OR Today - June 2015 by MD Publishing

CLOROX EXPERT ADVICE PAGE 16

SPOTLIGHT ON MIKE NEWELL, MSN PAGE 56

TAKE GOOD CARE

NURSES • SURGICAL TECHS • NURSE MANAGERS

FITNESS IMPROVEMENTS PAGE 64

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Be sure with Ruhof ATP Complete Contamination Monitoring System ®

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TAKE CONTROL OF INFECTIONS AND YOUR BOTTOM LINE Interchangeable disposable lead wires let you decide how to manage HAIs, reduce complications, and avoid costly penalties. These days, with financial penalties based on HAIs and hospital cleanliness, you can’t afford not to use disposables. And OnePatient lead wires from Curbell are a scalable, cost-effective, disposable solution. Interchangeable design lets you balance cost vs. risk ' Use disposables on all patients, only within specific departments, or only on at-risk patients Disposable lead wires work with existing monitor ' cables, so you can choose to use a disposable or reusable based on individual patient need Eliminate cross-contamination ' Reusable ECG lead wires are a known risk factor for HAIs ' Helps you comply with recommended standards from the CDC and others* * Siegel, JD et al (20060). “Management of Multidrug-Resistant Organisms In Healthcare Settings”. Centers for Disease Control and Prevention; the Healthcare Infection Control Advisor Committee (HIPAC); 1-74

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CONTENTS

features

OR TODAY | June 2015

CORPORATE PROFILE: PACIFIC MEDICAL

Pacific Medical opened its doors over a decade ago and is a growing and thriving organization. Pacific Medical President and CEO Andy Bonin started the business because he saw the need for quality equipment in the medical repair industry. His goal was to provide outstanding customer

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Last year, the Centers for Medicare and Medicaid Services (CMS) launched a renewed effort to reduce the frequency of hospital-acquired conditions (HACs) among hospitalized patients. The newest CMS Hospital-Acquired Condition Reduction Program ranks most U.S. hospitals against each other with regard to the frequency of hospital-acquired conditions occurring within them. Hospitals that rank in the bottom quartile of HAC performance will now lose one percent of their CMS IPPS reimbursements. MD Publishing 18 Eastbrook Bend Peachtree City, GA 30269

HIGH COST OF HACS

SPOT SN LIGHT ON: MIKE NEWELL, M

SPOTLIGHT ON: MIKE NEWELL, MSN

Newell, is a patient advocate. He describes his mission as “the same as working for the insurance company, but this time, the customer is the family.” His goal is to ensure that patients have the ability to maintain their independence and safety when they are ready to return home. He works with his clients and their families to address issues like installing handholds in the bathroom, home monitoring equipment, and prescription management.

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OR Today (Vol. 15, Issue #5) June 2015 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 302691530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2015

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June 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

Mike Venezia | mike@mdpublishing.com Jayme McKelvey | jayme@mdpublishing.com

36 INDUSTRY INSIGHTS 10 16 20 23 24

News & Notes Clorox Advice AAAHC Update OR Today Webinars ASC Update

Andrew Parker | andrew@mdpublishing.com

CIRCULATION Bethany Williams

ACCOUNTING Kim Callahan

WEB SERVICES Betsy Popinga Taylor Martin

IN THE OR 26 29 30 36

Suite Talk Market Analysis Talk Product Showroom CE Article

OUT OF THE OR 63 Health 64 Fitness 66 Nutrition 68 Recipe 70 Pinboard

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PROUD SUPPORTERS OF

74 Index

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INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

MOBILE APPLICATION SUPPORTS AORN GUIDELINES MyRounding and the Association of periOperative Registered Nurses (AORN) have created a partnership to create “myAORNguidelines,” a new product that will enable operating room managers and administrators to analyze and sustain compliance with AORN’s evidence-based Guidelines for Perioperative Practice. This SaaS-based product is built on the HIPAA-compliant MyRounding platform to reduce the amount of work and time that is required to audit, report and give feedback; it automatically identifies the gap between how guidelines are

being implemented and optimal adherence to the most current AORN Guidelines. Further, it has a powerful issue management function that allows for practice issues to be identified, assigned, tracked and monitored. MyAORNguidelines helps OR directors, managers and nurses with the implementation of the AORN Guidelines. Through the intuitive interface users can collect and organize data for quality assessments as well as monitoring adherence to policies and procedures. “This is an exciting partnership for the MyRounding team,” said

Tony Gorski, CEO of MyRounding. “We are excited to join with AORN in the creation of an easy-to-use mobile application for the AORN Guidelines. In addition, we will be creating an industry benchmark to measure compliance with the AORN Guidelines to help improve the quality of patient care.” Currently in the final stages of development, the product is slated to be released in the summer of 2015. • FOR INFORMATION on myAORNguidelines, visit www.myAORNguidelines.com.

SINGLE-USE RIGID ENDOSCOPE LAUNCHED Integrated Endoscopy Inc. has launched the nuvis single-use arthroscope at a time of heightened awareness about serious patient safety issues connected with endoscopic procedures, including a number of recent high-profile infection outbreaks caused by bacteria build up in difficult-to-clean endoscopes. “We’re excited to introduce the nuvis single-use arthroscope to orthopedic surgeons,” said George Wright, president and CEO of Integrated Endoscopy. “Our discussions with orthopedic surgeons across the country underscore the importance of exceptional optical quality in a disposable endoscope. The nuvis arthroscope is the first single-use rigid endoscope based on 21st century optical technology. Its excellent optics and improved safety provide firsttime quality for every procedure, benefiting surgeons and patients alike.” The nuvis single-use arthroscope features 12 molded glass lenses. These high-quality lenses are made with the same technology and low-temperature glass used to mass produce high-definition, low-cost optics for smartphone cameras. The nuvis arthroscope also 10

OR TODAY | June 2015

features patented light-emitting diode (LED) technology that provides improved white light at significantly lower temperatures than the fiber optic illumination used in conventional endoscopes. The nuvis single-use arthroscope received 510(k) clearance from the U.S. Food and Drug Administration in July 2014. Integrated Endoscopy is currently gearing up production of the nuvis arthroscope, and it will be available nationwide during the third quarter of 2015. • WWW.ORTODAY.COM

NEWS & NOTES

BIOVATION LAUNCHES BIOARMOUR BLOOD PRESSURE CUFF SHIELD Biovation has launched the BioArmour Blood Pressure Cuff Shield (BPCS) to mitigate the spread of infectious pathogens from blood pressure cuffs. This first-in-class medical product offers a multi-use barrier for prevention of hospital-acquired infections (HAIs). The BPCS has been designed, tested and validated over a two-year cycle. BioArmour is the first in a suite of infection and pathogen control products from Biovation. The easy-to-use BioArmour BPCS is a disposable antimicrobial hygienic barrier that attaches to the blood pressure cuff to prevent direct contact of the cuff with the patient’s skin. The latex-free shield material is composed of a sustainable biopolymer impregnated with antimicrobial and antifungal agents to mitigate the propagation of a wide spectrum of pathogens in controlled release fashion. Contaminant pathogens – including MRSA, VRE, c. difficile and others – are mitigated by the blood pressure cuff shield, allowing for multi-patient use over a 24-hour period. In lab testing, the BioArmour BPCS has been shown to kill up to 99.99 percent of tested microorganisms. The BPCS is manufactured with green technology and a sustainable biopolymer, with an industry-

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The easy-to-use BioArmour BPCS is a disposable antimicrobial hygienic barrier that attaches to the blood pressure cuff to prevent direct contact of the cuff with the patient’s skin.

leading 74 percent biocontent. Its slim profile does not adversely impact accuracy of the blood pressure measurement data. And, the BPCS provides another tool for risk mitigation for hospitals and health care facilities with proactive measures for infectious disease reduction and control. This cost-effective system requires no staff maintenance or disinfection between patients and is targeted for in-patient, physician offices,

hospice and nursing home facilities and emergency medical services. The BioArmour BPCS has been registered a CE Class I medical device marked for distribution in the EU. As a medical product, it is available for sale in Canada and all other non-U.S. countries. It is currently undergoing testing for FDA approval, which is anticipated to be received in late summer 2015. •

June 2015 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

COR MEDICAL TECHNOLOGIES APPOINTS NEW CEO

COR Medical Technologies (COR) has announced the appointment of John Scott as its Chief Technology Officer. In his new position, Scott is responsible for overseeing all technology-related aspects of the company. COR Medical Technologies offers CORcare, a comprehensive instant decision support system for rapid

and accurate diagnosis, treatment, and follow-up management of patients with acute and chronic, common and rare diseases involving the cardiovascular system. “John’s entrepreneurial vision and multinational technology experience, coupled with his digital communications technology patent knowledge, make him a valuable addition to our executive team,” said COR Founder and CEO Vincent Friedewald, M.D., F.A.C.C. “I look forward to working with John as we continue to expand the capabilities of CORcare.” Prior to joining COR Medical Technologies, Scott was Group President at Andrew Corp. in Chicago where he was responsible for business development, creating a network products division through the purchase and management of various technology companies. Under his direction, the

company was one of the first to link its headquarters with remote facilities in over 70 countries in real-time using an SAP enterprise system. In addition, Scott did extensive work in China and Russia with The Peoples Bank of China and Nanjing Radio Company, where he focused on satellite communication equipment and fiber optic communications systems. He was also an electrical engineer at International Communications Corp., where he worked with the United States Department of Defense. “CORcare has the potential to make a dramatic difference not only in the lives of patients, but also the health care professionals that serve them,” Scott said. “I’m very excited to be working with Dr. Friedewald and rest of the COR management team on this very important endeavor.” •

VTI DISPOSABLE TEARDROP SUCTION TUBES VTI has introduced disposable Teardrop Suction Tubes. The single-use Teardrop Suction Tubes deliver superior fine suction by utilizing a teardrop thumb-control. The suction tubes are available in sizes 6FR to 14FR and help achieve the clear visual field necessary for all delicate surgical procedures. The tubes have a tapered cannula that reduces clogging while the 30 degree pre-bent tube helps prevent kinking. VTI’s always-sterile, disposable suction tubes come with cost savings compared to replacing difficult-to-clean reusables in which the narrow channels become clogged with blood and tissue, posing a cross contamination risk to patients, according to a press release from VTI. •

OR TODAY | June 2015

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NEWS & NOTES

TWO NEW SOLUTIONS FROM DEPUY SYNTHES COMPANIES DePuy Synthes Companies is offering health care professionals a new way to track and analyze patient data in real-time and a new program to improve patients’ experience with joint replacement surgery. DePuy Synthes Companies is offering a subscription-based service called CareSense, a software solution that enables health care providers and institutions to collect and analyze real-time data. With CareSense, patient outcomes, patient satisfaction and cost information can be collected and evaluated before, during and after surgery, to help optimize care. The system makes it easy to conduct market research, administer patient satisfaction surveys, benchmark against peers, and analyze financial metrics. CareSense, which is licensed from Medtrak Inc. by DePuy Synthes Joint Reconstruction, is available globally through

DePuy Synthes Companies that addresses specialties including joint reconstruction, trauma, spinal surgery and sports medicine. While CareSense focuses on data collection and analysis, the video based Patient Athlete Program helps joint replacement patients take their experience beyond pain reduction to learning how to bring their full and best energy to the people and things that matter most in their lives — both before and after their surgery. The program includes self-guided lessons that a patient views four weeks prior to surgery and 11 refresher lessons to complete post-surgery. It provides patients with simple action steps and tools to help better equip them to understand how joint pain has affected all aspects of their lives, and helps them take steps to maximize their recovery. Both CareSense and the Patient Athlete Program are part of DePuy

Synthes Advantage, which offers customized, measureable solutions that help achieve triple aim performance – improved outcomes, increased patient satisfaction, and reduced cost. • TO FIND OUT MORE about the DePuy Synthes Advantage suite of solutions, visit www.depuysynthesadvantage.com.

SMITHS MEDICAL INTRODUCES CONVECTIVE WARMING BLANKET Smiths Medical has launched a new Snuggle Warm poncho-style convective warming blanket to help maintain a patient’s body temperature before, during and after surgery. The Snuggle Warm poncho blanket is ideal for pelvic, abdominal and leg surgery because it allows full access to those areas while simultaneously warming the patient’s back, shoulders and chest. It has pre-opened arm and head openings to save time and effort when placing on a patient, and its two hose ports allow flexible placement of the warming unit. The blanket accommodates lithotomy and supine positions with arms extended or tucked. In addition, this novel blanket can be reversed for use before or after surgery in warming the front of the patient’s torso as well as the shoulders and upper back. Made of soft, flexible, durable material, Snuggle Warm blankets conform to patient anatomy for maximum heat retention and comfort, and also resist tears and punctures. Convective warming blankets are designed to help surgical patients arrive in recovery normothermic (normal body temperature). •

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June 2015 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

INNOVATIVE MEDICAL PRODUCTS ADDS TO ITS LINE OF SURGICAL ACCESSORIES

Innovative Medical Products has introduced the De Mayo V2 E Knee Positioner, a new solution with a sterile extension swing arm that comes off the foot of the operating table while keeping solidly in place. This device allows the surgeon to stand between the patient’s legs during surgery making it easier to work on the inside of the patient’s knee if necessary. IMP also offers the De Mayo Knee Positioner used with De Mayo Universal Distractor, De Mayo Hip Positioner, Universal Lateral Positioner, and MorphBoard. Enabling the surgeon to fully control and maintain joint distraction, the De Mayo Universal Distractor lets the surgeon see into the posterior regions of the joint. The distractor, used in conjunction with the De Mayo Knee Positioner, allows precise control of flexation, extension, tilt and rotation of the knee during surgery. The De Mayo Hip Positioner is a complete hip positioning system that securely holds very thin or very obese patients in the lateral position. For the latter patient, the positioner can be “built up” around the patient so OR personnel don’t have to lift the patient on the positioner, avoiding strenuous exertion and minimizing the risk of a work-related injury. IMP’s Universal Lateral Positioner is ideal for any surgery requiring the patient to be fixed in a stable, lateral decubitus position. The MorphBoard is a three-piece modular pegboard that adjusts to accommodate obese patients, with optional locking pegs that will not jar loose during surgery. • 14

OR TODAY | June 2015

HALYARD HEALTH SIGNS FIRST GPO CONTRACT AS INDEPENDENT COMPANY Halyard Health, formerly Kimberly-Clark Health Care, was awarded a new purchasing agreement with HealthTrust for its complete line of face masks. Effective March 1, 2015, Halyard’s standard and ASTMrated face masks, including Fluidshield masks with So Soft lining, will be available to HealthTrust members made up of 1,350 acute care facilities, as well as 15,000 ambulatory surgery centers, physician practices and alternate care facilities. “We are committed to creating value for HealthTrust members by providing market leading surgical, infection prevention and medical device products and solutions,” said Chris Lowery, chief operating officer, Halyard Health. “We will continue to provide our customers with innovative products that help them provide quality care, reduce costs and achieve superior clinical outcomes.” While Halyard and HealthTrust have worked together for more than 15 years, this marks the first contract signed as Halyard Health.

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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®

EC1730BL combination warmer DC400L fluid warmer

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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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Enthermics Medical Systems ISO 13485:2003 Certified | 1-800-862-9276 | www.enthermics.com

June 2015 | OR TODAY

INDUSTRY INSIGHTS CLOROX ADVICE

BY KERI LESTAGE, PH.D., PMP, TECHNICAL SERVICES GROUP MANAGER AT CLOROX HEALTHCARE

HOW WET ARE YOUR DISINFECTANT WIPES?

leaning and disinfecting play a vital role in reducing healthcareassociated infections (HAIs), so a lot goes into choosing the best disinfecting product for your facility. In a recent article published in the American Journal of Infection Control, researchers from the University of Louisville School of Medicine studied the value of ready-to-use cleaning and disinfection wipes compared with the traditional towel and bucket method and found that using ready-touse wipes led to significantly higher compliance, a more rapid cleaning and disinfection process, and potential cost savings1. However, it is important to remember that not all disinfecting wipes are created equal.

Cost is an obvious, and often decisive factor in purchasing decisions but it is also important to understand how much surface area one wipe will cover and the impact that a disinfectant wipe’s wet-contact time can have on compliant use.

A CLOSER LOOK AT “WETTABILITY” Several factors impact a wipe’s “wettability,” or the ability of the disinfectant liquid to maintain contact with solid surfaces. Understanding the factors that impact how the disinfectant is released from the wipe will help the savvy consumer choose the most effective product. • Loading Ratio: Loading ratio refers to how much disinfectant is added to a dry canister of wipes and that disinfectant-to-wipe ratio determines how wet each wipe will be. A well-engineered product will have enough disinfectant to fully saturate each wipe, which in turn is what allows the treated surface to remain wet for the entire contact time. • Absorbency and Release: How the disinfectant is absorbed by the wipe and then released onto the surface depends on the wipe material and disinfectant formulation. The type of fiber and the amount and type of surfactant used in the formulation will either enhance or reduce the

disinfectant absorption rate and can play a key role in the wettability, compliance and cost of the product. PRODUCT SELECTION, COST AND QUALITY OF CARE Beyond the vale implications of surface coverage and the mechanics of disinfectant release for efficient product use, the most important reason to understand just how far one wipe will go is product efficacy. Misuse of disinfectant wipes leads to insufficient disinfection and can put patients and staff at risk. No matter what type of disinfecting wipe is used, it is important to remember that the best results are only achieved when they are used correctly. With the cost of caring for patients with a HAI estimated to be approximately $30,000 per case2, be sure to ask yourself, how wet is this wipe? FOR MORE INFORMATION about healthcare environmental disinfection and product options, visit www.CloroxHealthcare.com.

[1] Wiemken TL, Curran DR, Kelley RR, Abdelfattah RR, Carrico RM, Ramirez JA. “The value of ready-to-use disinfectant wipes: Compliance, employee time, and costs.” American Journal of Infection Control 42.3(2014): 329-330. [2] Stone PW. “Economic burden of healthcare-associated infections: an American perspective.” Expert Review of Pharmacoeconomics & Outcomes Research 9.5(2009): 417-422.

OR TODAY | June 2015

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For faster O.R. turnover times, everybody has to do their part.

Especially your disinfectant.

Clorox HealthcareÂŽ Hydrogen Peroxide Cleaner Disinfectants

FASTER, MORE EFFICIENT DISINFECTING EPA-registered to kill the pathogens that cause most SSIs in 30 to 60 seconds. At Clorox, we know that improving O.R. turnover times and protecting patients are both critical to you and your hospital. Fortunately, our quick, quality disinfecting is one solution that can make an important difference across the board. For a free sample and more information, visit cloroxhealthcare.com. Claims based on comparison of EPA federal masters as of 2/2014 versus leading competitors for general disinfecting. Organisms selected based on top 14 HAI associated pathogens reported to the National Healthcare Safety Network. ÂŠ 2014 Clorox Professional Products Company. NI-25591 WWW.ORTODAY.COM

June 2015 | OR TODAY

c i n c i n n a t i

s u b - z e r o

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

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

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

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June 2015 | OR TODAY

INDUSTRY INSIGHTS AAAHC UPDATE

BY GEOFFREY CHARLTON-PERRIN

JOHN BURKE A Man Who Revels in Managing Change

AAAHC

President and CEO John Burke plans to step down in 2015, ending his stewardship of a premier health care accreditation association after a tenure of 18 successful years. “I’ve always enjoyed the challenge of growing, or even building a new organization,” Burke said. “When I joined AAAHC in 1997, we had a staff of eight and 500 accredited organizations. We had a relatively small budget and meager resources, except for the volunteers who made up the organization.” Now, with a current staff of 66 and more than 6,000 accredited organizations, Burke feels that this is an appropriate time to hand over the reins to someone else with equally robust ambitions. It might also be an appropriate time to review the career of a man whose background straddles academia, communications and business. First, a few details on John Burke the man. Burke was born in Huntington, West Virginia, where, after high school he first entertained thoughts of entering the priesthood. He completed his first year of college at St. Fidelis College and Seminary, taught by a contemplative order of friars, followers of St. Francis of Assisi and devoted to simplicity and

OR TODAY | June 2015

hard work. From there, Burke entered the University of Kentucky where he joined the U.S. Air Force ROTC program and sported a white helmet as a member of the cadet police corps. At UK, he played on the varsity tennis team and continued (from high school days) as a collegiate fencer, winning national medals in foil and saber. Moving to Marshall University to complete his Baccalaureate degree, Burke worked as a news writer and editor at WSAZ-TV, sparking his interest in communications. He also worked for his first real mentor, Congressman Ken Hechler, a ranking Democrat who was formerly on the faculties of Marshall and Columbia universities. Incidentally, Congressman Heckler had previously written speeches for President Harry Truman and interviewed many of the defendants prior to the Nuremburg trials following World War II, including Hermann Göring. At Marshall, Burke did a lot of acting in University Theater while working toward his degree and before being offered an assistantship at Ohio University in

JOHN BURKE, PRESIDENT, CEO, AAAAHC

Athens to work on a master’s degree. At Ohio University, Burke decided to work beyond an MA degree to receive a master’s of fine arts, then considered a terminal degree in some circles. After completing his MFA and teaching three years at Kent State University, Burke moved to the Ohio State University in Columbus, Ohio, to study under a professor he considers his second mentor, Dr. Walter Emery, a noted authority on broadcasting regulations. While WWW.ORTODAY.COM

AAAHC UPDATE

studying there for his Ph.D., Burke became assistant to the director at the Ohio State University Telecommunications Center (WOSU-TV). There he worked for a third mentor, Richard B. Hull, who had established the first non-commercial, educational broadcasting station at WOI in Ames, Iowa. After completing his doctorate and publishing his dissertation on the history of public broadcasting, Burke was appointed as a new department head in the School of Allied Medical Professions at Ohio State (later renamed the School of Health and Rehabilitation Sciences). Here, he spearheaded the development of a new academic program in medical communications and did pioneering work in telemedicine, experimenting with a microwave system rather than the then experimental, but unreliable, laser communications system. After sixteen years at Ohio State (where he first earned his tenure and associate professorship, and where he became editor of the Journal of Allied Health, specializing in health care research and development for an audience of universities and health care organizations), Burke followed a colleague to the University of Illinois at Chicago . At UIC, Burke held six concurrent titles: Professor and Associate Dean for Academic Affairs; Chairman of the Department of Associated Medical Sciences; Professor of Biocommunication Arts; Professor in the Center for Educational Development; Professor of Communications; and remained editor of the Journal of Allied Health. To say that Burke was busy at UIC would be an understatement – he served on 28 different committees and the University Senate – during which period he traveled as part of a World Health WWW.ORTODAY.COM

Organization delegation to Africa (Congo and Kenya) to explore local issues in medical education. Finally, making an unusual transition to the for-profit world of industry in 1987, Burke joined the Pharmaceutical Division of Abbott Laboratories in North Chicago, Illinois, as Manager, Biomedical Communications. Tasked with building a worldwide medical education program for Abbott, Burke finally moved on from his tenured academic career. During his time at Abbott, Burke built new programs in medical education and established a new program in scientific relations. But after 10 interesting and challenging years (which entitled him to retire with full benefits), Burke was

recruited to join a small, nonprofit association with what he saw as enormous potential: the Accreditation Association for Ambulatory Health Care, (AAAHC).

GEOFFREY CHARLTON-PERRIN is Director of Marketing and Communications for AAAHC, the nation’s leader in ambulatory healthcare accreditation. Previously, he was Director of Marketing for the Chicago Convention and Tourism Bureau and, before that, President of a major Chicago advertising agency. CharltonPerrin has written several articles on marketing, as well as a couple of children’s books. In addition, he is an artist who creates folk art.

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Update Index Categories to: Gel Pads, Positioners/Immobilizers, Positioning Aids, Hand/Arm Positioners, and Leg Positioners, OT Tables/ Accessories Surgical, and Surgical Supplies.

DESIGNER: JL

OR TODAY | June 2015

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INDUSTRY INSIGHTS WEBINARS

STAFF REPORTS

AAAHC WEBINAR SETS NEW HIGH FOR OR TODAY SERIES

ccreditation standards are a hot topic for OR Today readers and health care professionals, especially when an expert presents a webinar on the subject. A recent webinar in the OR Today series “AAAHC Accreditation Standards Updates for 2015” presented by Ray Grundman, MSN, MPS, FNP-BC, CASC, was the most popular one in 2015 with a record high 84 attendees and the best overall rating at 4.4 on a 5-point scale. Grundman provided a thorough and easy-to-follow look at all major changes listed in the 2015 Handbook of Accreditation Standards. He also took time to point out and discuss changes that are especially relevant to specific types of organizations. Grundman took time to answer all of the questions posed by attendees

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in written format and the Q&A is posted on the OR Today website at ORToday.com along with a webinar workbook and a recording of his presentation. The workbook includes a worksheet with true/false statements to aid attendees as they view the presentation. Attendees were impressed and thankful for the informative webinar. “(The) presentation was given at a nice pace that was easy to follow. All information was relevant to the topic as advertised,” attendee Judy K. wrote in her post-webinar survey. “Mr. Grundman was informative and concise with the information he provided,” Cathy S. shared in her survey. The OR Today webinar series as a whole also received high marks. “Your presentations assist us in managing our expenses while providing professional development opportunities,” Kris S. wrote. “OR Today’s webinar series is a

valuable tool that is available to anyone who wants to keep up to date on their selected field of practice,” Elodia F. wrote in her survey. The webinar series continues with sessions scheduled for each month throughout the remainder of 2015. Carol Stamas, RN, will present “Mind the Gap: Raising the Bar with Patient-Focused Warming Strategies” on June 22 at 2 p.m. The webinar, sponsored by Encompass Group, will help identify patientfocused warming strategies to bank heat, prevent cutaneous heat loss, and maintain normothermia throughout a patient’s perioperative journey. Heat loss in the preoperative pathway will be explained as well as the benefits of prewarming or banking heat. ADDITIONAL INFORMATION about upcoming webinars and links to previous sessions are available online at ORToday.com/webinars/. June 2015 | OR TODAY

INDUSTRY INSIGHTS ASC UPDATE

BY WILLIAM PRENTICE

NEW TRUTHS ABOUT HEALTH CARE T

hree recent studies are challenging conventional wisdom about the U.S. health care marketplace that has prevailed for many years. The trends that the studies reveal could have profound effects on the ways that ASCs and other health care service providers do business.

In the past, due largely to the health insurance options available in the U.S. at the time, health care analysts routinely observed that patients had little or no interest in the total cost of their care and would obtain the care they needed without question in whatever facility their physician recommended. Two of these three recent studies, however, suggest that faced with high-deductible health insurance plans and a need to shoulder a greater percentage of the costs of their health care, Americans have begun looking for and comparing prices before getting care. Public Agenda, a nonprofit, nonpartisan consensus-building organization, conducted the most recent of these two studies late last summer with support from the Robert Wood Johnson Foundation. After surveying 2,010 adults, in a report titled “How Much Will It Cost: How Americans Use Prices in Health Care,” the researchers concluded that 56 percent of Americans have actively looked for health care prices before getting care. They also found that about one in five Americans, or 21 24

OR TODAY | June 2015

percent, have compared prices across multiple providers and that those who have compared prices say doing so has affected their choices and saved them money. Other findings from that study that run counter to long held beliefs about the U.S. health care system were that 71 percent of Americans do not think higher prices indicate better quality care and 63 percent do not think lower prices are typically a sign of lower quality care. Also of note, 57 percent of insured and 47 percent of uninsured Americans are not aware that providers might charge different prices for the same services. The second study demonstrating a trend toward consumer-driven health care choices was conducted on California Public Employees Retirement System (CalPERS) patients between January 2009 and December 2012 and published in Health Affairs in March 2015. Specifically, researchers looked at a reference-based benefit (RBB) policy initiated by CalPERS for cataract surgery. Under this policy, patients who choose an ASC for their procedure do not have

to pay anything but those who choose a hospital outpatient department (HOPD) have to pay the difference between the actual price charged by the provider and the CalPERS contribution. After controlling for a number of variables, the researchers’ key findings include: • The RBB policy was associated with an 8.6 percent increase in ASC use in comparison to a control group. By 2013, 91.4 percent of CalPERS members were using an ASC compared to 79.6 percent of the control group. • In the year following the implementation of RBB, the average price paid by CalPERS for cataract surgery declined by 10.2 percent as a result of the shift by its members to lower-priced ASCs. • In the first two years after implementation, RBB for cataract surgery saved CalPERS $1.3 million. The third study that upends some traditional health care management theory was published in February 2015 by the National Academy of Social Insurance. In this study, researchers set out to find support for the societal and cost control-benefits believed to be associated with integrated delivery networks (IDNs), which they defined as either vertically integrated health services networks that include physicians, post-acute services and/or health WWW.ORTODAY.COM

ASC UPDATE

Once again, ASCs are at the forefront of new developments that put patients first and are helping to define the future of patient-focused care. plans or fully integrated provider systems inside a health plan. Instead, what they found was evidence that IDNs have raised physician costs, hospital prices and per capita medical care spending. They also found that, for providers, greater investments in IDN development are associated with lower operating margins and return on capital. You can read more about the methodology used to conduct the study and the researchers’ other findings in their final report “Integrated Delivery Networks: In Search of Benefits and Market Effects.” Considered together, these three

studies reveal two essential truths about health care that ASCs and others working to provide the best care and value to their patients cannot ignore. First, patients are becoming savvier health care consumers who are more interested in obtaining the information they need to make informed choices related to their care. Second, health care is changing, and all health care service providers need to re-examine some of the conventional wisdom behind the policies and procedures that they have in place today so that they can make the changes needed to

be able to meet and exceed the needs and expectations of their patients in the future. The ASC community has long supported increased quality and price transparency and long questioned the benefits of consolidation in the health care marketplace. Once again, ASCs are at the forefront of new developments that put patients first and are helping to define the future of patient-focused care. WILLIAM PRENTICE is the chief executive officer of the Ambulatory Surgery Center Association.

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June 2015 | OR TODAY

IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

PACU REQUIREMENTS At some facilities PALS along with ACLS is required to work in PACU. Is this a standard across the board? A: We do Peds, so yes. A: We require ACLS. We occasionally have Peds, so we have a few PALS as well as a few TNCC. We are working at getting more Trauma and PALS certified. A: Mandatory to have ACLS and PALS. A: Our policy is that we have one person in the facility (we are a small facility) that has PALS when we have a pediatric patient. That being said, all my full-time nurses are required to have current ACLS and PALS so we don’t run into a staffing issue and we like to error on the side of being overprepared. I do not require my part-time or PRN staff to have PALS. A: Yes to PALS, if you provide pediatric services. A: We require the anesthesiologists and the CRNAs to have PALS and ACLS. A: Our OR policy is if you always use an anesthesiologist with pediatric patients then the OR nurses don’t need PALS. If they want to get it, they can. •

OR TODAY | June 2015

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SUITE TALK

ANESTHESIA PROVIDERS’ ATTIRE

I am in the process of updating our Attire Policy. I am using AORN’s latest recommendations. The new policy requires hospital-laundered attire for all staff in the semi-restricted and resticted areas. Our anesthesia providers are beginning to build their case to fight the new policy. They currently wear home-laundered scrubs. Do your anesthesia providers wear hospital-laundered scrubs? A: No, but they do wear the hats. A: For infection control, all providers must wear hospital-laundered scrubs/caps and adhere to AORN standards. A: At Mercy in Lorain, Ohio, the anesthesia team wears hospital-laundered scrubs. AORN states that the washer has to reach a certain temp that home washing machines do not reach. A: Hospital laundered only in our OR. A: They wear hospital-laundered scrubs. A: Yes, they wear hospital-laundered scrubs. A: Yes, but sometimes it is a struggle to keep them from wearing them home, then returning with them later. Or, we are connected to a hospital, and they wear the hospital scrubs here. A: They must follow the hospital policy for OR Attire which does not allow them to wear clothes from home. A: Hospital-laundered scrubs here. A: Home laundering is really old school. It hasn’t been acceptable for years. I stress that they are putting themselves and their families at risk of infection too by bringing germs home. We don’t allow it. As far as hats go – if anesthesia insists on wearing their “lucky” hat, we require them to put a disposable hat on top of it to completely cover it. Our multispecialty center

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opened in 2008 and we have never had a post-operative infection. A: If your anesthesia group is a contracted service or employees, they must follow hospital policy and protocol – just like everyone else. We found our biggest push back was not wearing long sleeves under the scrub tops. We did implement that if you wear a cloth hat, you must wear a disposable bouffant cap over the cloth hat since our laundry service, being a commercial laundry, could not track the hats well and their washers and dryers destroyed the hats. Infection control helped us in our initiative since they fully backed us up. A: Yes, our anesthesia providers wear our hospital-laundered scrubs. We even had their names monogrammed on their scrubs! A: Our anesthesia staff wears hospital-laundered scrubs as do all of the PeriOp services departments. This is not only an AORN standard, many states also require this. A: When I was a manager at a surgery center, I allowed people to have their own, mark them and have them laundered in the center’s laundry. It was an extra expense to have the laundry mark them and then launder attire they didn’t own, but the owners paid the initial expense. A: In our facility, anesthesia personnel and OB personnel as well as OR personnel and our students in all these areas all follow the Surgery Dress Code.

June 2015 | OR TODAY

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IN THE OR MARKET ANALYSIS

BY JOHN WALLACE

MARKET ANALYSIS

Pressure Relief Market expected to hit $2.8 billion

he pressure ulcer prevention market is expected to eclipse $2.5 billion in 2020. Transparency Market Research recently released the report â&#x20AC;&#x153;Pressure Relief Devices Market - Global Industry Analysis, Size, Share, Growth, Trends and Forecast, 2014-2020â&#x20AC;? in which the global pressure relief devices market was valued at $2.0 billion in 2013 and is estimated to reach a market value of $2.8 billion in 2020. The market will experience a compound annual growth rate of 5.2 percent from 2014 to 2020, according to the report. Pressure ulcers, also called bedsores or decubitus ulcers, are often observed in geriatric people and hospital patients. They are common in acute respiratory patients and others who spend an extended period of time in bed. Pressure ulcers can be prevented by a number of support surface devices that include cushions, mattresses, specialty beds and overlays. The report indicates that an increasing number of obese people and a growing focus on pressure ulcer prevention are prime factors

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driving the growth of the global pressure ulcer devices market. In addition, a growing geriatric population globally accentuates the demand for pressure relief devices. However, technical complexity, requirement of skilled personnel and the high cost of the devices are some factors restricting the demand of pressure relief devices, according to the authors of the Transparency Market Research report. The low-tech device segment accounted for the largest share of the global pressure relief devices market in 2013. Foam-based mattress, gel-filled mattress and air-filled mattress are some of the low-tech pressure relief devices commercially available. In 2013, the foam-based mattress segment dominated the low-tech devices owing to easy availability, low technical complexity and comfort of the mattresses. However, gel-filled mattresses are anticipated to grow at the highest growth rate from 2014 to 2020. The growth of this market segment was supported by rising preference among patients for gel-filled mattresses, as utilization of these mattresses enables easy repositioning on the bed. The dynamic air therapy bed segment of high-tech devices

accounted for the largest share and is expected to grow at the highest CAGR from 2014 to 2020. These products are highly efficient and effective in pressure ulcer treatment and those are factors driving the growth of this market segment, according to the report. In 2013, North America accounted for the largest share in the global pressure relief devices market. Increasing prevalence of pressure ulcers, growing awareness and rising demand for various advanced mattresses is propelling the market growth of pressure relief devices in North America. For instance, the Agency for Healthcare Research and Quality (AHRQ) stated that around 2.5 million people in the U.S. are diagnosed with pressure ulcers every year. Europe was the second largest market for pressure relief devices in 2013 in terms of revenue. Some industry leaders include ArjoHuntleigh, AB (Innova Extra mattress), Covidien plc (Wings quilted premium under pads), Hill-Rom Holdings Inc. (NP50 Prevention Surface), Invacare Corp. (Invacare Softform Excel Mattress) and Stryker Corp. (PositionPRO).

June 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

DABIR SURFCAES DABIRAIR™ MICROPRESSURE OPERATING TABLE OVERLAYS

DabirAIR™ Micropressure Operating Table overlays have been developed as a new tool for surgeons and perioperative professionals to help reduce the risks of hospital-acquired pressure ulcers in the OR. Immobilized acute-care patients may experience impeded blood flow (ischemia) anytime during perioperative and recovery that can lead to tissue damage and cell death. The DabirAIR™ System: • Provides low-profile, alternating support and tissue relief (only 1-inch thick when inflated) • Reduces skin-shear effects due to immersion and alternating inflation • Overlays are semi-disposable/multi-patient-use with standard hospital cleaning • Overlays are intelligent, X-ray translucent, easy-to-deploy, and come in various sizes and shapes depending on the specific procedural need •

OR TODAY | June 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

ENCOMPASS GROUP FUSIONTM PATIENT CARE UNDERPADS BY MIP

Maintaining skin integrity is a critical component in the care of the hospitalized patient. Understanding the impact of methods to maintain skin integrity is vital toward the prevention of pressure ulcers and skin breakdown. The use of a new technology synthetic reusable underpad is beneficial to the patient in the acute care setting because of its ability to promote skin integrity â&#x20AC;&#x201C; not just protect the bed linen. Encompass Group LLC offers a full line of synthetic underpads, all with the goal of providing enhanced protection for the patient. The FusionTM underpad is in addition to the clinically proven DermaCareTM underpad. This technologically advanced reusable underpad is intended to provide the ultimate in patient comfort and care. For more information, visit www.encompassgroup.net. â&#x20AC;˘

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June 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

MEDLINE HEELMEDIX HEEL PROTECTOR Heels are a common site for pressure ulcers, and one way to reduce the risk of skin breakdown is by off-loading the heel. Medline’s HeelMedix® Heel Protector is a combination of pressure relief and skin protection all in one. Some of the clinical benefits of HeelMedix include completely off-loading the heel and helping to redistribute pressure while the open heel design allows for airflow and easy monitoring of the skin. The device comes with the option of multiple strapping methods for enhanced foot drop protection and to help firmly isolate the entire foot, while still floating the heel. •

OR TODAY | June 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

SMITH & NEPHEW ALLEVYN LIFE DRESSINGS ALLEVYN Life Dressings are uniquely designed for pressure ulcer prevention and wound management. The innovative technology and multilayered construction collectively redistributes pressure more evenly than traditional foam dressings – all while providing excellent fluid management capabilities. The ALLEVYN Life dressing is a multi-layered design incorporating hydrocellular foam, hyper-absorber lock away core and masking layer which has been designed for people and their everyday life. •

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June 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

STRYKER ISOAIR Strykerâ&#x20AC;&#x2122;s IsoAir is an active therapeutic support surface that assists in managing pressure, shear, and moisture through its deep cell, low air loss design. IsoAir features both static pressure redistribution and alternating low-pressure therapies that can be used in conjunction with active sensor technology to help automatically control immersion for the patient. IsoAir support surface utilizes a low air loss system and breathable Equilibrium by DartexÂŽ cover to aid in the moisture management of the patient skin. IsoAir is a lightweight support surface that deflates and rolls up for easy storage, making it an ideal option for caregiver convenience and rental reduction. 34

OR TODAY | June 2015

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June 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 541E

OR TODAY | June 2015

SOPHIA MIKOS-SCHILD, RN, EDD, MSN, MAM/HROB, CNOR, AND NANCYMARIE PHILLIPS, RN, PHD, RNFA, CNOR(E)

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CONTINUING EDUCATION 541E

PERIOPERATIVE NURSES LEAD THE WAY IN MANAGING SURGICAL PATIENTS’ SKIN INTEGRITY

kin breakdown affects the more than 2.5 million hospitalized patients each year in the U.S.1 Studies have shown that patients who develop pressure ulcers have an increased rate of mortality. The most affected are the elderly and people with a major injury or comorbid disease. Others affected include those otherwise healthy people who have diseases such as vascular disease, diabetes and obesity. Patients older than 65 account for 72% of those hospitalized who will develop pressure ulcers. This results in an increase of $2.2 million to $3.6 billion in annual healthcare costs.1,2

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

The purpose of this program is to discuss evidence-based practice changes that will promote RNs’ management of skin integrity in the OR. After studying the information presented here, you will be able to: • Describe intraoperative skin integrity within a model of patient care outcomes • Discuss intraoperative skin integrity in relation to the position of a surgical patient • Discuss managing skin integrity in relation to the intraoperative care team WWW.ORTODAY.COM

The Joint Commission has proposed pressure injury prevention as one of its patient safety goals because of the high rate of occurrence.1 The Centers for Medicare and Medicaid Services (CMS) will not reimburse hospitals for pressure ulcers incurred during hospitalization.1,2 Pressure injury is defined as a localized response to external pressure or in combination with external pressure and shearing force.1 Shearing force occurs when underlying tissue is stressed and stretched while external tissue remains under pressure. Pressure injury may not be noticed until up to four days postop, and it may appear as a burn area by floor personnel. In the OR, the injured area may look purple, which is caused by reperfusion after prolonged ischemia. Patients with darker pigmented skin are often diagnosed later, when tissue begins to necrose.1 The perioperative nurse’s focus should be not only on the color itself, but on the potential internal tissue

damage that likely has already occurred, especially if the color is over a bony prominence. In other words, the external purple color is, in all likelihood, not the injury. The injury is internal to deep tissue; the color is only a manifestation of the deep tissue injury. This is important to understand to grasp the concepts of pressure, duration and the location of the pressure on various parts of the body (i.e., “pressure points”). In the OR, management of a patient’s skin integrity is a challenge. Anesthetized patients cannot adjust their position in response to physiological discomfort and lack of sensation. The state of anesthesia (general, local, block or sedation) and anesthetic agents may compromise physiological response to ischemic tissue under pressure. Perioperative nurses need to accept managing patients’ skin integrity during the intraoperative phase as an accountability as determined by the American Nurses Association and the Association of periOperative June 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 541E

Registered Nurses (AORN).3 Skin integrity is a nursing practice concept. “Skin is the first line of defense” is a mantra in nursing education programs, and nursing standard of practice supports that principle.3 Traditionally, nursing literature did not strongly support “pressure points padded” (PPP) in nursing care plans and intraoperative nursing notes. The benefits of different support surfaces in the OR have been studied, but it remains difficult to verify the best and most effective means to prevent ulcers.3 Research on pressure ulcers in non-OR settings showed that using standard-issue hospital linen, cotton blankets and rolled towels as PPP to position patients compromised skin integrity rather than promoted it.3 Research focused on egg crate foam “paddings” and stabilizers, such as heel and elbow protectors and headrests, has directed perioperative nurses to use alternating pressure surfaces that incorporate gel-filled padding. But the previously used standard devices actually increased pressure, especially with obese patients, and did more harm than good for skin integrity.3 Nursing research is now more sophisticated and supported by performance improvement projects in clinical practice. As a result of research, accrediting agencies, public and private payers, and evidencebased practice, a mandate has evolved for all nurses, including perioperative nurses, to manage skin integrity. The new concepts of skin injury prevention and skin integrity management include new pressurereducing surfaces and pressurerelieving devices. It is now crucial to change from the traditional OR mindset of PPP to a focus on managing skin integrity by integrating 38

OR TODAY | June 2015

OR-specific risk factors with knowledge about pressure-reducing and pressure-relieving devices. The change in practice is based on knowledge — not skill, evidence or routine — and two patient outcomes: freedom from injury and freedom from infection. The change is evidencebased practice, not just a rationale.

the first step in the sterilization process. Surgical technologists contribute when they manage sterile fields. All activities of perioperative nurses contribute to keeping a patient free from injury and infection. The RN circulator performs the preoperative assessment, noting patient needs and risk factors;

RESEARCH FINDINGS ON POSITIONING3 Research on positioning on various OR bed surfaces indicates that the lateral position creates the greatest potential for both deep tissue injury and surface skin injury. The dependent, or “down” side of a patient in the lateral position creates a potential for deep tissue injury and shear caused by the pressure between the patient’s skin and the surface of the OR bed. The “up” side of the patient creates a potential for skin surface injury caused by the physiological compromise at the capillary level because of the stretch of tissue over the femoral process and resultant tissue ischemia.

PREVENTING INJURY AND INFECTION Patient outcomes are observable, measurable physiological and psychological responses to any nursing intervention. A patientbased outcomes model focuses practice on the high risks that patients in need of surgery or other invasive procedures may encounter. In the OR, the high risks are injury and infection, so the focus for care team practice is based on freedom from infection and freedom from injury. All perioperative team members — regardless of license or title — contribute to these two patient outcomes. The environmental service staff contribute when they use disinfectant to clean all the horizontal surfaces in the OR. The sterile processing staffs contribute when they decontaminate instruments as

organizes and manages the OR care environment to promote freedom from infection and injury; and evaluates care based on outcomes.4 The AORN Standards and Recommended Practices emphasize the patient’s skin integrity in discussion of outcomes of both freedom from infection and freedom from injury. The relationship between AORN standards and a patient’s intraoperative position is a baseline skin assessment. Without a preoperative baseline skin assessment, the perioperative nurse will not be able to accurately evaluate skin integrity postoperatively. As a result, compromise to skin integrity from PPP or from pressure-reduction and pressure-relieving surfaces will be difficult to determine. A clear “before and after” comparison of the skin is the best way to determine whether WWW.ORTODAY.COM

CONTINUING EDUCATION 541E

any injury to skin integrity is related to pressure-reduction and pressurerelieving surfaces, which are part of positioning, according to AORN standards.4 In addition, during a baseline assessment, the perioperative nurse assesses a patient’s risk factors and can be an advocate for the patient if special intraoperative pressurerelieving devices are required. With such nursing interventions, intraoperative-related iatrogenic injuries, such as burns, nerve damage and deep pressure tissue injury or skin surface trauma, should decrease, as should hospital-acquired infections.3,5 Intraoperative skin injury related to intraoperative positioning is a physiological function at the capillary interface level. The pressure gradient at that level is normally in the range of 23 to 32 mmHg relative to the thousands of capillary interface levels in the body.6 Physical skin injury occurs when the skin is compromised at the capillary interface level, causing ischemia. Compromise is caused by one or a combination of these factors: • Unrelieved pressure (or intensity) • Pressure over time (duration) • The location of pressure that is unrelieved for any length of time on the patient’s body • If any pressure exceeds a capillary’s normal pressure, regardless of the length of time, it is enough to restrict the normal blood-to-tissue interface at the capillary level. Deep tissue deprived of oxygenenriched blood begins to break down at this microscopic capillary interface level. As pressure time (duration) increases, the rate of the tissue breakdown increases. As the density between deep tissue and skin surface decreases, the intensity of breakdown from WWW.ORTODAY.COM

microscopic to deep tissue to surface tissue to skin increases, and a skin surface injury occurs. This can occur especially when tissue is stretched over a bony prominence, and, as a result, capillary interface pressures are exceeded or diminished. Patients undergoing procedures lasting more than four hours or cardiac procedures are at greater risk for skin breakdown, nerve damage and compartment syndrome.6,7 In summary, key points about pressure and duration are that neither alone can cause deep tissue ischemia, and that high pressure for a short duration and low pressure for long durations are equally compromising to tissue. Conceptually, tissue tolerance is an actual or potential closed pressure sore, which, if intensity and duration continue, will manifest as a skin surface injury. If it is located in the coccyx area, heels or elbows, it may become a true pressure ulcer because of the small surface area.8 WHAT ENDANGERS SKIN INTEGRITY? Patients who have an operative or other invasive procedure are at increased risk of impaired skin integrity because of three variables: surface pressure, immobility and the length of time that the pressure and immobility are exerted on the body. Postoperatively, it is not unusual to observe reddened areas (hyperemia) on patients’ skin surfaces. Not all hyperemia is related to “poor” positioning.8 Skin injury also may be the result of tissue trauma during surgery; manipulation of internal organs and a homeostatic response to injury; thermal or chemical surface skin reaction to an agent

used to prepare the surgical site; placement of retractors during the procedure; iatrogenic factors, such as staff’s leaning against the draped patient; and the patient’s own hemodynamics during the procedure.8 Additional factors that may contribute to skin injury, but to a lesser extent, include medications, irrigating solutions and fluid overload. The patient also may be genetically or medically predisposed for impaired skin integrity. The skin integrity of such patients is then insulted a second time because of OR-specific risk factors. Important extrinsic factors that

PREDISPOSING PATIENT RISK FACTORS1,3,6 • Age in relation to skin health • Comorbidities: diabetes, hypertension, respiratory disease, vascular disease, immunocompromised disease processes and diastolic blood pressure • Nutritional status at the cellular level: hemoglobin levels, hematocrit levels, serum albumin and total protein counts • Body size • Mobility • Body temperature

June 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 541E

are gaining attention are the interfaces between the patient’s body and the bed surface and between the patient’s body and the positioning supplies and equipment used for intraoperative positioning.5,6 Heel pressure, for example, is difficult to relieve or reduce because of the heel’s small surface area. In fact, standard foam heel pads increase heel pressure, so hyperemia may even be expected if they are used. (Suspending heels over a gel “bump” is more effective.) A recent report on foam headrests suggests that they, too, are more likely to cause occipital pressure injuries and alopecia than to maintain skin integrity.8 Intraoperative extrinsic risk factors include pooled liquids from skin preps, shearing of skin and skin friction during positioning, intraoperative hypotension caused by anesthetic agents and manipulation of the patient’s body, alterations in hemodynamic and circulatory status related to the patient’s intraoperative position and the layering of material between the patient and the pressure-reducing or pressure-relieving surfaces.5,6 THE KEY ROLE OF THE PERIOPERATIVE NURSE Perioperative nurses use evidencebased patient-outcomes-focused principles when a patient requires intraoperative positioning. The ability of perioperative nurses to manage skin integrity is part of the perioperative patient care model and involves directing the OR team toward optimal patient outcomes. The outcomes are the result of all OR caregivers working to prevent skin surface injury and deep tissue injury. Positioning, therefore, is a responsi40 OR TODAY | June 2015

bility that all OR caregivers share. Perioperative nurses usually initiate evidence-based care because of their knowledge of the patient, the patient’s risk factors and the OR supplies and equipment available for intraoperative positioning.6,8 The surgical procedure, the surgeon’s preference and the patient’s condition are variables to consider when choosing the type of equipment for positioning. The type of position the patient is placed in affects every physiological system. All members of the OR team have their own interests in positioning and contributing to optimal outcomes by safe and appropriate positioning. The interests include: • Optimal exposure of the surgical site — surgeon • Airway management, ventilation and monitoring access — anesthesia care provider • Physiological safety for the patient — team • Maintenance of patient dignity — perioperative nurse Providing positioning devices that relieve and reduce pressure is part of the advocacy role and duty of the perioperative nurse. Pressure-reduction devices reduce pressure to lower than what a patient would experience on a standard-issue hospital mattress. An OR bed mattress-gel overlay is popular in OR skin integrity management. It’s efficient, effective and supported by evidence. Most overlays are gel-filled pads used to cover the entire OR bed mattress. Air- and fluid-filled overlays are also available, including as accessories (e.g., “bumps,” “rolls” and supports). An accessory molds to the body and distributes and supports the weight-bearing surfaces of the

body in contact with the pressurereducing overlay. The pressure alternates under the weight of the patient’s body and does not remain constant. Pressure at patient capillary interface levels is reduced (intensity), and the duration and location of pressure on the patient’s body surfaces are relieved.5,7 Research has shown that a gel or an air overlay is an effective barrier between deep tissue and skin surface (pressure potential) and between the traditional OR bed mattress (intensity potential) and the patient. All of these surfaces and devices help in managing a patient’s intraoperative skin integrity.5 ADJUSTING POSITIONING TO PATIENT NEEDS Preoperative assessment includes the factors outlined in the sidebar “Predisposing Patient Risk Factors.” The assessment is part of the OR duty because care must be individualized. As an example, if a patient’s musculoskeletal system is compromised, safe and appropriate positioning may not be possible because of anatomic limitations. In this case, the perioperative nurse will need to adjust the type of position and positioning devices in consultation with the surgeon and the anesthesia provider. Other preoperative assessments include a baseline assessment of skin, specifically in areas where the safety straps and patient return electrodes are placed.3 In the OR, positioning devices should be available in a variety of sizes and shapes. The devices should be durable, allergen-free, fire and moisture resistant, and easily cleaned and disinfected. They should retard microbial growth and be stored, handled and retrieved easily. All WWW.ORTODAY.COM

CONTINUING EDUCATION 541E

patients should be evaluated for any special need required for positioning. Positioning injuries are especially costly to hospitals because CMS does not reimburse for the cost of hospital-acquired injuries.1,2 AORN does not recommend specific policies and procedures or nursing protocols for various intraoperative positions, because it would be difficult to encompass all variables and scenarios. However, facilities should have practice guidelines premised on evidencebased principles and patient-outcomes standards. Intraoperative documentation should, at a minimum, include the perioperative nurse’s preoperative assessment, the type and location of positioning devices, the names and titles of people positioning the patient, and an evaluation of outcomes, such as the appearance of the skin.4 Also, when the patient is repositioned on the OR bed or the positioning devices are moved, the perioperative nurse should reassess the patient. Postoperatively, while the patient is still in the OR, the perioperative nurse should reassess the patient, noting hyperemia and washing off residual skin prep solution before applying a dressing. Some of the one-step alcohol-based preps are designed as a lasting antiseptic barrier on the skin’s surface postoperatively and should not be removed. If they must be removed, a special cleanser is used or skin injury or irritation could occur. The presence of this layer of prep solution can mask pressure injury indicators. Having four OR team members assist with transferring the patient from the OR bed to the gurney will WWW.ORTODAY.COM

help to avoid shearing injury, friction injury, physical patient injury and injury to OR personnel themselves.3 AORN provides guidelines on preventing shearing and friction as well as moving patients in its Perioperative Standards and Recommended Practices. During hand-off communication, the postanesthesia care unit RN incorporates effective communication with the perioperative nurse by reporting skin condition, performing a follow-up skin assessment and noting when any reactive hyperemic areas begin to fade. The nurse reports to the surgeon any purplecolored areas that do not regain blanch or diminish in time.4 RN RESEARCH SETS THE STAGE Perioperative nurses can assess the risks of deep tissue and skin surface injury in their own care setting to compare incidence and prevalence. The data are available from an institution’s quality and outcomes department. By identifying the risks of injury in an OR and calculating their incidence vs. prevalence, perioperative nurses can support changes in positioning practices that are focused on prevention.2 Cost savings in the OR, based on evidence-based research, can contribute to success with reimbursement, best practices and shorter hospital stays.2 This viewpoint represents a change from the traditional view of intraoperative patient positioning as a skill to that of positioning as an outcomes-based practice based on nursing knowledge and nursing evidence.3 This may be a culture change in some ORs. It is an opportunity to help control the problem of perioperative compromise of skin

integrity, which is debilitating to patients through injury and infection and, in turn, a financial challenge to the healthcare industry with the resulting longer hospital stays and lack of reimbursement for hospitalacquired injuries.1,2 SOPHIA MIKOS-SCHILD, RN, EDD, MSN, MAM/HROB, CNOR, is an educator at St. Mary and Elizabeth Medical Center in Chicago and the former legal/ethical column editor for the Journal of Nursing Staff Development. The author has declared no real or perceived conflicts of interest that relate to this educational activity. NANCYMARIE PHILLIPS, RN, PHD, RNFA, CNOR, is a professor of perioperative education for nurses and technologists at Lakeland Community College in Kirtland, Ohio. She is the author of several textbooks and articles and received the Lakeland Excellence in Teaching, the Association of periOperative Registered Nurses’ Perioperative Clinical Educator and the Sigma Theta Tau Virginia Olsavsky Mentorship awards. REFERENCES 1. Wentworth K. Diagnosis, management and prevention of pressure ulcers. Hosp Med Clin. 2013;2(2):274-291. 2. Moore Z, Cowman S, Posnett J. An economic analysis of repositioning for the prevention of pressure ulcers. J Clin Nursing. 2013;22(15-16):2354-2360. 3. Steelman V, Grailing PR, Perkhounkova Y. Priority patient safety issues identified by perioperative nurses. AORN J, 2013;97(4):402-418. (REFERENCES CONTINUED ON PAGE 43)

June 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 541E

CLINICAL VIGNETTE Mary Jasperson, 76, is admitted for surgery of a right total hip after falling in her home in the afternoon. She is diagnosed with mild dehydration and has an IV and a Foley catheter inserted before going to the OR. In the OR, she is positioned on a fracture table for the two-hour procedure with the physician and his assistant. The OR nurse, Kim Yu, provides preoperative education and assesses Mrs. Jasperson. Kim discusses the intraoperative plan for positioning the patient with the surgeon and the team. As an advocate for the patient, Kim is concerned about managing the integrity of the patient’s skin, knowing that older adult patients have special needs to prevent pressure ulcers.

When Mrs. Jasperson arrives in the OR, Kim’s initial assessment would include: A. Condition of skin, color, turgor, warmth, abrasions, bruises or any other abnormalities, such as anemia, potential blood loss and length and tolerance of procedure B. Blood pressure C. Knowledge of surgical procedure D. Knowledge of the risks, benefits and alternatives of surgery Kim’s role as a patient advocate in the perioperative setting would include: A. Noting the belongings of Mrs. Jasperson and her family B. Organizing and managing supplies needed for the case C. Maintaining an environment that prevents infections and pressure ulcers based on evidence-based practice D. Evaluating the need for X-ray

After positioning, Kim reassesses Mrs. Jasperson, including the following systems: A. Respiratory, circulatory, neurological, musculoskeletal and integumentary B. Circulatory only C. Neurological and respiratory D. Respiratory Kim realizes that Mrs. Jasperson’s susceptibility to pressure ulcers while on a fracture table can be caused by factors such as: A. Humidity in the OR B. The patient NOT being in proper alignment for an extended period with less than an inch of support material between a body part and the hard surface or the fracture table C. The cold environment in the OR D. The extreme care taken when positioning

4. Correct Answer: B — One inch of padding material is especially important to focus on when preventing formation of pressure ulcers in the elderly. 3. Correct Answer: A — The respiratory, circulatory, neurological, musculoskeletal and integumentary systems are important to assess when a patient is positioned for a surgical procedure. 2. Correct Answer: C — Nurses acting as advocates manage the environment to prevent infection and prevent pressure ulcers based on evidence-based practice. 1. Correct Answer: A — Initially, an assessment by the OR nurse includes condition of skin to include color, turgor, warmth, abrasions and bruises. In addition, anemia, potential blood loss and length and tolerance of the procedure are assessed to form a baseline for comparison. 42

OR TODAY | June 2015

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CONTINUING EDUCATION 541E

HOW TO EARN CONTINUING EDUCATION CREDIT REFERENCES (CONTINUED) 4. Thoroddsen A, Sigurjonsdottir G, Ehnfors M, Ehrenberg A. Accuracy, complete-

1. Read the Continuing Education article. 2. 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.

ness and comprehensiveness of information on pressure ulcers recorded in the patient record. Scand J Caring Sci. 2013:27(1):84-91. 5. McInnes E, Jammall-Blasi A, Cullum N, Bell-Syer S, Dumville J. Support surfaces for treating pressure injury: a Cochrane systematic review. Int J Nurs Studies. 2013;50(3):419-430.

DEADLINE Courses must be completed by 03/31/2016. 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer. 4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test. 5. 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.

6. MacDonald JJ, Washington SJ. Positioning the surgical patient. Anaesth Inten Care Med. 2012;13(11):528532.

ACCREDITED ContinuingEducation.com is accredited as a provider of continuing nursing education by the American Nurses Credentialing Centerâ&#x20AC;&#x2122;s Commission on Accreditation.

7. Kallman U, Bergstrand S, Ek A, Engstrom M, Lindberg L, Lindgren M. Different lying positions and their effects on tissue blood flow and skin temperature in older adult

Accredited status does not imply endorsement by the provider or ANCC of any commercial products displayed in conjunction with this activity. ContinuingEducation.com is also accredited by the Florida Board of Nursing (provider # FBN 50-1489). ContinuingEducation.com is approved by the California Board of Registered Nursing, provider # CEP13213.

patients. J Adv Nursing, 2013;69(1):133-144. 8. Colman S, Gorecki C, Nelson EA, et al. Patient risk factors for pressure ulcer development: systematic

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review. Int J Nurs Studies. 2013;50(7):974-1003.

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CORPORATE PROFILE …

acific Medical opened its doors over a decade ago and is a growing and thriving organization. Pacific Medical President and CEO Andy Bonin started the business because he saw the need for quality equipment in the medical repair industry. His goal was to provide outstanding customer service while meeting industry needs. The company achieved Bonin’s goal and continues to grow and provide excellent customer service throughout the world.

Pacific Medical has established itself as a trusted name in the health care industry that specializes in monitors, modules, telemetry, infusion pumps, suction regulators, fetal transducers, SpO2/ECG/Temp/NIBP cables, O2 blenders, endoscopes and gas analyzers. Patient monitor devices and accessories are the areas where Pacific Medical stands out as a trusted and established leader for the purchase and repair of patient monitoring equipment. Pacific Medical is unlike any of its competitors. It is made up of an incredibly strong team that excels in a company team environment. Since the very beginning, the company has been powered by a sense of trust among leadership and the employees and that is carried over to the relationships 46

OR TODAY | June 2015

with customers. The company holds dual ISO certifications (9001:2008, 13485:2003) and that further strengthens Pacific Medical’s credibility by demonstrating that its products and services meet customers’ expectations. The dedicated team at Pacific Medical also continues to meet emerging industry demands in patient safety and quality. Pacific Medical’s demand for quality and superior customer service results in satisfied clients. The company’s approach has also fueled accelerated growth as more and more health care providers depend on Pacific Medical for its equipment needs. Pacific Medical has grown exponentially with an increase of 50 percent in total sales from last year.

Bonin points out that the company’s success is based on his formula to provide outstanding customer service while meeting industry needs. “We are a quality-focused, customerfacing organization which understands and delivers innovative solutions for the greater good of our customers and biomeds. This approach, in-turn, ensures the safety of millions of patients worldwide,” Bonin says. “Pacific Medical carries the largest patient monitoring inventory in the industry and is recognized for its cutting-edge customer service response team,” Bonin adds. “Today, Pacific Medical has expanded its repair competencies which now cover multiple equipment modalities. Our success has been driven by our WWW.ORTODAY.COM

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Pacific Medical’s New Building Addition Includes an Exclusive Telemetry Monitoring Room.

commitment to be the absolute best with a core group of repairs.” The growth and success over the first 10-plus years is a sign of things to come. The future is very bright for Pacific Medical as its high-quality employees continue to focus on excellence in every aspect of the company’s operations. “Pacific Medical’s mission is about giving back to the customer, community and team. We also feel our mission and job is not just service, but to lead and partner with key biomed industry partners while providing them with solutions based on their specific needs,” Bonin says. “The executive management team is committed to hearing and serving our biomed partners and working together to the end result as a strategic partnering team.” Its ISO certifications are one sign of Pacific Medical’s dedication to maintain the highest level of quality. It is this approach that powers the company and its employees to exceed the work of its competitors. “Pacific Medical strives to outperform its peers through operational excellence, in accordance with providing a dynamic and challenging environment for employees to excel,” Bonin says. “Our vision is to continue to strengthen our position as the recognized industry leader, with the ability to sustain life through reliable medical equipment services.” Another crucial element of Pacific Medical’s success is the leadership’s decision to invest in the company. Capital improvements to maintain a top-notch facility is one example of this objective. Pacific Medical is constantly reinvesting in itself by ramping up a robust inventory of parts and complete off-the-shelf ready units to outfit a large hospital. The company also stays WWW.ORTODAY.COM

Pacific Medical’s New Dedicated Telemetry Building (left) was Opened in Addition to the Main Headquarters (right) to Support the Rapid Surge in its Telemetry Business.

abreast of all of the latest and greatest technology in the industry to maintain its position as a leader that customers can depend on. Pacific Medical is comfortable with this environment of fast-paced growth that continues to be supported by proper planning at the executive level. An example of this growth is Pacific Medical’s recent purchase of a new building to expand its telemetry business. The new telemetry building was created to meet an increase in the demand for a volume of repairs and customers’ requests for critical turn times. “The new building was acquired as a solution to support the rapid surge of Pacific Medical’s telemetry business and to provide for future growth,” Bonin says. “The telemetry department offers dedicated repair areas for the different types of telemetry devices, including a separate room for testing and quality control.” The new building is the solution for a current need. However, it will also support future growth while meeting the current critical turn times of Pacific Medical’s customers. Everyone at Pacific Medical understands the importance of the medical devices they provide to health care facilities and the entire team strives to improve its operations to better serve customers. “Pacific Medical is forward-thinking and understands the critical nature of timely telemetry repairs and the

industry demand for increased efficiency and streamlined repair processes,” Bonin says. “We created the new building to address the needs of our customers while meeting the increased volume in our telemetry business. We experienced a significant influx of repair volume from our customers and we needed to provide a solution to keep up with the demand. The new building allows us to decrease turn times, increase efficiency and overall customer satisfaction.” The recent expansion also provides room to meet other needs. “We also now have the extra space for the assembly of complete transmitter units on the shelf for purchase that can ship within the same day. We also created a dedicated department that offers a complete inventory of accessories including our disposable patient ready packs,” Bonin says. Pacific Medical’s pride in continuing to increase cost efficiency and volume while adhering to its strict ISO processes is evident. Pacific Medical’s telemetry repair department capacity has quadrupled since the new building opened, expanding its capability for testing hundreds of telemetry units per day. Pacific Medical is now able to complete the entire telemetry repair process within 48 hours. Again, the company’s success is a result of the foundation Bonin established to provide quality equipment more than 10 years ago when he started Pacific Medical. June 2015 | OR TODAY

Pacific Medical’s Monitor Repair Department

The goal to provide quality equipment and outstanding customer service to meet industry needs is alive and well at Pacific Medical. It is a hallmark of the company dating back to its humble beginnings and continues to guide every aspect of its business as it soars to new heights in the future.

“Pacific Medical’s core competencies are quality, innovation, customer service, flexibility and outstanding turn times,” Bonin says. “The heart and soul of our success is showcased in our satisfied customers. We go above and beyond to meet our customers’ needs and provide the solution for lower-cost, high-quality solutions.” Pacific Medical’s philosophy has carried over into biomedical departments who have contacted the company to partner with them and provide services over several facilities. “We work with our customers to drive down their operational costs through volume discounts that include repair services, parts acquisition and accessories,” Bonin says. “As the organization has fully integrated their repair process into its CRM system, it creates a seamless platform for partnering organizations.” Expert quality repairs are what customers want and Pacific Medical is there to deliver. The company carries a huge patient monitoring inventory of recertified equipment for sale along with OEM compatible accessories and parts from all major manufactures. “We understand the difficult balancing act between cutting costs and trying to maintain a patient safety-first directive,” Pacific Medical Director of Sales Eric Hatteberg said. “Many vendors choose to use lower-quality parts and employ unskilled technicians. We, on the other hand, have spent considerable time and resources 48

OR TODAY | June 2015

educating our engineers to understand repairs at the component level.” Pacific Medical carries a huge patient monitoring inventory of recertified equipment for sale along with OEM compatible accessories and parts from all major manufactures. The fast pace at which the industry is growing is matched, if not exceeded, by the rate at which new technology enters the marketplace and becomes a must-have for health care providers. “The pace at which new technology is being introduced into health care delivery has grown exponentially in the past decade and we always have our finger on the industry’s pulse for every change. We are proactive versus reactive,” Vice President of Operations Damon Kelly says. “Pacific Medical takes into account that the medical technology in use today requires a very different type of technical role that includes integration and networking.” Bonin says Pacific Medical is continuously on the lookout for ways to make life easier for customers. “Pacific Medical is always looking for more solutions to take our products to the next level,” Bonin says. “It doesn’t stop at telemetry, and we are always looking to stay one step ahead. Our job is not just to service, but to lead and partner with our hospitals and biomed teams to meet their budget, on time and with a turn time of less than 48 hours.” Pacific Medical’s focus on service extends to its desire to make a positive impact on the community. The

company and its employees are deeply committed to community service and giving back. “One of the focal points of Pacific Medical’s mission and vision is to give back. We have worked with several organizations and private parties to provide discounts on our equipment to help those in need,” Bonin adds. “Our contributions include special private party support for children in need of advanced patient monitoring equipment, support to worldwide biomed societies, biomed scholarship funds for students and colleges, and working with the American Red Cross.” Pacific Medical also works with Toys for Tots and the local Orange County Community Partners to deliver hope to less fortunate youngsters while engaging in the joy of Christmas. The company also supports Project C.U.R.E., the largest provider of donated medical supplies and equipment to developing countries around the world. In short, Pacific Medical fosters a sense of community with its employees creating an innovative and team-oriented organization that champions support and solutions for its customers. “Our organization is run on trust and a strong family-type of environment. Everyone genuinely cares about each other and our organized success,” Bonin says. “I have an open door policy and strong communication with my team. The culture is friendly, successful and cutting edge. Everyone owns their contribution and is continually looking ahead to take their team and their projects to the next level of success.” The goal to provide quality equipment and outstanding customer service to meet industry needs is alive and well at Pacific Medical. It is a hallmark of the company dating back to its humble beginnings and continues to guide every aspect of its business as it soars to new heights in the future. FOR MORE about Pacific Medical, visit them online at pacificmedicalsupply.com. WWW.ORTODAY.COM

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New Reduction Program Impacts Reimbursements BY DON SADLER

ast year, the Centers for Medicare and Medicaid Services (CMS) launched a renewed effort to reduce the frequency of hospital-acquired conditions (HACs) among hospitalized patients. The newest CMS Hospital-Acquired Condition Reduction Program was mandated by the Affordable Care Act and builds on the CMSâ&#x20AC;&#x2122;s previous HAC reduction program that was established under the Deficit Reduction Act of 2005. It became effective last October and ranks most U.S. hospitals against each other with regard to the frequency of hospital-acquired conditions occurring within them.

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June 2015 | OR TODAY

HIGH COST OF HACS

“

The CMS HAC Reduction Program is attempting to improve HAC performance at U.S. hospitals by penalizing the worst-performing hospitals with regard to HACs. — Lisa Spruce

HOW THE HAC REDUCTION PROGRAM WORKS Each one of nearly 3,000 U.S. hospitals now receives a Total HAC score of between 1 and 10 — the higher the score, the worse the hospital has performed under the CMS HAC-Reduction Program. Hospitals that rank in the bottom quartile of HAC performance with a Total HAC score of 7.5 or higher will now lose one percent of their CMS IPPS reimbursements. According to Lisa Spruce, DNP, RN, CNS-CP, CNOR, ACNS, ACNP Director, Evidence-Based Perioperative Practice for the Association of periOperative Registered Nurses (AORN), it appears that the new CMS HAC Reduction Program was necessary because the original CMS program had little impact on reducing HACs. “We first started talking about hospital-acquired conditions in 1999 when ‘To Err Is Human’ was first published by the Institute of Medicine,” says Spruce. “However, it doesn’t look like we have improved in this area very much over the past 15 years.” In a preliminary analysis of the 52

OR TODAY | June 2015

new CMS HAC Reduction Program conducted in April, more than 721 hospitals were assessed sanctions of approximately $371 million. This represents an average of 18 percent of a hospital’s operating margin. “In addition, approximately one out of every eight hospital patients in the U.S. suffers a potentially avoidable hospital-acquired condition,” says Spruce. “The CMS HAC Reduction Program is attempting to improve HAC performance at U.S. hospitals by penalizing the worst-performing hospitals with regard to HACs,” Spruce adds. “Unfortunately, drastic action was needed because hospitals weren’t improving performance on their own.” WHAT ARE HACS? The term “hospital-acquired condition” describes any condition affecting a patient that arose during a hospital stay. It encompasses a wide range of conditions, which include but are not limited to: • Hospital-acquired infections (HAIs) • Surgical site infections (SSIs)

”

• Accidental punctures and lacerations (APLs) • Central line bloodstream infections (CLABSIs) • Catheter-associated urinary tract infections (CAUTIs) • Deep vein thrombosis (DVT)/ pulmonary embolism (PE) following certain orthopedic procedures like total knee replacement and hip replacement • Foreign objects retained after surgery • Falls and trauma • Patient burns • Stage III and IV pressure ulcers The Total HAC score is determined by several different HACs, but mainly APLs, HAIs, CLABSIs, CAUTIs and other patient safety indicators. In fact, CAUTIs are the most frequent type of HAI, accounting for 40 percent of all HAIs. One CAUTI results in an average of $3,383 in additional treatment costs and 4.6 additional days in the hospital, and approximately 13,000 deaths each year are attributed to CAUTIs. WWW.ORTODAY.COM

However, APLs carry the most weight in the Patient Safety Indicator Composite (PSI-90) ratio. This is a weighted measure based on eight individual patient safety indicators that is a key component in determining the Total HAC score. Common APLs during laparoscopy procedures include stray energy burns and energy burns within the visual field, says Jeffrey L. Eakin M.D., a laparoscopic and robotic gastrointestinal and bariatric surgeon with Physician Group of Utah, Jordan Valley Medical Center, in Salt Lake City, Utah. Eakin recommends using advanced technologies like the Ethicon Harmonic Scalpel, the Coviden Sonicision, and the Encision AEM Endoshield burn protection system to eliminate stray energy burns. “This technology shuts the instrument down if it senses any possibility that electrical current could be leaking out that might lead to a patient burn, thus reducing the potential for human error,” he says. “Relying on luck is not a good system to have for reducing APLs.” HACs can happen immediately in the OR or later after the surgery is complete, Eakin adds. “For example, wound infections usually don’t transpire until some time after surgery,” Eakin says. “The same thing goes for CLABSIs and CAUTIs,” Eakin adds. “If catheters are not handled properly, there is an increased risk of bloodstream infections from common bacteria.” Eakin stresses that urinary catheters should be removed as quickly as possible post-op, preferably within 24 hours. Also, proper sterile technique should be WWW.ORTODAY.COM

used and protocols utilizing best practices followed to reduce CLABSIs. Evidence-based recommendations for preventing CLABSIs include the following: • Educate and train all health care personnel who insert and maintain catheters. • Use maximum sterile barriers and proper hygiene techniques during catheter insertion and handling. • Avoid routine replacement of catheters as a strategy to prevent infection.

“

Relying on luck is not a good

system to have for reducing APLs.

”

— Jeffrey L. Eakin

Spruce stresses that evidencebased practice guidelines exist and should be followed for almost every type of HAC. “These are practices that have been proven to work in reducing HACs, so it makes sense to know and follow them,” she says. In addition, AORN has published guidelines and tool kits designed to help reduce many HACs, says Spruce, including foreign objects retained after surgery, ALPs, sharps safety, fire safety, and patient positioning and handling. Patient burns are another type of HAC that is more common than many health care professionals realize. Over a 10-year period in

the U.S., patient burns resulting in thermal bowel injury have led to more than 16,500 patient complications and 4,000 preventable patient deaths. DATA TRACKING AND ANALYSIS Spruce believes that data tracking and analysis is one of the most important keys to reducing HACs. “Hospitals need to track data carefully to determine the areas where HAC improvements are most needed,” she says. “This data needs to be clinically based so hospitals can capture safety events as they happen in real time.” For example, electronic health records (EHRs) can track data automatically, Spruce notes. June 2015 | OR TODAY

HIGH COST OF HACS

“Data needs to be actively captured, rather than passively reported,” she says. “Once you do this, you can improve your processes in ways that will help prevent HACs. And the technology can help you monitor your processes to gauge compliance with the CMS HAC Reduction Program.” Hospitals can realize a number of concrete benefits by severely reducing or eliminating HACs, including: • Avoiding a reduction in CMS IPPS reimbursements, which will help

OR TODAY | June 2015

maintain operating margins. • Shorter hospital stays for patients and lower patient readmission rates, resulting in higher levels of patient satisfaction. • Improved hospital reputation in the marketplace. • Avoiding costly and timeconsuming patient lawsuits. • Better operational efficiency in the hospital. Spruce points out that hospitals’ Total HAC scores are made available to the public — they are posted on

the Medicare Hospital Compare website at data.medicare.gov. As a result, patients can make more informed hospital choices by comparing and choosing the best hospitals based on their history of HACs. “This will hit hospitals in the pocketbook in terms of reduced CMS reimbursements and fewer patients choosing to have surgeries performed there,” says Spruce. “So it is in the best interest of hospitals to do everything they can to reduce incidences of hospital-acquired conditions.”

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June 2015 | OR TODAY

SPOT SN LIGHT ON: MIKE NEWELL, M

OR TODAY | June 2015

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‘NURSE NAVIGATOR’

E S R U O C E F A S A S T R A H C FOR PATIENTS By Matthew N. Skoufalos

ears ago, you didn’t hear the term “nurse e Newell, navigator” or “case management,” said Mik took MSN. Nurses were people who came in and e your pulse and administered medication. Cas detectives, management was lingo used by lawyers and ient might and the only navigation experience a pat a wheelchair. have in the hospital involved crutches or

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June 2015 | OR TODAY

‘NURSE NAVIGATOR’ CHARTS A SAFE COURSE FOR PATIENTS

In fact, in 1979, when Newell was certified in critical care nursing, even that was a new specialty. Twelve years later, when he added a second certification in case management, “this new thing called managed care” was another first for nursing professionals — one that matched neatly with the needs of the private rehabilitation services group with whom he soon landed. “Nurses are generally altruists, and you get tired of working in the system as a technician,” Newell said. “You’re there to give pills, give your assessment, and take the flak from the patient and families and keep your mouth shut. The way I survived in nursing was to go where they were going to teach me something new.” At the time, catastrophic auto coverage and worker’s compensation insurance policies costs

Mike Newell, MSN, strives to help patients maintain their independence and safety when they return home.

He pursued a master’s degree in nursing and began consulting around managed care and health outcomes management, eventually returning to

YOUR PLAN OF CARE SHOULD BE MORE THAN A MEDICAL, TECHNICAL APPROACH. IT NEEDS TO TAKE INTO ACCOUNT THAT PERSON’S WORLDVIEW, THEIR RESOURCES, THEIR CURRENT FUNCTION.

approached $1 million, he said, because “if you were injured, their only way of [insurers] containing the cost was to make sure you got through the system as quickly as possible.” For Newell, who “already knew how to read between the lines on a medical chart,” he soon discovered the same skills applied to the insurance side of health care, too. 58

OR TODAY | June 2015

the bedside as a teaching nurse at Drexel University in Philadelphia. But Newell never lost sight of the need for more intuitive case management services, which only grew, particularly as health care laws became more complex. Eventually, with the Affordable Care Act tying health care reimbursements to patient outcomes, he saw a natural market opening for

someone with his skill set, which had been honed over 40,000 hours in practice. So, Newell founded a private patient advocacy business called LifeSpan Care Management, which he describes as “the same as working for the insurance company, but this time, the customer is the family.” A large portion of the client population served in the managed care industry is elderly, Newell said; many are cared for by their children, and want merely to be able to return to their home lives after a hospitalization or stint in an assisted living facility. His goal is to ensure that patients have the ability to maintain their independence and safety when they are ready to return home. Newell works with his clients and their families to address issues like installing handholds in the bathroom, home monitoring equipment, and prescription management — the most common reason most people wind up in assisted living, he said. “If you don’t take your pills safely, the regimen of care doesn’t WWW.ORTODAY.COM

work, or your overdose yourself and you fall,” Newell said. “If you have an injury, you lose function, and then you’re likely to need to leave home anyway.” “The more medications a person is on, they’re more likely to have an adverse drug event,” he said. “If you’re over 65, you have a 10 percent chance of an adverse drug event for every drug you’re on, and you won’t know what drug it is because it’s likely

such a setting as quickly as possible. With hospitalization typically reserved for patients in need of intensive care or around-the-clock monitoring, there are entire groups of individuals who merely require sub-acute care to rehabilitate. After as little as three days of being hospitalized, a senior qualifies for Medicare, he said; and in as little as three days, a bed-ridden senior may also have suffered some loss of

company,” Newell said, patient advocates give their clients the best possible chance of a full recovery as possible. “At the end of the day, when somebody gets sick, especially if they’re old, they’re dealing with loss – loss of job, loss of function,” he said. “Developmentally, we all have certain stages that we go through, and you’re more likely to be able to deal with that if you get assistance. Your plan of care

business called LifeSpan Care Newell founded a private patient advocacy same as working for the insurance Management, which he describes as “the family. company, but this time, the customer is the

to be a combination of those drugs.” Most of his patients are on eight or nine medications, Newell said, a regimen that can contribute to the specific conditions for which seniors may find themselves at risk. SSRIs may contribute to fall risk, he said; statin drugs, meant to lower cholesterol, may cause muscle weakness or cognitive impairment. Proton pump inhibitors, commonly prescribed for gastrointestinal distress, may demineralize bones, making a fall more serious if it does occur. For patients who do require hospitalization to recover, Newell said his task is to help them return from WWW.ORTODAY.COM

function, requiring rehabilitation that Medicare would cover. But when such care may not be approved by health insurance companies, patients are at often at a loss as to how to advocate for it. “The insurance company may not approve the stay because of their criteria in their system,” Newell said. “If this person has potential to make continued gains while they’re in sub-acute, they should have the opportunity to make those gains rather than be shipped home.” By paying attention to what the client’s needs are “rather than what’s good for the doctor, for the insurance

should be more than a medical, technical approach. It needs to take into account that person’s worldview, their resources, their current function.” “Obamacare introduced the fact that you need help just to navigate the system,” Newell said. “An outcome, by definition, is a customer-defined utility. We’ve relied on physicians to tell us the outcome for a long time, but we should have been asking the patients. To physicians, the outcome is what interventions they did and whether they got paid. The true outcome is for the person to self-assess, ‘Was this good for me?’ ” June 2015 | OR TODAY

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OUT OF THE OR HEALTH

PREMIUM HEALTH NEWS SERVICE

THOSE 5 EXTRA POUNDS WON’T HURT ... WILL THEY?

weets can be hard to resist, along with all those fatty foods that taste so good. And what about those occasional extra helpings of mashed potatoes and pie? Does putting on a little extra weight really matter that much?

In fact, gaining just five pounds can increase your blood pressure, according to a study presented at the American Heart Association’s High Blood Pressure Research Scientific Sessions 2014. Many people understand the health dangers of large amounts of extra body weight, but researchers in this study wanted to see the impact of a small weight gain of about 5 to 11 pounds. “To our knowledge, for the first time, we showed that the blood pressure increase was specifically related to increases in abdominal visceral fat, which is the fat inside the abdomen,” said Naima Covassin, Ph.D., the study’s lead author and a research fellow at the Mayo Clinic in Rochester, Minnesota. “Our research WWW.ORTODAY.COM

suggests that healthy people who are more likely to gain weight in the stomach area are also more likely to have their blood pressure increased.” At the beginning of the eight-week study, a 24-hour monitor tested the blood pressure of 16 normal weight people. Researchers fed them an extra 400 to 1,200 calories each day with their choice of an ice cream shake, chocolate bar or energy drink to increase their weight by about 5 percent. Afterwards, their blood pressure was taken for another 24-hour period. Their results were compared to 10 normal weight, healthy people who maintained the same weight over the eight weeks. Researchers discovered: 1. Those who gained weight had a systolic blood pressure (top number) increase from an average 114 mm Hg to an average 118 mm Hg. 2. Those who gained more weight inside their abdomen had a greater blood pressure increase. 3. A five- to 11-pound weight gain didn’t change cholesterol, insulin or blood sugar levels. The study was conducted in healthy people ages 18-48. Further

studies will need to be conducted to see if the results are similar in different age groups, those with a family history of high blood pressure and other groups, Covassin said. “The public awareness of the adverse health effects of obesity is increasing; however, it seems most people are not aware of the risks of a few extra pounds,” Covassin said. “This is an important finding because a five- to seven-pound weight gain may be normal for many during the holiday season, the first year of college, or even while on vacation.” So before you drop extra marshmallows in your hot chocolate or make another trip to the buffet line on a cruise, remember that even a little bit could hurt.

– Co-authors of the study included Prachi Singh, Fatima H. Sert-Kuniyoshi, Abel Romero-Corral, Diane E Davison, Francisco Lopez-Jimenez, Michael D. Jensen and Virend K. Somers. The National Institutes of Health and the American Heart Association funded the research. June 2015 | OR TODAY

OUT OF THE OR FITNESS

BY HOWARD LEWINE, M.D.

Health Improvements That Will Pay Off for a Lifetime

mproving your health and wellness can seem like a daunting task, especially if you know you have some bad health habits to break. But, several improvements you can make today can result in tremendous health benefits. “It starts with you,” says physician assistant Tricia A. Howard, a faculty member at South University, Savannah’s College of Health Professions. “You have more control over your health than you think you do.” Here are five steps you can take today that can have a positive impact on your overall health and wellness.

once a smoker quits. “Even if you’ve smoked for many years, you can reduce your lung cancer risks just by quitting,” says Howard. “And this isn’t just about your own health. Smoking puts the ones you love at risk, because even second-hand smoke can cause cancer. So, quitting is a win-win for you and those you love.” Howard says people who want to quit smoking do better when they set a target date to quit. She also advises working with your primary health care provider who can actually individualize a stop-smoking plan for you. And, Howard says getting support from others is a crucial part of the battle.

STOP SMOKING Everyone knows smoking is bad for you. In fact, people who smoke have by far the greatest risk of lung cancer – the number one cause of cancer deaths in the U.S. – and increased risk of a cardiac event. But, many people don’t realize that changes in the lungs caused by smoking can actually improve over time

OR TODAY | June 2015

INCREASE YOUR WATER INTAKE Sixty percent of your body weight is water. Your body depends on water to carry nutrients to cells and to flush toxins out of vital organs, so getting the right amount of fluids each day is crucial. Howard says men should drink 3 liters, or 13 cups, per day. For wom-

en, the recommendation is 2.2 liters, or 9 cups, per day. If that recommendation seems tough to follow, Howard says to divide it up throughout the day. “Make sure you have water with every meal and also drink water at least once between each meal,” she suggests. “That divides up your fluid intake and can make the amount seem less daunting.” And, Howard says you don’t have to stick to water. Milk, coffee, and other drinks that contain a lot of water and not a lot of calories count towards your daily fluid intake.

EXERCISE “Exercise reduces your risk for chronic disease, improves balance and coordination and helps with weight loss,” Howard says. “Exercise is a key part of living a healthy life.” Howard says the U.S. Department of Health and Human Services recommends 150 minutes a week of moderate exercise, or 90 minutes of vigorous exercise a week, for adults. “That sounds like a lot,” Howard WWW.ORTODAY.COM

FITNESS

acknowledges. “But, if you break it into 15- or 20-minute daily workouts it’s much easier to fit into your schedule. You don’t have to spend hours at a time in the gym to reap the benefits.” Howard says recent studies have shown that even short bursts of exercise can be helpful.

ADOPT THE MEDITERRANEAN DIET The Mediterranean diet is a diet rich in fruits, vegetables, olive oil, nuts and fish. The results of numerous studies show long-term health benefits to adopting the diet. “This is a diet filled with antioxidants and anti-inflammatories,” Howard explains. “This diet has been shown to reduce the risk of heart disease and cancer when adhered to long-term. Weight loss and improvement in cholesterol can be seen after just a few months.”

HAVE YOUR CHOLESTEROL CHECKED You might be surprised to learn that you should begin having your cholesterol monitored by a doctor at age 20. But since coronary artery disease is the number one cause of death in the U.S., it’s a recommendation you should take seriously.

WWW.ORTODAY.COM

“There is no reason to avoid having your cholesterol checked,” Howard says. “If your cholesterol levels aren’t where they should be, you can change them.” Howard says levels that are too high can be controlled by diet, quitting smoking, exercise, and even prescription medication. “There are so many things we can do to improve not only the length of our life, but the quality of those years,” Howard encourages. “Don’t wait. Commit today to making a few small changes, and see how they improve your health over time.”

HOWARD LEWINE, M.D., is a practicing internist at Brigham and Women’s Hospital in Boston and Chief Medical Editor of Internet Publishing at Harvard Health Publications, Harvard Medical School.

June 2015 | OR TODAY

OUT OF THE OR NUTRITION

Rambutan

BY JUDY THALHEIMER, RDN, LDN

Cherimoya

Dragon Fruit

DON’T FEAR THESE EXOTIC FRUITS

ruits come in all shapes, sizes, colors, flavors and textures. While there are so many fruits you may be able to grow in your own backyard, such as apples, strawberries and grapes, more exotic varieties are becoming increasingly available. Let these three fruits – dragon fruit, cherimoya, and rambutan – offer a world of delicious, nutritious discovery. RAMBUTAN: The name comes from the Malay word for “hairy.” It’s an appropriate name for this bright red little fruit that has a rind covered in soft hair-like spines. Grown in Southeast Asia and Puerto Rico, this lychee-like fruit has a natural sweet and sour effect that comes from a balance of acids and sugars. About 59 calories each, the two-to three-inch round or oval fruits are packed with nutrients, including calcium, magnesium, potassium, phosphorus, vitamin C, niacin, iron and even some protein. For most varieties, ripe rambutan will be bright red. The tips of the soft spines should have little or no black. To remove the thin rind, cut partway in then pry the fruit open, as if opening an egg. Watch out for sweet, dripping juice! Once the rind is open, gently squeeze the fruit out. Enjoy the flesh, but don’t eat the bitter central seed. Rambutan is best eaten fresh, but it can also be used in cocktails and tropical fruit salad, or simmered into a simple syrup. •

OR TODAY | June 2015

CHERIMOYA: What could be bad about a fruit with a fragrance so sweet you can tell it’s ripe even from a distance? In the case of cherimoya, nothing. Native to the tropical forests of South America, this greenishyellow, cone-shaped fruit has a sweet, creamy pulp with smooth, black seeds. It contains a good amount of fiber and an impressive list of nutrients. This fragrant fruit is loaded with antioxidants (including vitamin C) and B vitamins, especially B6. Plus, it has lots of minerals, including potassium, magnesium, copper, iron and manganese. The skin of a ripe cherimoya should be greenish-yellow to light brown, without blemishes. When you press gently, the flesh should just yield. Keep unripe fruit at room temperature, and eat ripe fruit immediately. Wash, pat dry, cut lengthwise and scoop the flesh out with a spoon. After removing the seeds, eat as is, or puree to mix into fruit salad or as an ice-cream topping. Mix chunks with mangos, jalapenos, red onions and cilantro for a fruity salsa, or warm slices and sprinkle with cinnamon. •

DRAGON FRUIT: It doesn’t really breathe fire, so don’t let this beautiful fruit with deep pink flame-like “leaves” scare you. Cut open a dragon fruit and you will find sweet, crunchy, white flesh, dotted with tiny edible WWW.ORTODAY.COM

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seeds, that tastes like a cross between kiwi and pear. Native to Thailand, dragon fruit is now grown in Southeast Asia, Mexico, Central and South America, and Israel. A type of cactus, dragon fruit is packed with nutrients. High in fiber, vitamin C and B vitamins, plus phosphorus, calcium and a healthy dose of antioxidants, this tropical fruit is a worthy addition to your fruit repertoire. Look for fruits with a bright, even color. A few blotches are normal, but too many means the fruit may be over-ripe. Avoid fruits with dry brown stems or brown tips on the “leaves.” When you press the skin with your thumb, the flesh should give just a little. To prepare, cut the fruit in half through the stem end, then scoop the flesh out with a spoon; remove all traces of skin, as it’s not edible. High water content makes dragon fruit good for mixing in exotic tropical drinks and smoothies. Or pair it with other tropical fruits like mango and pineapple for a fruit salad or a lightly grilled kabob.

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June 2015 | OR TODAY

OUT OF THE OR RECIPE

BY DIANE ROSSEN WORTHINGTON

SERIOUSLY SIMPLE Cut Calories Without SacriямБcing Flavor BUCATINI WITH SAUSAGE AND PEPPERS

OR TODAY | June 2015

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RECIPE

ood trends come and go. Pasta got a bad rap when carbohydrates became our enemy. If you talk to nutritionists, they will tell you carbs are an important part of our diet but with some caveats. The most important one is eating pasta in moderation. Smaller size portions are one of the keys to guiltless enjoyment. And, of course, it depends upon the sauce. Heavy butter, cream and cheese sauces are not on this pasta menu. San Marzano tomatoes are recommended for their sweet flavor, low acidity and deep red color in many of the sauces. According to authors Joseph Bastianich and Tanya Bastianich Manuali, in their new book “Healthy Pasta: The Sexy, Skinny, and Smart Way to Eat Your Favorite Food” ($26.95, Knopf ), pasta should be a staple in your kitchen. So how can we enjoy pasta that we crave in a healthy and satisfying way? This sibling duo has

answered the question with a collection of incredibly delicious recipes all under 500 calories. “Healthy Pasta” brings pasta back into our diet in a celebratory way. You’ll learn a lot from the Bastianichs’ book like what’s a reasonable serving size, what kind of tomatoes are best, lighter cooking techniques, different

types of pasta and much more. All of their recipes use ingredients that maximize the flavor and minimize the fat content. One thing you will notice is that they use pasta water to flavor and add volume to many of their sauces. Think dishes like gnocchi with broccolini, spaghetti primavera and spaghetti with turkey meatballs. This recipe is a prime example of how to cut calories without sacrificing flavor. A colorful mixture of vegetables and just a handful of flavorful sausage are the secret to this tasty dish. The authors advise to let the vegetables wilt slowly to bring out their inherent sweet, garden flavor. Begin with a lightly citrus dressed arugula salad with tangerines and toasted almonds.

BUCATINI WITH SAUSAGE AND PEPPERS Serves 6 1 tbs. extra-virgin olive oil 8 Ounces sweet Italian turkey sausage (2 links), removed from casings 1 Large onion, sliced 1 Medium red bell pepper, sliced 1 Medium yellow bell pepper, sliced 4 garlic cloves, thinly sliced 1/4 C. dry white wine 1 (28-ounce) can whole San Marzano tomatoes, crushed by hand 1 tsp. dried oregano, preferably Sicilian on the branch • Kosher salt • Crushed red pepper flakes 1 lb. bucatini 1/2 c. fresh Italian parsley leaves, chopped 1/2 c. freshly grated Grana Padano (or Parmesan ) WWW.ORTODAY.COM

1. Bring a large pot of salted water to a boil for pasta. In a large skillet over medium-high heat, add the olive oil. Add the sausage. Cook and crumble with a wooden spoon until the sausage is well browned, about 4 minutes. Reduce the heat to medium, add the onion, red bell pepper and yellow bell pepper and cook until wilted, about 8 minutes, adding a splash of pasta water if the pan seems dry at any point. 2. Add the garlic and cook until fragrant, about 1 minute. Pour in the wine and reduce, about 2 minutes. Add the tomatoes and 2 cups pasta water. Stir in the oregano and season with salt and red pepper flakes. Adjust the heat to maintain a simmer and cook until thick and flavorful, about 20 minutes.

3. When the sauce is almost ready, add the bucatini to the boiling water. When the pasta is al dente, remove it with tongs and add directly to the sauce, reserving the pasta water. Add the parsley. Toss to coat the pasta in the sauce, adding a splash of pasta water if the pasta seems dry. Remove the skillet from the heat, sprinkle with the grated Grana Padano, toss and serve. Diane Rossen Worthington is the author of 18 cookbooks, including “Seriously Simple Parties,” and a James Beard Award-winning radio show host. You can contact her at seriouslysimple.com.

June 2015 | OR TODAY

OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • JUNE •

CONTEST

WINNER { JUNE }

OR Today is great to read during a break at work, but it is even better when you read it at the beach or at another vacation spot. Snap a selfie while on vacation with your copy of OR Today and you could win FREE lunch for your department. Email the photo along with your name, title and contact information to social@mdpublishin.com. Every entry wins 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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Deborah DeSouza Deborah DeSouza is a certified Surgical Technologist and is over general surgery at Scottish Rite Hospital in Atlanta, Georgia.

Michelle and Sandra read Deborah’s copy of OR Today.

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OR TODAY | June 2015

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PIN BOARD

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CONTEST SUBMISSIONS “As technology continues to evolve and new companies come aboard, your magazine helps to keep us up to date. In reading OR Today, it is easy for me to find companies that distribute medical equipment, when and where conferences are being held, sterilizations, infections/disinfectants, etc. Our staff enjoys reading [the magazine] because it provides the tools we need.” - Erica Combs Office Assistant for SIPS Consults Corp.

Get your own FREE subscription to OR TOday at ortoday.com/subscribe WWW.ORTODAY.COM

Keep an eye on the Pinboard in every issue to stay in the loop about contests. You could win lunch for your team!

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June 2015 | OR TODAY

OUT OF THE OR PINBOARD

CRANBERRIES MAY HELP IN LOWERING DIABETES RISK

Cranberries continue to impress scientists with their whole body health benefits as evidenced by the profusion of cranberry studies presented at the 2015 Experimental Biology conference in Boston. The research buoyed the tart fruit’s reputation for supercharging well-being and spotlighted the cranberry’s emerging role in helping to maintain blood sugar levels, a finding that could provide promising news for the future management of diabetes risk factors. Given that cranberries are naturally low in sugar, fat-free and a good source of fiber, researchers from the University of Oklahoma and Oklahoma State University joined forces to determine whether cranberry consumption could improve blood sugar levels in adults with Type 2 diabetes. The spotlight study split participants into two groups: Both ate a high-fat breakfast, however, one group had dried cranberries with their breakfast, while the other was given bananas. Blood draws taken after the meal revealed modest but notable beneficial effects in blood sugar among those who had eaten cranberries with their breakfast. The findings set the stage for future research, which may provide welcome news for the 29.1 million people in the U.S. living with diabetes each year. •

Study finds cranberries provide health benefits.

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MedWrench……………………………………………………… 60 Pacific Medical LLC…………………………………… 46-49 Palmero Health Care…………………………………………61 Paragon Service……………………………………………… 45 Polar Products, Inc…………………………………………… 67 Ruhof Corporation…………………………………………… 2-3 Sage Services…………………………………………………… 22 SIPS Consulting, Corp.…………………………………… 62 Surgical Power………………………………………………… 60 Tru-D……………………………………………………………………… 6

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HAND/ARM POSITIONERS Innovative Medical Products, Inc………………… BC HIP SYSTEMS Innovative Medical Products, Inc………………… BC INFECTION CONTROL/PREVENTION Clorox Professional Products……………………… 16-17 Encompass Group, LLC ………………………………… 35 Government Liquidation…………………………………IBC Palmero Health Care…………………………………………61 Ruhof Corporation…………………………………………… 2-3 Tru-D……………………………………………………………………… 6 INFUSION PUMPS AIV, Inc…………………………………………………………………21 INSTRUMENTS Government Liquidation…………………………………IBC INTERNET RESOURCES MedWrench……………………………………………………… 60 KNEE SYSTEMS Innovative Medical Products, Inc………………… BC

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MONITORS Jet Medical Electronics…………………………………… 67

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OR TABLES/ ACCESSORIES Action Products, Inc.……………………………………… 22 Birkova Products……………………………………………… 35 Bryton Corporation………………………………………… 35 Dabir Surfaces……………………………………………………19 Innovative Medical Products, Inc………………… BC

SURGICAL SUPPLIES Cincinnati Sub-Zero……………………………………………18 Cygnus Medical………………………………………………… 55 David Scott Company…………………………………… 44 Government Liquidation…………………………………IBC Ruhof Corporation…………………………………………… 2-3

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SURPLUS MEDICAL Government Liquidation…………………………………IBC

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

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

PATIENT MONITORING Bio-Medical Equipment Service Co.…………… 62 Curbell Medical Products, Inc.………………………… 5 Pacific Medical LLC…………………………………… 46-49

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June 2015 | OR TODAY

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