OR Today - January/February 2015 by MD Publishing

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TAKE GOOD CARE

NURSES • SURGICAL TECHS • NURSE MANAGERS

YOURE IE D U G TO TH N R O A FERENCE CON

AORN

SPOTLIGHT ON: CINDY MASK

BOOTH #3545

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CONTENTS

features

OR TODAY | January/February 2015

YOUR GUIDE TO THE 2015 AORN CONFERENCE

The annual AORN Surgical Conference & Expo is one of the most popular events in the industry. The 2015 conference, scheduled for March 7-11 in Denver, Colo., will be bigger and better than ever. Attendees at the 2015 event will experience a number of new features. We interviewed AORN leaders to get the latest scoop on the conference and provide an insightful guide on how to best prepare for this signature event.

FOCUSED ON PATIENT SAFETY

Much has changed since certified surgical technologist Cindy Mask first began working in the operating room. Advances in medical imaging and roboticassisted surgery have changed the surgical suite to a degree, but Mask continues to stress the importance of a sterile working environment and a surgical conscience at Tarrant County College in Fort Worth, Texas.

OR Today (Vol. 15, Issue #1) January/February 2015 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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January/February 2015 | OR TODAY

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

EDITOR

John Wallace | jwallace@mdpublishing.com

ART DEPARTMENT Jonathan Riley Yareia Frazier Jessica Laurain

ACCOUNT EXECUTIVES

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

Jayme McKelvey | jayme@mdpublishing.com Andrew Parker | andrew@mdpublishing.com

CIRCULATION Bethany Williams

INDUSTRY INSIGHTS 10 12 18 20

Clorox Advice News & Notes AAAHC Update ASCA Update

ACCOUNTING Sue Cinq-Mars

WEB SERVICES Betsy Popinga Taylor Martin

IN THE OR 25 29 33 34 46

Vendor Q&A: Sealed Air Corp Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 74 77 80 82 86

Health Fitness Nutrition Recipe Pinboard

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

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INDUSTRY INSIGHTS CLOROX ADVICE

BY ROSIE D. LYLES, MD, MHA, MSC,

TAKING TIME OUT FOR OR SURFACE DISINFECTION

inging in a new year marks the perfect time to reflect on current OR surface disinfection practices and how we may improve upon them. This year, take time out and reevaluate some of the following practices to help your facility prevent the spread of healthcare-associated infections.

OR CLEANING AND DISINFECTING BEST PRACTICES There can be a rush to clean the OR in between procedures, but do not let that get in the way of cleaning and disinfecting surfaces in the correct manner. Monitor staff to ensure they clean and disinfect as recommended by industry guidelines from the Association of periOperative Registered Nurses (AORN), the Association for Professionals in Infection Control and Epidemiology, and the Association for the Healthcare Environment, including: • Use a clean, lint-free or microfiber cloth moistened with an Environmental Protection Agency (EPA)-registered disinfectant with appropriate microorganism kill claims (e.g., C. diﬃcile, VRE, MRSA). • Disinfect from high surfaces to low surfaces and from clean to dirty areas. • Disinfect floors surrounding the patient area between patients. In addition, ready-to-use wipes are especially useful in the OR. A study in the June 2014 issue of the American Journal of Infection Control found high cleaning efficacy (84 to 96 percent) and a high staff compliance rate (84 percent) when using ready-to-use improved hydrogen

peroxide wipes for in-between case disinfection in the OR. [1] NEW TECHNOLOGY CONSIDERATIONS AORN recommendations indicate that surgical procedure rooms and scrub/ utility areas should be terminally cleaned daily.[2] For terminal cleaning your facility may want to consider adding an extra layer of protection with ultraviolet radiation (UV-C) technology. While manual surface disinfection is still essential for removing soils and killing pathogens on surfaces, UV-C devices can serve as a supplement to inactive microorganisms in areas that may have been missed by manual cleaning, high-risk areas, or hard to reach areas (e.g., walls). Researchers from the University of North Carolina recently found that UV-C technology effectively reduces environmental contamination in patient rooms and should be considered when environmental transmission is significant. The study results showed that a UV-C device achieved a total 3.56-log10 reduction for MRSA in five minutes and a total 2.78-log10 reduction for C. diﬃcile spores in 10 minutes.[3]

ROSIE D. LYLES, MD, MHA, MSC, HEAD OF CLINICAL AFFAIRS

If your facility is interested in UV-C devices, consider some of the following questions: • Does the device kill the most relevant pathogens in healthcare facilities? How fast? • Can housekeeping staff easily operate the device? • Does the manufacturer provide a bundled approach, which includes protocols for both manual disinfection and UV-C decontamination? • Is the device affordable? What is the total cost of ownership when service and replacement parts are taken into account? FOR MORE OR cleaning and disinfecting tips, visit www.CloroxHealthcare.com.

[1] Wiemken, T.L., Curran, D.R., Kelley, R.R., Pacholski, E.B., Carrico, R.M., Peyrani, P., Khan, M.S.S., Ramirez, J.A. “Evaluation of the effectiveness of improved hydrogen peroxide in the operating room.” American Journal of Infection Control, xxx (2014):1-3. Retrieved from: http://www.ajicjournal.org/article/S0196-6553(14)00792-5/abstract. [2] “Recommended Practices for Environmental Cleaning in the Surgical Practice Setting.” AORN Journal 67.2 (1998): 448-452. [3] Rutala WA, Gergen MF, Tande BM, Weber DJ.“Room Decontamination Using an Ultraviolet-C Device with Short Ultraviolet Exposure Time.” Infection Control and Hospital Epidemiology 35.8 (2014): 1070-1071.

OR TODAY | January/February 2015

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INDUSTRY INSIGHTS NEWS & NOTES

WELCH ALLYN ACQUIRES HEALTHINTERLINK LLC ASSETS Welch Allyn Inc. has announced the acquisition of substantially all assets of Prairie Ventures telehealth company HealthInterlink LLC of Omaha, Neb. HealthInterlink is a medical software company and developer of a flexible, affordable, and scalable software-based remote patient vital signs monitoring solution that is 510(k) cleared for marketing in the U.S. HealthInterlink’s telehealth solution incorporates wireless patient monitoring devices and a mobile gateway device, (e.g., tablet or smartphone) that transmits vital signs data, answers to patient care plan questions, and patient messages

to a HIPAA-compliant cloud-based web portal for patient data management by healthcare professionals and other authorized stakeholders. According to Welch Allyn President and CEO Stephen Meyer the acquisition of the HealthInterlink assets offers Welch Allyn a unique opportunity to better serve its U.S. customers by offering them an mHealth solution optimized for cost-effective collection and delivery of remote health information. “The acquisition of HealthInterlink’s assets is exciting news for Welch Allyn and is in keeping with our vision to help transform care

wherever patients and healthcare professionals connect,” said Meyer. “As healthcare delivery becomes decentralized and extends beyond the traditional acute and ambulatory care locations where our offerings are used today, we intend to provide solutions that enable providers to deliver high-quality care, regardless of location.” During a transition period, HealthInterlink’s current product will continue to be developed, sourced and sold by HealthInterlink’s existing workforce. It will be business as usual for all HealthInterlink partners and customers while the integration and transition is underway. •

SMART-FOLD WRAP RACE RETURNS Halyard Health is out to find the fastest wrapper in the second annual Smart-Fold Wrap Race competition, a fun and fast-paced competition for Sterile Processing and Central Services (CS) professionals. Last year, more than 170 CS professionals entered the competition and the top wrappers demonstrated their skills in less than 10 seconds. If you are a CS professional who can wrap really fast this is the opportunity you’ve been waiting for. Participants do not need to be Halyard Health customers to participate, but will need to use Halyard Smart-Fold Wrap for their contest entry. This is a fun and fast-paced competition designed to test the wrapping skills and speed of CS 12

OR TODAY | January/February 2015

professionals using Smart-Fold Sterilization Wrap, a sterilization packaging designed with the toughest tasks in mind, engineered to protect heavy trays and loaner sets from tears and cuts in handling. CS professionals interested in competing in the Smart-Fold Wrap Race should contact their Halyard Health representative, who will visit participants’ facilities to videotape their fastest Smart-Fold wrapping times. The fastest wrappers will advance in the competition for an opportunity to be crowned the 2015 Smart-Fold Wrap Race Champion at the International Association of Healthcare Central Service Material Management (IAHCSMM) 2015 Annual Conference and Expo, May 3-6, 2015.

The delivery of safe, top quality patient care is critical in the hospital setting and CS professionals are among the most vital contributors on this front, responsible for cleaning, decontaminating, sterilizing and distributing medical and surgical instrumentation to the operating room. Using Smart-Fold Sterilization Wrap in this fun competition, CS professionals have an opportunity to demonstrate their hard work and dedication to preventing infections and keeping patients safe. • FOR ADDITIONAL INFORMATION and specific deadlines, visit www.halyardhealth.com/wraprace.

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NEWS & NOTES

AAAASF BOARD OF DIRECTORS ELECTS OFFICERS

Dr. Foad Nahai

The board of directors for the American Association for Accreditation of Ambulatory Surgery Facilities Inc. (AAAASF) elected officers and welcomed two new board members on Oct. 25. Dr. Foad Nahai of Atlanta, where he is a professor of plastic surgery at Emory University, was elected president. President-elect is Dr. David C. Watts of Vineland, N.J. The new secretary-treasurer is Dr. Lawrence S. Reed of N.Y. The new vice president of external relations is Darrell Ranum of Columbus, Ohio. The vice president of standards is Dr. Hector Vila, Jr. of Tampa, Fla., and the new vice president of education is Dr. Gary M. Brownstein of Cherry Hill, N.J. The new board members are Dr. Paul J. LoVerme of Verona, N.J., and Dr. William B. Rosenblatt of N.Y. Also during the board meeting, members presented a Past President’s Award to outgoing President Dr. Geoffrey R. Keyes of Los Angeles. He passed the gavel of leadership to Nahai. WWW.ORTODAY.COM

Nahai is internationally recognized as an innovator in the field of plastic surgery where he has developed and refined many procedures. He has co-authored 10 books and published more than 190 scientific articles on all aspects of plastic surgery. The latest book he authored and edited, published in 2011, is the second edition of his three-volume text “The Art of Aesthetic Surgery.” He served as the 2008 to 2010 president of the International Society of Aesthetic Plastic Surgery (ISAPS), is a past president of the American Society of Aesthetic Plastic Surgery (ASAPS), former director of the American Board of Plastic Surgery and is currently editor-in-chief of the Aesthetic Surgery Journal. “We are very pleased to welcome Paul and Bill to the AAAASF board of directors,” Nahai said. “Their leadership, commitment to patient safety and surgical expertise will make them valuable contributors to AAAASF as we continue to grow our business and mission of safety.” The board also named Theresa Griffin-Rossi, Certified Association Executive (CAE), as the AAAASF executive director, changing her status from interim executive director. She is the first female executive director to lead AAAASF in its 35 years. In addition, a Service Recognition Award was presented to Dr. James A. Yates of Camp Hill, Pa. •

ZOLL ANNOUNCES THE ACQUISITION OF PHILIPS INNERCOOL TEMPERATURE MANAGEMENT ZOLL Medical Corp. has signed an agreement to purchase substantially all of the assets of Philips’ InnerCool temperature management business, which includes catheter-based endovascular and surface temperature management technologies designed to improve outcomes for patients with a variety of temperature management-related needs. InnerCool’s technology includes the RTx Endovascular System, the Accutrol Catheter, and the CoolRepeat and STx Surface Cooling Systems. All four products have regulatory clearance in the United States. The acquisition provides synergy with ZOLL’s acute critical care portfolio of temperature management products. “The combination of InnerCool with ZOLL’s existing temperature management technologies expands ZOLL’s position as the leading provider of high technology systems for precise temperature management,” said James Palazzolo, President of ZOLL. “This underscores our commitment to provide a wide variety of clinical temperature therapies based on physician preference and clinical judgment.” The InnerCool assets also provide ZOLL with a rich patent portfolio and pipeline of future products. InnerCool will be integrated into ZOLL’s Temperature Management business in San Jose, Calif. • January/February 2015 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

3M LITTMANN CLASSIC III STETHOSCOPE ADDS UPDATED FEATURES 3M has announced the next generation of its Littmann brand stethoscopes: the 3M Littmann Classic III Stethoscope. The innovative design and consistent production quality give medical professionals a reliable tool to achieve their best. Dr. David Littmann, a Harvard Medical School professor, popularized the first lightweight, double-sided stethoscope in the early 1960s. Now the Littmann stethoscope has been updated once again with a new design, materials, and technology. Like its predecessor, the Classic II S.E. stethoscope, the new model has high acoustic sensitivity for general physical assessment. The new Classic III stethoscope, designed for use with adult and pediatric patients, is easier to maintain. Additionally, the chestpiece has an aesthetically distinctive design and less angular shape with smoother curves. The stem has an active-side indicator. The adult and pediatric sides of the chestpiece have 3M’s new single-piece, tunable diaphragm, which clinicians can tune for high or low frequencies by pressing the chestpiece against the patient, or easing up. The pediatric side is useful for small or thin patients, around bandages, and for carotid assessment. The same side is convertible, giving users the option to leave the bell side open or closed. An open bell is notorious for collecting dirt and debris and being

OR TODAY | January/February 2015

difficult to clean, so 3M has included a tunable diaphragm to close the bell. The diaphragm is easy to attach because it is a single piece, and easy to clean because the surface is smooth, and does not have the crevices of two-piece diaphragms. Made in the USA, the Classic III stethoscope comes with tubing that is longer lasting because of its improved resistance to skin oils and alcohol. It is also less likely to stain. The tubing does not contain phthalate plasticizers (nor do any other components of the Classic III stethoscope). 3M has identified a more sustainable substitute for phthalates — which are being phased out in parts of the globe over health and environmental concerns — and now incorporates this alternative in its non-metallic stethoscope parts. The Classic III stethoscope comes with a five-year warranty. It is initially available in 9 colors and a stainless steel chestpiece finish. •

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NEWS & NOTES

ENCOMPASS ANNOUNCES BRILLIANCE GEL FIBER PILLOWS Encompass Group LLC has announced its new Brilliance Gel Fiber Pillows. It offers patients and residents the experience of a down filled pillow with the advantage of a hypoallergenic polyester gel fiber. The Pillow Factory division of Encompass Group is the market leader in healthcare pillows. “Brilliance Gel Fiber Pillows are available in 100 percent cotton, with a choice of either a T230 crisp white or a soft T250 damask stripe shell; both are double stitched with a corded edge,” said Encompass Director of Marketing for The Pillow Factory Michelle Daniels. “Brilliance Pillows are machine washable and dryable so the care is easy. Our gel fiber technology has a luxurious, soft feel – ‘micro plus’ fibers provide immediate comfort that becomes even more comfortable with each washing,” she added. “The pillows are lightweight, filled to perfection in standard, medium, or full plus loft, and maintain their shape and loft night after night.” Brilliance Pillows are made in the U.S.A. and are available in standard, queen and king sizes. •

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INDUSTRY INSIGHTS AAAHC UPDATE

BY GEOFFREY CHARLTON-PERRIN

YOUR ASC HAS A MARKETING DEPARTMENT... WHETHER YOU KNOW IT OR NOT

hat’s that you say? I’m mistaken; you don’t have a marketing department?

Allow me to set you straight. You may be a nurse whose primary function is caring for patients. You may be a physician whose best work is done in the OR. You may be the receptionist greeting the patients and making sure their information is correct and up to date. I’d like to welcome all of you to the marketing department which, incidentally, you’ve been a vital member of ever since you joined the organization. Like it or not, everyone in your ASC is an ambassador for the organization. Even if you do have someone specifically designated to buy advertisements in local maga18

OR TODAY | January/February 2015

zines or send press releases to the community newspaper, that doesn’t let you off the hook. You’re still an unofficial, but just-as-important, representative whose job it is to create a favorable impression for your organization. Let’s say I’m a potential patient and call to make an appointment. The phone rings and rings … and rings some more. No one seems eager to pick it up. At the other end of the line, the receptionist is on the phone with her girlfriend blissfully discussing the double date they went on over the weekend. Or, let’s say I get through but the receptionist makes it plain that she’s too busy to give me the time of day or is just plain rude. Do I grit my teeth and take it in order to make an appointment, or do I politely bring the conversation to an abrupt end and

call another ASC? What if the receptionist is friendly and professional and I get in to see a physician who can’t seem to take his eyes off his smartphone while I’m reciting my symptoms or interrupts me to call out to a passing colleague about yesterday’s NFL game? Do I leave that office brimming with confidence that this practitioner of the Hippocratic oath will have my full interests at heart? Or, will I make a mental resolve to seek out another physician? There are no prizes for correct answers to the above. Some years ago, I was plagued by intense pain in my shoulder. On the advice of a colleague, I went to see an orthopedic surgeon who specialized in shoulder surgery. This man was straight out of a Hollywood film set; striking, with carefully-coiffed silver WWW.ORTODAY.COM

AAAHC UPDATE

Your actions can either polish your brand image until it gleams; or trample it into the dirt till it’s almost impossible to get the muck off. That’s something worth keeping in mind at all times.

hair, impeccable in a freshly pressed shirt and slacks, he was warm and friendly, listened attentively to my case, conducted a few simple tests on my shoulder, told me what he suspected was the problem, ordered an X-ray (which confirmed his diagnosis of a rotator cuff tear) and we agreed on next steps. Over the course of my treatment and procedure, I found out that this surgeon looked like a model from a TV commercial every day – freshstarched shirt, pressed slacks, firm handshake, pleasant demeanor, intelligent conversation. And guess what? He – and his surgeon assistant – turned out to be extremely accomplished and gave me back a fully performing shoulder that I’ve never had a problem with since. “Ah, yes, but … ” I hear you say. “Looking like a million dollars doesn’t guarantee that he was a master of his art.” And I’m sure you are following that with, “He could be a short, fat man with a stutter, or an unkempt woman with an absentminded air, and still be a wonderful practitioner.” And you would be right. But, alas, in this world, perception is reality. If you come across as a disinterested, rude, slovenly and uncaring person, for that moment in time you are. No potential patient will have the patience or inclination to delve into your back story to discover that you were feeling under the weather that day; or you had a fight with your partner that morning; or someone rear-ended you on the way to work. “Yes, I realize that the nurse was offhand, WWW.ORTODAY.COM

but she’s been having trouble with her eleven-year-old.” It doesn’t matter. The damage has been done. I’ll agree that you can’t necessarily look like Brad Pitt or Angeline Jolie in scrubs. But you can be professional in your bearing, attentive to patients’ needs, helpful with problems and courteous in your manner. Which brings me back to my original statement. You are in marketing whether you signed on for that or not. How you conduct yourself; how you treat your patients; how you do your job reflects on the organization.

Your actions can either polish your brand image until it gleams; or trample it into the dirt till it’s almost impossible to get the muck off. That’s something worth keeping in mind at all times. ABOUT THE AUTHOR Geoffrey Charlton-Perrin is Director of Marketing and Communications for AAAHC, the nation’s largest ambulatory healthcare accrediting organization. Previously, he was Director of Marketing for the Chicago Convention and Tourism Bureau, and before that president of a major Chicago advertising agency.

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INDUSTRY INSIGHTS ASCA UPDATE

BY WILLIAM PRENTICE

ASCA OFFERS

NEW EDUCATIONAL OPPORTUNITIES IN 2015

SCA is giving ASC professionals a number of new opportunities this year to get the information and continuing education credit they need. We will also be offering a few old favorites. If you own or work in an ASC, I encourage you to look into all of these programs and sign up now for those that best meet your needs.

ONLINE REGULATORY TRAINING SERIES To help ASCs orient new staff, meet regulatory and accreditation requirements, assess competency and achieve top outcomes, ASCA and HealthStream have teamed up to provide a series of 21 online, ondemand training courses that target the special needs of ASC professionals. Sixteen of these courses offer continuing education credit, and all provide important information that can help improve the patient care that ASCs deliver. Topics covered in the series include medication safety, safe patient handling, postoperative pain control, infection prevention, compliance with the Health Insur20

OR TODAY | January/February 2015

ance Portability and Accountability Act (HIPAA) and more. FOR INFORMATION, go to www. ascassociation.org/TrainingSeries.

MEDICAL DIRECTORS LEADERSHIP SEMINAR Also new this year, ASCA is offering a Medical Directors Leadership Seminar that will target the special interests and needs of ASC medical directors and other physicians. This program will take place May 16-17, 2015, at the Ritz-Carlton Orlando, Grande Lakes in Orlando, Fla. It will focus on emerging practice and business management techniques and examine key decisionmaking strategies.

This seminar will give participants a unique opportunity to step away from their demanding daily routines and take a high-level view of operations at their ASC from a leader’s perspective. Attendees will be able to help guide small-group discussions and focus the conversation on the topics that concern them the most. They will also have extensive networking opportunities to connect with other ASC medical directors and physicians from across the country who are facing the same changes, challenges and opportunities in their ASCs. Continuing medical education (CME) credit will be provided. FOR MORE INFORMATION, go to www.ascassociation. org/2015MedicalDirectors.

WEBINARS While our webinar series isn’t new, this year’s line-up may be the best we have ever offered. So much is new for ASCs in 2015 that the information that these programs provide will be WWW.ORTODAY.COM

ASCA UPDATE

essential for ASCs in the coming year. In the first half of the year, ASC professionals can learn what they need to know about the new Drug Enforcement Administration guidelines, new clinical evidence affecting endoscope reprocessing, new accreditation standards, how to make the most of ASCA’s new clinical and operational benchmarking program and the latest in Life Safety Code surveys. In the second half of the year, the programs will take a closer look at ICD-10 contingency planning, best practices for preventing surgical fires and Medicare’s payment and quality reporting changes that will affect ASCs in 2016. And that’s just the beginning. This year’s series also looks at cuttingedge business management advice, emerging concerns like managing social media in the workplace and what you need to know to move new procedures into your ASC. Each webinar lasts one hour and, unless otherwise indicated, offers one continuing education credit for nurses (CE) and one for administrators (AEU). ASCA members can register for the entire series at once and save 10 percent on the total price. GO TO www.ascassociation.org/ Webinars for more information.

ASCA 2015 Of course, ASCA will also be offering our popular annual meeting again in 2015. This year’s meeting, ASCA 2015, will take place May 13-16, at the Orlando World Center Marriott WWW.ORTODAY.COM

Each webinar lasts one hour and, unless otherwise indicated, offers one continuing education credit for nurses (CE) and one for administrators (AEU).

Resort & Convention Center in Orlando, Fla. As in year’s past, this meeting will offer something for everyone who works in and with an ASC. From new developments in human resources and cost control to future planning, compliance and managing liability risk, this year’s program looks at just about every aspect of ASC operations that keeps ASC professionals up at night and provides a one-of-a-kind opportunity for ASC professionals to find the answers that they need. FOR MORE INFORMATION, go to www. ascassociation.org/ASCA2015.

2015 FALL SEMINAR We are still working on the agenda for our 2015 Fall Seminar, but last year’s meeting got high marks from attendees and we hope to get similar results again this year. Our goal is to give attendees the tools and insights they need to combine best practices from the past

with new business management strategies and practice techniques that can help them craft a successful future for their ASC. We are also working to help participants determine how they can make the most of the opportunities available to them in today’s rapidly changing healthcare marketplace. Once we have more information to share, you will be able to find it at www.ascassociation.org/2015FallSeminar. If you work in or with an ASC, or hope to one day, I encourage you to look into all of these programs and register for the ones that are the best fit for you. Also, if you have ideas about other resources and information that you would like ASCA to offer, please send them our way. You can write us at asc@ascassociation.org or call our Member Services team at 703.836.8808. WILLIAM PRENTICE is the chief executive officer of the Ambulatory Surgery Center Association. January/February 2015 | OR TODAY

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Why more Health Care Professionals turn to AAAHC With Standards that are nationally recognized and annually reviewed, AAAHC accredits more than 6,000 health care facilities. Our surveys are conducted by experienced health care professionals, so they’re collaborative in nature and not just a check list.

For more information, Contact us: 847-853-6060 By email: info@aaahc.org Log on: www.aaahc.org

Improving Health Care Quality through Accreditation

OR TODAY | January/February 2015

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IN THE OR VENDOR Q&A

VENDOR Q&A Sealed Air Corp

Today keeps readers updated on the newest medical devices and products. Sealed Air’s Diversey Care Division’s Carolyn Cooke, Vice President Healthcare, North America, recently took some time to share more about the company and its products.

CAROLYN COOKE Vice President, Sealed Air Corp. Healthcare, North America

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WHAT IS THE COMPANY’S HISTORY AND HOW DOES IT ACHIEVE SUCCESS?

Cooke: Sealed Air Corp. creates a world that feels, tastes and works better. The company achieves success by helping customers achieve goals in the face of today’s biggest challenges. Our portfolio of widely recognized brands, including Cryovac® brand food packaging solutions, Bubble Wrap® brand cushioning and Diversey® cleaning and hygiene solutions, ensures a safer and less wasteful food supply chain, protects valuable goods shipped around the world, and improves health through clean environments. Diversey Care’s Solutions Designed for Healthcare™ is an integrated approach targeted to reduce the risk of HAIs, improve outcomes and satisfaction, and safely and sustainably enhance a facility’s image. Our solutions continue to help customers

achieve success, and enable us to grow together. To learn more, visit www.sealedair.com. WHAT ARE SOME ADVANTAGES THAT YOUR COMPANY HAS OVER THE COMPETITION?

Cooke: Sealed Air’s Diversey Care Division offers a broad range of products from disinfectants and cleaning validation systems, to cleaning equipment, work stations and tools that enable us to provide an integrated solution that addresses infection prevention and productivity. As experts in the arena of cleaning and disinfection, we understand the challenges faced by healthcare facilities. Our sales and service team is made up of dedicated healthcare experts who work with customers to assess their current programs, identify opportunities, and then work with customers to implement solutions that help them achieve their goals. Whether it is improveJanuary/February 2015 | OR TODAY

PRODUCTVENDOR SHOWROOM Q&A

Sustainability is incorporated in everything we do. It is part of our DNA. From more sustainable packaging, to super concentrates used with dilution control equipment, to systems designed to use less energy, chemical and water, we have a legacy of ensuring our products and practices reduce the environmental impact both internally, and within our customers’ environments.

ments in compliance, patient safety, productivity, speed of turnover, or patient and staff satisfaction, Diversey can help design an integrated solution to address a facility’s needs. WHAT ARE THE COMPANY’S CORE COMPETENCIES AND UNIQUE SELLING POINTS?

Cooke: Diversey Care’s focus on the healthcare sector is incorporated in all aspects of its structure, from research and development, marketing, application expertise, and sales and service professionals. This enables Diversey Care to invest its resources in product and process innovation which is designed to deliver the lowest total cost for customers. It would be very rare that a Diversey Care representative would ask only about current products used. They have all been trained to look at the total program of a facility including its processes, products, training and validation programs. By looking at all these components, they can help ensure that AORN recommended practices are introduced, that the most efficient and effective products are being used, and that implementation and monitoring programs are supported with customized training materials and a validation system. 26

OR TODAY | January/February 2015

Finally, sustainability is incorporated in everything we do. It is part of our DNA. From more sustainable packaging, to super concentrates used with dilution control equipment, to systems designed to use less energy, chemical and water, we have a legacy of ensuring our products and practices reduce the environmental impact both internally, and within our customers’ environments.

WHAT PRODUCT OR SERVICE THAT YOUR COMPANY OFFERS ARE YOU MOST EXCITED ABOUT RIGHT NOW?

Cooke: We have two very interesting products that can really improve the performance of operating room staff. The first is our Oxivir® Tb Wipe, which is powered by Accelerated Hydrogen Peroxide (AHP) technology. The wipes are effective against a broad spectrum of pathogens, in just one minute. The second is TASKI machines and tools. Our machines, work stations, and tools are designed to increase the speed and efficiency of any job, decreasing turnover times. Even better, the ergonomic design puts less strain on workers, and enables them to get more done on each shift, while reducing fatigue.

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

Cooke: At Sealed Air Diversey Care, we continue to work on innovative solutions that will create a safer environment for patients while creating a better environment for staff. Most of these innovations look at the overall cost of a process, and seek to reduce labor, inefficiencies and risk. It is all about optimizing outcomes!

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

Cooke: We are very focused on helping our customers “step up.” We understand that every facility has its own challenges and needs, and by working together closely, our goal is to jointly find solutions that help achieve at least a step change toward quality improvement or cost control. FOR INFORMATION, about Sealed Air Corp go to www.diversey.com

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Streamline Patient Warming from admission to discharge Warm fluids and blankets in bulk, then keep the fluids warm right in the OR with ivNow®

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Improve processes: • Efficiently warm patients from admission to discharge • Warm fluids in a cabinet and keep them warm at the point of use with the space-saving ivNow warmer ivNow increases regulatory compliance: • Display actual temperature of every bag • Records the shelf life of every bag ivNow saves money: • Reduce disposable costs while warming 20-140 liters of fluid over 12 hours

Increase reimbursements: • Reduce SSIs and time spent in the PACU • Improve patient satisfaction surveys & clinical outcomes

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

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

www.cszmedical.com Phone: 513-772-8810 Toll Free: 800-989-7373 Fax: 513-772-9119 28

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IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

STRINGS DANGLING IN THE BREEZE Often people step into an OR suite and have their mask on and only tied at the top with the strings hanging down. This can be X-ray, PACU, anesthesia, or someone just coming in to offer a break or get a status report on the progress of the case. How does one go about suggesting to another to tie their mask? Is it acceptable to have strings dangling in the breeze?

A: There are masks that have only one set of ties that prevent both this scenario and that of people having their masks hanging once the case is finished.

room and their attire. It’s about patient and staff safety. Those with masks inappropriately donned should be stopped at the door. Then inservice everyone!

A: The circulator is ultimately responsible for the people who come in and out of the

A: Do you have a Surgical Attire P&P? It is everyone’s responsibility to promote

DRINKING IN THE OR Is anyone allowing surgeons or staff to have bottled water in the semi-restricted areas? A: No food or drink in patient areas – an OSHA Standard: Employees often ask why the hospital doesn’t allow food or drink in patient care areas. Here’s the answerstraight from OSHA. “The Bloodborne Pathogens standard section 1910.1030(d) (2)(ix) says, “eating, drinking, smoking, applying cosmetics or lip balm, and handling

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worker/patient safety and provide a high level of cleanliness and hygiene within the periop environment (AORN recommended practices). See Recommendation VI.a.- “The mask should cover the mouth and nose and be secured in a manner to prevent venting.” •

contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.” According to a consultant from the Greeley Corp., convincing a surveyor that a patient care area doesn’t have a reasonable likelihood of an exposure is difficult. The bottom line: Don’t allow employees to increase their

personal risk, because the hospital runs the risk of an increased liability if an exposure occurs. A: No. A: We used to allow covered containers until the case started. Now it is no food or drink past the “red line.” •

January/February 2015 | OR TODAY

IN THE OR SUITE TALK

EXPLANTED HARDWARE Would anyone share their explanted hardware policy? How do you handle the return to patients? How do you prepare it? Does CS wash and sterilize the explants before returning them to the patient? A: Our Sterile Processing Department washes and sterilizes the explant. We provide it to the surgeon. He/She returns it to the patient at their office follow-up visit. A: We never return anything taken out to the patient. It goes to lab for testing. A: My hospital had to consider corporate compliance issues in regard to explants, as my hospital considers them the patient’s property, as he/she paid for them at the time of the surgery (see AORN Clinical Issues, February 2012, Vol 95, No 2, Page

A: We consider the patient’s explants (as well as other tissues) as their own property. I know this policy may open Pandora’s box but as long as we can have meaningful conversation about it – I’m supportive. You will find in our policy much more than has been requested thus far. Not only are explants covered, but also other tissues and materials including products of conception. Remember that while this works for us – I know it won’t fit everyone’s

needs. I offer this only as a reference point for consideration and discussion. A: Technically and legally any implants that are removed are the property of the patient and they are entitled to have them if requested. We send them to pathology and then they are disinfected before we release them to the patient. If the patient has a subpoena requesting that the implant(s) be turned over to their attorney, then we put them in a hard plastic specimen container and initiate a chain of evidence that stays with the implant. •

FLY IN THE OR How is the best way to get a fly out of the OR? A: Benzoin spray! A: Turn off lights in the room and open OR door to lighted area – hallway/substerile

294). However, if there is a recall, the explants is returned to the manufacturer after decontamination per the FDA.

OR TODAY | January/February 2015

room, etc. This usually works for me. A: Shut off the lights and turn on the X-ray box.

A: Here’s a trick I just used a few weeks ago, put rubbing alcohol in a syringe and spray the fly. The alcohol will kill the fly instantly. • WWW.ORTODAY.COM

SUITE TALK

NO RIDE HOME How often is it that patients come in for semi-minor procedures that they really need, however don’t have a ride home? It isn’t just that they don’t have a ride but sometimes patients are going home to an empty house. Is it acceptable to provide a ride home? Are there legal ramifications if you get in an accident and you are taking a patient home? Can the patient take a taxi? This is not an everyday occurrence, however it does seem to happen more and more frequently.

A: We require patients to be accompanied by a responsible adult anytime they receive sedation or anesthesia. The patient can take a taxi home as long as the adult goes with them. That is the standard of care. On rare occasions after a longer recovery period, our physicians will document that the patient is safe to travel home (not drive) without another adult with them, but that increases the physician’s liability if something should happen. We tell

e Th nal igi r O

patients that their procedure will be cancelled if there is no one accompanying them. A: If your policy says to discharge to a responsible adult then you need a responsible adult to give instructions to. A: TJC standard 03.01.07 ep # 6 states “Patients who have received sedation or anesthesia as outpatients are discharged in the company of an

individual who accepts responsibility for the patient.” We are a city hospital and our patient population will frequently have this issue, so we require patients who cannot meet this criteria on the day of surgery to either reschedule or admit overnight in observation status post-op. Our outpatient d/c documentation includes the name of the responsible party. The transportation method is not the issue, it’s meeting the element of performance in # 6.

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IN THE OR MARKET ANALYSIS

BY JOHN WALLACE

MARKET ANALYSIS

WEBINAR OPPORTUNITY! Learn “What’s New in Surface Disinfectants” by registering for OR Today’s FREE webinar on March 19th at 2p.m. ET! Visit goo.gl/8iBlKC for more information.

Continued Growth Forecast for Disinfectants Market

trict guidelines and certain measures of the Affordable Care Act emphasis the importance of cleanliness for hospitals and healthcare facilities. Healthcare-acquired infections continue to be a concern, especially when such incidents could impact the bottom line for these facilities. The recent Ebola scare also places more emphasis on sterile healthcare environments.

These are just some of the reasons experts predict growth in the surface disinfectants market as part of the overall global sterilization equipment and disinfectants market. The global sterilization equipment and disinfectants market was valued at $5.13 billion in 2012 and is expected to grow at a CAGR of 8.5 percent during the forecast period ending in 2019. It is predicted to reach a market value of $9.15 billion by 2019, according to Transparency Market Research. Disinfectants and sterilization equipment are used to sterilize various medical instruments, laboratory equipment and pharmaceutical components as well as surfaces throughout hospitals and healthcare facilities. Sterilization and disinfectants are a vital component for infection-control as medical devices, surgery suites and patient rooms require sterilization and disinfection after usage. An aging population is another reason for the growth of this market. In addition, the increasing number of WWW.ORTODAY.COM

surgeries being performed each year also impacts the market. The market for disinfectants has been segmented as low, intermediate and high level and oxidizing and non-oxidizing disinfectants, according to the report. The low, intermediate and high level disinfectants market is expected to grow at the highest CAGR of 7.0 percent during the forecast period because there are many companies active in manufacturing these particular disinfectants, according to Transparency Market Research. Also, the application area is wider, unlike oxidizing and non-oxidizing disinfectants, which has a limited scope. Sterilization equipment and disinfectants are utilized in three major application areas – medical devices, life-sciences and pharmaceutical companies. The market for sterilization equipment and disinfectants in medical devices applications accounted for the largest share (60.8 percent) of the total market in 2012 and is expected to grow at the highest CAGR during the forecast period.

The North American region accounted for the largest share in terms of revenue of the total market for sterilization equipment and disinfectants. A Global Industry Analysts Inc. report indicated “that outbreaks of infectious diseases and epidemics,” have made spending on cleaning and disinfectant products less discretionary and more indispensable. Recent Ebola cases have added to the concerns regarding the need for a sterile environment in developing nations as well as in the U.S., where some patients have received treatment. The Global Industry Analysts report says that the global disinfectants market will remain strong because sanitation and hygiene are essential. Aerosol and liquid products are the most commonly used surface disinfectants. However, more hospitals and healthcare facilities are using ultraviolet (UV) disinfection systems as an added measure. The Global Industry Analysts Inc. report indicates that major players in the global disinfectants marketplace include 3M Company, Ecolab Inc., Henkel KGaA, Kao Corporation, Prestige Brands Inc., Procter & Gamble Co., Reckitt Benckiser Plc, SC Johnson & Son Inc., Sealed Air Corporation Diversey Inc., The Clorox Company, Unilever Plc, and Zep Inc. January/February 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

CLOROX HEALTHCARE® HYDROGEN PEROXIDE CLEANER DISINFECTANT WIPES Clorox Healthcare® Hydrogen Peroxide Cleaner Disinfectant Wipes clean and disinfect in one step, cutting down the time it takes to effectively address blood and bodily fluids in the OR. These ready-to-use wipes are EPA-registered to kill more than 40 microorganisms, including those that cause most surgical site infections (SSIs), in 30-seconds to one minute. Clorox Healthcare® Hydrogen Peroxide Cleaner Disinfectant Wipes are non-flammable and noncorrosive, making them safe for use in perioperative settings and compatible with a broad range of operating room surfaces and medical equipment. For more information, visit www.CloroxHealthcare.com. •

OR TODAY | January/February 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

OXIVIR® TB WIPES Oxivir® Tb Wipes, powered by Accelerated Hydrogen Peroxide (AHP) technology, reduce OR turnover time while keeping costs in line. Turbocharge your wheels out to wheels in speed with disinfectant wipes that are effective against a broad spectrum of pathogens, in just one minute. Oxivir Tb Wipes improve compliance by staying wet for the required label contact time, ensuring disinfection while streamlining the process. With one pass, Oxivir Tb wipes are tough enough to clean and disinfect surfaces and equipment, while being gentle on staff, equipment and surfaces. Oxivir Tb Wipes are non-irritating to eyes and skin, and require no safety warnings or personal protective equipment. The Oxivir Tb wipes are available in a variety of sizes to meet your specific needs. •

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January/February 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

ECOLAB OXYCIDETM DAILY DISINFECTANT CLEANER Ecolab’s OxyCideTM is a daily disinfectant and cleaner proven effective in killing 33 different types of bacteria and viruses in five minutes or less, including Clostridium difficile in three minutes. OxyCide helps hospitals reduce the risk of healthcare-associated infections (HAI) by reducing pathogens on hard surfaces. In a pilot study, daily use of OxyCide decreased living organisms on hospital surfaces by 35 percent compared to a quaternary ammonium-based disinfectant. Its bleach-free formula is designed for daily use on multiple surfaces in the operating room, patient room and other common areas in the healthcare setting. For more information about OxyCide, visit http://www.ecolab.com/oxycide. •

OR TODAY | January/February 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

Hype-Wipe BLEACH TOWELETTES AND BLEACHRITE DISINFECTING SPRAY Hype-Wipe Bleach towelettes and Bleach-Rite Spray are ready-to-use, EPA registered hospital-grade disinfectants containing a 1:10 dilution of bleach and are stabilized for an extended shelf life. The products are approved for claims against C. Difficile Spores, tuberculosis (TB), acinetobacter baumannii, E-coli ESBL, Carbapenem-resistant Klebsiella pneumoniae (CRKP), Hepatitis A+B+C, Norovirus, Methicillin Resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococcus faecium (VRE), Influenza A (H1N1), and numerous additional organisms. Current Technologies is a certified small, woman-owned USA manufacturer to find out more about its products visit www.currtechinc.com. Samples may be requested by calling 800-456-4022. â&#x20AC;˘

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January/February 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

PALMERO HEALTH CARE DISCIDE ULTRA DisCide ULTRA is a one-step, quaternary ammonium, high-level, alcohol-based disinfectant that’s laboratoryproven to kill deadly pathogens in one minute. DisCide ULTRA is noncorrosive and nonstaining, and leaves behind a pleasant herbal scent with no unsightly residue. It’s registered with the U.S. Food and Drug Administration and Environmental Protection Agency, and it meets the disinfection requirements of the federal Occupational Safety and Health Administration’s (OSHA) Bloodborne Pathogens Standard. It is available as a spray, or towelette, and in gallon refills. Palmero’s DisCide disinfectants offer ready-to-use, fast-acting, hospital-quality products that are designed to expedite operatory turnover. Each of these products is ideal for use in the central sterilization room and office areas. • 38

OR TODAY | January/February 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

RUBBERMAID HYGEN SYSTEM The Rubbermaid HYGEN™ Disposable Microfiber System features innovative technology that offers optimal infection prevention, superior cleaning performance and improved productivity. It is the only disposable product line in the healthcare industry proven to remove 99.9 percent of microbes, including C. diff. The Rubbermaid HYGEN™ Disposable Microfiber Cloth Starter Kit provides 50 percent more surface coverage than traditional disposable products, sanitizer and bleach safe scrubbing strips built in to effectively remove dirt without smearing, disposable microfiber cloths and one charging tub, streak-free cleaning of mirrors, glass and stainless steel, and is safe for use with bleach, quat and neutral cleaners. •

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January/February 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

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

40 OR TODAY | January/February 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

ALLIED BIOSCIENCE SURFACEWISETM SurfaceWise™, by Allied BioScience, is a transparent, antimicrobial surface coating that binds to surfaces at a molecular level, forming a protective shield that makes it difficult for pathogens to survive. This revolutionary technology can be applied to hard and soft surfaces, including objects like surgical tables, equipment and fabric. As surfaces are touched, and therefore recontaminated, the treated surface itself reacts to fight the pathogen. Published studies have proven SurfaceWise™ effective in not only reducing pathogen growth by more than 99 percent, but also continually combating infectious threats up to 15 weeks; protecting patients and staff. For details, visit www.alliedbioscience.com. •

SURFACE

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January/February 2015 | OR TODAY

Join ASCA in Orlando for two exceptional meetings 2015 MEDICAL DIRECTOR LEADERSHIP SEMINAR ORLANDO : MAY 16-17

ASCA 2015 is the premier meeting for the ASC industry. Network with your peers and attend a wide variety of educational opportunities.

This new meeting is targeted exclusively to the unique interests and needs of medical directors and other physician leaders in the ASC setting.

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MedWrench HAS YOUR ANSWERS

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KEEP CALM AND ASK ON 42

OR TODAY | January/February 2015

The Medical Product Support Network.

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January/February 2015 | OR TODAY

PATIENT POSITIONING ArmGuard

Patient Arm Protector

• Low-profile sleds do not clash with robotic arms

• Eliminates arm tucking per AORN Guidelines • Immediate emergency access to IV ports and lines

• Comfortable profile for bedside assistant

PatientGuard Stirrups TM

Surgical Stirrups

• Familiar to use • Improved design adds axial rotation at the hip • Costs 100’s less than other stirrups • Fair and economical repair policy

FaceGuard

Face Shield & Instrument Tray

• Available in dual angle and flat tray models • Protects patient’s face and acts as an instrument tray Trendelenburg position

• Quick and easy emergency access to face • Folds for easy storage

PatientGuard

Lateral Positioner

• Safe and easy transition from supine to lateral • Shoulder channel provides exceptional patient comfort and nerve protection

• Built-in headrest and auxiliary support assists in

proper spinal alignment and surgical site access

ShroudGuard

Surgical Table Pedestal Protector • Prevents expensive shroud damage • Available for all model OR Tables • Protect from one to four sides

CALL US

OR TODAY | January/February 2015

800.261.9953

EMAIL US

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VISIT ONLINE

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Solutions for Robotic Surgery

TrenGuard

• Non-structural lateral stabilizing pillows control body mass shift. Shown: 505 lb patient in 40o Trendelenburg with PatientGuardTM 800 Stirrups, ArmGuardTM Arm Protector & TrenGuardTM 600 Trendelenburg Patient Restraint with Wedge Copyright 2014 D. A. Surgical Multiple Patents Pending

• Clinically proven “Speed Bump” bolster keeps patients of all sizes from sliding. • The only system capable of safely accommodating patients up to 550 lbs. “TrenGuardTM is the ONLY safe restraint for extreme Trendelenburg without a single report of a patient sliding. There has never been a report of post-operative discomfort or patient injury.” – Dan Allen

TrenGuard is the only NO-SLIDE Trendelenburg Restraint TM

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January/February 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 614B

BY SOPHIA MIKOS-SCHILD, RN, MSN, EDD, MAM/HROB, CNOR

HYPOTHERMIA HYPOGLYCEMIA HAND-OFFS

OR TODAY | January/February 2015

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CONTINUING EDUCATION 614B

PERIOPERATIVE PATIENT SAFETY: Hypothermia Hypoglycemia and Hand-offs 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 55 to learn how to earn CE credit for this module.

The goal of this continuing education program is to provide evidence-based practice information that will promote nurses’ management of three patient safety issues in the perioperative setting: hypothermia, hypoglycemia and hand-offs. After studying the information presented here, you will be able to: • State risk factors with evidence-based practice data for unintended perioperative hypothermia • List nursing interventions for the hypoglycemic patient • Describe an effective perioperative hand-off

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ou are the OR nurse caring for Marie Jenkins, an elderly woman scheduled for a coronary artery bypass graft. In the OR, Marie complains of being cold and is moving restlessly. You see that her temperature in the pre-op holding area was 37 C. You know that Marie’s age and her planned procedure put her at risk for hypothermia, so you place several warm blankets under and on top of her. Marie feels much warmer and begins to feel less anxious. You give the anesthesia provider a temperature probe and remind him that there’s a new IV fluid warmer available if he should need warmed fluids. Marie has diabetes, so you check her latest blood glucose level and communicate it to the team. During induction, Marie reports she is warm and comfortable. You have used your evidence-based knowledge to help your patient. January/February 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 614B

More than 27 million people undergo surgery annually in the United States,1 and many suffer from avoidable adverse events. These events put patients at risk for injury and death when perioperative team members do not take the time to help prevent negative outcomes by using evidence-based practice. Negative outcomes that compromise patient safety may lead to surgical infections and increase healthcare costs. For instance, healthcare costs for treatment of surgical infections are estimated to be about $120 billion annually.2 The federal government and organizations such as the World Health Organization, Association of periOperative Registered Nurses, Centers for Medicare & Medicaid Services and The Joint Commission have taken steps to promote patient safety by establishing patient safety goals. National patient safety goals are more than an attempt to standardize perioperative patients’ care: They promote actions that contribute to positive outcomes and optimal patient care. EBP serves as the underlying rationale for appropriate actions; therefore, it is key to practice and promote EBP in all clinical settings, including the perioperative environment. For the acute-care and outpatient nurse, that environment includes the preoperative holding area, the OR and the post-anesthesia care unit. This module covers the three “Hs” of potential adverse effects: hypothermia, hypoglycemia and hand-off miscommunication. Each topic includes an overview of EBP information that nurses can apply to help reduce patients’ risk of 48

OR TODAY | January/February 2015

suffering harm from these events. The ability to apply the information depends on a solid understanding of EBP in the perioperative setting. EVIDENCE-BASED PRACTICE EBP is a problem-solving approach to the delivery of care that incorporates the best evidence from studies, clinical expertise and patient preferences.3,4 It integrates both clinical practice and best clinical evidence from research, and adds in the practitioner’s expertise in clinical matters along with the patient’s preferences and values about his or her care and treatment during the surgical stay.5 All these factors are integral to establishing effective change. The fast-paced environment of the preoperative holding area, OR and PACU may allow little time for nurses to seek evidence-based information or conduct research during a typical day. Some nurses may not see how EBP is applicable in the clinical setting. Others may fear research and believe it is too time consuming to read, not readily available or too difficult to understand. Often, nurses discover that research is not as formidable as they believed when a mentor, such as a nurse educator, presents it. Nurse educators and advanced practice nurses have experience in searching for evidence-based information for the clinical setting and may help perioperative nurses implement it in their daily practice. Questioning our practice and determining if there’s a need for change begins the process of EBP. There are six steps for evidencebased change:6,7

1 Assess the need for change 2 Locate the best evidence 3 Critically analyze the evidence 4 Design the practice change 5 Implement and evaluate the change 6 Integrate and maintain the change Asking a clinical question about a practice need and searching for research-based resources increases knowledge and helps with critical evaluation of the evidence for usefulness and importance in the perioperative setting. After completing the analysis, designing a clinically applicable plan is the next step. Once the change is evaluated for practicality and implemented, it needs support to maintain the change over time. The support comes from peers, who must be committed to the change or have a buy-in, from administrators, who may need to provide additional resources — personnel, money or equipment — to maintain its implementation, and from physicians as well as anesthesia providers who support the new practice change. Nurses in each area of the perioperative setting can influence patient outcomes. Nurses can have a positive impact in the preoperative holding area during admission, in the OR during surgery, and in the PACU with recovering patients. None of the settings are islands to themselves, but rather they affect patient outcomes in the total continuum of care. EBP is not exclusive to any one of the settings, but it encompasses all of them, and nurses play a vital role in its promotion. WWW.ORTODAY.COM

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H = HYPOTHERMIA The most common complication of surgery is unintended hypothermia, which is the reduction of core body temperature to 35 C or lower.8 In the OR, 52% of patients and 42% in the PACU were found to have unintended hypothermia.9 In addition, some may be as high as 50% to 90%.10 For the surgical patient, hypothermia can be traced to heat loss due to the cold environment in the surgical room and the effects of anesthesia-induced thermoregulation impairment.8 Hypothermia can cause adverse events, such as cardiac arrhythmias, surgical site infections, increased mortality, metabolic acidosis, respiratory distress, increased blood loss, alteration of medication metabolism and muscle relaxation, and may prolong the post-surgical recovery time.8,11 Risk Factors: Risk factors for hypothermia can be placed into five categories: body weight, age, medications, environment and patient procedure elements. Thin patients who have a low body weight and less fat are at risk for hypothermia because of their limited insulation and large body surface area to weight ratio, unlike obese patients who have a high body-fat content and are able to maintain their tissues at higher temperatures and a vasodilated state before anesthesia induction.8 Similar risks for poor outcome in maintaining temperature is a consequence for the elderly, who are not as able to regulate their body heat and have less fat and muscle mass, which causes them to lose heat more rapidly.1 On the other side WWW.ORTODAY.COM

of the age spectrum, neonates and infants have a greater body surface to weight ratio, which increases heat loss through the skin.8 According to The Joint Commission and the Accreditation Association for Ambulatory Health Care, medications such as antipsychotics, antidepressants and muscle relaxants prevent the hypothalamus from being able to regulate the body’s heat production and increase heat loss.11,12,13 In addition, patients with depression tend to already have impaired thermoregulation. The nature of the surgical procedure can play a role in hypothermia. For example, a patient who requires a tourniquet experiences hypothermia because the constricted area impairs heat exchange between the limb with the tourniquet and the rest of the body. Limb temperature is maintained during inflation, but once the tourniquet is deflated, heat is lost as it is being redistributed to the limb.12,13 Surgical procedures leave the body vulnerable to heat loss, not only because of the cold OR environment, but also due to procedures with large incisions and the use of cool irrigation fluids. Any procedure that requires regional or general anesthesia also puts patients at risk. Anesthesia impairs the body’s ability to respond to the increased heat loss by reducing metabolism and depressing the hypothalamus’s ability to regulate the body’s heat production.1 In one research study, hypothermia induced during coronary artery bypass caused a decline in cognition.14 Another study found that mild hypothermia caused decreased heart rate, diastolic

dysfunction and lower cardiac output.15 Finally, hypothermia has been associated with a 68% increase in surgical site infection.16 Nursing Actions Across the Spectrum of Care: A team effort helps minimize hypothermia’s negative outcomes.17 In the preoperative holding area, the nurse can assess a patient’s risk of hypothermia by evaluating vital signs, laboratory results, planned type of anesthesia and general health status. Preoperative assessment provides a baseline for planning care.8 One of the first steps the nurse can take to minimize hypothermia is to maintain a warm preoperative holding area and provide warm blankets before the patient goes to the OR. The OR nurse can minimize heat loss by warming the OR table using warm blankets/forced-air blankets, monitoring temperature, using warm irrigating fluids and IV solutions, and observing patients’ temperatures during the procedure. Observation of temperature is done in conjunction with the anesthesia provider, who can obtain continuous intraoperative core temperature measurement by pulmonary artery, distal esophagus, tympanic membrane or nasopharynx. Finally, in the PACU, warm blankets/forced-air blankets, brought with the patient from the OR, and evaluation of the effectiveness of previous efforts to maintain the temperature above 36 C help maintain continuity of care. H = HYPOGLYCEMIA According to data from the 2011 National Diabetes Fact Sheet, 25.8 January/February 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 614B

million (8.3%) children and adults in the U.S. have diabetes, with 7 million of them yet to be diagnosed.18 In 2010, 1.9 million new cases were diagnosed in people over 20 years old.18 Diabetes cost $245 billion in care in 2012, the latest year a statistic is available.18 Poor glucose control can result in heart disease, stroke, amputations, infections, kidney disease and even death.18 This has led the Centers for Medicare & Medicaid Services to add death or disability due to hypoglycemia as a never event.19 Hypoglycemia (glucose levels of 70 mg/dL or below) occurs when glucose consumption or release from the liver does not keep pace with the amount entering the cells.20 Too little food and too much hypoglycemic medication cause patient blood glucose levels to drop below normal. Patients on insulin and oral glucose lowering drugs can experience hypoglycemia because of adverse reactions to insulin or hypoglycemic agents, which can cause injury, accidents, and in rare cases, brain damage and death.21 For example, injuries and accidents may occur as a result of confusion, weakness and motor deficits. Patients may be more susceptible to falling and loss of consciousness due to low levels of the brainâ&#x20AC;&#x2122;s fuel source, glucose. Controlling diabetes by keeping blood glucose levels near normal prevents adverse events and reduces complications. Signs and Symptoms Vary: Glucose is not only a source of fuel for the human body, but also a critical element for brain function. Yet symptoms do not necessarily 50 OR TODAY | January/February 2015

correlate directly to glucose levels. The American Diabetes Association says the relationship between blood glucose levels and hypoglycemia signs and symptoms vary from person to person and can differ in the same person depending on circumstances.20 For example, patients with low blood glucose levels may not have even mild symptoms, such as sweating, trembling, light-headedness, restlessness, confusion, irritability and hunger.21 On the other hand, signs and symptoms can occur even when tested blood glucose is within the acceptable range of 70 mg/dL to 100 mg/dL. This variation makes close monitoring and prompt treatment vital. Studies have shown that maintaining blood glucose levels between 80 to 120 increases excellent outcomes in patients after surgical procedures such as cardiac surgery. The positive outcomes are the result of nurses seeing glycemic control as an important component of nursing care and providing interventions to meet the goal of controlling reactions.22 Treatment and Nursing Protocols: Guidelines developed by the American Association of Diabetes Educators help RNs combat hypoglycemia. The guidelines include how to recognize and treat the patient when signs and symptoms become apparent.21 Preoperative blood glucose monitoring may prevent negative surgical outcomes, promote wound healing and decrease mortality and morbidity. Continuity of blood glucose monitoring by the anesthesia provider and PACU nurse can also help

prevent complications that may lead to seizures and death. The American Association of Diabetes Educators proposes that mild symptoms and blood glucose of less than 70 mg/dL be treated with 10 to 15 g of carbohydrates followed by retesting in 15 to 20 minutes. This treatment is repeated until blood glucose is above 70 mg/ dL.21 When the blood glucose level is below 50 mg/dL, 20 to 30 g of carbohydrates should be administered, glucose levels retested in 15 minutes and treatment repeated if the level remains below 70 mg/dL.21 Patients who are unable to swallow and have more advanced symptoms are treated with 25 g of 50% dextrose or 1 mg of glucagon IM. Patients with severe hypoglycemia who lose consciousness or have a seizure, or those who are unable to ingest carbohydrates by mouth receive 25 g of 50% glucose IV; those who do not have IV access are given 1 mg of glucagon IM or subcutaneously.21 Nurses provide the first line of defense against complications by using protocols to help treat patients with hypoglycemia. The protocol may include calling a rapid response team to help stabilize the patient and interact with the physician. The team is composed of on-call team members from the intensive care unit, ED, pharmacy, respiratory therapy and anesthesia. The protocol for the preoperative holding area nurse may be to call the rapid response team or an anesthesia provider who treats the patient. Each hospital and outpatient clinic needs to develop its own hypoglycemia WWW.ORTODAY.COM

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treatment protocols or programs based on recommendations from recognized national organizations and government resources to monitor patients and promote well-being. Having a protocol also promotes communication among nurses and physicians, including hand-off communication from the preoperative holding area to the OR and to the PACU. H = HAND-OFF COMMUNICATION Improving the effectiveness of communication among caregivers, including perioperative team members, is a safety goal of several agencies. The Joint Commissionâ&#x20AC;&#x2122;s 2011 National Patient Safety Goals include reporting critical results of tests and diagnostic procedures on a timely basis.23 The Joint Commission also developed a five-step process to implement a handoff tool.24 The Institute of Medicine also encourages patient-clinician communication to improve effectiveness and the value of healthcare.25 A key part of perioperative communication is the hand-off â&#x20AC;&#x201D; a report from one member of the team to another to ensure continuity of care. To be of value, a hand-off should be accurate, clear, specific and provide opportunity for all caregivers to ask questions or voice concerns.23 The Association of periOperative Registered Nurses states there must be limited interruptions, opportunity to question and clarify, and ability to verify information.26 Ongoing Communication: Hand-offs take place at each stage of the perioperative process, WWW.ORTODAY.COM

starting with the preoperative holding area. Here, the nurse obtains important information to communicate to the OR nurse. This includes identifying the patient using a double identifier of name and birthday or name and medical records number, verifying the consent has been signed, obtaining vital signs and assessing patient understanding. Other important information is history and physical results, NPO status, medications taken, laboratory test abnormalities and allergies. The nurse also completes pre-op teaching and teach-back of patient and family, and the surgeon verifies and marks the operative site for the OR team. These steps, along with patient concerns, cultural implications, medication reconciliation and vital signs, are documented, and the preoperative holding area nurse communicates this information to the OR nurse.26,27 Before surgery, the OR team discusses the plan of care and conducts a Time Out before the incision is made. The Time Out includes introduction of team members, verification of correct patient, signed consent, surgical procedure and site; NPO status; allergies; vital signs; and medications given. Relevant images, such as X-rays, are labeled and displayed so the team can see them. Any outstanding issues and concerns of the team and patient are discussed with the team members, including the circulating nurse, scrub nurse, anesthesia provider, assistants and surgeon. Examples of topics are availability of equipment, antibiotic prophylaxis, confirmation of

sterilization indicators, case duration, anticipated blood loss and critical or nonroutine processes. Each member plays a vital role in communicating the needs and wishes of the patient. Once the surgical procedure is completed, the OR nurse communicates to the PACU nurse. Patient identification, history, procedure, medications given, how the procedure was tolerated, fluids given, type of anesthesia, estimated blood loss, oxygen saturation, urine output, complications, hemodynamic stability and current level of pain are included in the report.26,28 In turn, the PACU nurse communicates similar information when transferring the patient to another area. The method of hand-off should be standardized and easy to use.28,29 Structured tools can help ensure consistency.26 For example, the ISBAR (Introduction, Situation, Background, Assessment, Recommendation) format could be used when a preoperative holding area nurse must call an anesthesia provider because of a particular issue. The Association of periOperative Registered Nurses has a Web-based tool kit to help perioperative professionals standardize hand-off communications. Effective communication will not only help in facilitating a safe environment and decrease the anxiety of the surgical patient and family, but it also will help the team to anticipate issues and may limit complications so positive outcomes and continuity of patient care may be achieved.26,27,30

January/February 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 614B

RISKS OF HYPOTHERMIA8 AGE

The elderly lose heat more rapidly.

The young can regulate their temperatures.

Obese patients maintain tissue at higher temperatures.

BODY WEIGHT

Thin patients have limited insulation.

MEDICATIONS

Antipsychotic medications decrease the Chronically depressed patients have ability of the hypothalamus to regulate thermoregulation impairment. temperature.

ENVIRONMENT

PATIENTS

Cold rooms, beds, blood and fluids increase heat loss.

Warming solutions, beds, patients and rooms help retain heat.

Large incisions cause loss of heat though exposure of internal organs.

Small incisions (e.g., laparoscopic incisions) cause less heat loss.

CONDUCT A SELF-ASSESSMENT Keeping the patient safe from hypothermia, hypoglycemia and hand-off miscommunication requires the nurse to understand evidence-based practices that should be implemented on a daily basis in the perioperative setting. Nurses, both individually and as a team, should periodically assess evidence in the three “Hs” to ensure their practice is congruent with the latest findings and to make 52

OR TODAY | January/February 2015

modifications as needed. Doing so is part of a nurse’s role as a patient advocate. SOPHIA MIKOS-SCHILD, RN, MSN, EDD, MAM/HROB, CNOR, is the Magnet Coordinator at Presence St. Mary and Elizabeth Medical Center in Chicago, Ill. She has presented various programs and written many publications, chapters and contact hour programs for the non-perioperative and perioperative settings. She is the former column editor of the legal/

ethical column for the Journal of Nursing Staff Development. The author has declared no real or perceived conflicts of interest that relate to the educational activity. REFERENCES 1. The Importance of Maintaining Normothermia. Eden Prairie, MN: Arizant Healthcare; 2009. 2. Girard N. Perioperative Nursing Clinics — Infection Prevention in the Perioperative Setting: Zero Tolerance for Infections. Philadelphia, PA: WB WWW.ORTODAY.COM

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Saunders Company; 2010. 3. Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine: How to Practice and Teach EBM. London, England: Churchill Livingstone; 2000. 4. Melnyk BM, Fineout-Overholt E, Stetler C, Allan J. Outcomes and implementation strategies from the first U.S. evidence-based practice leadership summit. Worldviews Evidence-Based Nurs. 2005;2(3):185-193. 5. Leufer T, Cleary-Holdforth J. Evidence-based practice: improving patient outcomes. Nurs Stand. 2009;23(32):35-39. 6. Rosswurm MA, Larrabee JH. A model for change to evidence-based practice. Image J Nurs Scholarship. 1999;4(31):317-322. 7. Larrabee J. Nurse to Nurse: Evidence-Based Practice: A Step-by-Step Handbook. New York, NY: McGraw-Hill; 2009. 8. AORN Recommended Practices Committee. Recommended practices for the prevention of unplanned perioperative hypothermia. AORN J. 2007;85(5):972-974, 976-984, 986988. 9. Winslow EH, Cooper SK, Haws DM, et al. Unplanned perioperative hypothermia and agreement between oral, temporal artery, and bladder temperature in adult major surgery patients. J Perianesth Nurs. 2012;27(3):165-180. 10. Moola S, Lockwood C. Effectiveness of strategies for the management and/or prevention of hypothermia within the adult perioperative environment. Int J Evid Based Healthcare. 2011;9(4):337-345. 11. Hooper V, Chard R, Clifford T, et al. ASPANâ&#x20AC;&#x2122;s evidence-based clinical practice guideline for the promotion of perioperative normothermia: second edition. J PeriAneth Nurs. WWW.ORTODAY.COM

2010;25(6):346-365. 12. Comprehensive Accreditation Manual for Ambulatory Care. Oakbrook Terrace, IL: The Joint Commission; 2006. 13. Accreditation Handbook for Ambulatory Health Care. Skokie, IL: Accreditation Association for Ambulatory Health Care; 2004. 14. Hall MW, Hopkins RO, Long JW, Mohammad SF, Solen KA. Hypothermia-induced platelet aggregation and cognitive decline in coronary artery bypass surgery: a pilot study. Perfusion. 2005;20(3):157-167. 15. Fischer UM, Cox CS, Laine GA, Mehlhorn U, Allen SJ. Mild hypothermia impairs left ventricular diastolic but not systolic function. J Invest Surg. 2005;18(6):291-296. 16. Hooper V. Revisiting the ASPAN evidence-based clinical practice guideline for the promotion of perioperative normothermia. J Perianesth Nurs. 2010;25(6):343-345. 17. Weirich TL. Hypothermia/warming protocols: why are they not widely used in the OR? AORN J. 2008;87(2):333-344. 18. Diabetes statistics. American Diabetes Association Web site. http://www. diabetes.org/diabetes-basics/diabetesstatistics/?utm_source=WWW&utm_ medium=DropDownDB&utm_ content=Statistics&utm_ campaign=CON. Accessed November 25, 2013. 19. Munoz C, Lowry C, Smith C. Continuous quality improvement: hypoglycemia prevention in the perioperative surgical population. MedSurg Nurs. 2012;21(5):275-280. 20. Watts SA, Anselmo JM, Smith MA. Combating hypoglycemia in the hospital and at home. Nursing. 2003;33(3):321-325. 21. Anthony M. Hypoglycemia in

hospitalized adults. Medsurg Nurs. 2008;17(1):31-34. 22. Henry L, Dunning E, Halpin L, Stanger D, Martin L. Nursesâ&#x20AC;&#x2122; perception of glycemic control in patients who have undergone cardiac surgery. Clin Nurs Spec. 2008;22(6): 271-277. 23. Ambulatory health care: 2013 national patient safety goals. The Joint Commission Web site. http://www. jointcommission.org/standards_information/npsgs.aspx. Accessed November 25, 2013. 24. Petrovic MA, Martinez EA, Aboumatar H. Implementing a perioperative handoff tool to improve post procedural patient transfers. J Comm J Qual Patient Saf. 2012;38(3):135-142. 25. Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine Web site. http:// www.iom.edu/Reports/2001/Crossingthe-Quality-Chasm-A-New-HealthSystem-for-the-21st-Century.aspx. Published March 1, 2001. Accessed November 25, 2013. 26. Patient hand-off tool kit. Association of periOperative Registered Nurses Web site. http://www.aorn. org/PracticeResources/ToolKits/PatientHandOffToolKit. Published 2012. Accessed November 25, 2013. 27. Amato-Vealey EJ, Barba MP, Vealey RJ. Hand-off communication: a requisite for perioperative patient safety. AORN J. 2008;88(5):763-770. 28. Forsythe L, Persaud D, Swanson M, Stierman C. Practice pointers: smoothing the process of hand-off communication. OR Nurs. 2008;2(2):56. 29. Perioperative grand rounds: tacit handover, overt mishap. AORN J. 2011;93(6):812. 30. Nagpal K, Arora S, Abboudi M, et al. Postoperative handover: problems, pitfalls, and prevention of error. Ann Surg. 2010;252(1):171-176. January/February 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 614B

CLINICAL VIGNETTE Karen Summers, age 69, is in the preoperative holding area before her scheduled open-heart surgery. She has type 2 diabetes treated with oral hypoglycemic and regular insulin and has an IV. Her vital signs are 132/78 mmHg blood pressure, 37 C temperature, 86 pulse, and 18 respirations. She has had nothing by mouth and only taken sips of water to swallow her medications. She appears thin and responds slowly to questions asked. She says she feels “chilly.” Soon, Karen begins to complain of a headache, vertigo and drowsiness. She becomes pale and has difficulty speaking. She is able to state that she did not eat but took her oral medications. The preoperative holding area nurse obtains a blood glucose level per protocol.

Given Karen’s history and planned surgery, the PRIMARY assessment areas for the preoperative holding area nurse include: A. Whether Karen has a family member with her B. Temperature and signs and symptoms of hypoglycemia C. Karen’s cultural background D. Reflex responses

Karen’s blood glucose level comes back as 40 mg/dL. Which is an appropriate hypoglycemia protocol order? A. Administer 25 g of 50% dextrose. B. Administer 15 g of carbohydrates. C. Repeat the blood glucose in 30 minutes. D. Repeat the blood glucose in 60 minutes.

The preoperative holding area nurse communicates what occurred with Karen to the OR nurse. Which would make the hand-off more effective? A. Not using the same hand-off tool for each communication B. Providing information that is extremely detailed C. Implementing a standardized tool that is easy to use D. Not including time for questions to avoid delays in patient care

In the OR, the nurse will know that Karen is experiencing hypothermia if her temperature is _____ or lower. A. 35 C B. 36 C C. 38 C D. 40 C

4. Correct answer: A — Unintended hypothermia is the reduction of core body temperature to 35 C or lower. Karen is at risk for hypothermia because of anesthesia and the fact that she is having a major surgical procedure. 3. Correct answer: C — The hand-off should be standardized and easy to use so it’s more effective. A tool can be used to help standardize the hand-off. Hand-offs need to be concise and allow time for questions. 2. Correct answer: A — Patients who are unable to swallow and have more advanced symptoms (like Karen) are typically treated with 25 g of 50% dextrose IV or 1 mg of glucagon IM. Glucose levels should be retested 15 minutes after dextrose administration. 1. Correct answer: B — Hypoglycemic signs and symptoms vary in patients with diabetes and must be monitored closely. Body temperature must be at least 36 C to prevent inadvertent hypothermia. Too little food and/or too much hypoglycemic medication can cause a patient’s blood glucose level to drop below normal. 54

OR TODAY | January/February 2015

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CONTINUING EDUCATION 614B

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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 11/30/2015. 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer. 4.

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

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This makes it important to get a jumpstart on your conference planning if you want to get the most beneďŹ t out of your time at the conference.

R U O Y E D I U G E TO TH N R AOFERENCE

CON

By Don Sadler

he AORN Surgical Conferenc e & Expo 2015 is rig ht around the corne r. And this year â&#x20AC;&#x2122;s AORN eve nt, which will be held Marc h 7-11 in D enver, Colo., is sh aping up t o be the bigge st and bes t AORN conferenc e yet.

Every year since 1949, thousands of perioperative nurses, representatives from OR technology and equipment manufacturers, and other industry participants have gathered for the five-day AORN Surgical Conference & Expo. This makes the AORN conference the largest event for the perioperative nursing profession in the world.

Opening day on the exhibit floor at the 2014 event in Chicago. Conference attendees spent hours on the floor meeting with reps and learning about new products for the operating room.

60 OR TODAY | January/February 2015

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A N

O R

HIGHLIGHTS OF THE 2015 CONFERENCE A number of new things are planned for the 2015 conference, according to Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, the Executive Director and CEO of the Association of periOperative Registered Nurses (AORN). “This makes it important to get a jumpstart on your conference planning if you want to get the most benefit out of your time at the conference,” says Groah. Back by popular demand this year is the OR Executive Summit. Designed for nurse executives, this exclusive event provides executivelevel education and information to help drive productivity and profitability in the OR. And new this year will be the Leadership Development Summit, where attendees can gain practical leadership skills and insight from a leadership point of view. Another exciting addition for this year’s AORN conference is the introduction of a new app that will enable attendees to plan out a personalized track for the conference before arriving in Denver. With this app, you can create your customized conference schedule; search sessions by date, time or track; get event announcements; locate sessions and exhibitor booths; learn about speakers, exhibitors and other attendees; and take notes. Download the app for free at aorn.org/2015Denver. In addition, the app will allow interaction between speakers and attendees in each session. “The days of sitting in a lecture room and listening to a speaker with a PowerPoint presentation are over,”

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says Groah. “The app will make the sessions more interactive by allowing speakers to poll attendees, and attendees to text questions to speakers in real time.” Another exciting new feature at the AORN conference this year is “Flip the Sessions.” Here’s how it will work: Before the conference, attendees can listen to a lecture via webinar to learn about an important topic. In some instances, attendees will be challenged to consider aspects of the discussion to prepare for the live session at the conference. Once onsite, attendees will meet with colleagues and the presenter to explore your questions and work in small groups to solve problems related to the topic. Attendees will receive a recording of the live webinar prior to the conference, and it will also be repeated onsite in the Education Hub prior to the session. Learn more at aorn.org/surgicalexpo.

Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, the Executive Director and CEO of the Association of periOperative Registered Nurses

The days of sitting in a lecture room and listening to a speaker with a PowerPoint presentation are over,” says Groah. “The app will make the sessions more interactive by allowing speakers to poll attendees, and attendees to

EDUCATION HUB IS EXPANDING This year, the popular Education Hub is expanding to 300 seats, and the hours are being extended so that it’s open from 7 a.m. until 7 p.m. each day of the conference. Up to eight conference sessions will be streaming at once, so attendees can relax in the hub with a cup of coffee and

text questions to speakers in real time.

– Linda Groah

January/February 2015 | OR TODAY

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catch up on any sessions they might have missed. The Periop Challenge is another new feature at the 2015 AORN Surgical Conference & Expo. In this competitive session, attendees will be divided into four teams pitted against each other in answering evidence-based questions related to perioperative practice. Cartoons, questions and real-life perioperative situations will be presented, and the team that responds the fastest with the most correct answers will win. At the new Buzz Sessions, attendees will drive the discussion in a facilitated format with a topic expert by sharing challenges and solutions. Registered attendees can submit topics in advance for these Buzz Sessions by sending an email to AORN’s Director of Education, Susan Bakewell, at sbakewell@aorn.org. Collaboration boards located throughout the conference area will

OR TODAY | January/February 2015

enable attendees to post questions they have or problems they’re dealing with so that other attendees can offer answers and suggestions. One full day will be devoted exclusively to patient positioning challenges, with hands-on simulation sessions focused on preventing pressure ulcers that occur due to improper positioning.

ATTENDEE TESTIMONIALS Larry Asplin, RN, MSN, CNOR, the Clinical Director, Surgery/Central Processing at CentraCare Health-St. Cloud Hospital in St. Cloud, Minn.,

has been regularly attending the AORN annual conference since 1991. He says one of the things he looks forward to the most each year is the OR Executive Summit. “It provides outstanding sessions designed specifically for perioperative leaders that truly inspire and motivate attendees,” says Asplin. “I believe the OR Executive Summit represents the best value for OR leaders. Each year, I leave with more inspiration and zeal for providing outstanding patient care.” At the other end of the attendee spectrum, Ann Shupe RN, MSN, CNOR, the Manager of Education, Safety, Quality and Informatics Surgical Services for Spectrum Health-Grand Rapids in Grand Rapids, Mich., attended her first AORN conference last year. “I had always wanted to attend AORN because I’d heard what a great experience it is,” says Shupe. “I also heard that

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Exhibitors at

the product displays are comprehensive, and I wanted to compare everything available all in one place.” Shupe says she realized many benefits from last year’s AORN conference. “It offered relevant and current educational sessions and poster presentations and the opportunity to network with other professionals in surgery from across the country, as well as to spend time with nurses from my hospital system brainstorming about new ideas,” she says. Asplin echoes Shupe’s recommendation of the AORN conference, especially the networking opportunities it presents. “The benefits realized from attending the AORN Surgical Conference & Expo make this conference a tremendous value. Once you have attended one AORN conference, you will likely be hooked,” Asplin says. WWW.ORTODAY.COM

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offer free CE the conference

He encourages new attendees not to be shy about wearing the green first-time attendee ribbon or attending the first-time attendee orientation. “The conference can be a little overwhelming at first, so take advantage of this and don’t be afraid to ask others for assistance,” Asplin says. “You have hundreds of colleagues who will welcome and support you during your inauguration to the AORN conference.”

FUN ACTIVITIES ALSO PLANNED Of course, there are plenty of fun activities planned for the time in Denver, including the AORN Foun-

the floor.

dation Race for Patient Safety 5K Run/3K Walk, Zumba Class, Party and Benefit, and Auction. Groah encourages anyone who plans to attend the 2015 AORN Surgical Conference & Expo to start planning out their conference agenda now. “There will be more than 100 sessions at the conference, so use the app to plan out the sessions you want to attend ahead of time,” she advises attendees. “And also think about how you will bring the information and resources from the conference back with you to implement and share with your colleagues in order to make positive changes in your environment.” IT’S NOT TOO LATE TO REGISTER for the 2015 AORN Surgical Conference & Expo. Visit www.aorn.org/surgicalexpo to download a conference brochure or to complete conference registration online. January/February 2015 | OR TODAY

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Action Products, Inc. Booth #3817 www.actionproducts.com Bemis Health Care Booth #1441 www.bemishealthcare.com Censitrac Booth #4025 www.censitrac.net Cincinnati Sub-Zero Booth #3017 www.cszmedical.com Clorox Professional Products Booth #1802 cloroxprofessional.com Cygnus Medical Booth #3825 www.cygnusmedical.com D.A. Surgical Booth #4212 www.da-surgical.com

OR TODAY | January/February 2015

GelPro Medical Booth #4329 www.GelProMedical.com Healthmark Industries Booth #1817 www.hmark.com Innovative Medical Products Booth #1837 www.impmedical.com KAPP Surgical Instrument Inc. Booth #3421 www.kappsurgical.com Key Surgical booth # 811 www.keysurgical.com

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January/February 2015 | OR TODAY

“There’s still no substitute for a sterile working environment and a surgical conscience” – Cindy Mask, CST, FAST, AA, BAAS

OR TODAY | January/February 2015

WWW.ORTODAY.COM

LENDING A HELPING HAND Spotlight On: Cindy Mask, CST, FAST, AA, BAAS By Matthew N. Skoufalos

n 1983, when certified surgical technologist Cindy Mask began working in the operating room, every patient that presented with complaints of pain was a candidate for exploratory surgery. Such practices were a product of the technological limitations of the day, but they also contributed to an increased risk of exposure to infection, physician error and other unintended consequences. In the years since, the adoption of technological advancements in medical imaging and robotic-assisted and minimally invasive surgeries has addressed many of those concerns, but thereâ&#x20AC;&#x2122;s still no substitute for a sterile working environment and a surgical conscience. Those are the hallmarks of professionalism in the OR, and the two biggest lessons that Mask, Clinical Coordinator of SurgicalÂ Technology at Tarrant County College in Ft. Worth, Texas, passes on to her charges.

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January/February 2015 | OR TODAY

“The role [of CST] is so important,” Mask said. “You treat my momma like you treat your momma. And you treat that person on the table as if they’re your family member.” Gone are the days, Mask said, when the general surgeon in your local hospital — especially in less urban areas — would be the neighborhood physician who handled all the needs of the community. Today, in an environment of specialization (and sub-specialization), practitioners meet with a patient once, if at all, and it’s much easier for the human element of the process to be lost in the relentless caseload.

“There is a disconnect,” she said. “Even for me, as a practitioner, it gets that way. You do the same kind of cases every day, you’re on call 40 hours a week, and it becomes like flipping burgers until you have that ‘a-ha’ moment, and something changes.” She’s speaking in generalities, of course, but Mask came face-to-face with the vivid reality of that attitude when her father was an open-heart surgery patient in 2000. “I knew how people acted and complained, and I wanted him treated like all those patients should be treated,” she said. “If you treat that patient like a family member,

“The role [of CST] is so important. You treat my momma like you treat your momma. And you treat that person on the table as if they’re your family member.” – Cindy Mask, CST, FAST, AA, BAAS

“Usually what happens is the surgeon literally walks in the room when you’re already draped, and he doesn’t even know who’s under that drape,” Mask said. “So you hope it’s the right part and you hope it’s the right patient, but that’s how mistakes are made. They just come in when everything’s already anesthetized and draped and they don’t even see you.”

OR TODAY | January/February 2015

then you’re going to go that extra step. You should be treating that ten-o’clock-at-night patient the way you do at 6 a.m., or you need to get out of the profession. That’s how I feel, and that’s what I instill in my students.” In Mask’s program, the principal burden for students is to understand and practice “impeccable sterile technique,” she said. According to

WWW.ORTODAY.COM

PAY IT FORWARD Sigma Tau continues to seek the donation of gloves, scarves and winter weather accessories for its glove charitable project benefitting SafeHaven of Tarrant County. Launched in 2006 by Instructor and Sigma Tau Advisor Cindy Mask, the project has helped to clothe thousands of children and women at the local domestic abuse shelter and continues to grow nationwide. Community colleges in several states have contacted Mask to implement the project in their own communities. Thousands of donations have been received already, but Mask welcomes any additional monetary or apparel contributions to help â&#x20AC;&#x153;glove the world.â&#x20AC;? Checks made out to the Glove Project can be mailed to The Glove Project, ATTN: Cindy Mask, 245 E. Belknap, Suite 6111J, Fort Worth, Texas 76102. FOR MORE DETAILS, contact Mask at 817-515-2403 or email her at Cindy.Mask@tccd.edu.

WWW.ORTODAY.COM

January/February 2015 | OR TODAY

Mask, CSTs who don’t know where their sterile boundaries are “don’t deserve to be in the operating room,” and students who fail to grasp the concept unceremoniously wash out of the program. “You have to know incredible sterile technique or you could kill somebody,” she said plainly. “It’s imperative that you know that. Doctors are very demanding, which they should be. I want them to be demanding if they’re cutting me open.”

“You will be put out of the program if you make a mistake and don’t own up to it immediately. If you try to lie about something like, ‘I gave the patient the wrong medication,’ or ‘I didn’t want the doctor to be mad,’ then my job is damage control.” “Everybody has a surgical conscience or you’re in the wrong profession,” Mask said. “Before the surgical technologist passes the scalpel to the surgeon, they do what’s called a time-out. ‘This is Mr. Jones,

about a surgical mistake is a life and death error. “If you lie about that, you’ll lie about anything,” she said. “You can’t live with yourself hurting a patient.” Tenets like that are going into Mask’s upcoming, self-published book, “Do Not Go to the Operating Room Without This Book.” She intends the guide to be a handbook for laypeople who feel intimidated or confused by doctors’ orders, and has been collecting stories for

rile technique or you could kill

ste “You have to know incredible

– Cindy Mask, CST, FAST, AA,

The 11-month accredited course is state-mandated in Texas, as well as in Indiana, New Jersey, Massachusetts, South Carolina, New York, Tennessee, Washington and Colorado. Only 80 percent of the students who begin Mask’s course complete it, she said. The only ways to fail are to mess up either of the two practicums in the program, or to demonstrate the absence of a surgical conscience. The lessons are severe, she said, but compromising on patient safety is out of the question. “I coach it into them from day one when they sign their code of conduct,” Mask said. 70

OR TODAY | January/February 2015

somebody.”

BAAS

he’s having an arthroscopy; he had antibiotics at 10 a.m.’ If one person in that room has a little voice that doesn’t feel right, you speak up.” “Always do the right thing for the patient,” she said. That’s your mom or dad or your kid on the table. Always remember that.” Fortunately, Mask said, she has never had to disqualify someone from the program on such grounds — which, from one perspective, indicates that her lessons are sticking. Her charges can be disciplined for making mistakes, and should expect to be. But, as Mask said, lying

months — mostly from friends of her parents who pepper her with queries when they discover she works in the healthcare field. “You ask questions about everything you do in your life,” Mask said. “Why didn’t you ask your doctor? ‘Well, he didn’t have time for me.’ That’s what my book’s about. And it’s for family members.” Coming from someone whose adage is “treat my momma like you would your momma,” it’s bound to be filled with practical perspectives — and worldly advice likely applicable beyond the scope of medicine. WWW.ORTODAY.COM

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January/February 2015 | OR TODAY

OUT OF THE OR HEALTH

DENSIE WEBB, PH.D., R.D., ENVIRONMENTAL NUTRITION

SHOULD YOU GO GLUTEN-FREE? Y

You may have noticed that gluten-free options are everywhere these days. It’s easy to find just about any food that involves grains, including breads, cookies, breakfast cereals, and snack bars in gluten-free form. So, should you go gluten-free? The odds are you don’t have to. But if you suspect gluten may be bothering you, here’s what you need to know before taking the gluten-free plunge. CELIAC DISEASE VS. GLUTEN SENSITIVITY Celiac disease is a serious genetic autoimmune disease in which the body reacts to the ingestion of gluten, a sticky protein found in wheat, barley and rye, by damaging the small intestine and interfering with the absorption of important nutrients. It is diagnosed by a blood test for gluten 74

OR TODAY | January/February 2015

antibodies and a small biopsy of intestinal tissue. It affects less than one percent of the population. If tests for celiac disease are negative and a wheat allergy has been ruled out, but symptoms continue, gluten sensitivity (nonceliac gluten sensitivity) may be the culprit. NCGS, a much less severe reaction to gluten, is estimated to affect as much as six percent of the population – still a minority, but six times more common than celiac disease. According to Rachel Begun, M.S., R.D.N., C.D.N., food and nutrition consultant and a gluten-related disorders expert, “There is no scientifically proven test for diagnosing NCGS; instead, it is a diagnosis of exclusion. Once celiac and other conditions have been ruled out and symptoms improve when gluten is eliminated from your diet, then NCGS is diagnosed. While not as damaging as celiac disease, the symptoms of NCGS can be just as bothersome.

THE GLUTEN SENSITIVITY RX There’s no pill or shot to treat gluten sensitivity. Shelly Asplin, MA, RD, LMNT, who herself requires a gluten-free diet, recommends a strict gluten-free diet for people with NCGS. “Watch for wheat, barley, rye and their derivatives on all products and buy grains, seeds and flours labeled ‘gluten-free,’ ” Asplin notes. As with celiac disease, a gluten-free diet is required for life. GLUTEN-FREE LABELS Beginning Aug. 5, 2014, the U.S. Food and Drug Administration mandated strict criteria on foods and supplements that are labeled “gluten-free.” That means that any product labeled gluten-free may contain no more than the smallest amount (20 ppm) of gluten believed to be safe for the majority of people with celiac. That goes for people with NCGS, as well. Keep in mind, however, that the USDA, which regulates meat and poultry, does not have gluten-labeling WWW.ORTODAY.COM

GLUTEN FREE DO’S AND DON’T’S DO EAT

THESE COULD CONTAIN GLUTEN

DON’T EAT

1. Amaranth

11. Nut flours

1. Barley

8. Malt

2. Arrowroot

12. Potato

9. Rye

3. Beans

13. Quinoa

2. Brewer’s yeast

1. Any food with starch or dextrin as an ingredient

10. Semolina

2. Brown rice syrup

4. Buckwheat groats

14. Rice

11. Spelt

3. Candy

5. Cassava

15. Sorghum

12. Triticale

4. French fries

6. Chia

16. Soy

13. Wheatberries

5. Potato chips

7. Corn

17. Tapioca

8. Flax

18. Teff

9. Gluten-free oats

19. Yucca

3. Durum 4. Emmer 5. Farina 6. Farro 7. Graham

6. Processed lunch meats 7. Salad dressings and marinades 8. Sauces and gravies

10. Millet

9. Scrambled eggs (some restaurants put pancake batter in their scrambled eggs and omelets) 10. Vegetarian meat substitutes

requirements. While meat and poultry are naturally gluten-free, cross contamination during processing can occur. In addition, gluten-free labeling is not required on restaurant menus and, as with meat and poultry, cross contamination of gluten-containing foods with foods that are otherwise gluten-free makes eating out a risky proposition. WWW.ORTODAY.COM

HOW DO YOU KNOW IF YOU’RE GLUTEN SENSITIVE? “People with NCGS are more likely to experience extra-intestinal symptoms than gastrointestinal symptoms, but it varies from person to person,” says Rachel Begun, M.S., R.D.N., C.D.N. Common symptoms include fatigue, headaches, bloating, foggy brain, and sometimes tingling

and numbness, but these are symptoms that could be caused by any number of conditions, making NCGS difficult to diagnose.

FOR MORE INFORMATION on gluten intolerance and gluten-free products, go to www.celiac.org. January/February 2015 | OR TODAY

OR TODAY | January/February 2015

WWW.ORTODAY.COM

OUT OF THE OR FITNESS

HARVARD HEALTH LETTERS

PHYSICAL AND MENTAL FITNESS ARE ESSENTIAL FOR A HEALTHY BACK W ith changes in the spine that come with aging, occasional backaches may grow more frequent and blossom into a chronic and disabling pain condition. But this doesn’t have to happen to you. To maintain the best back health possible, you have to address both the body and the mind, says Dr. Zacharia Isaac, a physical medicine and rehabilitation doctor at Harvard-affiliated Brigham and Women’s Hospital, Boston in Mass.

TIPS

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DON’T BABY YOUR BACK It’s important to respond to back pain constructively. “Acute back pain flare-ups are so painful that most people start to baby their backs,” Isaac says. “If people tend to shrink too much from their daily activity level, they get de-conditioned.” In turn, de-conditioning can lead to worse pain and disability. “Neurological changes happen

that sensitize you to the pain,” Isaac says. “That feeds into a cycle of more avoidance of activity and more de-conditioning.” When you have a sore back, avoid extended bed rest. Slowly transition back to your usual activities. “It’s important to maintain normalcy,” Isaac says. “Get up and walk around the house. Try to do light tasks. Maintain moderate activity.” January/February 2015 | OR TODAY

OUT OF THE OR FITNESS

“Moderate exercise is very helpful. Many people who are moderate exercisers have fewer musculoskeletal problems.”

STRENGTHEN YOUR CORE Strengthen the muscles that support the lower spine as an insurance policy. “Moderate exercise is very helpful,” Isaac says. “Many people who are moderate exercisers have fewer musculoskeletal problems.” Ask your doctor to suggest daily back exercises appropriate to your condition, or ask for a referral to a physical therapist to teach you the most effective exercises to prevent back pain.

OR TODAY | January/February 2015

STAY LIMBER If the muscles that support the lower spine become tight, it can make pain worse. Trouble generally develops in the muscles and ligaments of the pelvic girdle, which allow you to bend and twist at the waist. “When the hip girdle is unbalanced, you have more flare-ups of back pain,” Isaac says. Learn some stretches to keep your pelvic girdle limber. Some of the same exercises often recommended for routine back pain will help, but a physical therapist can carefully assess your specific musculoskeletal issues and prescribe stretches to release the tension.

STRAIGHTEN UP Poor posture can put stress on the back and trigger back pain. Don’t slouch when you sit. If you are slouching or leaning because of ongoing pain, loosening the hip girdle with stretching exercises may help. “That allows you to stand more upright and put less mechanical strain on the low back,” Isaac says. WWW.ORTODAY.COM

FITNESS

People who are depressed and anxious tend to have worse back problems. And, of course, back pain itself can get you down.

GET SOME SLEEP Getting restful sleep is essential for anyone with back problems because sleep deprivation sensitizes you to pain. “When you have poor sleep, it also alters brain chemistry and you’re more prone to developing a chronic pain state,” Isaac says.

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STAY POSITIVE AND RELAX People who are depressed and anxious tend to have worse back problems. And, of course, back pain itself can get you down. Like sleep deprivation, blue moods and anxiety can make you more sensitive to pain. Relaxing deep-breathing exercises can help relieve the stress of a back pain flare-up. If you are getting depressed, anxious, or hopeless about your condition, ask for more help from your doctor. Think of the flare-up as a temporary setback and focus on what you will be able to do in the future to make back pain a less frequent companion in your life.

Harvard Men’s Health Watch

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January/February 2015 | OR TODAY

OUT OF THE OR NUTRITION

BY LORI ZANTESON, ENVIRONMENTAL NUTRITION

CRAZY FOR CARROTS C

arrots were first cultivated about 1,100 years ago in the Afghanistan region, but seeds from its predecessor, the wild carrot, have been found in Europe dating back 5,000 years, when they were not grown as a vegetable, but as a medicinal herb and aphrodisiac by ancient Greeks and Romans. The first domesticated carrots were purple, yellow, red and white – but not orange. Over time, they have been domesticated from a tough and bitter root to the familiar crisp and sweet garden vegetable we adore today. One of the most popular root vegetables in this country, carrots (Daucus carota sativus) are related to other pantry staples – parsley, celery, parsnips and dill. Carrots are best known for their abundant source of the pro-vitamin A (which can be converted to active vitamin A) and antioxidant beta-carotene (named for carrots). But carrots also offer additional vitamins and nutrients with health-promoting benefits. A one-cup serving of chopped carrots provides off-thechart levels of vitamin A – over 400 times the DV (Daily Value, based on 2,000 calories per day) – for vision health, 14 percent DV of dietary fiber, and 21 percent DV of boneprotecting vitamin K. Carrots’ striking orange hue is courtesy of beta-carotene, which also provides protection against cardiovascular disease (CVD.) In a 10-year study of the effect of fruits

OR TODAY | January/February 2015

and vegetables on CVD, published in 2011 in the British Journal of Nutrition, carrots were the most prominent member of the dark yellow/orange food category. Participants who ate at least 25 grams (about one-quarter cup) per day of carrots had a significantly lower risk of CVD than those who didn’t eat carrots. Eating carrots also may help protect against some cancers. A study in the February 12, 2014 issue of European Journal of Nutrition found that carrot consumption significantly decreased risk of prostate cancer. Fortunately, carrots are available all year long. The freshest carrots will have vibrant color – orange, red, yellow, even white – and will be firm and crisp. If the greens are attached, be sure they’re fresh and brightly hued, but remove them right away and refrigerate separately (tops are edible, too, however.)

Enjoy raw carrots grated or sliced into most any dish, from salads and stir-fries to stews and baked goods. They are also divine roasted with olive oil and sea salt or cooked and pureed as a sweet soup – hot or cold! WWW.ORTODAY.COM

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o r v i s i t k e y s u r g i c a l .c o m January/February 2015 | OR TODAY

OUT OF THE OR RECIPE

OR TODAY | January/February 2015

BY EMMA CHRISTENSEN

WWW.ORTODAY.COM

RECIPE

CHICKEN TIKKA MASALA, SURPRISINGLY EASY TO MAKE

didn’t think chicken tikka masala could really get much better, but then I remembered my slow cooker. This is a curry dish that benefits from a nice, long simmer anyway, so why not let that happen while I’m off doing other things? That’s what I call smart cooking.

Spooned over some steamed rice, this easy slow cooker tikka masala is about to make your busy day less hectic. This is a simple “dump and go” recipe. But if you have some extra time, I heartily recommend marinating the chicken in some yogurt and sautéing the onions and garlic with the spices before putting everything in the slow cooker. While the extra steps give the dish a bit more depth and nuance, if you skip them I promise you’ll still be happy having this for dinner. Serve this with a simple pot of basmati rice. If you start cooking the rice at the same time you add the cream at the end of cooking, the whole meal is ready at the same time.

SLOW COOKER CHICKEN TIKKA MASALA Serves 4 to 6.

to 1 1/2 pounds boneless, skinless chicken thighs

large onion, diced

cloves garlic, minced

1”

piece whole ginger, peeled and grated

tablespoons tomato paste

1-2 tablespoons garam masala 2

teaspoons paprika

teaspoons kosher salt

(28-ounce) can diced tomatoes

3/4 cup heavy cream or coconut milk

•

fresh cilantro, chopped

cups cooked rice, to serve

WWW.ORTODAY.COM

1. Cut the chicken thighs into

bite-sized pieces and transfer them to a 3-quart or larger slow cooker. Stir in the onion, garlic, ginger, tomato paste, 1 tablespoon of garam masala, paprika and kosher salt until the chicken is evenly covered with spices. Stir in the diced tomatoes with their juices.

• If you have the time: Marinate the

chicken in 1/2 cup yogurt for up to 6 hours. Shake to remove excess yogurt before transferring to the slow cooker.

• If you have the time: Saute the

onion and garlic in a little olive oil over medium-high heat in a skillet until softened, then stir in the ginger, tomato paste and spices until fragrant. Transfer to the slow cooker with the chicken and diced tomatoes. This will give your tikka masala more depth of flavor.

2. Cover the slow cooker and cook for 4 hours on high or 8 hours on

low. Fifteen minutes before the end of cooking, stir in the heavy cream. If you prefer a thicker sauce, leave the slow cooker uncovered for the last 15 minutes. Taste and add more garam masala or salt to taste. Serve over rice with fresh cilantro sprinkled over the top of each serving. The tikka masala can be refrigerated for 3 to 4 days or frozen for 3 to 4 months.

RECIPE NOTES

Chicken breasts can be substituted for the thighs, though I find thighs hold up better over the long cooking and breasts tend to fall into shreds. Still delicious, though! For a little of that smoky tandoori flavor, try using smoked paprika and roasted tomatoes. • Emma Christensen is recipe editor at TheKitchn.com, a nationally known blog for people who love food and home cooking. Submit any comments or questions to kitchn@apartmenttherapy.com. January/February 2015 | OR TODAY

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January/February 2015 | OR TODAY

OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • JANUARY-FEBRUARY •

Stretch it Out

LOVE YOUR PET DAY

February 20 is National Love Your Pet Day! Snap a photo of you and your pet with a copy of OR Today and you could win FREE lunch for your department. Email your photo along with your name, title and contact information to Social@MDPublishing.com. Every entry will win a $5 gift card, but remember that the most creative photo wins a pizza party!

THE WINNER GETS LUNCH FOR THE ENTIRE TEAM!

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OR TODAY | January/February 2015

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TREAT THE FEET

Working on your feet all day can do a number on your feet, legs, and back. One way to reduce pain is to stretch. Muscles can become stiff and painful as you stand or walk all day. Stop every hour or so to stretch, relax and lengthen tightened muscles. *

Calf raises. Stand on the edge of a step or platform. Stand tall with your abdominal muscles pulled in. Secure the balls of your feet firmly on the step with your heels hanging over the edge. Raise your heels a few inches above the step as you stand on your tiptoes, and hold for a second. Lower your heels back to even with the platform. Repeat 10 times. This move helps pump blood out of the foot (where it has pooled while you were standing) and back to the body.

Runner’s stretch. Face a wall, and place your hands against the wall. Extend one leg behind your body. Push your heel to the floor as far as it will go. Hold for a moment to feel the stretch and then switch sides. Repeat three times on each leg.

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PIN BOARD

OR TODAY

CONTESTS WINNERS { OCTOBER } Norma Hopkins and her team at Franciscan St. James Health enjoyed the prize pack she won in the OR Today Favorite Healthy Snack or Candy Contest. Pictured are team members Imaging Specialist Doug Austin, Anesthesia Tech Juan Stroop, Norma Hopkins, Clinical Engineer Roy Sida and Manager Dan Palmerin.

r, and her e t n e c , s in k Norma Hop a prize pack. team won

{ NOVEMBER } FOR WHAT ARE YOU THANKFUL?

I am thankful for the wonderful team that I work with at BMC. My father and mother became ill suddenly and many of the team members came to me offering to help, even with the small things like sitting with my father while I took my mother for testing. They are a totally awesome team and I am very thankful that I get to work with them each day. â&#x20AC;&#x201D; Robin Webb, RN, CNOR, Supervisor of Surgical Services, Bayshore Medical Center

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January/February 2015 | OR TODAY

{DECEMBER } THE PERFECT GIFT

OR Today, The perfect gift. Is there such a thing as the perfect gift. My goal when rewarding my staff is to make sure they know they are appreciated. Once a month I look around my surgery center and take the employee who I (or sometimes I take suggestions) feel went above and beyond and take them out for lunch. There are several reason why this works so well: 1. Gets the employee away from the hospital for 30-60 minutes (makes them feel really special). 2. Allows me time to express my gratitude and reinforce their behavior. 3. Other team members see this or hear about it and strive to be better. I just did this today and the employee who has been at Regina for over 26 years has never had gift like that and was extremely grateful and honored. Well worth every penny. Thanks, Jason Bainbridge RN, BSN Patient Care Manager • Surgery Center, Regina Hospital, part of Allina Health

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January/February 2015 | OR TODAY

INDEX ALPHABETICAL 3M Critical & Chronic Care Solutions……………… 9 AAAHC……………………………………………………………… 22 Action Products…………………………………………………15 AIV, Inc.…………………………………………………………………19 AORN Works…………………………………………………… 65 ASC Association……………………………………………… 42 Bemis Health Care……………………………………………… 6 Birkova Products……………………………………………… 57 Bryton Corporation………………………………………… 73 C Change Surgical……………………………………………… 4 Censis Technologies……………………………………………17 Cincinnati Sub-Zero………………………………………… 28 Clorox Professional Products……………………… 10-11 Cygnus Medical………………………………………………… 32 Dan Allen Surgical……………………………………… 44-45

Didage Sales Company, Inc.…………………………… 43 Eizo, Inc…………………………………………………………………71 Encompass Group…………………………………………… 72 Enthermics Medical Systems, Inc.………………… 27 Flagship Surgical, LLC………………………………………16 GelPro………………………………………………………………… 22 Government Liquidation…………………………………IBC Healthmark Industries……………………………… 72, 84 Innovative Medical Products, Inc………………… BC Innovative Research Lab, Inc………………………… 93 Jet Medical Electronics…………………………………… 88 Kapp Surgical Instrument, Inc…………………………31 Key Surgical…………………………………………………………81 MAC Medical, Inc.…………………………………………… 76 MD Technologies……………………………………………… 72

MedWrench……………………………………………………… 42 Mobile Instrument Service & Repair…………… 94 Pacific Medical………………………………………………… 23 Palmero Health Care……………………………………… 89 Polar Products……………………………………………………91 Rubbermaid Commercial………………………………… 5 Ruhof Corporation…………………………………………… 2-3 Sage Services…………………………………………………… 43 Sealed Air…………………………………………………… 24-26 SIPS Consults, Corp.………………………………………… 79 SMD Wynne Corp.…………………………………………… 79 Surgical Power……………………………………………………91 TBJ, Inc.……………………………………………………………… 56 VBN Medical Inc.……………………………………………… 85

ENDOSCOPY Government Liquidation………………………………… IBC Innovative Research Lab, Inc………………………… 93 Kapp Surgical Instrument, Inc…………………………31 MD Technologies………………………………………………… 72 Mobile Instrument Service & Repair………………… 94 Ruhof Corporation………………………………………………2-3 SIPS Consults, Corp.…………………………………………… 79 TBJ, Inc.……………………………………………………………… 56 VBN Medical Inc.……………………………………………… 85

INSTRUMENTS Government Liquidation………………………………… IBC Mobile Instrument Service & Repair………………… 94

INDEX CATEGORICAL ACCESSORITES Action Products…………………………………………………15 ACCREDITATION AAAHC………………………………………………………………… 22 ANESTHESIA Innovative Research Lab, Inc………………………… 93 SMD Wynne Corp.…………………………………………… 79 VBN Medical Inc.……………………………………………… 85 APPAREL Healthmark Industries……………………………………72, 84 ASSOCIATIONS AAAHC………………………………………………………………… 22 AORN Works…………………………………………………… 65 ASC Association……………………………………………… 42 AUCTIONS Government Liquidation………………………………… IBC MedWrench………………………………………………………… 42

EMPLOYMENT SIPS Consults, Corp.…………………………………………… 79 FALL PREVENTION Encompass Group…………………………………………… 72 GEL PADS Innovative Medical Products, Inc……………………… BC

INTERNET RESOURCES MedWrench………………………………………………………… 42 KNEE SYSTEMS Innovative Medical Products, Inc……………………… BC LAB TBJ, Inc.……………………………………………………………… 56 LEG POSITIONERS Innovative Medical Products, Inc……………………… BC MOBILE NURSE STATION Rubbermaid Commercial………………………………… 5 MONITORS Eizo, Inc…………………………………………………………………71 Jet Medical Electronics……………………………………… 88 Pacific Medical………………………………………………… 23

CARDIAC SURGERY C Change Surgical………………………………………………… 4

GENERAL 3M Critical & Chronic Care Solutions……………… 9 Didage Sales Company, Inc.……………………………… 43 GelPro…………………………………………………………………… 22 Government Liquidation………………………………… IBC Innovative Research Lab, Inc………………………… 93 MAC Medical, Inc.…………………………………………… 76 MedWrench………………………………………………………… 42 SIPS Consults, Corp.…………………………………………… 79 Surgical Power…………………………………………………… 91

CABLES/LEADS Sage Services……………………………………………………… 43

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

ORTHOPEDIC Surgical Power…………………………………………………… 91 VBN Medical Inc.……………………………………………… 85

CARTS Sealed Air…………………………………………………… 24-26

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

PATIENT AIDS Innovative Medical Products, Inc……………………… BC

CLEANING SUPPLIES Cygnus Medical…………………………………………………… 32 Rubbermaid Commercial………………………………… 5 Ruhof Corporation………………………………………………2-3

INFECTION CONTROL/PREVENTION Bemis Health Care……………………………………………… 6 Clorox Professional Products………………………… 10-11 Cygnus Medical…………………………………………………… 32 Encompass Group…………………………………………… 72 Government Liquidation………………………………… IBC Palmero Health Care…………………………………………… 89 Rubbermaid Commercial………………………………… 5 Ruhof Corporation………………………………………………2-3 Sealed Air…………………………………………………… 24-26 SMD Wynne Corp.…………………………………………… 79

PATIENT MONITORING Encompass Group…………………………………………… 72 Pacific Medical………………………………………………… 23

BIOMEDICAL Innovative Research Lab, Inc………………………… 93 BEDS Innovative Medical Products, Inc……………………… BC

CLAMPS Innovative Medical Products, Inc……………………… BC DISPOSABLES Flagship Surgical, LLC………………………………………16 Government Liquidation………………………………… IBC Kapp Surgical Instrument, Inc…………………………31 Pacific Medical………………………………………………… 23 Sage Services……………………………………………………… 43 92

OR TODAY | January/February 2015

INFUSION PUMPS AIV, Inc.…………………………………………………………………19

OR TABLES/ ACCESSORIES Action Products…………………………………………………15 Birkova Products……………………………………………… 57 Bryton Corporation…………………………………………… 73 Innovative Medical Products, Inc……………………… BC

POSITIONING AIDS Action Products…………………………………………………15 Innovative Medical Products, Inc……………………… BC POSITIONERS/IMMOBILIZERS Innovative Medical Products, Inc……………………… BC PROCESSING Key Surgical…………………………………………………………81 TBJ, Inc.……………………………………………………………… 56 WWW.ORTODAY.COM

INDEX CATEGORICAL RADIOLOGY Eizo, Inc…………………………………………………………………71 REPAIR SERVICES AIV, Inc.…………………………………………………………………19 REPLACEMENT PARTS Birkova Products……………………………………………… 57 SHOULDER RECONSTRUCTION Innovative Medical Products, Inc……………………… BC

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SIDE RAIL SOCKETS Innovative Medical Products, Inc……………………… BC SOCIAL MEDIA MedWrench………………………………………………………… 42 STERILIZATION Clorox Professional Products………………………… 10-11 Key Surgical…………………………………………………………81 SIPS Consults, Corp.…………………………………………… 79 TBJ, Inc.……………………………………………………………… 56 SURGEON COOLING Polar Products……………………………………………………… 91 SURGICAL 3M Critical & Chronic Care Solutions……………… 9 AAAHC………………………………………………………………… 22 Birkova Products……………………………………………… 57 Censis Technologies……………………………………………17 Clorox Professional Products………………………… 10-11 Dan Allen Surgical……………………………………… 44-45 Eizo, Inc…………………………………………………………………71 Flagship Surgical, LLC………………………………………16 MAC Medical, Inc.…………………………………………… 76 MD Technologies………………………………………………… 72 Mobile Instrument Service & Repair………………… 94 SMD Wynne Corp.…………………………………………… 79 Surgical Power…………………………………………………… 91 SURGICAL EQUIPMENT Mobile Instrument Service & Repair………………… 94 SURGICAL SUPPLIES Action Products…………………………………………………15 Cincinnati Sub-Zero…………………………………………… 28 Cygnus Medical…………………………………………………… 32 Government Liquidation………………………………… IBC Kapp Surgical Instrument, Inc…………………………31 Pacific Medical………………………………………………… 23 Ruhof Corporation………………………………………………2-3 SURPLUS MEDICAL Government Liquidation………………………………… IBC SUPPORTS Innovative Medical Products, Inc……………………… BC TEMPERATURE MANAGEMENT C Change Surgical………………………………………………… 4 TOURNIQUETS VBN Medical Inc.……………………………………………… 85 ULTRASOUND AIV, Inc.…………………………………………………………………19 VIDEO Eizo, Inc…………………………………………………………………71 WARMERS Enthermics Medical Systems, Inc.………………… 27 WASTE MANAGEMENT Bemis Health Care……………………………………………… 6

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January/February 2015 | OR TODAY

Enhanced Humbles LapWrap Positioning Pad ®

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

Designed to meet

The operative word in patient positioning.

AORN

recommendations

www.impmedical.com

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

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

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

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

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

For more info or to order call 1-800-467-4944 Please visit us at AORN Booth 1837 and AAOS Annual Meeting Booths 225 and 127 US Patent No. 8,001,635

. AORN is a registered trademark of AORN, Inc. AORN does not endorse any commercial company’s products or services.