OR Today - December 2014 by MD Publishing

PRODUCT SHOWROOM

SPOTLIGHT

PATIENT LIFT SYSTEMS

THE GOOD NURSE

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CONTENTS

features

OR TODAY | December 2014

CALZURO DURABLE AND HEALTHY COMFORT Calzuro footwear is great for hospital and operating room personnel. They provide hours of comfortable standing, a slipresistant sole and side ventilation holes let feet breathe. They are also easy to clean and come in a variety of different colors.

SAFE

PATIEN

HANDLIN 44

SAFE PATIENT HANDLING

The practices of transporting, lifting, positioning and holding patients in the OR are fraught with danger for patients and OR personnel alike. We take a look at safe patient handling and the impact it has on healthcare.

THE GOOD NURSE

Ileana Breaux decided to become a nurse at an early age and continues to enjoy the rewarding career choice on a daily basis.

By Don Sadle r

OR Today (Vol. 14, Issue #10) December 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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December 2014 | OR TODAY 7

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

EDITOR

John Wallace | jwallace@mdpublishing.com

ART DEPARTMENT

YOU CAN WEAN YOURSELF OFF SLEEP AIDS

Jonathan Riley Yareia Frazier Jessica Laurain

ACCOUNT EXECUTIVES

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

CIRCULATION Bethany Williams

INDUSTRY INSIGHTS 11 News & Notes 16 AAAHC Update

ACCOUNTING Sue Cinq-Mars

WEB SERVICES

IN THE OR 18 21 22 28

Suite Talk Market Analysis Product Showroom CE Article

Betsy Popinga Taylor Martin

OUT OF THE OR

56 Health 59 Fitness 62 Nutrition 64 Recipe 68 Pinboard

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

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OR TODAY | December 2014

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INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

BLACK DIAMOND VIDEO INSTALLS NEW ZERO FOOTPRINT OR Black Diamond Video has announced that it has completed installation of a state-of-the-art Zero Footprint OR in the Huntair showroom in Phoenix, Ariz. The showroom displays the latest in OR integration solutions from Black Diamond Video, surgical lights and booms from Trumpf, and innovative CLEANSUITE laminar flow ventilation technology from Huntair. “The partnership with Huntair developed naturally as both of our companies are best in class and are focused on designing and developing meaningful technologies for today’s

OR,” says Devon Bream, Global Vice President of Medical Sales and Marketing for Black Diamond Video. In the showroom, Black Diamond Video showcases its newly launched methodology for operating room design, the Zero Footprint OR, by positioning the IDSS equipment rack outside of the showroom’s mock operating room. BDV’s Zero Footprint OR approach locates BDV’s IDSS equipment rack outside of the operating room at a distance up to 1,000 meters without video signal degradation. By removing the rack from the operating room, BDV

supports infection control and lends flexibility to architects and equipment planners. Clients visiting the showroom are able to experience advanced features of Black Diamond Video’s IDSS including ultra HD 4K image management, multi-source windowing of surgical video, unique tabletbased viewing and control functions, and intuitive device auto-identification provided by BDV’s common connector technology. Clients can see firsthand how BDV systems integrate with boom, light and other equipment manufacturers. •

DEPUY SYNTHES ANNOUNCES AGREEMENT WITH BLUE BELT TECHNOLOGIES INC. DePuy Synthes has announced a worldwide commercial agreement with Blue Belt Technologies, a global medical technology company specializing in enabling technologies for orthopedic surgery. The agreement will enable orthopedic surgeons to use the SIGMA HP Partial Knee System with Blue Belt’s Navio surgical system. SIGMA HP, combined with Navio surgical system for orthopedic surgery, has the potential to help minimize surgical disruption of healthy tissue while enabling more precise implant placement through minimally invasive incisions. The Navio System combines CT-free WWW.ORTODAY.COM

navigation software with a handheld, computer-controlled bone shaping tool that is designed to bring a high degree of implant placement accuracy along with soft tissue balancing benefits. Today, approximately seven percent of all knee replacement patients worldwide are treated with uni-compartmental knees. The SIGMA HP Partial Knee is a modular system specifically designed to allow uni-compartmental, bi-compartmental (unicompartmental

tibiofemoral with patellofemoral) or staged replacement of the knee joint, meaning surgeons can match the implant specifically to a patient’s disease state to retain healthy bone, cartilage and ligaments. •

December 2014 | OR TODAY 11

INDUSTRY INSIGHTS NEWS & NOTES

COVIDIEN SONICISION PORTFOLIO EXPANSION ENABLES CORDLESS ULTRASONIC DISSECTION DEVICE OPTIONS

Covidien has announced the expansion of its Sonicision Cordless Ultrasonic Dissection Device portfolio, following U.S. Food and Drug Administration 510(k) clearance of three additional device lengths: 13 cm, 26 cm and 48 cm. Covidien now offers surgeons more options when performing pediatric, urological and bariatric procedures on patients of all sizes. The U.S. Food and Drug Administration cleared three new device shaft lengths in addition to the current 39 cm device. Covidien’s Sonicision Cordless Ultrasonic Dissection Device portfolio consists of: 13 cm, 26 cm, 39 cm and 48 cm. “Covidien is a pioneer in developing energy-based medical devices and the Sonicision system’s groundbreaking cordless technology continues to transform how minimally invasive surgery is performed,” said Chris Barry, president, Advanced Surgical, Covidien. “These new device lengths enable surgeons to use Sonicision technology in a more diverse range of surgical 12

OR TODAY | December 2014

procedures while avoiding the need for cords and separate generators.” The Sonicision system gives surgeons complete freedom of movement in the operating room. Increased mobility eliminates the frustration of managing cords in a sterile field and helps to increase procedural efficiencies. The Sonicision system is used in a wide variety of general, bariatric, colorectal, gynecological and urological surgical procedures. The device’s design allows a surgeon’s eyes to remain in the surgical field rather than on the instrument. The new device lengths allow surgeons to expand their use of the Sonicision system to an increasing number of procedures, including pediatric colectomy, splenectomy, and appendectomy. The full cordless ultrasonic portfolio is currently available in the United States. • FOR MORE INFORMATION on Sonicision products, visit covidien.com/sonicision.

MEDROBOTICS ANNOUNCES LAUNCH OF THE FLEX RETRACTOR Medrobotics Corp., a surgical products company with core competencies in medical robotics, has announced the market release of its Flex Retractor in the U.S. and Europe. The Flex Retractor is lightweight and easy to handle and position. It has been designed to facilitate exposure in advanced transoral surgeries, including robotic and laser microsurgery procedures. Medrobotics has incorporated an industry first axial tongue blade rotation capability, which allows surgeons to create unprecedented exposure in certain procedures involving the base of tongue. Dr. Marshall Strome, M.D., Professor and Chairman Emeritus, Cleveland Clinic Head and Neck Institute and Co-Chair of Medrobotics Medical Advisory Board, said, “The Flex Retractor is a significant advance for transoral surgery. With its unique adjustability and ease of use, the Flex Retractor offers head and neck surgeons the confidence that they can efficiently achieve the exposure that they need for advanced transoral procedures.” Medrobotics received the CE mark for the Flex Retractor which permits distribution in the European Union. The Company has met all applicable FDA requirements to distribute the Flex Retractor in the U.S. where it is a class I device and exempt from FDA’s premarket notification process. • WWW.ORTODAY.COM

NEWS & NOTES

JUST MANUFACTURING OFFERS PRODUCTS FOR INFECTION CONTROL Just Manufacturing has expanded its healthcare products line with the addition of sinks, hand wash stations and fixtures made with CuVerro Antimicrobial Copper Surfaces. One of the most frustrating problems professionals in Infection Control and Epidemiology face is how to prevent hospital-acquired infections. More public and healthcare environments supplement current infection and disease control practices with antimicrobial copper, antibacterial products, hospital sinks, hand wash sinks and scrub sinks. CuVerro Antimicrobial Copper Nickel surfaces are attractive, safe to use and never wear or wash away.

Copper is the only active, bacteriakilling ingredient in CuVerro alloys. EPA-registered CuVerro surfaces begin killing pathogens on contact killing 99.9 percent within two hours, and keeps on killing 24/7. Just Manufacturing healthcare products made with CuVerro Antimicrobial Copper Surfaces include: healthcare fixtures, scrub sinks, sinks and nurse’s hand wash stations. The sinks, hand wash stations and fixtures made with antimicrobial copper surfaces take the complexity out of the infection control process while helping to ensure maximum effectiveness. •

OLYMPUS PARTNERS WITH BRAINLAB AS EXCLUSIVE DISTRIBUTOR FOR ENT PRODUCTS Olympus has announced that it has reached a deal with Munich-based Brainlab to be the exclusive U.S. distributor of Kick Navigation. This agreement applies to the U.S. ENT market; Brainlab will maintain distribution for cross-disciplinary U.S. sales and all distribution outside the U.S. The system, offering both optical and electromagnetic guidance options, offers surgeons advanced image enrichment and visualization for complex ENT surgeries. Surgical navigation — also called image-guided surgery, computer-assisted surgery, or software-guided surgery — is similar in concept to a GPS system used in today’s electronic devices. It is designed to continuously track surgical instrumentation relative to the patient’s anatomy and display the relationship in real time on a monitor during surgery. Navigational assistance becomes critical during complex ENT surgeries where instruments are used in close proximity to the optical nerve, the brain and other sensitive tissues. Navigation software is used to perform intricate surgeries such as sinus and intranasal surgeries, maxillary antrostomies, ethmoidectomy surgery, spheno-idotomies/sphenoid explorations, transphenoidal surgery, tumor resection, turbinate reduction, frontal and lateral skull base as well as pursue interdisciplinary approaches with neurosurgery or CMF departments. According to Truven Health Analytics Inc., there were more than 4 million sinus procedures performed in the United States in 2014, and more than 75,000 of those surgeries were performed using navigation software. •

WWW.ORTODAY.COM

December 2014 | OR TODAY 13

INDUSTRY INSIGHTS NEWS & NOTES

DRÄGER RELEASES PERSEUS A500 ANESTHESIA WORKSTATION IN U.S.

Dräger has announced the release of the Perseus A500 anesthesia workstation, one of the largest development projects ever from Dräger. This device offers configurability, high-performance ventilation, enhanced ergonomics, and automation to support the workflow of the operating room. The new workstation was introduced at anesthesiology 2014, the annual meeting of the American Society of Anesthesiologists. “Flexibility is a major advantage of the Perseus A500 anesthesia workstation,” says David Karchner, Dräger’s Director of Marketing in North America. “The Perseus A500 can be easily tailored to meet the needs of users, and thereby help them achieve departmental and hospital goals. It’s a powerful addition to an already solid anesthesia portfolio, which includes the Apollo and Fabius product families.” The Perseus A500 offers a number of ergonomically enhanced features to support 14

OR TODAY | December 2014

the workflows of clinicians, biomedical engineers and anesthesia technicians. A large, well-lit workspace keeps tools and supplies organized and within easy reach. For added convenience, there are large storage drawers, a pull-out writing tray that doubles as a drawer, various shelving options, and a number of hooks and rails. Composed of just a few easy-to-assemble/disassemble components, the breathing system facilitates the cleaning process and helps reduce the amount of time required to maintain the device. Integrated cable management channels are designed to reduce the risk of infection and accidental disconnection. Hoses and cables are guided through designated channels to keep them well protected, organized, and easily accessible. •

SHARN ANESTHESIA ANNOUNCES ENVIRONMENTAL CHARITY COMMITMENT In recognition of the environmental consciousness of healthcare professionals everywhere, Sharn Anesthesia announced their commitment to make a donation of $1 for every box of disposable laryngoscope handles sold. “We, along with our customers, recognize the need for disposable medical products and their role in reducing infection. We also understand the impact on our landfills, just like we understand the impact of cleaning solutions on the environment. Medical waste is not (yet) recyclable but that doesn’t mean we are powerless. In some small way, by supporting the work of a national environmental charity, we can offset these impacts,” says Julie Anderson, General Manager of Sharn. Sharn Anesthesia is a market leader focused on anesthesia related specialty devices and one of the largest suppliers of laryngoscopes in the U.S. On Sept. 1, 2014, Sharn began donating $1 for every box of disposable laryngoscope handles sold. The donation will be made annually to one or more national environmental charities. If successful, the company may expand the offer to include other products in 2015. •

TO LEARN MORE about the Perseus A500, visit www.draeger. com/perseusA500.

WWW.ORTODAY.COM

NEWS & NOTES

UV-C DISINFECTION SYSTEM UTILIZES 3 EMITTERS TO ERADICATE DRUG-RESISTANT ORGANISMS

Surfacide has introduced a new UV-C hard surface disinfection system for healthcare providers. The Helios system uses three light-emitting towers in the patient environment to eradicate drugresistant organisms, including: C. Diff, MRSA, VRE, CRE and Acinetobacter. The Helios system is faster and more effective than single emitters because the three-piece system covers an entire room, including the bathroom and other hard to reach areas. In addition, the Helios emitters are positioned closer to hard surfaces, which cuts down cleaning time and improves overall efficacy. “UV-C disinfection is one of the most effective tools to combat WWW.ORTODAY.COM

healthcare-associated infections,” said Gunner Lyslo, president of Surfacide. “However, the eradication of drug-resistant organisms begins to diminish the further a UV-C emitter is positioned from hard surfaces. Single emitters may leave areas untreated and require more disinfection time, while the Surfacide Helios system can clean an entire room in as little as 30 minutes.” To operate the Surfacide Helios system, three articulating UV-C towers are wheeled into a patient room and positioned approximately 1.5-meters away from any surface. Each tower comes equipped with laser validation to ensure the room is completely covered during the

disinfection process. Once validation is completed, the towers are activated. The disinfection process – which lasts roughly 30 minutes – reduces drug-resistant organisms found on hard surfaces such as, C. Diff, MRSA, VRE, CRE and Acinetobacter. This process significantly reduces the risk of HAIs, which are a major threat to hospitals, outpatient clinics, long-term care facilities and other healthcare environments. The Surfacide Helios UV-C hard surface disinfection system is available in the U.S. and European markets. FOR MORE INFORMATION about the product, visit Surfacide.com or call 844-390-3538. December 2014 | OR TODAY 15

INDUSTRY INSIGHTS AAAHC NEWS &UPDATE NOTES

BY JACK BY EGNATINSKY, AUTHOR NAME MD

IF YOU’RE SEEKING ACCREDITATION, IT’S NOT ENOUGH TO HAVE A POLICY.

hen you’re being surveyed for accreditation, policies and procedures are important; and the AAAHC Standards increasingly call for quite a few to be written – although most organizations have many more written policies than we require. But at AAAHC we do require that some programs (quality management and improvement and safety programs, for example) be written and designate who shall be responsible for administering them. Other Standards, such as Risk Management, Clinical Records and Infection Control and Prevention, require that an individual be designated as the person in charge of these programs.

OR TODAY | December 2014

While we look for these and many others during our accreditation survey, we also look to see how familiar your staff is with your policies and how you implement them. The latter is a big concern. Let’s concentrate on one area that impacts all ASCs. I can’t think of an ASC that does not have very thorough policies for site marking prior to administration of medications to an eye, for instance, or for marking the site of a block. Every ASC should have policies for the surgeon or the proceduralist marking the operative site. To assure that this is done, and everything else is ready for the planned procedure including the correct patient, correct site and necessary instruments and staff, a timeout involving the entire operating and anesthesia team must be done and documented before starting the procedure.

Does this reflect what you are doing? Everyone, I’m sure, will answer yes. But if that’s the case, why do we still get notifications of wrong side or site blocks, wrong side application of eye drops, wrong tooth extracted, and even wrong site surgery being started or even completed? How are you implementing your policies? How are you educating your staff and physicians about their role in assuring that policies are being carried out as written and intended to be used? Do you have checklists? Are you completing them item by item, not just as a blast completion so that when records are reviewed it will be complete? Are you doing your timeout requiring each member of the team to respond out loud to each question? Who is responsible for documenting each item of the checklist? Are they signing, with date and time, that they have done this? WWW.ORTODAY.COM

AAAHC UPDATE

Standard 10.1.V in the AAAHC Accreditation Handbook is clear on who is responsible for the timeout. It states that “the provider performing the procedure is personally responsible for ensuring that all aspects of this verification have been satisfactorily completed immediately prior to beginning the procedure.” The excuses we often hear: “the surgeon is out talking to the family of the previous patient,” or “the surgeon is getting the next patient ready in pre-op,” don’t meet the requirements of this AAAHC Standard. The emotional and physical trauma to the patient and their families, and the frequent bad publicity and medico-legal action that follows when one of these events occurs, far outweighs the

few minutes’ delay to do the time-out correctly. Policies, procedures, protocols, adopted guidelines, etc., all exist for a purpose; and circumventing them in any way often leads to unfortunate circumstances. Standardize the way your staff implements your policies. Review what everyone is doing and select the best practice as the policy that all your staff is taught and required to follow. “Well, we’ve always done it that way” is no longer acceptable. Using the terminology of one of our competitors, these should be “never events.” It is up to you, your staff, your providers, and your governing bodies to assure that they are “never events.” I don’t want to read about you in a national newspaper, or in OR Today, unless the articles are about some

exciting innovation you’ve developed, or an award you’ve won, or it is recognizing something especially noteworthy that you have done to benefit your patients. ABOUT THE AUTHOR Dr. Jack Egnatinsky is an anesthesiologist with extensive experience in the ambulatory surgery arena, both HOPD and ASC. He is a Past-President of the Board of FASA, a predecessor to the ASC Association, and Past-President of AAAHC. He Is also on the board of the Accreditation Association for Hospital and Health Systems (AAHHS) and is a representative of Acreditas Global. He remains extremely active as a Medical Director for AAAHC, in addition to being a well-travelled AAAHC accreditation surveyor, both in the USA and internationally.

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

YEARS STRONG

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

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

WWW.ORTODAY.COM

December 2014 | OR TODAY 17

IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

PRE-OPERATIVELY APPLYING ARMBANDS FOR BLOOD We are putting armbands on patients that have blood type and cross preoperatively. Sometimes this may be 4 or 5 days before the scheduled surgery. We have some feedback from patients that they don’t feel comfortable wearing the armband that early before surgery. We all know the need for accurate patient identification when administering blood products, but I am wondering if there are any alternatives short of scheduling the pre-operative visit the day before surgery? A: We do day before or day of. A: If the patient prefers you can place the blood band around an ankle (a non-operative one if the planned surgery is orthopedic). A: We schedule them early enough to come in the day of the procedure and have it done. This may result in them coming in very early, but it keeps them from wearing the bracelet or losing it. A: Our cross match is only good for three days in our facility so we have them come in no sooner than the day before for type and cross. A: We put them on our patients the day of admission. It is part of our preoperative checklist that our outpatient nurses do. This is doubled checked by our OR nurse who is caring for the patient and doing her pre-operative assessment. A: We do type and screen pre-op, then if needed day of surgery we do the cross match. •

OR TODAY | December 2014

WWW.ORTODAY.COM

Q Q

SUITE TALK

ENDOSCOPY For those who have endoscopy in their service. Do you routinely perform pregnancy testing on patients that receive conscious sedation from the RN? We use versed and fentanyl. A: We do.

A: We do as well.

A: We do pregnancy tests on all patients unless documented menopause for one year or hysterectomy.

A: We do allow the patient to decline a pregnancy test via documentation (hospital form) attesting their status.

GETTING PATIENTS READY When getting patients ready in SDS, are the patients interviewed and changed into gowns prior to their family being present? Sometimes patients have information that they don’t want their families to know, and it is difficult to obtain this information if the family is at the bedside. A: Yes. A: This can be a very difficult situation and I try to let the patient know it is their decision if, and when, to have

family with them. If I sense they are reluctant to have family in pre-op with them I am the bad guy and let family know they have to wait but will see their loved one before

surgery. It is difficult to have a hard and fast rule that no family is allowed until the assessment is done. •

AVAGARD SURGICAL SCRUB Is anyone aware of any standard or regulation about putting Avagard Surgical Scrub pumps inside the actual operating room? Where do most facilities mount the pumps? A: We have the Avagard located at the scrub sinks with the directions for use. Some staff members take short cuts when applying the waterless product. A: We have ours mounted next to our scrub sinks. A: We found that a good place to locate the pumps is by the scrub sinks and outside the OR entry door.

WWW.ORTODAY.COM

A: Absolutely! We need to provide the information to the patient regarding the risks to the fetus of the medications to be administered. •

A: We use Surgicept instead of Avagard, and it is mounted outside each room by the scrub sinks. It is also mounted in two of our ORs where total joints are performed. We needed approval from the fire marshall to add additional quantities of an alcohol solution into our total, but it isn’t really different than having alcohol gel in the room. He was more concerned with our total volume.

A: We have it inside our robot rooms so the surgeons don’t have to leave when they return to the field from the console. A: We have ours in our operating rooms. A: Our Avagard dispensers are outside of the OR, next to the scrub sink.

December 2014 | OR TODAY 19

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IN THE OR MARKET ANALYSIS

MARKET ANALYSIS

BY JOHN WALLACE

Patient Lift System

n emphasis on patient safety and satisfaction along with a focus on caregiver safety make lifting and moving patients a very important aspect of care in hospitals, surgical centers and healthcare facilities across the United States.

A 2013 study calls for government action to require the use of safe lifting and moving devices in healthcare settings. The report “The Case for Caring Technology” produced by Patient & Family stresses the use of new technology when it comes to moving patients. It also includes examples of improper techniques for lifting and moving patients. An increasing number of obese patients in the U.S. are adding to the ill effects many associate with repositioning or moving patients. Many newer patient lift systems reduce or eliminate the need for caregivers to risk injury when moving those under their care. This is one reason the market is expected to grow in the next decade. An increase in the number of surgeries and procedures expected due to the number of aging baby boomers with health issues is also expected to impact the patient lift system market. When more individuals need or elect for surgeries, there will be an increased demand for devices that provide the safe and effective lifting and transport of patients. The Patients & Family report suggests that caregivers should not manually lift more than 35 pounds of body weight. This recommendation is impossible without patient lift systems when it comes to transporting a patient from a bed to a chair, a WWW.ORTODAY.COM

shower to a bathtub or onto a stretcher. “Indeed, a typical bedside nurse lifts two tons a day,” according to the report. In the operating room, nurses are often required to help move and position patients. Patient lift systems make this task easier and safer for the caregivers as well as the patients. Manually lifting patients can also cause concern regarding the possibility of slips, trips, fainting or muscle spasms by a patient that can cause sudden unexpected movement. The report states that it is impossible to predict that a manual lift of a patient will be safe. In 2013, eight states had “safe patient handling laws,” and the U.S. Veterans Health Administration has made it a policy for all of its facilities. OSHA is also a proponent of the use of technology to make patient handling and movement safe. “Patient transfer and lifting devices are key components of an effective program to control the risk of injury to patients and staff associated with lifting, transferring, repositioning or movement of patients,” according to the agency’s Safe Patient Handling website. “Essential elements of such a program include management commitment to implement a safe patient handling program and to provide workers with appropriate measures to avoid manual handling; worker

participation in the assessment and implementation processes and the evaluation and selection of patient handling devices; a thorough hazard assessment that addresses high risk units or areas; investment in equipment; care planning for patient handling and movement; training for staff; and program review and evaluation processes.” “The education and training of healthcare employees should be geared towards assessment of hazards in the healthcare work setting, selection and use of the appropriate patient lifting equipment and devices, and review of researchbased practices of safe patient handling,” the website adds. Injuries to healthcare workers can be expensive and that is another reason facilities are expected to invest in patient lift systems. “The monetary cost of failing to adapt new methods and technologies is substantial, and encompasses medical expenses, disability compensation and litigation,” according to a recent article on ISHN.com. “Direct and indirect costs associated with only back injuries in the healthcare industry are estimated to be $20 billion annually. Injuries that leave providers in chronic pain cause functional disabilities, absenteeism, and high turnover and make workers less productive, less attentive and more susceptible to further injury. As many as 20 percent of nurses who leave direct patient care positions do so because of risks associated with the work.” December 2014 | OR TODAY 21

IN THE OR PRODUCT SHOWROOM

ARJOHUNTLEIGH MAXI AIRTM The Maxi Air™ is an air assisted single patient multiple use system that seeks to promote a safe and effective solution for lateral transfers. Lateral transfers and repositioning are the most commonly cited patient handling tasks reported in healthcare, but change is in the air. Maxi Air cushions the patient on a bed of air – a floating effect created by air flowing through the perforated underside of the inflatable single patient use mattress. This effect minimizes friction and shearing forces when transferring and repositioning the patient, resulting in a gentle and safe transfer for both the patient and caregiver. More information about ArjoHuntleigh can be found at www.arjohuntleigh.com. •

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PRODUCT PRODUCT SHOWROOM FOCUS

ENCOMPASS GROUP LLC SWIFT® SLIDER PATIENT REPOSITIONER The Swift® Slider Patient Repositioner from Encompass is a cost-effective, low-friction taffeta positioner intended to allow nurses to safely and easily perform patient repositioning tasks with little physical strain. Manual repositioning with traditional drawsheets or incontinent pads exposes caregivers to increased risk of neck, shoulder and back injuries. Implementing the standard use of this repositioner will create a safer healthcare environment for caregivers, ensure the comfort and security of patients and residents, and support no-lift policies. The Swift Slider is constructed of two layers – a 50/50 cotton polyester twill surface and a thin, breathable taffeta backing. The breathable backing and thin profile minimize discomfort and injury to skin. •

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IN THE OR PRODUCT FOCUS

GULDMANN GH3 PATIENT LIFT SYSTEM Guldmann GH3 patient lift systems are the ideal solution for lifting, moving and repositioning patients in all kinds of care environments, including the OR, ICU, Bariatric and Burn Unit. Mounted on the ceiling, lift systems keep the floor space uncluttered. A wide array of slings provides greater comfort and safety and can assist in over 22 clinical procedures such as catheterization. Offering flexibility and safety for patients and caregivers, customized lift systems lift up to 770 pounds with one lifting strap or 1,100 pounds with two straps. Lifts are available with features such as weight scale, service module or CareLift management. â&#x20AC;˘

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PRODUCT FOCUS

Hill-Rom LIKO® PATIENT HANDLING SYSTEMS More than 30 years of experience lifting and transferring people in a safe and careful manner has given Hill-Rom expert knowledge, technology and methodology. The company’s goal is to develop the world’s easiest, safest and most efficient aids for use during lifts and transfers, designed to mitigate risk of injury caused by manually transferring and moving patients. Hill-Rom has a wide, functional range of patient lifts, slings and accessories. Combined with other solutions from HillRom’s wide product range, the company can provide total room solutions for hospitals and other care facilities worldwide. • WWW.ORTODAY.COM

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IN THE OR PRODUCT FOCUS

PRISM MEDICAL C-SERIES The Prism Medical C-Series delivers innovation, affordability and quality. Ceiling lifts dramatically reduce injuries resulting from the handling of patients. The C-Series is designed with a full set of standard features and can be safely operated by a single caregiver. Built for quiet operation, these lifts provide a smooth and effortless transfer that safely enhances the working conditions of caregivers. The Prism Medical C-450 has a 450 pound maximum capacity and the C-625 has a 625 pound maximum capacity, providing supreme flexibility in the type of patients that can be transferred. For additional flexibility, power traverse is an option.

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OR TODAY | December 2014

BY CONNIE GOLDSMITH, RN, MPA, CRYSTAL DUNLEVY, RRT, EDD; AND DALE AMES KLINE, RD, MS, CNSC, LD

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HEALTHY PEOPLE 2020, PART 2 Roadmap for the Nation’s Health

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 37 to learn how to earn CE credit for this module.

The purpose of this program is to inform healthcare professionals about the U.S. Department of Health and Human Services’ Healthy People initiative and to review selected objectives related to diet and nutrition, food safety, respiratory diseases and tobacco use. After studying the information presented here, you will be able to: • Discuss the vision and mission of the Healthy People 2020 program • Describe the initiative’s baseline and target objectives and their significance • Identify one objective each for diet and nutrition, food safety, respiratory diseases and tobacco use WWW.ORTODAY.COM

ealthy People “is the nation’s roadmap and compass for better health, providing our society a vision for improving both the quantity and quality of life for all Americans,” Assistant Secretary for Health Howard K. Koh, MD, MPH, said in a news release announcing the unveiling of Healthy People 2020 in December 2010.1 Healthy People is a set of goals and objectives with 10-year targets designed to guide national health promotion and disease prevention efforts to improve the health of all people in the United States. Released by the U.S. Department of Health and Human Services each decade, Healthy People reflects the idea that setting objectives and providing science-based benchmarks to track and monitor progress can motivate and focus action. Healthy People 2020 represents the fourth generation of this initiative, building on a foundation of three decades of work. December 2014 | OR TODAY 29

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Part 1 of this two-part interprofessional module focused on the HP2020 initiative itself, including newly added objectives and leading health indicators. This module, Part 2, includes sections about selected topics and objectives relevant to a variety of healthcare providers, especially dietitians, nurses and respiratory therapists. HEALTHY PEOPLE 2020 Healthy People 2020’s objectives and targets are used to measure progress for health issues in specific populations and serves as 1) a foundation for prevention and wellness activities across various sectors and within the federal government and 2) a model for measurement at the state and local levels. The vision of Healthy People 2020 is a society in which all people live long, healthy lives.2 Its mission is to:2

• Identify nationwide health improvement priorities • Increase public awareness and understanding of the determinants of health, disease and disability and the opportunities for progress • Provide measurable objectives and goals that are applicable at the national, state and local levels • Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge • Identify critical research, evaluation and data collection needs HP2020 offers many ways to connect with the initiative, including emails, webinars and conferences. Interested people can follow HP2020 on Twitter and LinkedIn, and can watch videos on YouTube. The consortium toolkit helps members understand and implement HP2020 and market it to constituents.

It includes planning tools and PowerPoint presentations for healthcare professionals, educators, businesses and community members. The Centers for Disease Control and Prevention has also prepared a detailed guide called The Health Communicators Social Media Toolkit to show participants how to integrate social media into health communication campaigns. Interactive features on the website allow users to take a closer look at health disparities by comparing the top 10 causes of death across populations by gender and ethnicity (http:// healthypeople.gov/2020/default. aspx). There are nearly 600 objectives in HP2020, and healthcare providers are certain to find that many are relevant to their practice. This module discusses objectives from the topics of food safety, nutrition and weight status, physical activity, and respiratory diseases (specifically asthma and COPD).

OVERARCHING GOALS

HEALTHY PEOPLE 2020

a society in which all people live long, healthy lives

Source: Healthy People 2020 Framework: http://healthypeople.gov/2020/Consortium/HP2020Framework.pdf

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• Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; • Achieve health equity, eliminate disparities, and improve the health of all groups; • Create social and physical environments that promote good health for all; and • Promote quality of life, healthy development, and healthy behaviors across all life stages.

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Source: CDC at http://www.cdc.gov/Features/dsFoodborneEstimates/

TOP PATHOGENS CONTRIBUTING TO DOMESTICALLY ACQUIRED FOODBORNE ILLNESSES AND DEATHS, 2000-2008 ILLNESS

DEATHS

Norovirus Salmonella, Nontyphoidal Clostridium perfringens Campylobacter spp. Staphylococcus aureus Toxoplasma gondii Listeria monocytogenes PERCENT:

60 45 30 15 0 15 30 45 60

FOOD SAFETY Foodborne illnesses are a burden on public health and contribute significantly to the cost of healthcare. Foodborne illness is a preventable and underreported public health problem that presents a challenge to both healthy and at-risk populations. Food contamination can occur at many points in the food supply chain, including production, processing, transportation, storage and preparation.3 According to the CDC, about 48 million Americans each year suffer from a foodborne illness; of that number, 128,000 are hospitalized and 3,000 die.4 Data from a multiyear surveillance study show that while children under 4 years have the greatest number of foodborne illnesses, people 50 and up are hospitalized most often and die most often of foodborne illness.5 Food safety objective FS-1.1 is to reduce infections caused by key WWW.ORTODAY.COM

pathogens transmitted commonly through food, specifically Campylobacter species, from 12.7 cases per 100,000 population to 8.5 cases, a 33% reduction.6 Campylobacter infections are usually caused by consumption of unpasteurized milk, raw or undercooked meat or poultry, or other contaminated foods or water and contact with feces from infected animals.7 Campylobacter are potent bacteria: As few as 500 organisms can cause illness.7 Symptoms can include fever, abdominal cramping and diarrhea (often bloody); complications may include meningitis, urinary tract infections and rarely Guillain-Barre syndrome.7 While Campylobacter can make anyone ill, infants, young children, pregnant women and fetuses, older adults and people with weakened immune systems are most susceptible to infection.7 Campylobacter and other foodborne illnesses are largely preventable.

Objective FS-5.1 is to increase the proportion of consumers who follow key food safety practices like the food safety guideline “Clean: Wash hands and surfaces often” from 67.2% to 74%.6 This is one step of a four-step consumer program designed to help ensure safe food-handling practices at home. The steps are 1) Clean: Wash hands and surfaces often; 2) Separate, don’t cross contaminate; 3) Cook to the right temperature; and 4) Chill: Refrigerate promptly. These simple measures can greatly reduce the risk of foodborne illness at home. NUTRITION AND WEIGHT HP2020’s nutrition and weight status goal is to promote health and reduce chronic disease risk through healthful diets and healthy body weights. Americans should consume a healthful diet that contains a variety of nutrient-dense foods across the food groups: whole grains, fruits, vegetables, low-fat or fat-free dairy products and lean meats and other protein sources.8 People should limit their intake of saturated and trans fats, cholesterol, added sugars, sodium and alcohol. And access to healthier foods can help people follow better diets.8 For example, better access to retail venues that sell healthier options may have a positive impact on a person’s diet; these venues may be less available in low-income or rural neighborhoods. The places where people eat appear to influence their diet. Foods eaten away from home often have more calories and are of lower nutritional quality than foods prepared at home.8 Nutrition status. According to the CDC’s web page Fruits and Vegetables, people who eat more vegetables are likely to have a lower risk of chronic diseases (including stroke and perhaps other cardiovascular December 2014 | OR TODAY 31

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diseases and certain cancers) than those who consume a diet with few fruits and vegetables.9 A higher vegetable intake may also decrease the risk of obesity. However, many Americans do not eat enough vegetables. Objective NWS-15.1 is to increase the contribution of vegetables to the daily diets of the population 2 years and older from 0.8 cup equivalents to 1.1 cup equivalents.8 It would seem easy enough to increase vegetable consumption by such a small amount. But for veggie haters, every bite is a struggle. One resource suggests several easy ways to incorporate more vegetables into the diet:10 • Add veggies you almost like to dishes you already love. • Try vegetables in soup, and add those you like or can tolerate to salads. • Add vegetables to spaghetti and pizza. • Drink vegetable juices alone or mixed with fruit juices. Weight status. Today, more than one-third of adults and 17% of children in the U.S. are obese.11 The consequences of obesity include heart disease, stroke, hypertension, type 2 diabetes, cancers such as breast and colon cancer, dyslipidemia, liver and gallbladder disease, sleep apnea, osteoarthritis and reproductive health problems. 11 Obesity is costly to the nation’s healthcare system: Medical costs related to obesity exceed $147 billion annually.11 To help address both adult obesity and childhood obesity, HP2020 has included a number of weightrelated objectives. Nutrition and weight objective NWS-9 is to reduce the proportion of adults who are obese from 34% to 30.6% over the next 10 years.8 The 32

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“secret” to weight loss remains unchanged. A new study shows that obese adults who achieved meaningful weight loss ate less fat, exercised more, used prescription weight-loss medications and/or participated in commercial weight-loss programs.12 Objective NWS-10.3 is to reduce the proportion of adolescents who are obese from 17.9% to 16.1%.8 One study showed that children would have to reduce their caloric intake by 41 calories per day to prevent weight gain and 160 per day to meet the objective by 2020, a potentially achievable target.13 RESPIRATORY DISEASES Asthma and COPD are significant public health burdens. There are methods of detection, intervention and treatment that may reduce this burden and promote health. More than 23 million Americans have asthma while about 13.6 million adults have been diagnosed with COPD (an equal number have not yet been diagnosed).14 Respiratory diseases affect individuals, families, schools and workplaces. The cost of treating respiratory diseases falls on the healthcare system and society; it’s paid for with higher health insurance rates, lost productivity and tax dollars. Annual healthcare expenditures for asthma and COPD are estimated to be $70.6 billion.14,15 These expenses can be reduced with better diagnosis and management practices, which may prevent hospitalizations. Improving outcomes for people with respiratory disease will benefit all stakeholders. Asthma. Asthma is a chronic inflammatory disorder of the airways characterized by episodes of reversible breathing problems due to airway narrowing and obstruction. Episodes range in severity from mild

to life-threatening. Symptoms of asthma include wheezing, coughing, chest tightness and dyspnea. The prevalence of asthma has increased steadily over the past three decades. Asthma affects people of both sexes and every age and race. However, significant disparities in asthma morbidity and mortality exist, in particular for low-income and minority populations. While there is not yet a cure for asthma, treatment guidelines are available that can enable people with asthma to live full and active lives. HP2020 objectives related to asthma include:16 • RD-7.1 People with asthma should receive written asthma management plans from their healthcare providers. Baseline: About 33.4% of people with asthma received written asthma management plans from their healthcare providers in 2008. Target: increase to 36.8%. • RD-7.4 Increase the proportion of people with asthma who do not use more than one canister of short-acting inhaled beta agonist per month. Baseline: 87.9% of current asthma patients do not use more than one canister per month. Target: 90.2% should not use more than one canister per month. The National Asthma Education and Prevention Program, commissioned by the National Heart, Lung and Blood Institute, has provided expert direction for the diagnosis and treatment of asthma for years. The newest version, “Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma,” was released in 2007.17 The report is organized around the four components essential to effective asthma management: 1) monitoring asthma control through assessment, history, physical examination, patient report and objective testing; 2) education WWW.ORTODAY.COM

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of the patient with asthma; 3) control of environmental factors and comorbid conditions; and 4) pharmacologic therapy.17 Even though education is a major part of asthma management, only one-third of asthma patients receive written asthma action plans from their healthcare providers.16 Such plans are vital to guide patient care. One study showed that children with a written asthma action plan were significantly more adherent to their medications than those without a written plan.18 Typically, people who use more than one canister of their rescue inhaler per month do not have their asthma under optimal control and may benefit from the introduction of a controller medication, often an inhaled corticosteroid.17 COPD. COPD is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. It refers to a group of pulmonary disorders that make exhaling difficult by creating an obstruction to airflow. The two main components of COPD are emphysema (destruction of alveolar walls, resulting in reduced surface area for gas exchange) and chronic bronchitis (chronic cough and/or mucous production for three consecutive months for two consecutive years). The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases (typically from cigarette smoke).15 Treatment can lessen symptoms and improve the quality of life for those with COPD. COPD is the third leading cause of death in the United States.14,15 About 80% of cases of COPD are caused by tobacco smoking.14 Other environmental exposures and genetic factors also may contribute to COPD. Quitting smoking may slow the progression of COPD, but will not WWW.ORTODAY.COM

reverse the damage. While women and men are affected equally, more women than men have died of COPD since 2000.15 HP2020 objectives related to COPD include:16 • Objective RD-9. Reduce activity limitations among adults with COPD. Baseline: 23.2% of adults with COPD who are 45 and older experienced activity limitations due to their illness in 2008. Target: Reduce that percentage to 18.7%. • Objective RD-12. Reduce hospital ED visits for COPD: Baseline: Adults 45 and up with COPD had 79.6 ED visits per 10,000 adults in 2007. Target: Reduce to 55.2 in 2020. Not every patient with COPD knows how to use medications appropriately (especially inhalers), yet use of bronchodilator medications on an as-needed or regular basis can prevent or reduce COPD symptoms that may limit activity and lead to preventable ED visits.19 Other patients may not be receiving benefits of the most current treatment. For example, one study reported that combined treatment with formoterol (Foradil Aerolizer), a long-acting beta agonist, and tiotropium (Spiriva HandiHaler), an anticholinergic, is more effective than treatment with tiotropium alone.20 Patients with COPD often need additional education to use their medications more effectively and to learn energy conservation and breathing techniques. TOBACCO USE Tobacco use is the single most preventable cause of death and disease in the United States. Each year, about 443,000 Americans die of tobacco-related illnesses.21 In addition, tobacco use costs the U.S. $193 billion annually in direct medical expenses and lost productivity.21 Smoking has been proven to cause

many types of cancer, primarily lung, oral and laryngeal cancers; heart disease; lung diseases; and premature birth, low birthweight, stillbirth and infant death.21 There is no risk-free level of exposure to secondhand smoke. Secondhand smoke causes heart disease and lung cancer in adults and a number of health problems in pregnant women, infants and children, including severe asthma attacks and ear and respiratory infections.21 Healthy People 2020 objectives involving tobacco focus on three key areas: 1) implementing policies to reduce tobacco use and initiation; 2) adopting polices and strategies to increase access to, affordability of and use of tobacco cessation services and treatments; and 3) establishing policies to reduce exposure to secondhand smoke, increase the cost of tobacco, restrict tobacco advertising and reduce sales of tobacco products to minors. HP2020 objectives related to smoking include:22 • Objective TU-2.2. Reduce tobacco use by adolescents. Baseline: 19.5% of adolescents in grades nine to 12 smoked cigarettes in the past 30 days in 2009. Target: Reduce to 16% by 2020. • Objective TU-11.3. Reduce the proportion of nonsmokers exposed to secondhand smoke. Baseline: 37.6% of nonsmoking adults 18 and older were exposed to secondhand smoke in 2005 to 2008. Target: Reduce that proportion of exposure to 33.8% by 2020. Nearly as many adolescents smoke cigarettes as adults – 19.5% of adolescents compared to 20.6% of adults.22 A program called N-O-T (Not on Tobacco), sponsored by the American Lung Association, is designed for teens who want to quit smoking. It is the most researched, December 2014 | OR TODAY 33

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most widely used and most successful such program in the United States.23 One study of high school students in the program showed a reduction in cigarettes smoked from a preprogram level of 73 per week to a postprogram level of 39.24 The U.S. Preventive Services Task Force strongly recommends that healthcare providers screen all pregnant women for tobacco use and provide counseling to those who smoke.25 Women who smoke may be more receptive to smoking cessation when pregnant than at other times. The task force found strong evidence that tobacco cessation counseling for as little as five to 15 minutes using materials tailored for pregnant smokers substantially increased abstinence rates during pregnancy and led to increased birthweights.25

Nonsmoking pregnant women are also at risk because of the known dangers of secondhand smoke. A meta-analysis of 19 studies showed that pregnant women who were exposed to secondhand smoke were estimated to be 23% more likely to experience stillbirth and 13% more likely to give birth to a child with a congenital malformation.26 Because the timing and mechanism of this effect is not clear, the analysis recommended that women avoid secondhand smoke exposure before and during pregnancy.26 Only a few of the nearly 600 HP2020 objectives have been introduced in this module. Some are sure to be relevant to your practice. Are you hoping to fund an idea to improve the health of your community?

NUTRITIONAL AND WEIGHT RESOURCES • BMI Calculator (adults): http://nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm • BMI Calculator (children & teen): http://apps.nccd.cdc.gov/dnpabmi/ • CDC Fruits and Vegetables: http://www.cdc.gov/nutrition/everyone/fruitsvegetables/index.html • CDC Healthy Weight: http://www.cdc.gov/healthyweight/index.html • CDC Nutrition for Everyone: http://www.cdc.gov/nutrition/everyone/index.html • Dietary Guidelines for Americans: http://health.gov/dietaryguidelines/ • Physical Activity Guidelines for Americans: http://health.gov/paguidelines/

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The initiative provides information on how to obtain funding for projects:27 • Get the data. Use Healthy People 2020 as a data source to support applications for grants or other funding opportunities. • See how you measure up. Compare your city or state to HP2020 national baseline data. • Connect to something larger. Tie your local health promotion efforts to a national public health movement. • Identify new stakeholders and partners. Make connections across HP2020 topic areas and with professionals in other states. • Plan a strong public health program. HP2020 provides a framework for planning, goal setting and agenda building. Organizations and healthcare providers can use HP2020 to identify many of the common issues that threaten the health of all Americans. Once problems are identified, we can move toward solutions that improve the health status of everyone. While the targets are ambitious, they are achievable. CONNIE GOLDSMITH, RN, MPA, is a freelance health and medical writer and a frequent contributor to Gannett Education. CRYSTAL DUNLEVY, RRT, EDD, is clinical associate professor at The Ohio State University School of Health & Rehabilitation Sciences in Columbus, Ohio. DALE AMES KLINE, RD, MS, CNSC, LD, founded Nutrition Dimension Inc. and is the clinical editorial director of food, nutrition and dietetics for Gannett Education. WWW.ORTODAY.COM

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REFERENCES 1. HHS announces the nation’s new health promotion and disease prevention agenda. U.S. Department of Health and Human Services Web site. http://www.hhs.gov/ news/press/2010pres/12/20101202a.html. Published December 2, 2010. Accessed March 8, 2013. 2. About Healthy People. Healthy People Web site. http://www.healthypeople. gov/2020/about/default.aspx. Accessed March 8, 2013. 3. Food safety: overview. Healthy People Web site. http://healthypeople.gov/2020/ topicsobjectives2020/overview. aspx?topicid=14. Accessed March 8, 2013. 4. Food safety at CDC: foodborne illness, foodborne disease (sometimes called ‘food poisoning’). CDC Web site. http:// www.cdc.gov/foodsafety/facts.html. Accessed March 8, 2013. 5. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food. MMWR. 2010;59(14):418-422. 6. Food safety: objectives. Healthy People Web site. http://healthypeople.gov/2020/ topicsobjectives2020/objectiveslist. aspx?topicId=14. Accessed March 8, 2013. 7. Fact sheets: foodborne illness and disease: Campylobacter questions and answers. U.S. Department of Agriculture Web site. http://www.fsis.usda.gov/ Fact_Sheets/Campylobacter_Questions_and_Answers/index.asp. Accessed March 8, 2013. 8. Nutrition and weight status. Healthy People Web site. http://www.healthypeople.gov/2020/topicsobjectives2020/ overview.aspx?topicid=29. Accessed March 8, 2013. 9. Fruits and vegetables. http://www.cdc. gov/nutrition/everyone/fruitsvegetables/ index.html. CDC Web site. Accessed March 8, 2013. 10. Eat your vegetables: 15 tips for veggie haters. WebMD Web site. http://www. webmd.com/diet/features/eat-yourvegetables-15-tips-for-veggie-haters. Accessed March 8, 2013. WWW.ORTODAY.COM

11. Obesity: halting the epidemic by making health easier, at a glance 2011. CDC Web site. http://www.cdc.gov/chronicdisease/resources/publications/aag/ pdf/2011/Obesity_AAG_WEB_508.pdf. Accessed March 8, 2013. 12. Nicklas JM, Huskey KW, Davis RB, Wee CC. Successful weight loss among obese U.S. adults. Am J Prev Med. 2012;42(5):481-485. 13. Want YC, Orleans CT, Gortmaker SL. Reaching the Healthy People goals for reducing childhood obesity. Am J Prev Med. 2012;42(5):437-444. 14. Respiratory diseases. Healthy People Web site. http://www.healthypeople. gov/2020/topicsobjectives2020/overview.aspx?topicid=36. Accessed March 8, 2013. 15. COPD fact sheet. American Lung Association Web site. Chronic Obstructive Pulmonary Disease (COPD) Fact Sheet. http://www.lung.org/lung-disease/copd/ resources/facts-figures/copd-fact-sheet. Published February 2011. Accessed March 1, 2013. 16. Respiratory diseases: objectives. Healthy People Web site. http://www. healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=36. Accessed March 8, 2013. 17. National Asthma Education and Prevention Program: expert panel report 3: guidelines for the diagnosis and management of asthma. 2007. National Heart, Lung, and Blood Institute Web site. http:// www.nhlbi.nih.gov/guidelines/asthma/. Accessed March 8, 2013. 18. Ducharme FM, Zemek RL, Chalut D, et al. Written action plan in pediatric emergency room improves asthma prescribing, adherence and control. Am J Respir Crit Care Med. 2011;183(2):195-203 19. Strategy for the diagnosis, management and prevention of chronic obstructive pulmonary lung disease. 2011. Global Initiative for Chronic Obstructive Lung Disease Web site. http://www.goldcopd. org/uploads/users/files/GOLD_Report_2011_Feb21.pdf. Updated 2011. Ac-

cessed March 8, 2013. 20. Tashkin DP, Varghese ST. Combined treatment with formoterol and tiotropium is more efficacious than treatment with tiotropium alone in patients with chronic obstructive pulmonary disease, regardless of smoking status, inhaled corticosteroid use, baseline severity or gender. Pulmonary Pharmacol Ther. 2011;24(1):147152. 21. Tobacco use: overview. Healthy People Web site. http://healthypeople.gov/2020/ topicsobjectives2020/overview. aspx?topicid=41. Accessed March 8, 2013. 22. Tobacco use: objectives. Healthy People Web site. http://healthypeople. gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=41. Accessed March 8, 2013. 23. About N-O-T. Not On Tobacco Web site. http://www.notontobacco.com/ about-n-o-t.php. Accessed March 8, 2013. 24. Torok DJ, Cuddihy A, Chewin J. Not On Tobacco helps to reduce smoking behavior in high school smokers. Med Sci Sport Exerc. 2011;43(5):637. 25. Counseling to prevent tobacco use and tobacco-caused disease. U.S. Preventive Services Task Force Web site. http:// www.uspreventiveservicestaskforce. org/3rduspstf/tobacccoun/tobcounrs. pdf. Published November 2003. Accessed March 8, 2013. 26. Leonardi-Bee J, Britton J, Venn A. Secondhand Smoke and Adverse Fetal Outcomes in Nonsmoking Pregnant Women: A Meta-analysis. Pediatrics. 2011;127(4):734-741. 27. Funding resources. Healthy People Web site. http://www.healthypeople. gov/2020/implement/Funding.aspx. Accessed March 8, 2013.

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CLINICAL VIGNETTE Sylvia, a family nurse practitioner; Marta, a registered dietitian; and Jay, a registered respiratory therapist, work at the only acute care hospital in a southern rural county. The hospital just received a major grant from the National Institutes of Health to establish a primary care clinic designed to provide educational, diagnostic and treatment services for patients with asthma and COPD, conditions that plague the state’s population, which has a large number of smokers. In addition, the clinic will provide general counseling related to nutrition and weight because so many of the people in the area are obese.

A reasonable objective for the clinic’s asthma patients is to: A. Ensure that parents of children with asthma carry at least two rescue inhalers at all times B. Increase the percent of people with written asthma management plans from their providers C. Prescribe an inhaled corticosteroid for every asthma patient D. Make sure that asthma patients do not have cats or dogs in their homes

A reasonable objective for the clinic’s COPD patients is to: A. Ensure that every patient with COPD stops smoking B. Prescribe home oxygen for the clinic’s COPD patients C. Reduce ED visits D. Teach CPR to family and friends

A reasonable objective for the clinic’s patients related to smoking is: A. Counsel pregnant women to avoid exposure to secondhand smoke B. Provide free nicotine patches to every person who admits to smoking C. Enroll every smoker in a smoking cessation class D. Require all patients to stop smoking or be turned away from the clinic

A reasonable objective for the clinic’s adult patients related to obesity is: A. Encourage obese patients to lose 20% of their body weight in six months B. Ensure that obese patients reach a BMI of 30 or less C. Prescribe weight-loss medications for all obese patients D. Reduce the proportion of clinic patients who are obese by 10%

1. Correct Answer: B — Currently only 33.4% of people with asthma have written asthma management plans from their healthcare providers. The clinic wants to improve that number by at least 10%.

4. Correct Answer: D. 34% of adult Americans are obese. The HP2020 goal is a 10% reduction in the proportion of adults who are obese, a reasonable target. Not all obese patients should take weight-loss medications, and the other choices are not reasonable targets. 3. Correct Answer: A —Studies prove that pregnant nonsmoking women exposed to secondhand smoke have an increased risk of stillbirth and delivery of children with congenital malformation. They should not be exposed to any secondhand smoke. OR TODAY | December 2014

2. Correct Answer: C — While all COPD patients should stop smoking, this is not a reasonable expectation. However, patients who receive education on using their medications correctly have fewer visits to EDs because their symptoms are better controlled.

Sylvia, Marta and Jay are selected to head up the new clinic because of their leadership skills and experience in their fields. A pulmonologist will serve as medical director, but the trio will manage the clinic on a day-to-day basis. Sylvia, Marta and Jay select an interprofessional team that includes other clinicians and administrative staff to form a planning committee. The first project is to establish objectives for the clinic to measure its effectiveness and to secure future funding. The chief nursing officer reminds the team that the hospital is part of the Healthy People 2020 consortium and suggests using HP2020 objectives.

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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 April 22, 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.

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December 2014 | OR TODAY 37

OR TODAY | December 2014

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December 2014 | OR TODAY 39

CORPORATE PROFILE

CALZURO Durable and Healthy Comfort

he Calzuro product was originally engineered and designed in 1983 for medical professionals (specifically for surgeons) who would be standing on hard surfaces for long periods of time. After very successful results in their home country of Italy the manufacturer, Bihos, was looking for new distributors in other countries such as the Calzuro U.S. distributorship relationship that began in 1987 at a medical trade show in Germany.

Calzuro was originally sold in the USA via postcard mailings and trade show exhibitions. Calzuro was immediately successful, as it was the best footwear on the market, especially for the OR, with the ability to be cleaned and sterilized. Calzuro products then, and now, have many other benefits and are sold at a reasonable price and are 100 percent Italian made. The company has grown from making sales via postcards and medical trade show exhibitions to phone and fax orders, to online sales through Calzuro.com and Amazon. The shoes are promoted merely by marketing ads, Calzuro walking advertisements and testimonies posted for Calzuro and Amazon. For more about Calzuro, we sat down with business owner Jenifer Wynne to find out how this company continues to meet the needs of healthcare professionals.

OR TODAY | December 2014

WHAT ARE SOME ADVANTAGES THAT YOUR COMPANY HAS OVER THE COMPETITION?

Wynne: Our company sells the only footwear product that can be steam autoclave up to 300˚ F making it possible to sterilize the comfortable footwear along with medical equipment.

WHAT ARE SOME CHALLENGES THAT YOUR COMPANY FACED LAST YEAR? HOW WERE YOU ABLE TO OVERCOME THEM?

Wynne: During the years of 1996 through 2011, SMD Wynne sold retail plus wholesale to brick and mortar stores and some online stores. In 2013, we overcame the obstacle of selling wholesale by offering excellent customer service and patience. We have found success in online marketing.

PLEASE EXPLAIN YOUR COMPANY’S CORE COMPETENCIES AND UNIQUE SELLING POINTS.

Wynne: First of all, if customer service representatives didn’t have a chance to speak with shoppers, the only selling point would be the high importance we place on making sure we have a quality product. We also make sure the correct quantity is shipped within one to five business days as noted in our shipping and returns policy. Calzuro responds to shoppers and customers needs in a timely

fashion. Our goal is to be professional, helpful and courteous. It is very important for customer satisfaction that their expectations are met and we strive to meet Calzuro’s standards.

WHICH PRODUCT THAT YOUR COMPANY OFFERS ARE YOU MOST EXCITED ABOUT RIGHT NOW?

Wynne: European hospitals have purchased Calzuro for their OR to provide their staff with clean, disinfected shoes. Calzuro. com is receiving orders from U.S. hospitals due to concerns about infectious disease transmission and our footwear’s unique ability to be cleaned and sterilized daily. Calzuro can be customized with heel straps. Calzuro.com will attach the heel straps prior to shipping the order as a free service on request. Optional Comfort Insoles are machine washable, dryer safe and autoclavable. SMD Wynne Corporation has great employees who get the job done correctly. We are always excited when someone has better protection and treats his or her feet with Calzuro footwear.

WHAT IS ON THE HORIZON FOR YOUR COMPANY? HOW WILL IT EVOLVE IN THE COMING YEARS?

Wynne: More sales. We can only hope that more people in the professional world who stand on their feet for long periods of time WWW.ORTODAY.COM

CALZURO SHOES ARE GREAT FOR PROFESSIONALS WHO WORK IN THE HOSPITAL, ESPECIALLY IN THE OPERATING ROOM.

The one and a half inch heel reduces fatigue allowing for hours of comfortable standing. Calzuro are also anti-static, have slip-resistant soles to prevent slipping on hospital floors and have side ventilation holes to let feet breathe! Calzuro can be sterilized in the autoclave or bleached.

are educated about the many benefits of wearing Calzuro. They are healthy, comfortable shoes.

PLEASE SHARE SOME COMPANY SUCCESS STORIES WITH OUR READERS — ONE TIME THAT YOU “SAVED THE DAY” FOR A CUSTOMER.

Wynne: We have many testimonials in which customers tell us how Calzuro “saved the day.” Here are a few: “After accidentally ordering the wrong color shoes, the company was very willing to correct my mistake before shipping my package. Great

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customer service. Working 12- to 16-hour shifts in a busy SICU, my feet normally are sore when I get home, but these shoes are amazingly comfortable and stopped my typical aches. I can’t stop telling my co-workers to make the switch also!” “Hi Jen, I just arrived home from a long and busy day at work. I am so excited to hear your voicemail message! Thank you so much for the second pair of your most comfortable and reliable surgical shoes! Long hours of standing and running around a surgical suite can be so painful and tiring to our legs and feet. Calzuro

shoes make it tolerable and less painful. That’s why we nurses, especially surgical RNs, love Calzuro! I have purchased and tried many pairs of shoes of different brands, but I am never satisfied. I always go back to my Calzuro. My last pair lasted me a long time until it ripped, ha ha ha! That’s why I thought I had to order a new pair, and now I get two for one price! I will then choose the fancy green and white as my second pair. Again, thank you so much. You don’t know how excited I am about this purchase! Have a great day! God bless … ”

December 2014 | OR TODAY 41

CORPORATE PROFILE

3 from a doctor’s wife. The doctor Another recent comment came

took a new pair of Calzuro to work to wear for scheduled surgeries and found out the pair shipped was ill fitting due to a shipping error on our end. An apology was made and accepted. The correct size was shipped by UPS, along with a label for returning the wrong size. While we have quality control, we are human and make mistakes. We hope we “saved the day” by reshipping ASAP. “I love my Calzuro! I had seen and heard about them for many years, from friends at different hospitals while I working for Sunstar EMS. I finally decided that I was going to get them and I have never regretted it. They are the most durable, comfortable shoes I have ever worn.

PLEASE DESCRIBE YOUR COMPANY’S FACILITY.

Wynne: We are located in Plain City, Ohio, in the northwest area of Columbus. It is a tiny town known for Amish home cooking. The facility is an office space and warehouse condo unit owned with great neighbors who share a forklift when the Bihos order arrives

from Italy once a month via airfreight. The owners live very close to the office and hire all local employees.

PLEASE HIGHLIGHT ANY RECENT CHANGES TO YOUR COMPANY, INVENTORY, SERVICES, ETC.

Wynne: Our inventory is at a higher level to minimize back orders, although during specials or when we have a high volume of orders, back orders can happen once in a while.

WHAT IS MOST IMPORTANT TO YOU ABOUT THE WAY YOU DO BUSINESS?

Wynne: What is most important in our business is treating others right. We have integrity and we sit back and look at what we expect when we are shopping. How do we want to be served? Calzuro.com is all about community. We may be an online store and a small business, but we strive to help others as often as we can. Having an online domain allows us to be part of many communities, where we can offer our outstanding product for the betterment of others’ lives. Calzuro soles have traveled from

Italy to Ohio and have found new souls locally and throughout the USA to students, to Recovery Ventures Corp., Soles to Souls, silent auctions and worldwide mission fields.

IS THERE ANYTHING ELSE YOU WANT OR TODAY READERS TO KNOW ABOUT YOUR COMPANY?

On our website www.calzuro.com, you will read many benefits of wearing Calzuro. In conclusion, Calzuro shoes are great for professionals who work in the hospital, especially in the operating room. The one and a half inch heel reduces fatigue allowing for hours of comfortable standing. Calzuro are also anti-static, have slip-resistant soles to prevent slipping on hospital floors and have side ventilation holes to let feet breathe! Calzuro brand can be sterilized in the autoclave or bleached. They can also be machine washed up to 212°F and come in a variety of different colors to personalize your scrubs. At the same time, we all know everyone’s feet are unique and have different needs for footwear. Our motto is, “If the shoe fits, you get to wear Calzuro.”

FOR MORE INFORMATION please call 800-257-9472 or visit calzuro.com

Why buy Calzuro?

DURABLE & HEALTHY COMFORT Calzuro was founded in 1983 to provide medical personnel with a comfortable shoe that could be cleaned and sterilized to provide a safer work environment. Safety that is even more import today! Healthcare professionals want shoes with features such as slip resistance, anti-static and have one and half inch heels which reduce leg fatigue. Calzuro can be customized with heel straps and comfort insoles. Calzuro is also washer and dryer safe and can be cleaned with bleach plus sterilize in the autoclave up to 300Ë&#x161; F.

Italian Made *heel straps available

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CALZURO.COM 800-257-9472

By Don Sad ler

SAFE

PATIENT

HANDLING I BY: DON SADLER

tâ&#x20AC;&#x2122;s one of the most dangerous and highest risk activities that occurs in the OR that almost nobody talks about: safe patient handling and mobility, or SPHM.

The practices of transporting, lifting, positioning and holding patients in the OR are fraught with danger for patients and OR personnel alike. In fact, musculoskeletal disorders (MSDs) represent one of the leading causes of occupational injury and disability in healthcare.

THE HIGH COST OF MSDS According to OSHA, sprains and strains are the most often reported nature of healthcare worker injuries, and the shoulders and lower back are the most affected body parts. The Bureau of Labor Statistics (BLS) notes that 12 percent of nurses leave the profession every year as the result of a MSD. Meanwhile, the average MSD claim costs $11,771, while the average cost of a back injury is $37,000, according to the BLS. “The unsafe manual lifting and moving of patients has been identified as a key cause of musculoskeletal injuries among healthcare teams,” says Dee Kumpar, MBA, BSN, RN, CSPHP, the Director Safe Patient Handling Programs and Services and a Clinical Marketing Consultant with Hill-Rom. “Unsafe manual handling tasks such as lateral transfers, limb holding and positioning patients in prone position are everyday occurrences in the OR.” “For the OR nurse, MSD injuries are a direct result of overexertion, which includes motions such as lifting, bending, reaching or slipping without falling,” adds Patty Taylor, vice president, Professional Education and Clinical Affairs with Ansell. “The consequences of unsafe patient handling have led to a wide range of different types of nurse injuries, as well as a negative impact on the quality of patient care.” The handling and movement of patients in the OR presents a

OR TODAY | December 2014

number of challenges due to the patient’s level of consciousconscious ness, physical disabilities, cognitive understanding, size and medical condition. “Compounding this unfavorable situation is that patients are lifted by OR nurses by reaching over the patient bed or stretcher and the OR table, which places heavy loads on the spine,” says Taylor. CUMULATIVE REPETITIVE EFFECTS The repetitive nature of patient handling tasks in the OR, combined with unsafe patient handling techniques and the failure to use SPHM techniques and technology, are what put OR nurses at such high risk of MSD injuries, says Mary J. Ogg, MSN, RN, CNOR, a Perioperative Nursing Specialist with AORN. Ogg says she once oversaw a staff of 50 perioperative personperson nel and five of them — or 10 percent — had back, shoulder or neck injuries. “More than half of all AORN members are over the age of 52, so the cumulative effect of unsafe patient handling practices over many years can be very damaging on OR nurses,” Ogg says. The National Institute for Occupational Safety and Health (NIOSH) has recommended that healthcare workers should not manually lift more than 35 pounds of a patient’s body weight themselves. If more than this weight must be lifted, NIOSH recommends that assistive lifting devices and technologies like

More than half of all AORN members are over the age of 52, so the cumulative effect of unsafe patient handling practices over many years can be very damaging on OR nurses. -Mary Ogg

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Unfortunately, many nurses just accept the fact that their back will hurt and they’ll just take a couple of pain pills. But this shouldn’t be acceptable. We

need to do things differently. - Heather Monaghan

air-assisted lateral transfer devices, new technology transfer boards, friction reducing sheet and ceiling lifts be used. It might surprise you to learn that one leg accounts for approximately 16 percent of a patient’s total body weight. So a 250-pound patient’s leg can weigh 40 pounds, thus exceeding the NIOSH recommendation for safe manual lifting. “In this situation, at least two perioperative team members should raise or hold the leg in position, or a mechanical device should be used to help,” says Ogg. “Most OR suites do not use safe patient handling devices and technologies,” notes Ronda Fritz, RN, BSN, MA, a Safe Patient Handling Facility Champion at VA NebraskaWestern Iowa Health Care

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Systems in Omaha, Neb. “Ceiling lifts are the gold standard for patient lifting and handling in the OR, but there are only two ORs in the country that I’m aware of that use ceiling lifts.” “I have risk assessed many ORs and most have not adopted safe patient handling techniques,” adds Heather M. Monaghan MHSc, RN, the president and CEO of Visioning HealthCare Inc. in Sarasota, Fla. “Unfortunately, many nurses just accept the fact that their back will hurt and they’ll just take a couple of pain pills. “But this shouldn’t be acceptable,” Monaghan says. “We need to do things differently.” Monaghan points out that the OR is just the midpoint in a surgical patient’s journey through the hospital. She says she counted the number of

times she was physically transferred when she had knee surgery recently. “I was transferred four times, not including onto the OR table because I was able to move myself across to it,” says Monaghan. “So there are many opportunities for hospital staff to injure themselves and potentially increase risk to patients during the transfer process.” Of course, obese patients present special challenges when it comes to safe patient handling techniques. “Obesity presents a unique challenge, as it increases the risk of lifting, moving and repositioning injuries to both patients and OR nurses,” says Taylor. Obese and morbidly obese patients require specialized equipment in the OR to accommodate their body size, Taylor adds.

December 2014 | OR TODAY 47

For the OR nurse, MSD injuries are a direct result of overexertion, which includes motions such as lifting, bending, reaching or slipping without falling. The consequences of unsafe patient handling have led to a wide range of different types of nurse injuries, as well as a negative impact on the quality of patient care. -Patty Taylor

“The OR table may need to have extensions, attachments, longer restraining straps and padding added. And sufficient manpower will be required to care for the obese patient — additional OR staff will need to help with positioning and removal of the patient from the OR table.” STEPS THAT ARE BEING TAKEN The good news when it comes to safe patient handling is that there seems to be an increased level of attention being paid to the problem at several different levels. “Organizations, especially OSHA and The Joint Commission, have taken great strides in establishing regulations and protocol to make the healthcare work environment ergonomically safe,” says Taylor. “Many states are now passing ‘no-lift’ laws to protect nurses from injuries resulting from unsafe patient handling and lifting,” Taylor adds. “These new laws require healthcare facilities to establish safe

OR TODAY | December 2014

patient handling committees, programs, practices and zero-lift policies.” In addition, AORN has created a Safe Patient Handling and Movement Guidance Statement and Safe Patient Handling Toolkit, which AORN members can download for free at www.aorn.org. And the American Nurses Association (ANA) has published the Safe Patient Handling and Mobility Interprofessional National Standards, which can be purchased at www.nursesbooks.org. “Hospitals are implementing products, policies and procedures to reduce the number of slips, trips and falls that occur each year,” says Taylor. “And safe patient handling committees have been formed and ergonomic specialists have been put on staff at many hospitals. Also, the National Association of Orthopaedic Nurses (NAON) and the ANA have adopted patient handling guidelines.”

Fritz believes that one of the keys to reducing MSD injuries among OR nurses and improving patient safety when it comes to patient handling is getting hospitals to implement the right SPHM devices and technologies. “Manual patient handling should be eliminated to the highest degree possible,” she says. “However, most surgeons don’t like change, and time is always a factor in the OR,” Fritz adds. “The best solution is to design new ORs with the latest safe patient handling technology and devices, because retrofitting existing ORs can be difficult and costly.” “Safe patient handling and mobility is an issue that should be addressed by every hospital OR today,” says Ogg. “The negative consequences of unsafe patient handling practices on OR nurses and patients are just too costly — in both financial and, more importantly, nurse and patient safety terms.”

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

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December 2014 | OR TODAY 51

E H T

D O GORSE NU es inspir e c n ie exper o make d o o t Childh na Breaux ients t a p n Ilea pact o m i e itiv n for a pos ofessio

the pr lling; to a e c s o a o h â&#x20AC;&#x2122;s c it . Nurses ns. To some, radition t y il m o s rea a fa various e pursuit of th others, ~ can r, who e v e w o ning hose, h a single defi t e r a There eers to nd Operating r a c ir the s, a trace x, RN, is eir live u h a t e r in B moment rvisor Ileana upe them. Room S one of

Breaux : Ileana n O t h g Spotli falos t Skou t a M y B

n s 12. She wa p in a traditio ed u ow t ll h s a g a u w ’t Bro nd I eren a w r n e e t r . s d adults, Ea hil alls “It was ress,” she rec en where c heir voices to ions. t ct ad d be to raise ifled her obje wearing because it ha t s e d x h u e s Brea “I slipp r, when her ek late e office to ” . e g t w e in g in A a o r d to th ed, she nting t d Not wa reaux grabbe ce returne sutures remov the a B the et, very o br dress w rby fence t arm have ed up the bra a r n e o e n . h m d e sum for a sliced request nd I ll — and rse had up to her a to u n her fa barbed wires. r d e e h lk oing ed n “I wa y I’m g e, and open o ely, she cover ld a d e m o to iv ‘S urs Instinct her hand and need said, p and be a n mean u h grow u oing to be a said. arm wit er, “I think yo r.” g o h aux t t c o o m d I’m not u!’” Bre e car, her o o the y d t e e k e k r li m o into th witch to take pediatrician w r, it n I got elled up, e e e h v h e W t “ w s o w A ,h ’s eyes me, ‘Thank her up ocess. m h o c m it t y s r m to th p aid to a smoo itches d she s ying what I n a wasn’t t s the the r sa “Either p enough or you fo ” I being .’ t dee ouldn’t s my intro to sn’t ork, bu . c w weren’t ’t n id a id a tic d ux sa “That w eaux said. “I w .” anesthe ything,” Brea g, r ry B u j ,” in in r e y e s o r r v a nu sult t felt e eaming and c hut in d d a o ‘S cr going t “I was s urse told me, n e and th e.’ ” be brav d n a p u

Lauren and Sarah keep Illeana busy as a softball mom away from work Ileana and her daughters, Lauren and Sarah, congratulate Michael Breaux at his masters gradutaion ceremony at the University of Nevada-Reno.

Good to her word, Breaux began her professional training at Miami-Dade, finished school at the University of Florida, and spent almost nine years working as a pediatric nurse at Miami Children’s Hospital. At its outset, the program took her through three different units in

their strength and resilience. “Then I had my own kids and things hit a little closer to home,” she said. “I would sit in the car after work and start bawling. ‘Why does this 18-month-old have leukemia?’ ” Then, Breaux found an opportunity with Drs. Michael

“I love it,” Breaux said. “It’s a different type of rewarding, but it’s exactly what I wanted to do.” Breaux said the most rewarding part of her job is noticing the difference in the way patients will carry themselves before and after a procedure. Those who make alterations to their facial

“Nursing on the whole, it’s just like any profession. [You] get into it because you enjoy it. The reality is that you spend more time at your place of employment than you do at home sometimes. [You] go in to it because you want to tman Daniel Zai iologist Dr. es th es An a photo. Ileana and pose for

make a difference and you want to help.”

three months to get her exposed to the various aspects of the job. Breaux worked in an endoscopy lab, treating children with reduced appetites; worked in recovery, caring for children who’d had tonsillectomies, and generally marveled at 54

OR TODAY | December 2014

-Ileana Breaux Kelly and Carlos Wolf of Miami Plastic Surgery in Miami, Fla. Beginning as a staff relief nurse, she joined the practice full-time when a second nursing position opened up. Nine years later, she is still with the same facility.

features will go from being timid and shy to confident and direct, she said. Even those who are there for the most common procedures performed at the facility, liposuction and breast augmentation, inspire her with their personal transformations. WWW.ORTODAY.COM

Lauren Breaux (second from the right) loves medicine

Michael, Lauren, Sarah, and Ileana enjoy some downtime after a youth

and might follow in her mother’s footsteps.

softball tournament.

“I think it reinforces why I’m here,” Breaux said. She also described feeling much more confident of her own professional abilities in the scaled-back demands of the cosmetic surgery clinic. In a hospital setting, Breaux described feeling like her “hands were tied a lot” by the demands of caring for greater numbers of increasingly sicker patients. “You’re not equipped with enough resources to do what you should be able to do,” she said. “If they give you 10 very, very sick patients, you have to split up and prioritize. You rely on your nurse’s assistants, and it opens up the possibilities for things to happen.” Breaux is also critical of insurance companies that try to rush patients out of the hospital too quickly. Although she realizes that the cost of a hospital stay is expensive, “if you’re a little more proactive than reactive, a lot of things don’t recur,” she said. Still, Breaux said she loves the profession that has given WWW.ORTODAY.COM

her so much, and hopes to continue her work for as long as her body can withstand the physical demands of 10- to 12-hour days. “A lot of people don’t realize that when you have surgery that goes on for seven hours, you’re in there for that amount of time,” she said. “As long as I can do it, I’ll be doing it.” When Breaux does retire from full-time practice, she said, her “bucket list” includes mission work. It’s something she’s wanted to pursue, but has held off since starting a family. After 11 years of marriage, Breaux has gone from being an avid CrossFit practitioner to a softball mom who drives seven-year-old Sarah and nine-year-old Lauren to practices and games — but she doesn’t regret a moment of it. Her older daughter “loves medicine,” and “likes to see videos and know what’s going on, and for me to tell her stuff.” The younger “won’t say

‘blood’ because she’s so creeped out by it.” But if neither follows in her mother’s footsteps, Ileana Breaux won’t be upset. “Nursing on the whole, it’s just like any profession,” she said: “get into it because you enjoy it. The reality is that you spend more time at your place of employment than you do at home sometimes. Go in to it because you want to make a difference and you want to help.” Of course, given the way she discovered the profession, Breaux likely wouldn’t criticize someone for finding their career path out of spite. But she recognizes it’s not an ideal motivator. “Do it because you want to make a difference, not just because you’re going through the motions,” Breaux said. “Ultimately, the person who pays the price for that is the patient, because they’re the most vulnerable. Do it because you want to do it, not because it’s something that you have to do.” December 2014 | OR TODAY 55

OUT OF THE OR HEALTH

HARVARD HEALTH LETTERS

YOU CAN WEAN YOURSELF OFF SLEEP AIDS

o you take a drug to help you sleep every night? You’re not alone. Millions of Americans rely on prescription sleep medications, called sedative hypnotics. “People believe they can’t sleep without them, and they stay on them for years,” says sleep expert Dr. Lawrence Epstein, an instructor in medicine at Harvard Medical School. But you can wean yourself off the drugs using a combination of dose reduction and behavior changes.

OR TODAY | December 2014

UNDERSTAND WHAT YOU’RE UP AGAINST Epstein points to two challenges when it comes to fighting sleep aid dependence. One is that when you stop taking the drugs, you get a withdrawal response that keeps you from sleeping well. “If you stop too quickly you can get rebound insomnia, which makes symptoms worse,” says Epstein. The other challenge is that the rebound insomnia then convinces users they need the drugs to sleep. In reality, the medication is just preventing withdrawal symptoms. That cycle creates dependence, which is different from an addiction that’s

characterized by compulsive use and preoccupation with a drug that interferes with normal life. STARTING THE PROCESS The encouraging news is that Epstein helps people end the use of sleep medications every day. It starts with a gradual, progressive reduction in the amount of sleep medication you take. Make sure this is done under the direction of a physician. Abrupt stopping can trigger seizures in some people. Reducing the medication requires planning. “Each time you lower the dose your sleep will be disrupted because WWW.ORTODAY.COM

HEALTH

you’ll have the withdrawal effect. So be prepared, and know your sleep won’t be as good for a few days,” says Epstein. The longer you’ve been on the medications, the slower your doctor will make the taper. It’s a process that can last weeks to months. THE KEY TO SLEEP SUCCESS Reducing medications may not be enough to help you rest each night. So your doctor will likely pair the process with tools to counter behaviors that do not promote sleep. This includes:

Cognitive behavior therapy, which helps you redirect your thoughts to reduce anxiety about sleeping

2 3

Relaxation techniques such as guided visualization

Recognizing the stimuli that prevent sleep, such as television, computer, or smartphone screens

Improving sleep hygiene, by using the bed for sleep and sex only; blocking as much noise and light as possible; going to bed and waking at the same times each day; and getting out of bed if you haven’t fallen asleep within 20 minutes

Dietary changes, such as avoiding alcohol, caffeine, and foods that promote acid indigestion.

DON’T DRIVE WITH SLEEP AIDS IN YOUR SYSTEM Know your reaction to a medication before you get behind the wheel in the morning. WWW.ORTODAY.COM

Sleep drugs may help you get a decent night’s rest, but they come with the risk of impairment – even amnesia – the next morning. “It’s not an unusual side effect. It has to do with how long the drug lasts in your system,” says Epstein. You’ll know you’re affected if you have a hard time getting started in the morning, or if you’re groggy when you wake up. That may put you at risk for impaired driving, or an amnestic effect on your behavior. “Sometimes people tell me they’ve done things and they do not remember them, including driving,” says Epstein. It’s vital to know how long these drugs last in your body. There are short-, medium-, or long-acting drugs within the various classes of sleep medications. Some, like zolpidem (Ambien), are short-acting. Others, such as eszopiclone (Lunesta) and temazepam (Restoril), are medium-acting. Long-acting drugs include flurazepam (Dalmane) and clonazepam (Klonopin). Make sure you ask your doctor or pharmacist how long your medication lasts. WHAT TO DO ABOUT IT? “If the problem is falling asleep, pick a drug that doesn’t last long. If the problem is awakening during the night, pick one that lasts longer, but learn how long it takes you to get rid of the medication, and put aside enough time for sleep to let the drug clear from your body,” advises Epstein. In general, long-acting drugs are most likely to cause trouble. If you’re still groggy in the morning, talk to your doctor about a different medication or dose, and don’t get behind the wheel of a car.

December 2014 | OR TODAY 57

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OUT OF THE OR FITNESS

BY MCKENZIE HALL, R.D., ENVIRONMENTAL NUTRITION NEWSLETTER PREMIUM HEALTH NEWS SERVICE

1 3

2 4

STAY HYDRATED THE HEALTHY WAY

our body is comprised of roughly 60 percent water, which has many essential tasks, including cushioning your joints and organs, transporting essential nutrients, maintaining internal temperature and electrolyte balance, and eliminating waste. During hot days, water is even more important. Your body can withstand intense heat conditions, as well as vigorous activity, because water can effectively cool down your system through sweating. Given such an essential role, your daily beverage choices have a major impact on health. HEALTHY BEVERAGE CHOICES Supermarket shelves are filled with dozens of beverage choices, from vitamin waters and sports drinks to juices, teas, wine and soda. Here’s our best advice on which beverages best quench your body’s thirst: WWW.ORTODAY.COM

WATER

Turn to this inexpensive, calorie-free drink most of the time. Skip water bottles, however, which contribute to both greenhouse gas emissions and bulging landfills. Instead, rely on a home water filtration system to create the best water straight from your tap.

SPORTS DRINKS

Rather than reaching for a post workout sports drink enhanced with electrolytes and sugar, you’re probably best off with plain water.

“For most people who exercise casually and have a good diet, this type of fluid replacement is not needed, as all electrolytes will be replaced via meals,” says hydration expert, Robert W. Kenefick, Ph.D., Research Physiologist with the Thermal and Mountain Medicine Division for the U.S. Army Research Institute of Environmental Medicine. However, for those working daily in heat or engaging in intense aerobic activity for long durations, electrolyte-enhanced beverages may be helpful for hydration.

COFFEE AND TEA

Both non-caffeinated and caffeinated coffee and tea beverages can contribute to hydration, without a diuretic effect, says Kenefick. Moderate intakes of coffee or tea have been linked with a variety of health benefits, from December 2014 | OR TODAY 59

OUT OF THE OR FITNESS

cancer protection to enhanced mental performance. Additionally, tea has been linked to heart health, weight loss and even bone protection. Keep in mind that high intakes of caffeine can lead to side effects in some people, such as anxiety, irritability, insomnia, uneven or rapid heart rate and stomach upset.

ALCOHOL

Even alcohol contributes to your daily fluid needs. “But, there is a caveat,” says Kenefick. “Concentrations of 12 to 14 percent alcohol, such as liquor and wine, do contribute to dehydration by increasing urine output. Fluids with lower alcohol concentrations, such as beer, tend to not have that effect.” Moderation (up to one drink per day for women and two drinks for men) is the key to health when it comes to alcohol. One drink is considered 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard alcohol.

FITNESS

Institute of Medicine. Some foods, such as fruits and vegetables, contain high amounts of water. Research from the University of Kentucky indicates that red tomatoes, radishes, strawberries, and cantaloupe, for example, consist of 94, 95, 92 and 90 percent water, respectively. FIGHT DEHYDRATION If your fluid intake is inadequate and you develop dehydration, it can lead to cardiovascular strain, compromised physical and mental performance, and even heat stroke. “Studies consistently show that dehydration results in mood changes, including anger, confusion, fatigue and vigor,” adds Kenefick. Yet, dehydration is a common occurrence, even among healthy individuals. Older adults, particularly those over age 71, are at even higher

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ZERO-CALORIE SODAS

Artificially sweetened beverages are under scrutiny for their role in increasing the risk for obesity and other risk factors, such as stroke and heart attack. It’s a good idea to limit this drink, which provides no nutritional benefits.

HIGH FLUID FOODS

Approximately 80 percent of total water comes from beverages and 20 percent comes from food, according to the

OR TODAY | December 2014

Reprinted with permission from Environmental Nutrition

PowerMATE®

SWEETENED BEVERAGES

Research indicates that sugar-sweetened beverages, including sodas and artificially flavored “fruit” drinks—rich in calories through readily absorbable sugars—may contribute to chronic diseases. While these beverages may help to meet your hydration needs, it’s best to limit them.

risk for dehydration, according to data on fluid intake from the Third National Health and Nutrition Examination Survey. This could be due to multiple reasons, including changes in body water composition, alterations in thirst perception, impaired kidney function, and even reduced appetite and the subsequent reduced food intake. It seems that the body’s thirst mechanism is not the most reliable, especially during exercise. According to Kenefick, by the time the brain registers thirst during exercise, you may already be dehydrated. And as exercise continues, it can be difficult to achieve adequate rehydration.

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December 2014 | OR TODAY 61

OUT OF THE OR NUTRITION

BY KATHLEEN ZELMAN, M.P.H., R.D., ENVIRONMENTAL NUTRITION NEWSLETTER

LOCALLY GROWN, SEASONAL PRODUCE

OFFERS NUTRITIONAL, ENVIRONMENTAL BENEFITS

hen you recall of eating a delicious. juicy peach or nearperfect ear of sweet corn, summertime comes to mind. The thought of crisp apples or the perfect plump pumpkin triggers images of fall. Asparagus, lettuce and radishes fresh from the garden make you think of spring.

harvested year round, but elsewhere the harvest may only last 4-6 weeks,” says Amy Myrdal Miller, M.S., R.D.N., dietician and owner of Farmer’s Daughter Consulting. Some fruit trees, like peach and cherry, bear fruit only once a year, whereas you can plant and harvest multiple lettuce crops in a single season. And if the climate is milder, you have longer growing seasons.

Eating a diet rich in fruits and vegetables is the foundation of a healthy diet. Low in calories and loaded with fiber, vitamins, minerals and antioxidants, fresh produce is always a good choice – especially when it comes from your own community and eaten while it’s in season. Of course, seasonality depends on where you live. While many fruits and vegetables are confined to specific seasons – berries and melons in the summer and winter squashes and pears in the fall – availability may vary depending on your location. “In California, where the vast majority of domestic produce comes from, crops like strawberries are

BENEFITS OF SEASONAL EATING “Eating seasonally gives you something to look forward to each season,” says culinary nutritionist Jackie Newgent, RD. Fruits and vegetables sold locally at farmers’ markets and co-ops are picked at the peak of ripeness, and thus are more delicious, as well as richer in nutrients, compared to produce picked green to sustain long-distance shipping, she says. And the benefits extend to the environment. You can reduce your carbon footprint when you buy locally produced fruits and vegetables in season, which don’t need to be transported for long distances.

OR TODAY | December 2014

“Eating seasonally reduces greenhouse gases because the produce does not need to make a gas-guzzling trip,” says Newgent. OFF-SEASON PRODUCE The quality of some produce, like tomatoes or peaches, in peak season simply can’t be compared to flavorless produce that is picked green and shipped long distances. “We have an intense appreciation for ‘fresh’ in this country, often forgetting that other forms of produce are also healthful, flavorful and convenient,” says Miller. Freezing, canning and preserving is an excellent way to optimize seasonal produce year round. When your favorite produce is not in season, it’s still important to fill at least half your plate with fruits and vegetables. They offer so many health benefits, regardless of whether you choose fresh, local, seasonal, organic, frozen, dried or canned. SEASONAL EATING TIPS Here are some helpful insights for finding fresh produce for your plate: • Buy produce in bulk when it is at the height of its season and preserve it by freezing or canning. WWW.ORTODAY.COM

NUTRITION

SEASONAL PRODUCE GUIDE

• Go to a farmers’ market early in the day for the best selection. • Build meals, such as vegetable stew, around just-harvested foods. • Don’t be afraid to try a new fruit or vegetable, such as kale or persimmons. • Don’t just limit your farmers market shopping to summer; take full advantage of offerings at each season. • Use winter produce as part of recipes, such as tossing diced apple into a spicy stir-fry or layering sliced pears into a cheesy sandwich. • Browse cookbooks, recipe blogs, and food-focused social media sites for produce inspiration. • Don’t over-think your dishes; let the full flavors of the produce stand out. • Simple preparations with few ingredients often work best, like sweet potato hash prepared with olive oil, onion, parsley, and served with an egg for protein. • Plant your own seasonal produce in a garden or in a pot on a balcony.

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SPRING Apricots, artichokes, Belgian endive, broccoli, cauliflower, cucumber, collard greens, corn, fava beans, honeydew melon, mango, morel mushrooms, mustard greens, okra, oranges, peapods, pineapple, radicchio, rhubarb, sorrel, spinach, strawberries, Swiss chard, Vidalia onions, watercress.

FALL Acorn squash, Asian pear, Belgian endive, broccoli, Brussels sprouts, butter lettuce, butternut squash, cauliflower, cranberries, diakon radish, endive, grapes, guava, Jerusalem artichoke, key limes, kohlrabi, kumquats, pears, persimmon, pineapple, pomegranate, pumpkin, quince, radicchio, sweet potatoes, Swiss chard, turnips.

SUMMER Apricots, beets, berries, boysenberries, cantaloupe, melons, cherries, cucumbers, eggplant, figs, garlic, grapefruit, grapes, green beans, green peas, kiwi fruit, lima beans, limes, nectarines, okra, peaches, pineapples, plums, radishes, raspberries, strawberries, sweet corn, summer squash, tomatillo, tomatoes, watermelon, zucchini.

WINTER Belgian endive, Brussels sprouts, clementines, collard greens, date plums, dates, grapefruit, kale, kiwi fruit, Mandarin oranges, oranges, pears, persimmons, red currants, sweet potatoes, tangerines, turnips. YEAR-ROUND Apples, avocados, carrots, celery, cherry tomatoes, Chinese eggplant, leeks, lemons, lettuce, mushrooms, onions, papaya, parsnips, potatoes, rutabagas, snow peas.

December 2014 | OR TODAY 63

OUT OF THE OR RECIPE

OR TODAY | December 2014

BY DIANE ROSSEN WORTHINGTON

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RECIPE

ELEGANT, SIMPLE & PERFECT GRILLED LAMB CHOPS

elebrate the pomegranate season with these savory lamb chops. The combination of lamb with pomegranate juice was a favorite in California rancho kitchens in the early 1900s. The pomegranate juice may have been intended to mask the strongly flavored lamb produced on the ranches in those days. On the other hand, the combination could have had appeal then, as now, simply because it tastes so good.

This pomegranate juice, mint and whole grain mustard marinade gives a spicy, herbal flavor to the lamb. Pomegranate juice is easy to find in most markets today. I use the Pom brand. This quick entree has been a lifesaver when I’ve been in a hurry and wanted something a bit out of the ordinary. Many people disagree about what the best-flavored lamb is. I tend to be an American lamb fan for its young, sweet flavor. Others prefer the stronger flavor of New Zealand or Australian lamb. I leave it up to you to decide which to choose. I have used the New Zealand lamb for this recipe with great results because the marinade is bursting with sweet herb flavor and tempers the strong, slightly gamey taste. Watch the meat carefully as it grills – it can burn from the sugars in the marinade. I favor the rib chop but this sauce would be equally good with the loin lamb chop too. And if you are not a fan of lamb don’t worry. This marinade and sauce is a perfect match with meaty sea bass, shrimp, scallops or chicken. This is also lovely to serve at a small dinner party. The lamb chops look very elegant when they are served with their ends crisscrossed. Begin with a tossed green salad with colorful vegetables. Serve the chops with grilled or roasted baby potatoes and green beans. Serve with an Argentine malbec or a California zinfandel.

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GRILLED LAMB CHOPS WITH POMEGRANATE MINT MARINADE Serves 4 to 6.

MARINADE: 1/2 cup

pomegranate juice (Pom recommended) 2 tablespoons balsamic vinegar 2 tablespoons whole grain mustard 2 garlic cloves, minced 3 tablespoons finely chopped fresh mint leaves, plus whole leaves for garnish 2 teaspoons agave syrup 1/4 cup vegetable oil • Salt and freshly ground black pepper to taste 8 TO 12 thick lamb chops, up to 3/4 inch thick • Pomegranate seeds, for garnish

1. In a food processor

fitted with the metal blade, combine all of the marinade ingredients and process until completely blended and smooth. Taste and adjust the

seasonings. Set aside. 2. Put the lamb chops in a large plastic lock-top bag and pour in the marinade. Turn the lamb in the bag to coat it evenly. Close the bag and refrigerate for at least 30 minutes or up to 8 hours, turning once or twice. 3. Preheat a barbecue grill or an oiled grill pan to medium-high-heat. Remove the lamb chops from the marinade and grill for 5 to 7 minutes per side for medium rare, depending on thickness of the meat. 4. Place the lamb chops on serving plates, crisscrossing the ends for a pretty presentation. Garnish with mint leaves and or pomegranate seeds. Serve immediately. Advance Preparation: May be prepared up to 8 hours in advance through Step 2, covered and refrigerated DIANE ROSSEN WORTHINGTON is an authority on new American cooking. She is the author of 18 cookbooks, including “Seriously Simple Parties,” and a James Beard Awardwinning radio show host. You can contact her at www.seriouslysimple.com. December 2014 | OR TODAY 65

NO MORE

Wheel obstructions KEEP CALM AND

ASK ON The Medical Product Support Network.

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OR TODAY | December 2014

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OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • DECEMBER • Favorite Gift

What is the perfect gift for an OR nurse or tech? Send us a photo of yourself with the gift and you could win a $5 Starbucks gift card, including FREE lunch for your department. Each entry will receive a $5 gift card! Email your entry to social@mdpublishing.com or post it to the OR Today Facebook page.

THE WINNER GETS LUNCH FOR THE ENTIRE TEAM!

{

EACH SUBMISSION WINS A $5 GIFT CARD

Manicure TOP GIFTS FOR NURSES:

Do you want to buy a coworker a gift this Chirstmas? Or maybe you want to leave your copy of OR Today opened to this page and leave it where a loved one will see it so that you get the perfect gift this year. You could even circle your favorite gift below in bright red ink so it stands out. Whatever the case, here are some gifts ideas for nurses from nurses: 1. Manicure and/or pedicure 2. Massage and/or facial 3. Custom-made OR caps 4. Support hose

$5 Starbucks gift card

Win Lunch!

5. A donation in the nurse’s name to AORN Foundation

PINBOARD

OR TODAY

CONTESTS WINNER { OCTOBER }

“America’s nurses are the beating heart of our medical system.”

– President Barack Obama

OR TODAY IS NOW ON LINKEDIN Join our group! Enjoying a team lunch!

Karely Deal, RN, Center Director, and her coworkers at the Airport Endoscopy Center in Los Angeles enjoy a free pizza lunch. She won the lunch in an OR Today contest.

Join the community!

Laughter is the best medicine… except for treating diarrhea.

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POSITIONERS/IMMOBILIZERS Innovative Medical Products, Inc……………………… BC

ACCREDITATION AAAHC……………………………………………………………………17

Government Liquidation………………………………… IBC Lumalier Corporation………………………………………… 20 MedWrench………………………………………………………… 66 SIPS Consults, Corp.…………………………………………… 58 Surgical Power…………………………………………………… 39

ANESTHESIA SMD Wynne Corp.……………………………………… 40-43

HAND/ARM POSITIONERS Innovative Medical Products, Inc……………………… BC

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

APPAREL Healthmark Industries………………………………………… 10

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

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

ASSOCIATIONS AAAHC……………………………………………………………………17

INFECTION CONTROL/PREVENTION Clorox Professional Products……………………………… 5 Cygnus Medical…………………………………………………… 49 Encompass Group…………………………………………… 27 Government Liquidation………………………………… IBC Palmero Health Care…………………………………………… 39 Ruhof Corporation………………………………………………2-3 SMD Wynne Corp.……………………………………… 40-43

SOCIAL MEDIA MedWrench………………………………………………………… 66

INDEX CATEGORICAL ACCESSORITES Action Products…………………………………………………51

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OR TODAY | December 2014

INFUSION PUMPS AIV, Inc.……………………………………………………………… 60 INSTRUMENTS Government Liquidation………………………………… IBC Mobile Instrument Service & Repair…………………… 4 INTERNET RESOURCES MedWrench………………………………………………………… 66 KNEE SYSTEMS Innovative Medical Products, Inc……………………… BC LEG POSITIONERS Innovative Medical Products, Inc……………………… BC MONITORS Jet Medical Electronics……………………………………… 61 OR TABLES/ ACCESSORIES Action Products…………………………………………………51 Bryton Corporation……………………………………………… 9 Innovative Medical Products, Inc……………………… BC ORTHOPEDIC Surgical Power…………………………………………………… 39 PATIENT AIDS Innovative Medical Products, Inc……………………… BC PATIENT MONITORING Encompass Group…………………………………………… 27 POSITIONING AIDS Action Products…………………………………………………51 Innovative Medical Products, Inc……………………… BC

REPAIR SERVICES AIV, Inc.……………………………………………………………… 60

STERILIZATION Clorox Professional Products……………………………… 5 Lumalier Corporation………………………………………… 20 SIPS Consults, Corp.…………………………………………… 58 SURGEON COOLING Polar Products……………………………………………………… 38 SURGICAL AAAHC……………………………………………………………………17 Clorox Professional Products……………………………… 5 Lumalier Corporation………………………………………… 20 MD Technologies………………………………………………… 27 Mobile Instrument Service & Repair…………………… 4 SMD Wynne Corp.……………………………………… 40-43 Stryker Sustainability Solutions……………………… 6 Surgical Power…………………………………………………… 39 SURGICAL EQUIPMENT Mobile Instrument Service & Repair…………………… 4 SURGICAL SUPPLIES Action Products…………………………………………………51 Cincinnati Sub-Zero…………………………………………… 50 Cygnus Medical…………………………………………………… 49 Government Liquidation………………………………… IBC Ruhof Corporation………………………………………………2-3 SURPLUS MEDICAL Government Liquidation………………………………… IBC SUPPORTS Innovative Medical Products, Inc……………………… BC TEMPERATURE MANAGEMENT C Change Surgical……………………………………………… 57 ULTRASOUND AIV, Inc.……………………………………………………………… 60

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New Technique for Femoral Distraction

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Finally an external distractor outside the surgical site. The new, patented De Mayo Universal Distractor速 delivers finite joint distraction without obstructing your field of vision, tying up a pair of hands or placing lamina spreaders. You get finite distraction and reduced procedure time for Unicompartmental, MIS Techniques, Arthroscopies, ACL and TKA surgeries. To see all the advantages, visit www.impmedical.com or call 800-467-4944 today. And get positioned for success.

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Tension release lever to fine-tune spacing or disengage distraction Broad distribution of pressure with sterile protector pad that will not rotate or roll

Hand control for finite adjustment of distraction De Mayo Knee Positioner : US Patent No. 7,380,299 Single Lever Clamp : US Patent No. 7,003,827 De Mayo Universal Distractor : US Patent No. 8,048,082 B1 息 2013 IMP