh in a typical procedure. Such pressure can be harmful to the circulatory system. “The IMP distractor is a lot gentler for the patient,” notes Danny Choung, M.D. and Board Certified Podiatric Surgeon. The De Mayo Ankle Distractor is reliable and is designed for all shapes and sizes of patients. Unlike cumbersome strap devices to hold the ankle in place, the IMP distractor will not slip off the foot during surgery. Its ergonomic design positions the ankle to face toward the surgeon, rather than toward the ceiling, Choung points out. • FOR MORE INFORMATION, visit www.innovativemedical.com

ULTRA CLEAN NAMED PROREVEAL DISTRIBUTOR Scientific Digital Imaging’s Synoptics Health Division, a manufacturer of innovative digital imaging systems for healthcare applications, has announced the appointment of Ultra Clean Systems Inc. as its North American distributor of the ultra-sensitive ProReveal Protein Detection Test. Ultra Clean Systems will distribute and support Synoptic Health’s ProReveal Protein Detection Test (a rapid and ultra-sensitive fluorescence technique that detects microgram levels of residual protein remaining on surgical instruments after the washer disinfector process) through its extensive support network across North America. This agreement will allow Sterile Services Departments (SSDs) throughout the country to assess the ProReveal technology on site and accurately discover how well their surgical instrument decontamination processes perform. The ProReveal Test uses fluorescence to detect microgram amounts of protein on surgical instruments and is the only commercial test on the market which complies with new recommendations for preventing iatrogenic vCJD infections. ProReveal offers a highly sensitive alternative to swabbing techniques and tests the whole instrument for protein, rather than just a small, swabbed area. Taking less than 5 minutes to carry out, ProReveal generates results as a visual display of the presence (or absence) of any protein and these results can be documented and archived as proof of process cleanliness. Since the test is both visual and quantifiable, ProReveal provides confidence that decontamination processes are performing to the correct standards. • 12

OR TODAY | September 2014

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NEWS & NOTES

SMARTPHONE ADAPTED TO MEASURE PERSON’S GAIT, REDUCE FALLS Researchers have shown how to modify a smartphone so that it can be used to measure a person’s walking gait to prevent falls in people with compromised balance, such as the elderly or those with Parkinson’s disease. The innovation, being commercialized as SmartGait, is designed as a tool to aid healthcare officials in assessing a person’s risk of falling and identifying ways to avoid injury. “We know that people who are more likely to fall have slower gait speeds and variable stride time, step length and step width. But it’s hard to gather that information in

an everyday environment,” said Shirley Rietdyk, an associate professor in Purdue University’s Department of Health and Kinesiology and a faculty associate with Purdue’s Center on Aging and the Life Course. The new system captures the gait length – the distance from the tip of the front foot to the tip of the back foot – and the gait width, the distance between each foot, and walking speed, said Babak Ziaie, a professor in the School of Electrical and Computer Engineering and Weldon School of Biomedical Engineering. Until now, there has been no

portable user-friendly system that could be worn for a period of time to record a person’s gait, said Ziaie, who is working on SmartGait with Rietdyk, doctoral student Albert Kim and graduate student Junyoung (Justin) Kim. The researchers adapted a conventional smartphone that is worn on the waist, and the system records a person’s gait by measuring the distance between colored “foot markers” attached to the tip of each shoe. Findings were detailed in a paper presented during the International Society for Posture & Gait Research 2014 World Congress.

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INDUSTRY INSIGHTS ASC UPDATE

BY WILLIAM PRENTICE

PROMOTING ACCESS TO ASC BENEFITS FOR MEDICARE AND ITS BENEFICIARIES

ith the fourth quarter of 2014 fast approaching, ASCA and the ASC community are looking forward to seeing the final rule that will set Medicare reimbursement policies for ASCs that provide services to the program’s beneficiaries in 2015. This rule is due out from the Centers for Medicare & Medicaid Services (CMS) on or around November 1. If it mirrors the proposed rule that CMS released in July, Medicare and its beneficiaries have a lot to gain.

ASCA and the ASC community have long advocated for changes to many of CMS’ policies to allow ASCs to better serve the Medicare patient population and increase savings to the Medicare program. Demonstrating that these efforts are having an impact, several policies that CMS included in its proposed 2015 ASC payment rule would do exactly that. Let’s look at three. 16

OR TODAY | September 2014

CMS proposed to add 10 new spine procedures to the ASC list of payable procedures for 2015. The codes for these procedures are:

22551.........Neck spine fuse & remov bel c2 22554.......Neck spine fusion 22612.........Lumbar spine fusion 22614........Spine fusion extra segment 63020......Neck spine disk surgery 63030......Low back disk surgery 63042......Laminotomy single lumbar 63045......Removal of spinal lamina 63047......Removal of spinal lamina 63056......Decompress spinal cord

ASCA representatives conducted a presentation for CMS staff earlier this year that highlighted the safety and efficacy of these procedures when performed in the ASC setting. This team of ASC

professionals also provided CMS staff with outcomes data from centers across the country that are routinely performing these procedures. Based on that data, CMS made a wise choice in proposing to include these procedures on its list of procedures that it will reimburse ASCs for providing.

CMS’ proposed rule defines ASC device-intensive procedures as those procedures that are assigned to any Ambulatory Payment Classifications or APC (not only an APC formerly designated device-dependent) with a device offset percentage greater than 40 percent based on the standard Hospital Outpatient Prospective Payment System (OPPS) APC rate-setting methodology. The previous threshold was 50 percent. ASCA and the ASC community have been involved in ongoing conversations with CMS officials over this issue and advocating strongly for a lower threshold for some time. This proposed change is a strong step in the right direction. WWW.ORTODAY.COM

ASC UPDATE

Citing operational difficulties involved in reporting this measure, CMS proposed to make ASC-11: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery a voluntary measure in Medicare’s ASC Quality Reporting Program. ASC-11 is a physician-level measure that does not speak to the quality of the ASC, and ASCA worked closely with a coalition of representatives from the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery and the Outpatient Ophthalmic Surgery Society to influence CMS and raise awareness in Congress. This coalition, along with hospital associations, sent a letter to CMS Administrator Marilyn Tavenner in spring explaining that ASC-11 is inappropriate as a facility measure. On this issue too, in its proposed rule, CMS makes the right choice. All three of these proposed changes benefit the Medicare program and its beneficiaries in key ways. They enable Medicare patients to have the surgical procedures that they need in less time, at less cost and with less hassle. They also offer the Medicare program significant savings. Still, CMS’ final ASC payment rule could deviate from the proposed rule. If you are reading this message before September 2, 2014, you still have time to help make certain that these proposed changes are adopted. Please help ASCA and ASCs across the country by taking about 10

WWW.ORTODAY.COM

minutes to submit your comments on these issues using the materials available at www.ascassociation. org/2015ProposedRuleComments. Despite the good news, ASCs are still working with CMS to resolve many other issues that prevent the Medicare program and its beneficiaries from taking full advantage of the many benefits that ASCs offer. One of our key concerns is that, again, in this proposed rule, CMS continues to use an inappropriate measure of inflation, the Consumer Price Index for All Urban Consumers (CPI-U), to update ASC rates. The CPI-U takes into consideration the cost of consumer goods, such as gas, milk and eggs. In contrast, CMS used the more appropriate Hospital Market Basket cost measure — which contemplates costs associated with healthcare facilities, such as medical equipment, gauze and nursing costs — to update the hospital outpatient department (HOPD) rates. Under this proposal, the rates paid to ASCs and HOPDs continue to diverge in 2015. If this piece of the proposed rule is finalized for 2015, ASCs will be paid 54 percent of what HOPDs are paid to perform the same procedures. This growing disparity between ASC and HOPD rates is fueling ASC to HOPD conversions, stalling new growth in the ASC community and inflating costs for the Medicare system and patients. ASCs can do much more to benefit Medicare beneficiaries. ASCA will continue to reach out to CMS policymakers to educate them

on the many additional procedures that ASCs could safely and effectively perform for its beneficiaries and policies that might allow patients better access to care in the ASC setting. If you work in an ASC that is not already an ASCA member, I encourage you to make sure that your facility becomes a member. Begin by calling Mykal Cox of our Membership Services team at 703.836.8808 ext. 114. If you are already a member, I encourage you to get more involved with ASCA. If you don’t already receive the ASCA News Digest and our Government Affairs Update, please contact asc@ ascassociation and ask to be added to our distribution lists for these weekly e-newsletters. If you haven’t participated in one of our Capitol Fly-Ins, consider joining us. Make sure that you are staying connected to the ASC community using our members-only online networking tool ASCA Connect. Information about all of these opportunities and more is on ASCA’s web site at www.ascassociation.org. Please visit us there regularly and write or call us anytime that we can be of service to you. WILLIAM PRENTICE is the chief executive officer of the Ambulatory Surgery Center Association. September 2014 | OR TODAY

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YEARS STRONG

Weâ&#x20AC;&#x2122;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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September 2014 | OR TODAY

INDUSTRY INSIGHTS AAAHC UPDATE

BY MICHAEL PEABODY, MBA

THE 12 KEYS

TO UNLOCKING A SUCCESSFUL ACCREDITATION

MANAGING ANXIETY

ew things in our industry produce more anxiety than accreditation, the process by which ambulatory surgery centers (ASCs) meet specific administrative and clinical standards and have the quality of their facility validated; and, in many cases, become certified to receive reimbursement from Medicare or other payers. But based on my experience of achieving accreditation for numerous ASCs, it doesn’t have to be an anxiety producing process.

Yes, accreditation is a lot of work. Yes, the cost is not insignificant. Yes, the application process is paperwork-intensive and the day when surveyors tour your facility can be stress inducing. But I’ve found that ASCs that make a determined effort to adopt best practices and embrace the process are most likely to achieve a successful accreditation. More importantly, at such ASCs the accreditation process serves as a strong platform for clinical excellence and long-term profitability. On the other hand, those who resist or resent the process, or take the view that it’s simply a big regulatory hassle, experience more anxiety and invite a greater likelihood of not attaining their accreditation. The following 12 steps have been the key to our success in achieving accreditation and building profitable ASC businesses based on clinical excellence and physician leadership. 20

OR TODAY | September 2014

1. CHOOSE THE RIGHT AGENCY There are three primary accrediting agencies – AAAHC, AAAASF and TJC. Each has its particular strengths and specialty, and slightly different compliance standards. ASCs seeking accreditation should look closely at the specific standards for each organization and determine, based on their size and specialty mix, which is the most relevant type of accreditation for them. In my view, AAAHC usually offers the best fit for freestanding surgery centers. 2. START EARLY AND DO YOUR HOMEWORK Accreditation is an open-book test! In many ways, ASCs have all the answers before they undergo the accreditation survey; but this doesn’t mean you can wait until the last minute to prepare. Each of the three-accreditation organizations mentioned above provides highly detailed handbooks and information on how to meet the standards.

This information offers a playbook for success – so by all means take advantage of it. If you know the requirements, you’ll understand the need to start early and work steadily and consistently in the few months between the date your application is accepted and the day the surveyor turns up to inspect your facility. In other words, time is of the essence. 3. THINK STRATEGICALLY The real value of accreditation is that it promotes patient safety and clinical excellence, as well as effective management of the business. I believe the accreditation process underscores many things most ASCs should do anyway if they want to succeed. That’s why surgeons and administrators should reject the notion that accreditation is a “onetime” or “once every few years” event. The standards – from clinical QI to governance to facilities management – should be integral to your everyday processes and procedures. In this way, the accreditation process can help you build a better business for patients, payers and the physicians themselves. 4. DON’T REINVENT THE WHEEL The accrediting agencies provide a wealth of information, including various checklists and forms designed to help you meet the stanWWW.ORTODAY.COM

AAAHC UPDATE

dards. Use them. Many ASCs hire consultants – and there are many – to help them through the process. Depending on how well your business is organized in the first place, this may be a worthwhile idea. AAAHC has a consulting subsidiary, Healthcare Consultants International (HCI) that provides this type of consulting assistance. I’m one of their consultants, myself. But it operates separately from AAAHC, so using HCI in no way guarantees that your ASC will be “given a pass.” 5. SELECT A LEADER, BUT GET EVERYONE INVOLVED In many ways, accreditation is about the people at ASCs, not the facility itself. That – along with the survey team’s comprehensive examination of all areas of operations – is why it’s important to make this a team effort. One person, probably an experienced administrator or clinical director, should lead the effort; but the entire staff must understand what the standards stipulate and why they’re important. In this way, accreditation helps build a culture of excellence. Likely, this will require training and cross training, too. The team approach is vital because, as you must remind your staff, in certain circumstances the surveyors could show up unannounced on a day when the administrator isn’t in the WWW.ORTODAY.COM

office. (CMS deemed status surveys are unannounced; Non-Medicare surveys are scheduled in advance.) Further, there is a good chance that the survey team will interview staff in addition to administrators or managers. The point is, no one person can handle accreditation alone and surveyors will seek to verify that everybody, including the physicians, are with the program. 6. CONDUCT A MOCK SURVEY This may be the single most important step you can take to prepare. Set aside one day – and better not to tell everyone when it will be – to have a person experienced with the survey process come in and go through the full survey process. This may sound disruptive, but it’s invaluable in getting staff ready. 7. THINK LIKE A PATIENT Because patient care is at the heart of the survey, you should adopt the patient’s perspective as you prepare for the survey. You may want to have a “mystery patient” come through your center and provide a report about his or her experience. Or, as part of a training exercise, do some role-playing so staff can see the facility and operations through the eyes of a patient. Here again, accreditation emphasizes something you should be doing anyway – operating a customer-centric facility and

regularly communicating with patients. Remember, it’s possible that the surveyors will interview patients. 8. CLEANLINESS IS NEXT TO GODLINESS OR, IN THIS CASE, ACCREDITATION Beyond the need for sterile operating environments, a clean, well-organized and clutter-free facility reflects well on the overall quality of the operation. It shows that the staff cares for and takes pride in the facility – an important intangible in the eyes of surveyors. Cleanliness takes ongoing dedication — you can’t schedule a major cleaning if you don’t know when the surveyor will turn up! The bottom line is that the surveyors will be favorably impressed if the information they request is readily available in clearly labeled and organized file cabinets or in folders on a computer network. It also means surveyors will be able to complete their tasks more easily, which they will certainly appreciate. 9. EMBRACE AUTOMATION AND TECHNOLOGY Accreditation is largely a matter of keeping documentation and records up to date and complete. There are software tools that can proactively notify you when physicians’ licenses or privileges need to be updated; or maintenance is required for certain equipment or on the building itself. September 2014 | OR TODAY

INDUSTRY INSIGHTS AAAHC UPDATE

Workflow or practice management software may help ensure that QI committee recommendations are forwarded to the board meetings and all decisions are carefully captured in the minutes. The same holds true for financial management and accounting. Further, you can use email newsletters to track changes to various accreditation standards. The survey team will pore over some or all of these records, so best to automate the potentially overwhelming tasks of keeping them current and organized. 10. SURVEYORS ARE NOT THE ENEMY Recognize that, however stressful the surveyors’ arrival may make you and your staff; you really are on the same team. In the case of AAAHC, which I am most familiar with, surveyors are dedicated healthcare professionals like your own staff. Consequently, they love to suggest improvements that may lead to higher quality care. It’s appropriate to ask questions and, if necessary, question the surveyor’s findings, though of course you’ll want to do so civilly and professionally. Just as importantly, if you don’t know the answer to a question the surveyor asks, just say “I don’t know” and then go seek the answer. You don’t have to score 100 percent on every standard, and I’ve always found the vast majority of surveyors to be very fair-minded. 11. SMILE ON SURVEY DAY When the big day finally arrives, do 22

OR TODAY | September 2014

your best to relax. Avoid going into fire drill mode. You should make the surveyor or survey team feel as welcome as possible in your facility. Provide a comfortable working space (which of course you’ll have designated well in advance). After an opening conference and introductory facility tour, the surveyor will ask to see specific areas or records. The key for interacting with surveyors is to be professional and personable. Courtesy, warmth and friendliness go a long way and tell surveyors a lot about how you treat patients and their families. 12. IT AIN’T OVER WHEN IT’S OVER Even when the survey is complete and you’ve achieved accreditation, it pays to keep in mind that the process never really ends. Beyond supporting clinical quality and sound financial health of the business, you must stay on top of changes to the accreditation standards and ensure that ongoing procedures for documentation, maintenance and governance function properly. I recommend periodic training and regular clinical, financial and operational audits to keep your ASC in tip-top shape and in a permanent state of compliance with accreditation standards. Annual mock surveys are also a good way to monitor on-going compliance. If you succeed in seeing the link between these standards and management best practices, you’ll no longer view surveys as

anxiety-producing events, but rather as a means to keep your ASC performing at the highest level. THE BOTTOM LINE When people ask me what’s the secret to accreditation, I tell them there are actually three secrets – preparation, preparation, and preparation. The suggestions above really add up to that simple idea. And because in certain types of surveys (Medicare deemed status, for instance), the surveyors can show up at any time, preparation is never complete. Through operational discipline, constant attention to detail and steady focus on the patient, ASCs can use the lessons learned through accreditation as a springboard to long-term clinical excellence and financial success. ABOUT THE AUTHOR Michael Peabody is an HCI consultant and has been involved in ambulatory healthcare for over 20 years: as hospital vice president, surgery center administrator, regional vice-president and consultant. Currently, he is certified as a Medicare surveyor for AAAHC and serves both as a survey chairperson and a surveyor mentor. Peabody is also a member of the AAAHC Corporate Alliance Survey team. In his 12 years with AAAHC, he has conducted over 200 surveys including ambulatory surgery centers, office based surgery centers, urgent care centers, dental centers, lithotripsy centers, imaging centers and radiation oncology centers. WWW.ORTODAY.COM

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IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

DRYING CANNULATED INSTRUMENTS I am looking for a company that sells air hoses to dry out cannulated instruments. Do any of you do this and if so can you tell me where you might have purchased one? I have searched on the web for days and have come up empty. A: You can get a cylinder of air from your gas company and they can get you a hose and nozzle to attach to it. All you have to do is squirt the air down through the cannulation.

A: Call Healthmark at 800-521-6224. •

SMARTPHONES Should smartphones be eliminated from the OR?

A: We don’t allow any personal phones in the ORs. Our hospital policy states that no personal phones or personal wireless devices are permitted in any patient care areas – that goes for physicians as well. I wrote a memo to the physicians and staff from the Chief of Surgery and me citing that policy. I posted it in the staff and physician lounges and asked the clinical managers to review the 24

A: We use O2 tubing.

OR TODAY | September 2014

memo with their staff and have the staff initial that the policy was reviewed with them and that they understand the expectations. After that the disciplinary process starts for people who ignore the policy. After the first offenders were counseled by their managers, the behavior changed. People respect what you check. A: There should be a no

cellphone policy, however, that would be hard to enforce because there are so many surgeons who go to many facilities and each may have a different policy. As we all know, they can be very disrupting when doing procedures. Many of our surgeons leave them in the surgery office and then get their messages at the end of the case. • WWW.ORTODAY.COM

SUITE TALK

COMMUNICATION Why is it so hard to communicate with one another? When the OR is crazy busy, everyone is getting along, and remembering stressful yet exciting times. When the OR is slow, people are quick to start gossiping. Any suggestions on stopping the gossip mill? A: Perhaps you could try creating “no vent zones” and one “vent zone.” At one facility I put up “No Vent Zone” signs in the lounges and ORs and control desk, etc … and I turned a small supply closet into a “Vent Zone” with Zen-like features, including a plant, a lamp, a couple of chairs, etc. I introduced the program as a way to reduce the distractions around patient care. It was fairly effective. Of course, keeping folks very busy helps them to focus on work and not gossip. I remember one of my leaders very early in my career who used to round to all areas on slow days and if she found people hanging out she would send them home. If she found people stocking, cleaning, working on projects they got to stay. She never said much just rounded and sent folks home who were just hanging out. We got the message very quickly and people tended to keep themselves busy. I’ve never forgotten that. A: Put them to work cleaning, send them to another department to work, or send them home. Always works for me! A: I try to keep them busy even if we are slow. I find that keeps it to a minimum. There are always

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plenty of policies to review, competencies and education boards. Keep them busy. A: I recently became a trainer for lateral violence. In that program, we discussed the importance of having a response in your mind prior to an event, such as backstabbing or gossiping. For example, a nurse approaches a colleague and says, “Did you hear the news? Mary’s husband has been cheating on her, and they’re getting a divorce.” The colleague responds, “Sue, I don’t think we should be discussing Mary’s personal life at work. We have a procedure to prepare for — let’s focus on that task.” Having a “ready response” for various common situations staff encounter in the workplace prevents that familiar feeling we have an hour later, thinking, “Gee, I should have said this or that.” It takes practice to have some “canned” responses ready for action. Ready responses can cut back on gossiping by stopping the promoter of the gossip dead in their tracks and allow for a re-focus on work-related tasks. It’s not a cure-all, but food for thought.

same issues when the schedule is low. Sad thing is we worry about how the physicians act and don’t recognize how we impact one another. A: If you come up with something, pass it on. This seems to be a universal problem. You certainly can’t stop staff from communicating with each other, however, maybe giving them tasks to complete will help. There’s always something that needs to be done in the OR. A: The staff needs projects to do, otherwise idle minds have time for belittlement and gossip. Of course you can’t stop people from talking A: One of my nurse educator colleagues decided to adopt a program using a code word if someone was either unprofessional or using gossip. She was from the south, so her unit used the word “moonpie” to help her staff identify when a line had been crossed. It became a humorous way to redirect her staff. The signal word worked well in her unit. A: Great idea! Thanks for sharing. •

A: That is a great response! I think all units experience the September 2014 | OR TODAY

IN THE OR SUITE TALK

IS OB ACLS RECOMMENDED?

Is OB ACLS recommended for OB nurses or PACU nurses who take care of OB patients post C-Section? A: Yes, in our institution. A: All my PACU nurses are ACLS certified for all patients. A: Yes, at Onslow Memorial Hospital it is required. A: We do the C-sections in the OR. I require all the OR, PACU and ASU staff to be ACLS and PALS. You never know when you might need it. You also have a child with the section. We also are NRP. A: All my OR and PACU nurses are ACLS certified.

A: We don’t do OB, but every RN in the surgery/PACU is required to be ACLS and PALS certified. A: In my experiences, ACLS for all peri-op and maternal health RNs is required. A: Our hospital does not require that PACU or L&D nurses be ACLS certified. However, it would be up to each facility to determine this and include it in their policy. A: For clarification, the question is referring to

“ACLS-OB.” It is a slightly different approach to the traditional ACLS, including an additional 6 hours of OB focus. I’m not personally familiar with the program or how popular it’s becoming (or not), but an online search will yield additional information. I found one website with references to St. Luke’s Hospital in Boise, Idaho, as being the founder of the program and also found other sites with conflicting information as to whether or not the program is endorsed by the AHA. •

ENDOSCOPY PROCEDURES AND CLOTHES It is understandable that some patients are uncomfortable without their clothes on. It is also extremely difficult to do a colonoscopy on a patient that has shorts on, not to mention a cystoscopy. Is it acceptable to have patients keep their clothes on for endoscopy procedures? Of course not their pants, shorts, or underwear for colonoscopies. If a patient is not doing well, clothes can hinder rapid assessment of certain things. For example, it is challenging to locate a dislodged EKG wire under someone’s clothes? While trying to be patient friendly, are we doing more harm than good? A: You also need to think about infection control with them wearing their own clothing into the suite. A: We have our patients remove their clothing for endoscopies. It is more sanitary as well as safer.

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

OR TODAY | September 2014

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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

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IN THE OR MARKET ANALYSIS

BY JOHN WALLACE

MARKET ANALYSIS

Decontamination Systems

erosol and liquid products are common surface disinfectants and important parts of decontamination systems used by healthcare facilities throughout the world. The market has seen growth in recent years with the addition of new products. A growing number of hospitals are also implementing ultraviolet (UV) disinfection systems as an additional measure when it comes to a decontamination system. The application of UV radiation in the healthcare environment is limited to the destruction of airborne organisms or inactivation of microorganisms on surfaces, according to a 2008 report from the Centers for Disease Control and Prevention. UV radiation inactivates microorganisms by destroying nucleic acids in bacteria and viruses. UV radiation has been shown to disinfect surfaces contaminated with viruses, bacteria and fungi, including superbugs such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C. diff ) and CarbapenemResistant Enterobacteriaceae (CRE). Ultraviolet disinfection systems are typically portable units that can be easily transported from one room to another. The mobile aspect of these devices helps them become a part of a hospitalâ&#x20AC;&#x2122;s cleaning and disinfection protocols along with aerosols and liquid products. The devices tend to be automated and run in cycles that are usually less than one hour. WWW.ORTODAY.COM

The recent and continued focus on healthcare-acquired infections (HAIs) should push the growth of this market in both new and traditional aspects of disinfection and decontamination. In January 2012, CMS began requiring hospitals to report surgical site infections (SSI) and denied reimbursement for the added cost of SSIs beginning in January 2013. Hospital-acquired condition (HAC) data is also publicly available on the CMS website. The threats of added costs and increased public awareness have driven hospitals to dedicate more resources to infection prevention measures, such as multiple methods of room and surface disinfection. According to a recent CDC report, ongoing efforts are needed to combat infections impacting hospital patients and more work is needed to improve patient safety. According to the CDC, approximately one in 25 U.S. patients contract at least one infection during the course of their hospital care and every day more than 200 Americans with HAIs will die during their hospital stay. The CDCâ&#x20AC;&#x2122;s HAI Progress Report showed minimal decreases for hospital-

onset C. diff infections and hospitalonset (MRSA) bloodstream infections. Hospital cleanliness plays a role in the spread of HAIs, which are caused by microorganisms such as C. diff, MRSA, CRE and Acinetobacter baumannii. Some superbugs such as C. diff are showing resistance to chemical disinfectants, making them more difficult to eliminate. Many patients, especially those on antibiotics, are susceptible to C. diff, which can live for up to five months on surfaces in a hospital. Others, like CRE, have developed a resistance to antibiotics, making them very difficult to treat. Peer reviewed studies have proven that some new UV technologies are highly effective. A study published in the American Journal of Infection Control (August 2013) reported that Cooley Dickinson Hospital (an affiliate of Massachusetts General Hospital) experienced a 53 percent decrease in the rate of hospital-acquired C. diff infections after implementing a pulsed xenon UV light room disinfection system. The global market for ultraviolet (UV) light disinfection equipment was worth $790 million in 2010, according to BBC research. This market is expected to reach a value of $1.6 billion in 2016. UV disinfection equipment is most popular in the wastewater treatment market, though BBC Research expects popularity to continue to increase in the healthcare market. September 2014 | OR TODAY

IN THE OR PRODUCT SHOWROOM

BIOQUELL Q-10 The Bioquell Q-10 provides an automated room disinfection system utilizing hydrogen peroxide vapor. The technology is proven to eliminate pathogens from surfaces and reduce infection rates in hospitals. Features of the Bioquell Q-10 include: 3-D disinfection with vapor distributed equally throughout the room in a single cycle; instantly verified disinfection results through chemical indicators; compatibility with sensitive medical equipment; residue-free process; effective in eliminating pathogens, including spores; uses an EPA registered sterilant, the Q-10 uses only 30-35 percent w/w Hydrogen Peroxide. The Q-10 has been utilized in over 100,000 operating rooms, patient rooms and pharmacy clean rooms throughout the world. 30

OR TODAY | September 2014

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PRODUCT SHOWROOM

CLOROX HEALTHCARE™ OPTIMUM-UV™ SYSTEM Clorox Healthcare, known for its line of innovative hospital disinfectants, is partnering with Ultraviolet Devices Inc. (UVDI) to introduce the Clorox Healthcare™ Optimum-UV™ System, an all-in-one comprehensive solution, providing powerful surface treatment enhanced by ultraviolet radiation (UV-C) technology to inactivate dangerous and persistent pathogens, including C. difficile and MRSA for optimum prevention. It achieves 99.992% C. difficile reduction in 5 minutes at 8 feet. The Optimum-UV™ System is designed to supplement manual surface disinfection with EPA-registered disinfectants, such as Clorox Healthcare® Bleach Germicidal Wipes and Clorox Healthcare® Hydrogen Peroxide Cleaner Disinfectants. For more information, visit www.CloroxHealthcare.com/UV. •

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September 2014 | OR TODAY

IN THE OR PRODUCT FOCUS

RUHOF BIOCIDE® DETERGENT DISINFECTANT PUMP SPRAY Ruhof Biocide® Detergent Disinfectant Pump Spray is a quaternary germicide for cleaning, disinfecting and deodorizing any hard, non-porous surface. Ruhof Biocide® is bactericidal, virucidal, fungicidal, tuberculocidal and non-corrosive. It is ideal for use on all hard, non-porous inanimate environmental surfaces including floors, walls, metal surfaces, stainless steel surfaces, bathrooms, shower stalls, bathtubs, cabinets, and more. In addition, this product deodorizes smelly areas such as garbage storage areas, basements, restrooms and other places that are prone to odors caused by microorganisms. Ruhof Biocide® is also effective against Mycobacterium tuberculosis (BCG) at 20 degrees C, Staphylococcus aureus, Salmonella choleraesuis, Pseudomonas aeruginosa, Clostridium difficile vegetative form (C.diff), Escherichia coli 0157:H7, Methicillin resistant Staphylococcus aureus (MRSA), Vancomycin intermediate resistant Staphylococcus aureus (VISA), Vancomycin resistant Enterococcus faecalis (VRE), H.I.V.-1virus (associated with AIDS), Polio virus Type 1, Hepatitis B virus (HBV), Tricophyton mentagrophytes (athlete’s foot fungus), mold and mildew. •

OR TODAY | September 2014

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PRODUCT SHOWROOM

STERIS VAPROQUIP™ DECONTAMINATION ROOM The STERIS VaproQuip™ Decontamination Room enables decontamination of high-touch, difficult-to-clean environmental surfaces on non-critical equipment and furniture, such as wheelchairs, IV poles and pumps. Its modular, panel-construction allows existing equipment storage rooms to be converted into functional, highturn processing centers, minimizing the need for extensive construction. VaproQuip uses Vaprox® Hydrogen Peroxide Sterilant as a low-temperature dry vapor in a sealed room to neutralize a broad spectrum of biological organisms, including spores, bacteria, viruses and fungi. “Customers should continue to manually clean to remove visible soils, but no longer have to use bleach or disinfectants when used in conjunction with the VaproQuip Decontamination Room,” said Doug Goldman, Senior Product Manager at STERIS Corp. Its single, pre-programmed cycle makes it easy to use and helps eliminate human error. And its self-contained nature was engineered for safe operation away from patient care areas. •

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September 2014 | OR TODAY

IN THE OR PRODUCT FOCUS

TRU-D SMARTUVC TRU-D SmartUVC™ is the only portable UV disinfection system that precisely measures reflected UVC emissions with Sensor360™ to automatically calculate the pathogen-lethal UV dose required for each room, dynamically compensating for room size, shape and other dose altering variables such as the position of contents, windows, blinds and doors. TRU-D is the device of choice for nearly all existing independent research on UV disinfection technology, including a $2 million infection reduction study funded by the Centers for Disease Control and Prevention’s Epicenter Program at Duke University and the University of North Carolina. •

OR TODAY | September 2014

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PRODUCT SHOWROOM

XENEX GERM-ZAPPING ROBOT Xenex’s portable UV room disinfection system uses pulsed xenon ultraviolet light to quickly destroy the viruses, bacteria, mold, fungus and bacterial spores that cause healthcare-associated infections (HAIs). Not all UV is the same. Xenex is the only company that uses xenon to create UV light – all other UV systems use toxic mercury. As a result, Xenex’s Germ-Zapping Robots produce the only full spectrum UV disinfection that can kill C. diff spores in 5 minutes. The efficacy of the Xenex device has been published in peer-reviewed journals and many healthcare facilities in the U.S. credit it for reductions in their C. diff and MRSA infection rates.•

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September 2014 | OR TODAY

WHO WILL YOU CALL? Repair, Exchange, and Parts for Rigid & Flexible Endoscopes

At Tenacore, we understand the ongoing need to work within the constraints of a repair budget. We offer minor repairs that can be done in a day. We also offer major overhauls that can return your scope to “like new” condition for much less than the OEM. Tenacore is committed to quality, service and fast turn times – all at a competitive price. WE ARE PROUDLY ISO 13485:2003 Certified & Insured

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See what EPA had to say 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. HOW DID YOUR DISINFECTANT RATE? Visit EPA website for more info http://www.epa.gov/oppad001/atp-product-list.pdf Kills over 21 Microorganisms! Kills in1 minute or less! No mixing easy to use!

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IN THE OR CONTINUING EDUCATION 365-60E

BY MAUREEN HABEL, RN, MA

THE POWER OF CHANGE

Nurses Make the Difference

OR TODAY | September 2014

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CONTINUING EDUCATION 365-60E

ou and your colleagues have been talking about the possibility of developing selfscheduling on your unit. You believe that having RNs develop their own work schedule will improve patient outcomes by promoting professional collaboration, reduce absenteeism and overtime costs, and free up your manager’s time for other tasks. You’ve begun to do some homework — talking with nurses on other units who participate in self-scheduling and having the medical librarian provide articles on the topic. However, you’ve not been involved in leading a change project before, especially one that will directly affect your colleagues and manager. So how do you begin? What do you need to know about how change happens, what strategies will build support for your idea and how to anticipate and manage possible resistance? This module will help you answer these questions. 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 45 to learn how to earn CE credit for this module.

The purpose of this continuing education program is to help nurses understand how they can participate in changes that will continue to improve healthcare in the U.S. After studying the information presented here, you will be able to: • Describe economic and political forces that drive changes in the healthcare system • Compare and contrast three common change strategies • Discuss how resistance to change can be anticipated and managed

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You’re not alone in thinking about pressures on the healthcare system and how your organization needs to change to perform more effectively. Chances are you’ve been challenged to assume additional responsibilities, become crosstrained to cover another area or learn to use sophisticated new equipment and technology. The pressure to adapt to an unprecedented number of changes will continue to affect most aspects of your daily work life. The reality is that change is necessary for innovation and a successful future.1,2 By learning more about the process of change and how to make it work effectively, you can help shape the future of nursing and healthcare. FIRESTORM OF CHANGE The healthcare industry is changing at an unprecedented rate. Healthcare organizations are open systems that operate in

complex and rapidly shifting environments.3 In the last two decades, economic and political forces have combined to create tremendous pressure to control costs, ensure safety and quality, and increase healthcare access.4 Exciting advances in imaging technology and noninvasive treatments, sophisticated surgical procedures, increased spending for drugs and the aging of the U.S. population continue to drive up costs. As a result, healthcare will continue to experience radical change. Organizations that can respond to new market conditions are those that will survive in a competitive environment.5 As patient care safety and quality issues continue to drive change in the healthcare industry, we must acquire the knowledge and skills to be full partners in determining how healthcare will be provided.6 Changes occur as a result of internal or external forces. September 2014 | OR TODAY

IN THE OR CONTINUING EDUCATION 365-60E

Internal forces are created from within the organization or by one person. Internal forces might involve a program for customer relations formulated by top management or a decision to purchase new technology.7 External forces for change originate outside the organization. Driven by regulatory requirements, consumer expectations, research findings and technological advances, external forces can affect healthcare organizations dramatically. For example, the Health Insurance Portability and Accountability Act mandated privacy protections for patients and has required significant modifications in the way patient information is managed in healthcare organizations. The Institute of Medicine’s report “To Err is Human: Building a Safer Health System” outlined the problem of medical errors in the U.S. and is a major driver of change in healthcare organizations. Change can be unplanned or planned. Nurses make unplanned changes every day. Unanticipated admissions, the need to transfer a patient to intensive care or a staff member’s sick call are examples of unplanned changes to which nurses respond skillfully. Planned change involves a deliberate analysis of the need for change, consideration of appropriate strategies and the selection of a change agent — the person who seeks to create the change.8 The rising cost of hospital care is a major force for change. The driving force to reduce costs — while maintaining or improving safety and quality — can affect the cost of hospital care significantly. Nurses have an astounding influence on the cost of care. We control the majority of supplies, and the nursing department budget often accounts for more than 50% of an acute care hospital’s operating budget.4 Our ability to 40 OR TODAY | September 2014

devise and champion ideas that ensure safety and promote quality can improve care delivery and patient outcomes. Our skill in assessing patients carefully, recognizing potential problems at an early stage and using appropriate interventions quickly to prevent complications is vital for cost containment.4 Nurse leaders and managers must educate staff about the current marketplace and how nursing is affected. For example, a change in reimbursement may influence staffing patterns. All nursing staff must know about the forces that drive change.5 CHANGE RECIPIENTS OR CHANGE AGENTS? The nursing profession has often been viewed as the target of change rather than a force that proposes, leads and implements change. In the past, our involvement in quality initiatives was limited; our focus was primarily on doing chart audits, filing incident reports and changing practice when new policies or procedures were introduced in the workplace.6 Healthcare is now at the point that nurses and other professionals must know how to recognize and implement patient safety and quality improvements.6 To be seen as powerful and effective change agents, nurses must learn more about change theory, change strategies and ways to anticipate and manage resistance to change. Social theorist Kurt Lewin, PhD, developed a change model that views human behavior as a dynamic balance of forces that work in opposite directions.3,9 Driving forces are behaviors that help promote change; restraining forces are behaviors that impede change.9 For example, an organization that wants to change its staff mix to include more unlicensed assistive personnel

will benefit from a force field analysis — an exercise that identifies both driving and restraining forces. Driving forces might include increased patient care hours, reduced costs, elimination of nonprofessional duties for RNs and increased time for patient and family teaching. Restraining forces might be loss of control over patient care, concerns about supervising unlicensed staff, comfort with the status quo and resistance to training new staff.4 With a force field analysis, the change agent can evaluate the driving and restraining forces and devise strategies to increase driving forces while decreasing restraining forces.7 Lewin’s change theory proposes that change occurs as a three-step process known as unfreezing, moving and refreezing.9 Unfreezing refers to techniques that motivate staff to be aware of the coming change and that build recognition of the need for change. In the unfreezing phase, discomfort with the present state is felt and the status quo is questioned. In the moving phase, problems are assessed and analyzed, options and alternatives are identified and action occurs. In the refreezing phase, new ways of behavior are integrated into working relationships, and efforts are made to ensure the change will be sustained.9 This model has prompted successful change in healthcare organizations. However, Lewin’s model is linear in that those involved have time to move sequentially from step to step in the change process.3,5 Nonlinear theories, such as chaos theory and learning organization theory, are change models that are increasingly relevant to healthcare organizations that face continuous and rapid change.3,5 The premise of chaos theory is that chaos is a natural phenomenon in organizations, and it WWW.ORTODAY.COM

CONTINUING EDUCATION 365-60E

has an intrinsic order that can be used to promote effective change.5 The learning organization theory, developed by Peter Senge, PhD, in the 1990s, seeks to create an organizational culture that encourages and supports change. Learning organizations are characterized by flexibility and responsiveness.5 John Kotter is another leading change expert. His book “Leading Change” outlines an eight-step model for successful organizational change. “The Job Survival Guide: A Manual for Thriving in Change” by Gregory Shea and Robert Gunther is another excellent book that provides suggestions about how to improve change management skills. MAKING CHANGES ON THE FRONT LINES Nurse managers face many challenges as change agents. Let’s say two nurse managers face changing their staffing mix. To make such a change, the managers must select the most appropriate change strategy. Frequently used options include powercoercive, rational-empirical and normative-re-educative strategies.7,8 People with legitimate organizational authority can use a powercoercive strategy to produce change.4,10 Changing from fee-forservice reimbursement to prospective payment using diagnostic-related groups to help control Medicare costs is one example of a powercoercive strategy implemented by the federal government.10 Those affected by a power-coercive strategy have the choice of accepting the change or leaving the organization. In addition to creating resistance, a power-coercive strategy can produce a passive and unempowered staff, creating a climate in which highquality patient care is less likely.11 Although a power-coercive strategy WWW.ORTODAY.COM

may appear draconian, it is appropriate and effective in selected situations. For example, organizational leadership may have no choice but to use this strategy when faced with significant resistance to change that is crucial to the survival of the organization.7 A power-coercive strategy may also be used to force a change for the common good when there is an expectation that the change will lead to a change in values. The racial desegregation laws of the 1960s, based on the assumption that promoting interracial contact would lead to a change in attitudes and beliefs, are examples of changes mandated by law to provide equal opportunity.10 A rational-empirical strategy is based on the assumption that people are rational and will act in their own self-interest if they have enough information.4,8,10 This strategy assumes that a change agent can persuade others to accept a change through a rational appeal to selfinterest.4,8,10 For example, if your manager outlined a new method of giving a report that would save you time, it would be consistent with your personal self-interest: finishing your shift on time. Rational-empirical strategies are appropriate when the change is seen as reasonable and little resistance is expected, such as when introducing new technology, especially when staff can be convinced that the change will save nursing time and improve patient care. Normative-re-educative strategies are based on the assumption that people are strongly influenced by social norms and values. A normative-re-educative strategy depends on the change agent’s skill with interpersonal relationships.10 Using this strategy, the change agent involves those who will be most

affected by the change. The change agent considers people factors to be as important to the success of change as knowledge and technology.4 In most situations, a normative-re-educative strategy is effective in stimulating creativity and reducing resistance; the downside is the time required for group consensus and conflict resolution.4,10 The two nurse managers faced with making a change in their staffing mix chose different strategies. The first used a rational-empirical strategy, educating the staff about the reasons for the change and the positive results the change would produce. Staff attitudes or feelings about the change were not discussed. When presented with a new staffing plan and a start date, the nursing staff rebelled and threatened to resign.4 The second manager, faced with the same problem, selected a normative-re-educative strategy. He introduced the proposed change and invited staff reactions. The manager listened carefully to staff opinions and concerns, and invited the staff to propose suggestions to make the change more acceptable. After further discussion, the staff agreed to use a trial unit to test the new staffing model.4 In using the rational-empirical strategy, the first nurse manager failed to take into account the strong beliefs and attitudes RNs often have about care delivery models and the quality of patient care. When a change affects the use of time or beliefs about nursing practice and quality of care, a normative-re-educative strategy is often more appropriate. ‘IT WON’T WORK’ Although change is necessary for growth, it can produce feelings of anxiety, loss and doubt.10 And even when change is carefully planned and anticipated, such as a move into September 2014 | OR TODAY

IN THE OR CONTINUING EDUCATION 365-60E

a new facility, it can create negative stress because change always involves the experience of loss.10 Most people prefer what is familiar and comfortable and have a natural tendency to question change, especially if it means a change in values or beliefs.4 In healthcare, some old habits die hard. For example, all physicians and nurses are familiar with the safety measure of prolonged preoperative fasting. However, research has shown that pulmonary aspiration is rare with modern anesthesia techniques. As a result, the American Society of Anesthesiologists published research-based recommendations in 1999 to allow clear liquids up to two hours before elective surgery, a light breakfast six hours before a procedure and a heavier meal eight hours preoperatively. But today most patients are still NPO a great deal longer than the recommended time.12 INNOVATORS AND LAGGARDS Reaction to change ranges from eager acceptance to frank resistance and even sabotage. Everett M. Rogers, PhD, a noted researcher on the diffusion of innovations, identified five types of response to change:13 • Innovators — those who love change and thrive on it • Early adopters — those who are usually receptive to change. They are opinion leaders and willing to try out new ideas in a thoughtful way • Early majority — thoughtful people who accept change more quickly than the average • Late majority — people who initially resist change, but accept change after the majority • Laggards — those who dislike change and are openly critical and antagonistic Based on Rogers’ work, a change agent should not try to persuade the 42

OR TODAY | September 2014

majority of people to accept a controversial idea. Instead, he or she can start influencing innovators and early adopters and enlist their support. Because change disrupts the status quo, resistance should be anticipated as part of the process. In fact, change without resistance may produce no change at all or result in the illusion of change. Some people may resist a change by demeaning the idea or organizing resistance among coworkers. Others may resist passively by ignoring the change, or they may seem to agree with the change but refuse to change behavior.11 Resistance may be overcome by involving those who will be most affected and helping them to see the benefits of the change.1 Some resistance to change can improve the process because it forces the change agent to be very clear about why the change is needed and the steps needed to implement it. However, if resistance persists after a change is carried out, it can divert energy away from making the change successful. To manage resistance, the change agent can use techniques such as determining the root cause of concern, clarifying information and outlining the negative consequences of resistance and the positive aspects of the change.1,7,11 Even if you’re not the person leading the change effort, you can help the process by being an effective follower. Effective followers view themselves as peers of the change agent and are willing to commit effort to make the change successful.7 Because resistance often arises from irrational beliefs, one expert emphasizes that change agents should not spend an inordinate amount of time analyzing reasons for resistance.10 Whatever the change anticipated, the change agent should maintain a climate of trust, support and confidence throughout the

process.10 A successful change agent constantly moves the group toward clear and achievable outcomes.3,14 If resistance persists, the change agent may need to alter some goals to help people successfully move through the change process.15 People can become distressed when major change occurs and they don’t understand or feel they don’t have complete information or a say in their future.14 Losses occur in any change process, and failure to acknowledge losses is one reason some change efforts fail.2 Factors often associated with resistance to change include poor timing of the change, inadequate presentation of the need for change, weaknesses in the change proposal, fear of loss of control, lack of trust, comfort with the status quo, uncertainty about the effects of the change and the need to expend additional personal energy to adapt to the change.2 During the exciting process of designing a change project, a change agent can overlook or ignore the human responses to change.5 A change agent must realize that people have a right to express their opinions and feelings about a change that affects them.5 THE CHANGING NURSING ROLE The skills needed to change practice are complex, but you can develop expertise in change management in the same way you’ve become an expert in other areas of nursing practice.16 Several programs teach nurses the skills they need to lead quality change projects with interprofessional colleagues.6 Three of these programs are Transforming Care at the Bedside, Integrated Nurse Leadership Program and Clinical Scene Investigator Academy. The transforming care program, developed by the Institute for Healthcare Improvement, is a national program WWW.ORTODAY.COM

CONTINUING EDUCATION 365-60E

for frontline staff and managers to teach them how to develop and implement specific change projects. The nurse leadership program, developed by the Center for the Health Professions at the University of California, San Francisco, prepares nurses to take leadership roles in response to clinical or operational problems. The CSI Academy, developed by the Bi-State Nursing Workforce Innovation Center in the Greater Kansas City metropolitan area, teaches nurses how to make sustainable process changes. The mission of these programs is to teach, coach and mentor nurses. After participating in programs like these, nurses are better able to recognize problems and take the lead in producing significant changes.6 RNs can stimulate change in nearly any setting. Staff nurses in particular are well positioned to determine where change is needed and to propose better ways of providing care.10 Here are examples of nurses who changed the “system” to improve patient care: • A group of nurses increased healthy behaviors in patients in 10 primary care clinics in two hospital systems.17 • Pediatric nurses made changes on their unit that significantly increased patient and family satisfaction.18 • Nurse managers played a key role in implementing improved bedside handovers in their organization; the effectiveness of handovers is a key element in safe patient care.19 MAKE YOUR VOICE HEARD Nurses can also influence healthcare policy changes in many ways. One of the most important is to become a member of a professional nursing organization, such as the American Nurses Association or an organizaWWW.ORTODAY.COM

tion in your area of practice. Professional nursing organizations represent thousands of nurses who share interests and concerns about nursing and patient care. As a member of a professional organization, you have access to the latest information about healthcare policy and the direction of change. By participating in one of these organizations, you can add your voice to your colleagues’ to influence the kind of change that will continue to improve healthcare for millions of Americans. RNs are respected professionals whose opinions are valued by elected leaders and the public. Contact your congressional representatives to share your ideas about the changes you think are needed to improve healthcare access while increasing quality and decreasing costs. Write letters to the editors of your local newspapers offering your perspective about the need for positive change. In your own organization, step up as the person who will be the voice of nursing on hospitalwide committees charged with implementing change. Seek input from your nursing colleagues about the changes they think would benefit patient care and ask for their help in making needed changes. Nurses who work in today’s healthcare environment must view change as a part of life and seek ways to become involved in the process. As the largest healthcare profession, nursing makes the healthcare system run — and many nurses have worthy ideas about how to make healthcare organizations run better. By continuing to learn more about change and how to make it happen, nurses are in a key position to help goals become realities. MAUREEN HABEL, RN, MA, is an award-winning nurse author living in Seal Beach, Calif.

REFERENCES

1. Sims E. The components of change: creativity and innovation, critical thinking and planned change. In: Roussel L. Management and Leadership for Nurse Administrators. 4th ed. Sudbury, MA: Jones and Bartlett; 2006:55-75. 2. Porter-O’Grady T, Malloch K. Managing for Success in Health Care. St. Louis, MO: Mosby Elsevier; 2007:73-86. 3. Donahue MAT. Leading change. In: YoderWise P, ed. Leading and Managing in Nursing. 5th ed. St. Louis, MO; 2011:324-343. 4. Ellis JR, Hartley CL. Managing and Coordinating Nursing Care. 4th ed. Philadelphia, PA: Lippincott Williams Wilkins; 2005:239-272. 5. Anderson MM. Change, innovation and conflict management. In: Kelly P. Nursing Leadership and Management. 3rd ed. New York, NY: Delmar. 2012:298-315. 6. Kiger J, Lacey S, Olney A, Cox K, O’Neil E. Nurse-driven programs to improve patient outcomes: transforming care at the bedside, integrated nurse leadership program and the clinical scene investigator academy. J Nurs Adm. 2010;40(3):109-114. 7. Tomey AM. Guide to Nursing Management and Leadership. 8th ed. St. Louis, MO: Mosby Elsevier; 2008:315-329. 8. Marquis BL, Huston CL. Leadership Roles and Management Functions in Nursing. 4th ed. Philadelphia, PA: Lippincott Williams Wilkins; 2003:80-92. 9. Lewin K. Frontiers in group dynamics: concepts, methods and reality in social science. Hum Relations. 1947;5(1):5-41. 10. Sullivan EJ. Effective Leadership and Management in Nursing. 8th ed. Boston, MA: Pearson; 2012:61-63. 11. Whitehead DK, Weiss SA, Tappen RM. Essentials of Nursing Leadership and Management. 4th ed. Philadelphia, PA: FA Davis; 2007:111-121. 12. Crenshaw JT, Winslow EH. Preoperative fasting: old habits die hard. Am J Nurs. 2002;102(5):36-44. 13. Rogers EM. Diffusion of Innovations. 3rd ed. New York, NY: The Free Press; 1983:241-259. 14. Robinson-Walker C. Managing an onslaught of change. Nurs Leader. 2011;9(5):10-11. 15. Grossman SC, Valiga TM. The New Leadership Challenge: Creating the Future of Nursing. 4th ed. Philadelphia, PA: FA Davis; 2013:129143. 16. Wright S. Taking charge of transformation. Nurs Standard. 2010;24(22):20-22. 17. Holtrop JS, Bauman J, Arnold AK, Torres T. Nurses as practice change facilitators for healthy behaviors. J Nurs Care Quality. 2008;23(2):123-131. 18. Mac Davitt K, Cleplinski TA, Walker V. Implementing small tests of change to improve patient satisfaction. J Nurs Admin. 2011;41(1):5-9. 19. Mc Murray A, Chaboyer W, Wallis M, Fetherston C. J Clin Nurs. 2010;19(17/18):2480-2889.

September 2014 | OR TODAY

IN THE OR CONTINUING EDUCATION 365-60E

CLINICAL VIGNETTE Lucy Kim, an OR nurse manager, is considering making a number of changes. She plans to introduce new Association of periOperating Room Nurses (AORN) guidelines, change break schedules, hire a new shift supervisor and develop a new graduate internship program. Lucy’s staff includes nurses with many years of experience as well as nurses who are just completing their OR orientation.

Which of the changes Lucy is considering is an example of an external change? A. Hiring a new shift supervisor B. Introducing new AORN guidelines C. Changing break schedules D. Developing a new graduate internship program To change the break schedule, which strategy would be most likely to create resistance among staff? A. Conducting a staff meeting to discuss potential break schedule changes and reasons for the change B. Discussing the need for the change with influential staff members C. Posting a notice describing how breaks are to be scheduled in the future D. Asking staff to volunteer to try out a new break schedule

After interviewing several candidates for the shift supervisor position, Lucy decides to hire a person new to the organization. Which change strategy would be most effective to use in announcing her hiring decision? A. Power-coercive B. Normative-re-educative C. Rational-empirical D. Selecting a specific strategy is not relevant in this situation. Lucy decides to involve her staff in a force-field analysis before establishing the new graduate internship program. Which factor do staff members identify as a restraining force? A. The opportunity to have a steady supply of new staff B. The chance to influence new graduate practice C. The opportunity for experienced staff to develop mentoring skills D. The time needed to orient and train inexperienced staff

4. Correct Answer: D — This change will require more staff time for training and is therefore a restraining force to be managed. All the other factors are benefits of or driving forces for the change. 3. Correct Answer: B — A normative-re-educative would be most appropriate in this situation, especially because the person is being hired from outside the organization. Using this approach, the manager can involve the staff who are most likely to be affected in the interviewing process. The other strategies are likely to increase resistance. 2. Correct Answer: C — Informing staff about a change that directly affects their work without explanation or discussion is power-coercive strategy likely to create resistance. The other strategies allow staff to be involved in decision making and are less likely to be resisted. 1. Correct Answer: B — Implementing change based on forces outside the organization is an example of an external change. All of the other changes Lucy is planning are due to individual or group forces originating from within the organization. 44 OR TODAY | September 2014

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CONTINUING EDUCATION 365-60E

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 February 28, 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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September 2014 | OR TODAY

CORPORATE PROFILE

HEALTHMARK INDUSTRIES

“

ealthmark Indus-

One of our newest products that we are excited about is our Safe-T-Cals. Many healthcare departments need to communicate in a specific manner and Safe-T-Cals are a great way to liven up your department while doing so.”

tries is a familyowned healthcare

supplier business founded by Ralph A. Basile in 1969. After a successful career in medical sales, he established his own company with his wife, Suzanne. A business

— Ralph Basile

based on the principles of Healthmark’s Safe-T-Cals applied to a wall

providing innovative and cost-effective products for customers in order to meet their sterilization, decontamination, storage, distribution and security needs.

Over the years, the company has experienced a great deal of growth with a variety of products and services. Healthmark even offers continuing education opportunities. 48

OR TODAY | September 2014

going into a hospital Decontam Department.

The company has about 100 employees at its more than 20,000-square-foot headquarters in Fraser, Mich. The latest growth at Healthmark includes the launch of the brand new Cool Aids product line of beanies, skull caps and vests designed to be worn under PPE to provide extended cooling relief. This new offering echoes Healthmark’s longstanding ability to meet its customers’ needs in a shifting healthcare environment. “We will continue to adapt with the changes in the healthcare

industry,” says Ralph Basile, vice president of marketing. “As our healthcare partners face new challenges, we will be working with them in order to help provide innovative solutions.” One way the company is adapting to meet customers’ needs is by offering continuing education credits through online games. “CSSD professionals can also earn free CEUs on our website Crazy4Clean.com,” Basile says. “There are educational games that when you play and take a quiz, you earn one free CEU.” WWW.ORTODAY.COM

SPECIAL ADVERTISING SECTION

Sonocheck is used to test for the presence of cavitation energy — the cleaning power — of ultrasonic cleaners. Healthmark employee Dzelma Dedovic is seen wearing Cool Aids. There are few better ways to beat the heat within the SPD or Operating Room than these lightweight, latex free cooling devices. Simply submerge the head gear or neck band in cold water for 2-3 minutes, and enjoy hours of cool temps.

Healthmark’s growth has prompted a need for a structure of professional commitment for healthcare facilities throughout the country and that is why it has representatives in designated territories throughout the country. Cleaning verification is an important issue in healthcare across the country. News headlines often consist of articles about complications from surgeries caused by instruments and equipment that have not been properly cleaned. It has affected the healthcare field in recent years. WWW.ORTODAY.COM

Healthmark added products to its Proformance Monitoring Tools line over the past 15 years to help ensure surgical instruments and other equipment are reprocessed correctly. AAMI1 and AORN2 recommend at least weekly testing of the cleaning process. These products are designed to help facilities comply with standards and ensure they are reprocessing equipment and cleaning surgical instruments properly. “One of the most difficult challenges in the healthcare industry is to consistently reprocess surgical instruments effectively,” Basile said.

Healthmark has products designed to help hospitals and healthcare facilities provide safe environments and prevent infections. Researchers have discovered that devices that haven’t been reprocessed correctly can emerge from the cleaning process with bits of bone, blood and tissue from the previous operation, contaminants that can become reservoirs for some potentially lethal bacteria. Proper cleaning and sterilization are essential for ensuring that medical and surgical instruments do not transmit infectious pathogens to patients. September 2014 | OR TODAY

Stephen Kovach lectures at College of Clean, a free CEU class offered by Healthmark.

According to the Centers for Disease Control and Prevention, multiple studies in many countries have documented a lack of compliance with established guidelines for disinfection and sterilization. Failure to comply with scientifically based guidelines has led to numerous outbreaks. “Our ProFormanceTM products are designed to help hospitals and heathcare facilities overcome the challenge to regularly test their cleaning equipment in order to ensure their surgical instruments are being reprocessed properly,” Basile explained. Quality is a key component to Healthmark’s business as well as ensuring the satisfaction of its customers. Healthmark offers you a 30-day free trial evaluation of any product it sells. Healthmark also has a website, www.healthmark.info/hmarkqa. html, that is a non-biased forum to 50

OR TODAY | September 2014

Healthmark is looking forward to an exciting future with its continued expansion of staff and products. With almost 50 years of experience, Healthmark continues to adapt to the business needs of their customers.

encourage healthcare workers to ask questions and share solutions anonymously. It is easy to sign up and share experiences with other peers within the industry. If you are looking for industry news, helpful hints and other information, Healthmark produces a weekly newsletter that is distributed to thousands of readers. Each Healthmarket Digest features a story written by a member of the Healthmark team as well as a weekly coupon. Healthmark is looking forward to an exciting future with its continued

expansion of staff and products. With almost 50 years of experience, Healthmark continues to adapt to the business needs of their customers. “One of our newest products that we are excited about is our Safe-TCals,” says Ralph Basile. “Many healthcare departments need to communicate in a specific manner and Safe-T-Cals are a great way to liven up your department while doing so.” FOR MORE INFORMATION, about Healthmark Industries, visit www.hmark.com or call 800-521-6224. WWW.ORTODAY.COM

PROTECT YOURSELF

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with PPEs from Healthmark Face Shield with Drape The Wide Drape Shield is ideal for use in departments where maximum personal protection is the goal. This new PPE is a full face shield which provides the best splash protection against exposure to bloodborne pathogens.

Long Sleeve Gloves The sleeve gloves are a unique fusion of an 8 mil nitrile glove and a 4 mil protective sleeve. With an overall length of 28 inches, these gloves provide complete durable hand and arm protection.

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Stay Cool with Cool Aids! These products are designed to keep your body at a comfortable temperature while you are on your feet for an extended period of time. You could be in the OR, Endoscopy or the Decontam room for a long shift. When you are wearing Cool Aids under your PPE you will feel more comfortable because the light weight and durable fabric is designed for the active individual. These quality items are easy to put on and activate for use.

RIGHT SKILLS, GOOD FIT

TWO SIDES OF A COIN Recruiting and retention are two separate sides of the same coin.

GET IN FRONT OF RESIGNATIONS Once you have recruited the best OR nurses, your hospital should be doing everything within its control to hold onto them.

Despite the competitive hiring environment for OR nurses, you should still take great care in trying to hire nurses with the right skill sets who will be a good fit with the rest of your team.

Recruitment and retention of talented personnel is crucial

PIECING TOGETHER A WINNING TEAM By Don Sadler

Hiring and holding onto the most talented and skilled employees is critical for any business including hospitals and healthcare facilities. This is especially true when it comes to OR nurses. ...

ell-trained, top-notch OR nurses are in high demand today, which makes it critical that hospitals devise a plan for how they will recruit and retain their OR nursing staff and build their OR nursing teams.

The American Nurses Association cites a study estimating that it

costs between $62,000 and $67,000 to replace a single RN.

OR TODAY | September 2014

High turnover among OR nurses can be extremely costly to hospitals. In an article on its website, the American Nurses Association cites a study estimating that it costs between $62,000 and $67,000 to replace a single RN. There are also human costs involved in high turnover, as other nurses must absorb the extra workload when nurses leave, as well as help train new nurses after they are hired. “Management must realize that nurse recruitment and subsequent retention are competitive aspects of the healthcare business,” the article concludes. TWO SIDES OF A COIN Recruiting and retention are two separate sides of the same coin, notes Josiah Whitman, the founder of Whitman Partners, a staffing firm that specializes in the healthcare industry. “When recruiting, due to the high demand for OR nurses, hospitals need to view those applying for jobs as true candidates, not just applicants,” says Whitman. “You can’t just instruct them to go to your website and fill out an application — you have to be more proactive than that.” Whitman urges directors of surgical services and surgical supervisors to branch out far and wide in their search for good OR nurse candidates. “Don’t just post an opening on your hospital’s website or a job board, but also tap your professional networks and LinkedIn connections,” Whitman says. “And ask your existing staff

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nurses if they know of any good candidates.” In such a competitive environment, it’s also helpful to try to distinguish your hospital as an employer of choice. If your hospital has won any “best place to work” awards or Magnet status, promote this heavily in your recruiting efforts. You should also determine what are the most important factors to most OR nurses when deciding where they want to work. “The number one thing we are asked about by candidates is whether the hospital will pay for continuing education, CNOR certification and ongoing professional development,” says Whitman. “Candidates also usually want to know about schedule flexibility — for example, many ask about four-day workweeks, or how much they’ll be on call,” Whitman adds. “Achieving work-life balance is usually important to OR nurse candidates.” Travis Dorvall, RN, CNOR, who works at North Valley Hospital in Whitefish, Mont., says that most OR nurses are looking for a hospital that provides a culture for great patient care, teamwork and the opportunity to work with clinically competent nurses. “Having a respectful, non-toxic working environment is also important,” Dorvall says. “Most OR nurses want to have autonomy in their practice and be empowered by supportive managers who are willing to back their staff.” “Top-flight OR nurses today want support from administration to keep up with technological advances, and access to continuing education that will keep them functioning at a high level,” adds Deborah A.

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“Don’t just post an opening on your hospital’s website or a job board, but also tap your professional networks and LinkedIn connections. And ask your existing staff nurses if they know of any good candidates.” — Josiah Whitman, founder of Whitman Partners, a staffing firm that specializes in the healthcare industry

Herdman, RN, BSHA, the director of PeriOperative Services at Trinity Health System in Steubenville, Ohio. “And they want a collegial relationship with the surgeons they’ll be working with, without the burden of chasing after them to complete their paperwork,” says Herdman. “This is another way administration can support OR nurses.”

RIGHT SKILLS, GOOD FIT Despite the competitive hiring environment for OR nurses, you should still take great care in trying to hire nurses with the right skill sets who will be a good fit with the rest of your team. “Hiring managers should be very selective when hiring OR nurses,” says Dorvall. “The operating room

September 2014 | OR TODAY

is a unique, highly technical workplace.” Herdman recommends conducting peer interviews so that the OR staff who will be working directly with the new hire has a hand in selecting future team members. “Follow up with new OR nurses every week for the first 30 days to ensure that they are receiving a good orientation and the organization is meeting their expectations,” she says. Joan Anderson, RN, CNOR, the surgical supervisor at Schoolcraft Memorial Hospital in Manistique, Mich., agrees about the importance of getting input from the rest of the OR team when interviewing candidates. “Everyone on the team is going to be working together very closely,” says Anderson. “So, I always introduce candidates to the staff and ask for their input, which I take into consideration when making a hiring decision.” Your application and interview process for hiring OR nurses should lay out the specific qualities and expectations you’re looking for in candidates, Dorvall says. “Have a keen understanding of the characteristics that define the ideal OR nurse for your facility,” he says. “These generally should include, but aren’t limited to, having patient safety as their highest priority, having self confidence, being flexible with their time and workload, being a problem solver, and being able to admit an error.” GET IN FRONT OF RESIGNATIONS Once you have recruited the best OR nurses, your hospital should be doing everything within its control

OR TODAY | September 2014

“Everyone on the team is going to be working together very closely,” says Anderson. “So, I always introduce candidates to the staff and ask for their input, which I take into consideration when making a hiring decision.” — Joan Anderson, RN, CNOR, surgical supervisor at Schoolcraft Memorial Hospital in Manistique, Mich.

to hold onto them. The key, says Whitman, is to “get out in front of potential resignations before OR nurses give notice. Once they have resigned, there’s usually not much you can do to change their minds.” Of course, offering a competitive salary is important. “Look at your pay practices and make sure they’re competitive,” says Dorvall. “Also consider implementing strategies to retain staff during low census, such as guaranteeing a percentage of pay if hours are not met. And you should offer and promote continuing education and training for OR nurses.” But job satisfaction for OR nurses is usually about more than money. “Like anybody else, OR nurses want to feel valued,” says Herdman. “In other departments, nurses get feedback from the patients and their families,” Herdman adds. “But OR nurses get very little patient feedback because patients are anesthetized or sedated and spend a short amount of time in direct communication with them. So we need to make sure OR nurses are recognized and rewarded for doing a great job.” Being flexible to accommodate OR nurses’ needs and unforseen situations

is also important, says Anderson. “I realize that sometimes, things happen and a nurse can’t come in for an unforeseen reason,” says Anderson. “Even though the hospital’s policy only allows for three short-term call-ins, I try to be as flexible as I can in these situations.” And you can never say “thank you” to your OR nursing staff too often. “I thank my nurses every day for all their hard work,” says Anderson. “And once a month, I personally buy lunch for everybody. They all know that I have an open-door policy and they can talk to me any time about anything that’s concerning them.” Finally, it’s important to monitor OR nurses’ workloads and schedules to make sure they aren’t being overworked and getting burnt out. “Exhaustion is definitely an issue among OR nurses, as is maintaining a healthy work-life balance,” says Whitman. “We have a saying that you need to understand your nurses’ house-spouse-kids in order to know what’s really going on in their lives. And then be as flexible and accommodating as you can with regard to these areas of their personal lives.”

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PATIENT CARE, SAFETY MOTIVATE CAREER NURSE s lo fa

u ko

tS at

Donna Watson wants to make a difference

fter 33 years in perioperative practice, Donna Watson, RN, MSN, CNOR, FNP, is living proof that a career in nursing is more than the sum of its parts.

+ + + + + + Watson entered the field straight out of high school because she “wanted to have a career in the sciences and provide care to individuals.” Today, she is the Director of Societies and Patient Advocacy Programs for the medical device company Covidien. “Nursing was a perfect fit for me immediately out of high school and continues to be a perfect fit,” she said. Throughout those decades in the field, Watson said, she has seen many things change. Foremost among them is an increased global emphasis on data-driven outcomes, from patient safety to the role of nursing in the continuum of patient care. A significant component of the latter involves the role of nurse as patient advocate, a label she described as “very appropriate,” given the responsibilities of her profession.

“We are professional nurses behind closed doors,” Watson said, “and often patients or professionals who work outside of the operating room do not know what it is that we do.” “As a member of that perioperative team, I am one of the team; however, my role and responsibility is that the patient is able to have a safe patient journey, from the beginning to discharge,” she said. “There’s value behind your perioperative nurse being your advocate from the beginning to the end,” Watson explained. “My role is to promote and to adhere to what that patient has agreed whenever he or she has turned their care over to the perioperative team.”

Donna Watson has helped educate nurses around the world. She is seen here talking with colleagues during a trip to China.

Nursing was a perfect fit for me immediately out of high school and continues to be a perfect fit. — Donna Watson

Patient advocacy includes making sure that standards of care are met throughout the “patient journey,” Watson said, including while those under her care are under anesthesia. Responsibilities can include communicating with family members during and after surgery as well as monitoring a procedure to eliminate the potential for mistakes. Sometimes, she said, it can mean having to speak up in a potentially uncomfortable circumstance to adhere to a patient’s wishes. “A patient may come in with a request that they do not have blood products,” Watson said. “If you get into a situation that may demand the use of blood products, then that is where you as the nurse must step up, suggest other options, and advocate for what the patient expects; what 62

OR TODAY | September 2014

they have agreed to during surgery. “That can be a very difficult situation.” But such challenges are just part of the job, Watson said. Whether working in administrative, clinical or perioperative roles, nurses will always encounter moments during which they must balance their best professional recommendations with the personal wishes of their patients. The ability to compartmentalize the demands of the job without judging a patient for his or her decisions is one of the earliest skills Watson believes a nurse must master. Patient advocacy also is assuring that every patient has a perioperative Registered Nurse to provide care throughout the surgical experience. Among her career achievements, Watson is also a past president of

AORN, the Association of periOperative Registered Nurses. With that position comes the charge of selecting a presidential initiative. Watson established the Patient Safety First Initiative during her tenure. Many initiatives last for a limited time, she said, but because AORN was able to secure a $1 million grant from Sandel Medical in support of the Patient Safety First Initiative, it was extended to a three-year plan in 2002, and “is still strong today,” she said. In the 25-plus years during which Watson has worked with AORN, she has helped develop recommended practices, standards of care, practice guidelines, and elements for the perioperative nursing data set. She credits “a lifelong commitment to learning” as one of the pillars of her WWW.ORTODAY.COM

+ +

Instead of influencing one patient at a time, I may have a group of 500 to 5,000 nurses,” she said, “but the message I deliver to those nurses is able to carry on in multiple levels. The joy for me in that is the impact on care that the patient receives. — Donna Watson

professional career; others include research, practice, and scholarship. “I am a beginning nurse scientist, and I enjoy contributing to evidence-based practice,” Watson said; “being able to provide evidence to what you may feel is a hunch and being able to quantify that in terms of data analytics.” A love of research doesn’t survive in a vacuum, either, Watson said. She still receives “a great joy from practicing,” but thanks to the platform that her studies and professionalism have given her, she also enjoys the opportunity to share information with colleagues on a bigger stage. “Instead of influencing one patient at a time, I may have a group of 500 to 5,000 nurses,” she said, “but the message I deliver to those nurses is able to carry on in multiple levels. “The joy for me in that is the impact on care that the patient receives,” Watson said. Her advice for prospective nurses as well as those continuing to advance their careers is that nursing is “the perfect profession,” blending excitement, innovation, dynamism, and the ability to “make it what you want it to be.” Watson considers the future of her career as continuing to track along her passion for safety in the healthcare field, and wants to continue to conduct research “that makes a difference for the profession and nursing care.” “You are able to influence patients’ lives and make a significant impact on patients’ lives [and upon] the community in general,” Watson said. “We make a difference for every patient, every time,” she added. WWW.ORTODAY.COM

Donna Watson is seen enjoying the snow and winter decorations along the streets of Dublin, Ireland.

Donna Watson poses for a photo during a trip to Kyoto, Japan. As a nurse educator, she has done work in several countriaes.

September 2014 | OR TODAY

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September 2014 | OR TODAY

OUT OF THE OR HEALTH

HARVARD HEALTH LETTERS

STOP COMMON SLEEP STEALERS BEFORE THEY PUT YOUR HEALTH AT RISK

ou might remember a time when you could drift off to sleep in an instant and remain in a state of blissful slumber well past lunchtime the next day. Now your sleep is more likely to be lighter and more fitful, and when you wake up in the morning you don’t always feel refreshed. A lack of good-quality sleep could be a natural consequence of changing sleep-wake patterns after menopause. It’s also likely that the issue is physical – and fixable. Many conditions can disrupt your rest, and they can be treated. It’s important to address these issues. Lack of sleep does more than make you drowsy. Chronic insomnia has been linked to a variety of health problems, including obesity, high blood pressure, heart disease, diabetes and depression. 66

OR TODAY | September 2014

Go through this list to see whether you might have one of these sleepstealing conditions. Also check your medicine cabinet. Some medications, including corticosteroids, beta blockers, cold and flu remedies, and certain antidepressants also can interfere with sleep.

SLEEP APNEA

The conventional image of sleep apnea is of the overweight man who snores, but women of any size can also develop these repeated pauses in breathing while they sleep. “A woman who has a narrow jaw or a change in muscle tone can get apnea,” says Dr. Julia Schlam Edelman, clinical instructor in obstetrics and reproductive biology at Harvard Medical School and author of “Successful Sleep Strategies for Women and Menopause Matters: Your Guide to a Long and Healthy Life.” Either of these anatomical issues can block oxygen from reaching your lungs (and subse-

quently the rest of your body) while you sleep. Snoring might not be your main symptom if you do have sleep apnea, but you will notice that you’re especially sleepy during the day. Solution: See a specialist for a sleep study. You may be able to relieve apnea with a few lifestyle adjustments, such as sleeping on your side or losing weight. Your doctor might also suggest an oral appliance or a CPAP machine that blows air into your airways to keep them open at night.

DIET

What you eat can affect your sleep. Spicy foods can contribute to painful heartburn. Big meals leave you uncomfortably full, and over time can contribute to obesity – a well-known risk factor for sleep apnea. Too much caffeine could keep you wide awake, even if you finish your coffee in the morning. “It takes six hours to clear half of the caffeine from your body. If you have WWW.ORTODAY.COM

HEALTH

enough caffeine, it’s still in your body at 4 in the morning,” says Edelman. And though a glass of wine or two with dinner will make you feel relaxed or even sleepy, it won’t help you sleep. “You can fall asleep, but once you’re asleep you can’t sleep deeply,” she says. Solution: Eat dinner at least a couple of hours before bedtime, and keep the meal light. Avoid spicy, fatty foods, as well as alcohol and caffeine. Also, don’t drink too many fluids before bed. Having to constantly get up to go to the bathroom can disrupt your sleep, too.

LACK OF EXERCISE

Sleep and exercise complement each other. Working out regularly can help you sleep better, and conversely, you’re more likely to exercise if you get a good night’s rest. Solution: Exercise every day if you can, ideally in the morning. Doing a high-energy aerobic routine too close to bedtime can have the opposite of the intended effect, making you too energized to sleep. A gentle yoga stretch before bed probably won’t hurt, though. It might even help you relax.

PAIN

Arthritis aches or any other kinds of pain don’t make for restful slumber. Conversely, a lack of sleep can increase your pain. Researchers believe that a lack of sleep may activate inflammatory pathways that exacerbate arthritis pain. Poor sleep can also make you more sensitive to the feeling of pain. Solution: In addition to the pain remedies your doctor recommends, try using a heating pad or taking a WWW.ORTODAY.COM

warm bath before bed to soothe achy joints or muscles. Lying against a body pillow can put you in a more comfortable position while you sleep.

RESTLESS LEGS SYNDROME

Women are twice as likely as men to have restless legs syndrome (RLS) – a condition that causes a creepy, crawly feeling and uncontrollable movements in the legs at night. It’s often linked to hormonal changes early in life and during pregnancy, but RLS can continue as you get older. RLS isn’t just miserably uncomfortable – researchers at Harvard have linked this condition to an increased risk for heart disease and depression in women. Solution: Try simple interventions first. Exercise every day, take a hot bath before bed, massage your legs, and cut back on things that can make you jittery – like caffeine and tobacco. If these measures don’t work, your doctor may recommend one of several medicines that reduce RLS symptoms – including ropinirole (Requip), pramipexole (Mirapex), rotigotine (Neupro), or gabapentin enacarbil (Horizant).

DEPRESSION

“Depression is a common compromiser of sleep, and it’s much more common in women than in men,” Edelman says. Women who are depressed may sleep more than usual, but their sleep isn’t restful. Some of the antidepressants meant to counteract depression, particularly SSRIs, can also interfere with sleep. Solution: See your primary care

doctor, psychologist, psychiatrist, or therapist for help, which may include medications, talk therapy, or both. If your antidepressant seems to be keeping you awake, ask your doctor to switch you to another drug.

STRESS

It’s impossible to sleep when the weight of the day is pressing on you. Finding a sense of calm before bed isn’t easy, especially when you can’t unplug from the demands of your day. Solution: Establish wind-down time. Do a quiet, relaxing activity before bed that doesn’t involve a screen. Talk to a friend or family member, sew, or read a real book – not one on a backlit tablet device. “Just allow yourself to have quiet time,” Edelman adds. And don’t sleep with your smartphone on your bedside table.

POOR SLEEP HABITS

Sometimes insomnia stems from long-ingrained behaviors, like staying up too late or engaging in stimulating activities before bed. Solution: Follow a few basic sleep hygiene strategies. Go to bed and wake up at the same times each day. Keep your bedroom cool, dark, and comfortable. Use your bed for sleep and sex only. If you can’t fall asleep within 15 minutes, get up and leave the bedroom. Read or do another quiet activity for 15 to 20 minutes until you get sleepy. If these sleep strategies don’t help, Edelman recommends talking to a sleep expert. September 2014 | OR TODAY

OUT OF THE OR FITNESS

BY MARILYNN PRESTON

LEGAL IN EVERY STATE:

How to Keep Your Joints Happy

ealthy joints make for happy athletes. A bum knee, sore shoulder or painful wrist gets in the way of your best time – playing tennis, riding your bike, humiliating yourself at golf.

Research shows that more than 80 percent of all sports injuries involve joints. Ouch! The good news is that there’s a lot you can do, and pain relief medicine cannot, to keep your joints strong and healthy all year long. Here are seven points about joints that will save you time, money, aggravation and dependence on painkillers:

CROSS-TRAIN

LOSE WEIGHT

The more fat you lug around, the more stress to your joints. Every pound you lose equates to four pounds less pressure on your knees. Best advice? Don’t diet. Eat real food in modest amounts, lots of fruits and vegetables, limiting sugar and gluten.

This is just a fancy way of saying you shouldn’t focus on one sport or activity to get fit. By cross-training – doing a mix of sports you enjoy – you avoid the kind of single-sport repetitive motion that can cause joint problems over time. Cross-training helps you develop muscles in areas untouched by your primary sport, and strong muscles help stabilize and protect your joints. If you’re uncertain about a good cross-training complement to your sport, do yoga. It’s an ancient and magnificent way to keep your joints strong, flexible and spacious.

LUBRICATE

Joints have juices, lubricating fluids that allow your joints to move with more ease and less stress. To activate those juices, start your exercise routine with a gentle 5-10-minute warm-up and gradually increase your effort. Another good way to selflube is to drink water, water and more water.

OR TODAY | September 2014

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FITNESS

GET BALANCED

STRENGTH TRAIN

Joints need protection. Your muscles, tendons and ligaments are designed to protect your joints. If they’re weak, they can’t do their job. It’s your job to get them strong and flexible, and the best way to do that is a well-designed, wellexecuted strength-training program that includes stretching. Get a trainer, read a book or take a class, but do something! If you do nothing, over time you will become weaker and weaker and – believe this – your joints will suffer.

About 55 percent of all joint injuries involve the knee. Balance exercises promote leg strength and stability and protect the knee. There are many wonderful standing poses in yoga, qi gong and tai chi that challenge your balance and help you improve it. So will working out with wobbly balance boards, rubbery half domes and exercise balls. Muscle imbalance also contributes to joint problems. Typically, it’s your back, side and rear leg muscles that are underdeveloped and overly tight. Yoga and qi gong, so different from traditional sports, help you create awareness of these areas and position you to bring them back into balance.

DON’T OVERDO IT

Joints need tender care. If you carelessly yank them around, overuse them or work them in ways they’re not intended to go, they will rebel. Trying to lift too much weight, for instance, is a very jerky thing to do. So is overtraining, doing too much, too often, on muscles and joints not ready for the stress and strain. Learn to listen to your body. Think about giving it a name: “Hi, Hal. Are you warmed up yet?” Understand the range of motion for joints (knees, for example, are supposed to hinge, not rotate). Be mindful about your movement and never push past joint pain.

FIGHT INFLAMMATION WITH FOOD

The anti-inflammatory diet is a well-documented way of eating that decreases disease-causing inflammation throughout the body, including the joints. It avoids foods that make inflammation worse – processed food, grain carbs, sugar – and emphasizes healthy fats, including olive oil and omega-3 foods like salmon, herring, sardines, flaxseed and walnuts. Antioxidants, such as vitamin C (in foods, not supplements), selenium and carotenes are part of the anti-inflammatory diet, and so are bioflavonoids (quercetin and anthocyanidins) found in onions, kale, leeks, blueberries and red and black grapes. Ginger and turmeric are two spices that also fight inflammation. Interested? Good! Stick with a smart eating plan and your joints will thank you.

MARILYNN PRESTON – well-being coach, Emmy-winning producer – is the creator of Energy Express, the longest-running syndicated fitness column in the country. She has a website, marilynnpreston.com, and welcomes reader questions, which can be sent to MyEnergyExpress@aol.com. WWW.ORTODAY.COM

September 2014 | OR TODAY

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September 2014 | OR TODAY

OUT OF THE OR NUTRITION

VITAMIN D KEY TO PREVENTING A WIDE RANGE OF DISEASES, CONDITIONS

he sunshine vitamin may be important for health benefits beyond just bone protection.

THE A-B-CS OF VITAMIN D Vitamin D’s primary job is to regulate calcium absorption. But the specifics of how vitamin D is used by the body are far more complex. Research has suggested that getting enough vitamin D may play an important role in the prevention of a wide variety of conditions and diseases, including colorectal cancer, cardiovascular disease and high blood pressure, and that it may help boost the immune system (DermatoEndocrinology, 2013.) Vitamin D comes in several forms; the two most commonly found in foods and supplements are vitamin D2 (ergocalciferol) and D3 (cholecalciferol). Some research suggests that vitamin D3 is more potent than D2, though Michael Holick, Ph.D., M.D., vitamin D expert and profes72

OR TODAY | September 2014

In the 1940s, vitamin D became synonymous with bone health, when it was discovered that fortifying milk with the vitamin greatly reduced the incidence of bone-deforming rickets in children. While it’s true that vitamin D, along with calcium, is critical for building bone and maintaining bone density, a growing body of research suggests that vitamin D is a much more versatile vitamin than we realized 70 years ago. sor at Boston University School of Medicine, says, “Vitamin D2 is as effective as vitamin D3 in raising and maintaining serum blood levels of the vitamin.” GOOD VITAMIN D STATUS Your blood level of 25-hydroxyvitamin D is the primary indicator of vitamin D status. The Institute of Medicine (IOM) says that maintaining a serum level of 20 nanograms/ milliliter (ng/ML) is enough for bone health. However, Holick and others recommend higher levels (40-60 ng/ ML) for overall health. The level that is considered “normal” may vary among clinical laboratories. VITAMIN D AND DIET Milk is fortified with about 100 IU per cup and is the major source of

this vitamin in the American diet. The intake of vitamin D dropped 15 percent between 1980 and 2009, mainly due to a drop in milk consumption (Journal of the American Dietetic Association, 2011.) A few foods, including salmon and tuna, are naturally rich in vitamin D, but several products, including some brands of orange juice and breakfast cereals, are fortified with the vitamin. Mushrooms are possibly the least known source of vitamin D. When exposed to ultraviolet light, mushrooms can provide as much as 400 IU per three-ounce serving. Check the label to see if your mushrooms are rich in vitamin D. But if you’re not a milk drinker or a mushroom fan, get little sun. If you are over 50, you’ll need supplements to meet recommended intakes. WWW.ORTODAY.COM

NUTRITION

THE SUNSHINE VITAMIN Vitamin D is also produced by the body when your skin is exposed to the ultraviolet rays of the sun. These rays trigger the production of a vitamin D precursor found in skin called previtamin D3, which is then activated in the liver and kidneys. Only activated vitamin D can perform in the body. The standard recommendation for getting your D quota from the sun is 5-20 minutes of sun exposure between 10 a.m. and 3 p.m. twice a week on the face, arms, and legs without sunscreen. Vitamin D is fat-soluble, which means your body has the ability to store it for days or months, so it’s OK if you don’t get sun exposure every day. But this varies depending upon the following factors: 1. Skin color.

Darker skin produces less vitamin D. 2. Location.

Northern latitudes get fewer ultraviolet rays. 3. Age.

After age 50, the skin’s ability to produce vitamin D is reduced. 4. Medications.

Some medications, such as corticosteroids and cholestyramine lower vitamin D levels.

5. Chronic kidney disease.

This condition lowers the ability to activate vitamin D.

6. Cloud cover.

Complete cloud cover reduces UV rays by 50 percent. FUTURE OF VITAMIN D AND HEALTH Research into the roles of vitamin D in the body continues. “The effects of vitamin D on the immune system holds a lot of promise,” says Holick. “The importance of maintaining a healthy vitamin D status through life may play an important role in reducing the risk of deadly cancers, heart disease and type 2 diabetes later in life.” VITAMIN D REQUIREMENTS In 2010, the Institute of Medicine issued official recommendations for the amount of vitamin D individuals should take in every day for bone health: 600 International Units (IU) per day for 1-70 years of age, and 800 IU for those over 70. The IOM said there was not enough evidence to make vitamin D recommendations for the prevention of disease or other conditions. However, some experts believe that in this case, more is better. “I recommend 1,000 IU daily for children and 2,000 IU for adults. I, personally, take 3,000 IU daily and aim for a blood level in the range of 40-60 ng/ML,” says Holick.

SOURCES OF VITAMIN D oil

COD LIVER OIL 1 tablespoon: 1,360 IU SALMON (sockeye), cooked, 3 ounces: 447 IU TUNA FISH canned in water, drained, 3 ounces: 154 IU ORANGE JUICE fortified with vitamin D, 1 cup: 137 IU MILK nonfat, reduced fat and whole, 1 cup: 100 IU YOGURT fortified with vitamin D, 6 ounces: 80 IU MARGARINE fortified, 1 tablespoon: 60 IU SARDINES canned in oil, drained, 2 sardines; 46 IU EGG 1 large (vitamin D in yolk): 41 IU READY-TO-EAT CEREAL fortified, 1/4 to 1 cup: 40 IU

Reprinted with permission from Environmental Nutrition, a monthly publication of Belvoir Media Group, LLC. 800-829-5384. www.EnvironmentalNutrition.com. WWW.ORTODAY.COM

September 2014 | OR TODAY

OUT OF THE OR RECIPE

OR TODAY | September 2014

BY FAITH DURAND

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RECIPE

ROASTED SHRIMP SCAMPI M

y favorite recipes are the ones I call fancy-not-fancy. A little luxurious, but so quick and easy they might actually qualify as 15-minute meals. Roasted shrimp scampi is the perfect example of fancy-not-fancy – ultra quick, and ridiculously good, with broiled shrimp swimming in garlicky white wine and butter, with parsley and flecks of red pepper.

ROASTED SHRIMP SCAMPI

Roasting is one of my favorite ways to cook shrimp. I like how it gives me a few extra moments to focus on something else, like making a buttery white wine sauce, for instance. Shrimp scampi is easy, but it’s also luxurious, a restaurant-style meal at home; and we all know how restaurants make their dishes taste so good. Butter. Lots of it. These shrimp are roasted in butter, and then tossed with a simple sauce made of white wine, garlic, lemon and more melted butter. The funny thing about shrimp scampi, though, is that it didn’t originate with shrimp at all. Scampi is actually the Italian word for langoustine and its kin, which are small lobsters whose tails are considered quite a delicacy. These small lobsters are similar to shrimp in their mellow sweetness, and they are often poached in white wine or butter. So the scampi in shrimp scampi actually signifies the common preparation of shrimp’s distant cousin. All right, enough with the semantics. Let’s scampi, shall we?

DIRECTIONS: Heat the oven to broil. Move a rack into the top

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Serves 4 to 6. 2 pounds medium (26 to 30) shrimp, peeled, deveined and tails removed 1/2 cup unsalted butter • coarse kosher salt and freshly ground black pepper 4 cloves garlic, very finely minced • dash of crushed red pepper flakes, optional 1 lemon, zested and juiced, about 3 tablespoons juice 1/4 cup dry white wine 3 tablespoons finely chopped Italian parsley • lemon wedges, to serve

third of the oven. If necessary, thaw the shrimp under cold running water. If already thawed, rinse lightly and then pat very dry with paper towels and transfer to a large bowl. Melt the butter in a medium saucepan. Pour about half of the butter over the shrimp, and toss to coat. Season the shrimp generously with salt and pepper. Return the remaining butter to low heat. Stir in the garlic and warm for about 1 minute or until fragrant. Add the red pepper flakes, if using, and lemon zest, and stir over low heat for about 1 minute. Whisk in the wine and lemon juice. Keep warm over very low heat. Spread the shrimp in a single layer on a baking sheet and roast for 4 minutes or until pink, stirring halfway through. Toss the shrimp with the butter sauce and the parsley. Serve immediately over pasta or vegetables with lemon wedges on the side. Note: Rather than broiling the shrimp, you can roast it at the lower 400 F to 425 F for 6 to 8 minutes. I call for broiling mostly for speed, since it’s summer, and once you’ve heated up the oven you want to turn it off as soon as possible. FAITH DURAND is executive editor of TheKitchn.com, a nationally known blog for people who love food and home cooking. Submit any comments or questions to kitchn@apartmenttherapy.com. September 2014 | OR TODAY

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OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • SEPTEMBER • Where in the World?? OR Today is everywhere you are!

“Sometimes I have to remind myself around my non-nurse friends not to talk about bodily functions at dinner.”

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THE WINNER GETS LUNCH FOR THE ENTIRE TEAM!

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EACH SUBMISSION WINS A STARBUCKS GIFTCARD

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How do you handle a “no-win” situation? According to worldrenowned cardiothoracic surgeon Robert J. Cerfolio there’s often no such thing. Sharing his feats as a collegiate first-team academic all-American baseball player, his rise from a surgical resident at the Mayo Clinic to the recognized world authority in chest and robotic thoracic surgery, and anecdotes from his long career as a Little League coach and father, Dr. Cerfolio shows you how to think like a super performer in everything you do in his book “Super Performing At Work and At Home: The Athleticism of Surgery and Life.”

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A GOOD CHEW a Bites Broccoli Cheddar Quino

Researchers at Stony Brook University School of Dental Medicine and Ortek Therapeutics Inc., have developed a chocolate-flavored soft chew that is beneficial for teeth. BasicBites is a sugar-free chewy treat that helps maintain healthy teeth by supporting the normal acid-base (pH) levels that exist on tooth surfaces while coating the teeth with a mineral source. BasicBites are designed to mimic saliva’s profound and natural benefits. It is a new oral care product that contains AlkaGen Technology. BasicBites, 20 calories per piece, is available exclusively from Ortek via its website, www.basicbites.com.

W E B IN A

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OR TODA Y IS NOW DOING W EBINARS !

Tune in S ept. 18 @ 2pm ET for our fir s t w e b inar sponsore d by Clor ox! Visit www.ORT oday.com / to learn m webinars ore.

What is a nurse? To go above and beyond the call of duty. The first to work and the last to leave. The heart and soul of caring. – Anonymous

INDEX ALPHABETICAL AAAHC…………………………………………………………………19

Ecolab Inc, Professional Products Div.………… 57

OR Specific…………………………………………………………71

Allen Medical Systems……………………………………… 4

Fluke Biomedical………………………………………………… 5

Palmero Health Care……………………………………… 37

ASC Association……………………………………………… 47

GelPro……………………………………………………………………13

Polar Products………………………………………………… 65

BEMIS Healthcare……………………………………………… 6

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

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

Bryton Corporation……………………………………………19

Healthmark Industries………………………… 48-51, 70

Sage Services…………………………………………………… 58

C Change Surgical…………………………………………… 46

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

SIPS Consults, Corp.……………………………………………81

Censis Technologies, Inc. …………………………………18

Innovative Research Labs, Inc.……………………… 46

SMD Wynne Corp.…………………………………………… 58

Cincinnati Sub-Zero………………………………………… 27

Lumalier Corporation……………………………………… 23

Surgical Power………………………………………………… 65

Clorox Professional Products……………………… 9, 15

MD Technologies……………………………………………… 58

Surgical Services Summit………………………… 76-77

Cygnus Medical………………………………………………… 28

MedWrench…………………………………………………………71

TBJ, Inc.……………………………………………………………… 64

Didage Sales Company, Inc.…………………………… 47

Mobile Instrument Service & Repair………………14

Tenacore Holdings, Inc.…………………………………… 36

ENDOSCOPY Ecolab Inc, Professional Products Div.………… 57 Government Liquidation…………………………………IBC Innovative Research Labs, Inc.……………………… 46 MD Technologies……………………………………………… 58 Mobile Instrument Service & Repair………………14 OR Specific…………………………………………………………71 Ruhof Corporation…………………………………………… 2-3 SIPS Consults, Corp.……………………………………………81 TBJ, Inc.……………………………………………………………… 64 Tenacore Holdings, Inc.…………………………………… 36

INSTRUMENTS Government Liquidation…………………………………IBC Mobile Instrument Service & Repair………………14

INDEX CATEGORICAL ACCREDITATION AAAHC…………………………………………………………………19 ANESTHESIA Innovative Research Labs, Inc.……………………… 46 SMD Wynne Corp.…………………………………………… 58 APPAREL Healthmark Industries………………………… 48-51, 70 ASSOCIATIONS AAAHC…………………………………………………………………19 ASC Association……………………………………………… 47 AUCTIONS Government Liquidation…………………………………IBC MedWrench…………………………………………………………71 BEDS Innovative Medical Products, Inc………………… BC BIOMEDICAL Innovative Research Labs, Inc.……………………… 46 CARDIAC SURGERY C Change Surgical…………………………………………… 46 CABLES/LEADS Sage Services…………………………………………………… 58 CLEANING SUPPLIES Cygnus Medical………………………………………………… 28 Ruhof Corporation…………………………………………… 2-3 CLAMPS Innovative Medical Products, Inc………………… BC DISPOSABLES Government Liquidation…………………………………IBC Sage Services…………………………………………………… 58 ELECTROSURGERY Fluke Biomedical………………………………………………… 5

OR TODAY | September 2014

EMPLOYMENT SIPS Consults, Corp.……………………………………………81 GEL PADS Innovative Medical Products, Inc………………… BC GENERAL Didage Sales Company, Inc.…………………………… 47 GelPro……………………………………………………………………13 Government Liquidation…………………………………IBC Innovative Research Labs, Inc.……………………… 46 Lumalier Corporation……………………………………… 23 MedWrench…………………………………………………………71 SIPS Consults, Corp.……………………………………………81 Surgical Power………………………………………………… 65 HAND/ARM POSITIONERS Innovative Medical Products, Inc………………… BC HIP SYSTEMS Innovative Medical Products, Inc………………… BC INFECTION CONTROL/PREVENTION BEMIS Healthcare……………………………………………… 6 Clorox Professional Products……………………… 9, 15 Cygnus Medical………………………………………………… 28 Ecolab Inc, Professional Products Div.………… 57 Government Liquidation…………………………………IBC Palmero Health Care……………………………………… 37 Ruhof Corporation…………………………………………… 2-3 SMD Wynne Corp.…………………………………………… 58

INTERNET RESOURCES MedWrench…………………………………………………………71 KNEE SYSTEMS Innovative Medical Products, Inc………………… BC LAB TBJ, Inc.……………………………………………………………… 64 LEG POSITIONERS Innovative Medical Products, Inc………………… BC OTHER TBJ, Inc.……………………………………………………………… 64 OPHTHALMICS Ecolab Inc, Professional Products Div.………… 57 OR TABLE ACCESSORIES Bryton Corporation……………………………………………19 Innovative Medical Products, Inc………………… BC ORTHOPEDIC OR Specific…………………………………………………………71 Surgical Power………………………………………………… 65 PATIENT AIDS Innovative Medical Products, Inc………………… BC POSITIONING AIDS Innovative Medical Products, Inc………………… BC POSITIONERS/IMMOBILIZERS Innovative Medical Products, Inc………………… BC RADIOLOGY Ecolab Inc, Professional Products Div.………… 57

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INDEX CATEGORICAL SHOULDER RECONSTRUCTION Innovative Medical Products, Inc…………………………………………………………… BC SIDE RAIL SOCKETS Innovative Medical Products, Inc…………………………………………………………… BC SOCIAL MEDIA MedWrench………………………………………………………………………………………………… 71 SPINE OR Specific………………………………………………………………………………………………… 71 STERILE PROCESSING TBJ, Inc.………………………………………………………………………………………………………… 64 STERILIZATION Clorox Professional Products………………………………………………………………… 9, 15 Lumalier Corporation………………………………………………………………………………… 23 SIPS Consults, Corp.…………………………………………………………………………………… 81 SURGEON COOLING Polar Products…………………………………………………………………………………………… 65 SURGICAL AAAHC………………………………………………………………………………………………………… 19 Allen Medical Systems………………………………………………………………………………… 4 Censis Technologies, Inc. ………………………………………………………………………… 18 Clorox Professional Products………………………………………………………………… 9, 15 Ecolab Inc, Professional Products Div.…………………………………………………… 57 Lumalier Corporation………………………………………………………………………………… 23 MD Technologies………………………………………………………………………………………… 58 Mobile Instrument Service & Repair……………………………………………………… 14 SMD Wynne Corp.……………………………………………………………………………………… 58 Surgical Power…………………………………………………………………………………………… 65 SURGICAL EQUIPMENT Mobile Instrument Service & Repair……………………………………………………… 14 SURGICAL SUPPLIES Cincinnati Sub-Zero…………………………………………………………………………………… 27 Cygnus Medical…………………………………………………………………………………………… 28 Government Liquidation………………………………………………………………………… IBC Ruhof Corporation………………………………………………………………………………………2-3 SURPLUS MEDICAL Government Liquidation………………………………………………………………………… IBC SUPPORTS Innovative Medical Products, Inc…………………………………………………………… BC TEMPERATURE MANAGEMENT C Change Surgical……………………………………………………………………………………… 46 TEST EQUPIMENT Fluke Biomedical…………………………………………………………………………………………… 5 TRADE SHOWS Surgical Services Summit…………………………………………………………………… 76-77 ULTRASOUND Ecolab Inc, Professional Products Div.…………………………………………………… 57 Tenacore Holdings, Inc.……………………………………………………………………………… 36 VIDEO Ecolab Inc, Professional Products Div.…………………………………………………… 57 WASTE MANAGEMENT BEMIS Healthcare………………………………………………………………………………………… 6

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September 2014 | OR TODAY

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