OR Today - September 2015 by MD Publishing

ASC

UPDATE PAGE 22

CONTINUINING EDUCATION

ANESTHESIA PAGE 34

SPOTLIGH ON

SARAH MATNEY PAGE 54

TAKE GOOD CARE

NURSES • SURGICAL TECHS • NURSE MANAGERS

SEPTEMBER 2015

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MENT » N E RO

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Control

ICIE N T EFF S

Define

LISHING B A A ST

Analyze

Improve

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CONTENTS

features

OR TODAY | September 2015

CORPORATE PROFILE: AMERICAN SURGICAL PROFESSIONALS

Staffing an OR facility with qualified mid-level professionals is a challenge today because it not only involves the costs and management effort of additional personnel but also ensuring that the mid-levels are trained. That’s why healthcare facilities are turn to American Surgical Professionals.

Measure

Define

ESTABLISHING AN EFFICIENT SURGICAL ENVIRONMENT

Many hospitals have adopted the principles of Lean Six Sigma in their efforts to create a more efficient surgical environment and thus reduce costs and improve the patient experience. Lean Six Sigma was originally developed for the manufacturing industry, but its principles are just as applicable to the OR.

SPOTLIGHT ON: SARAH MATNEY

Sarah Matney always dreamed of being a nurse. Now, she has her Analyze dream job at the Center for Cancer and Blood Disorders at Connecticut Children’s Medical Center in Hartford.

Improve Control OR Today (Vol. 15, Issue #7) September 2015 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530.

For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2015

WWW.ORTODAY.COM

September 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

INDUSTRY INSIGHTS 11 14 18 20 22

News & Notes AAAHC Update The Heat Is On 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 24 27 28 34

Suite Talk Market Analysis Talk Product Showroom CE Article

OUT OF THE OR

58 OR Today Live! Exhibitor Showcase 60 Health 62 Fitness 64 Nutrition 66 Recipe 68 Pinboard

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

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OR TODAY | September 2015

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ScopeTrac

ensitrac® is the leading provider of proprietary marking, scanning technology and application software for hospitals.

Provides automated tracking and documentation for endoscopes that will help you meet regulatory standards. Upload videos, PDFs, Word documents and have connectivity to oneSOURCE™. ScopeTrac Helps: • Save time and increase OR efficiency • Validate inventory data for all endoscopes • Ensure compliance with guidelines from the FDA, CDC, Joint Commission and AAMI • Reduce reprocessing errors and damage to your endoscope inventory • Provide complete information for audits, trend analysis and benchmarking for process improvement • Provide the ultimate patient safety/infection control for endoscope inventory • Create the foundation for Patient Safety in the OR Scan this tag to PROOF APPROVED learn more about Censitrac®.

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OR TODAY | September 2015

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INDUSTRY INSIGHTS NEWS & NOTES

MEADVILLE MEDICAL CENTER INSTALLS VIZTEK DR SOLUTIONS NEW, REUSABLE PILLOW AVAILABLE The Right Pillow-Healer is an organic, customizable, washable and reusable back sleeping pillow created to minimize post-op movement and increase comfort while recovering. This pillow’s design cradles the patient’s head, neck and shoulders keeping their body and spine in a neutral position, allowing for better rest and less movement while healing. The Right Pillow-Healer, is the medical version; designed specifically for the medical industry, and it’s improving the way people heal post-op. It allows patients to sleep in a supported, natural position without the need for multiple pillows around them, holding them still and in place. Allowing the body to relax and rest means less pain and decreased post-op trauma. The Right Pillow is made in the USA with environmentally sustainable and certified organic materials. The reusability, washability and longevity of the pillow means less waste in the landfills, less expense for disposal and WWW.ORTODAY.COM

much happier and healthier post-op patients. The reusability of this pillow is due to the fill – an organic, shredded latex, which is perfect for machine washing and drying as needed. Organic, shredded latex fill is extremely durable, environmentally friendly and does not give off harmful or dangerous fumes. Shredded latex provides comfort and adjustability, allowing for personalized contouring per patient. The Right Pillow offers several versions of the pillow, using organic wool or organic latex fills. The Healer was designed for medical use, maintaining quality and comfort while enduring frequent washing, while the two other versions are designed for single-owner use. The Right Pillow uses only certified organic materials: latex, wool and cotton for our products because the company believes in providing environmentally sustainable and healthy products. •

Viztek has announced that Meadville Medical Center in Meadville, Pennsylvania, is expanding its Viztek product suite and installing its Leggera Wireless DR panels. In 2013, Meadville implemented Viztek’s Opal-PACS. The Viztek DR solution uses integrated, wireless flat panel detectors offering advanced image quality and dose conscious capabilities, allowing for the most efficient workflow. The 235-bed hospital previously used a two-panel detector system, each with a tethered cord. The design proved to be cumbersome and difficult to position under a patient. Now, with Viztek’s DR solution, the lightweight and durable wireless detectors are easy to use and provide high-quality images within seconds of exposure. “To me, being a leader in the imaging world means educating yourself on the latest and greatest technologies available on the market; do not follow

the status quo,” stated Terry Beck, BSBA, RT, MR (R) Director of Radiology & Emergency Management. “Just because it’s a wellknown original equipment manufacturer, does not mean it’s the best. Customer service is, hands down, one of my top requirements in selecting a vendor and Viztek does an exceptional job with this.” The Leggera panels have increased productivity at Meadville, positively impacting the bottom line. Technologists and physicians have noticed a more efficient workflow mainly due to the wireless technology, streamlined workstation interface and the speed in which the image is processed. For patients, Meadville was able to reduce imaging techniques and that has reduced patient radiation dose, which is its most important goal, to deliver safe, high-quality, cost-effective care. • FOR MORE INFORMATION, visit www.viztek.net.

LEARN MORE at therightpillow.com. September 2015 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

BLUE BELT TECHNOLOGIES ANNOUNCES ORTHOPEDIC ROBOTICS PARTNERSHIP

Blue Belt Technologies has announced a partnership with SurgCenter Development, a leader in the launch and growth of physicianowned Ambulatory Surgery Centers across the United States. The partnership will enable SurgCenter Development locations to build streamlined Orthopedic Robotics Programs with Blue Belt Technologies’ Navio Surgical System. The Navio system is an advanced robotics-assisted technology for partial knee replacement procedures. Unlike other robotic technologies, the Navio system does not require a pre-operative CT scan. Using Navio, surgeons build patient-specific surgical 12

OR TODAY | September 2015

plans and implant prosthesis with a high degree of accuracy. Its open implant software supports many of the leading implant manufacturers’ knee systems. Dr. Greg D’Angelo of Bluegrass Orthopaedic and Hand Care in Lexington, Kentucky, and Dr. Sridhar Durbhakula of Piccard Surgery Center in Rockville, Maryland, will be the first physician partners of SurgCenter Development to take advantage of the program. “Navio delivers patientspecific and robotic advantages at an economic price point that takes into consideration the current health care environment,” said D’Angelo. “The technologies’ intraoperative planning software allows me to virtually measure soft tissue in real time for a well-balanced knee. It accomplishes all this without requiring patients to get a pre-operative CT scan.” “This partnership is an excellent opportunity to provide SurgCenter Development’s partner sites with leading technology in robotics-assisted partial knee replacements,” said Craig Markovitz, COO of Blue Belt Technologies. “We look forward to success at our initial two SCD facilities and expanding this relationship throughout their organization.” •

MÖLNLYCKE HEALTH CARE DEBUTS BIOGEL PI MICRO GLOVE FOR CLINICIANS

Expanding the Mölnlycke Health Care surgical glove range, the Biogel PI Micro surgical glove offers new levels of comfort, flexibility and protection. At 20 percent thinner than the Biogel PI UltraTouch, the Biogel PI Micro surgical glove offers enhanced tactile sensitivity and comfort while delivering the same protection of the full Biogel range. Biogel PI Micro can also be incorporated into a safe gloving program that addresses the risks of latex sensitivity, as a fully synthetic option for the latex allergic or the treatment of patients with latex sensitivities. The new thinness of Biogel PI Micro helps to provide the tactile sensitivity clinicians need. Biogel PI Micro can also be used in combination with Biogel PI Indicator Underglove for a double-gloving system. Up to 46 percent of surgeons cited a possible loss of manual dexterity as their reason for not double gloving. With Biogel PI Micro as part of the Biogel Puncture Indication System, the double-gloving solution is thinner than ever. “Double-gloving protection is critical, both in surgical guidelines for staff and for patient protection,” said Judith Seltzer (MS, BSN, RN, CNOR), Surgical Clinical Director with Mölnlycke Health Care. “These recommendations are part of the fight to protect patients and clinicians, especially in light of recent health crises, such as the ongoing fight against the spread of Ebola.” Biogel PI Micro gives clinicians full protection without sacrificing comfort or sensitivity. The Biogel PI Micro is now available through distributors nationwide. • WWW.ORTODAY.COM

INDUSTRY INSIGHTS NEWS & NOTES

NEWS & NOTES

SURGEON’S INVENTION ADDRESSES EXTREMITY WOUND PROCEDURES

Irrigating a wound is crucial for removing debris and promoting healthy healing. However, the traditional design of basins can create an unstable positioning of the limb, leading to leakage of fluids and an unsafe work environment. According to data from the National Electronic Injury Surveillance System, the National Hospital PROOF S Ambulatory Medical Care Survey and the U.S. Department of Defense, an irrigation basin may be PROOF APPROVED CHANGES NEEDED utilized in nearly seven million instances each year working environment. It is simply more convenient for the care of upper and lower extremity problems than the traditional process.” CLIENT SIGN–OFF: such as ulcerations, lacerations, burns, as well as PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT extremity war injuries. The use of basins in the FOR MORE INFORMATION on the Limb Basin and LOGO PHONE NUMBER WEBSITE ADDRESS SPELLING GRAMMAR operating room for surgical wounds only adds to a free trial, visit http://www.medline.com/products/ this overall number. perioperative-supplies/limb-basin/more-info. Wound irrigation has traditionally required the TRIM 3.25” assistance of multiple team members to position the limb and hold the suction apparatus. Furthermore, because basin walls are not contoured, surgical teams are forced to cut the basin walls to create “windows” to accommodate the limb, leaving sharp edges that need to be padded with sterile towels. An orthopedic surgeon has created a solution to these everyday obstacles by teaming up with Medline to bring a safer and more time-efficient option to market. The patented invention is called the Limb Basin. “Basins have historically been less than userfriendly for surgeons. The Limb Basin is the first and only irrigation basin that is hands-free and ergonomically engineered to cradle upper and lower limbs,” said Dr. Raymond Wurapa, a surgeon with Orthopedic ONE who has more than 15 years of experience operating at Columbus, Ohio-based Mount Carmel Health System. “Because the Limb Basin incorporates all relevant aspects of the traditional basin, it can be easily adapted into practice without changing a surSterilize in the geon’s typical protocol.” autoclave up to 300F Wurapa and Medline coordinated a trial among surgeons in the Columbus area. One participating surgeon, Dr. Ty Fowler, orthopedic surgeon and www.calzuro.com trauma specialist, said “this innovation just makes 800.257.9472 sense. The Limb Basin helps decrease operating room time for surgical staff and provides a safer

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September 2015 | OR TODAY

INDUSTRY INSIGHTS AAAHC UPDATE

BY SANDY BERRETH, RN, MS, CASC

THE WHAT AND HOW

OF AN ASC GOVERNING BOARD

hen I’m on an accreditation survey for AAAHC, one of the most frequently misunderstood CMS Conditions for Coverage and AAAHC accreditation chapters pertains to Governance. So what are the main components to governance of a surgery center?

LET’S START WITH THE CMS CONDITION FOR COVERAGE §416.41 CONDITION FOR COVERAGE: GOVERNING BODY AND MANAGEMENT The ASC must have a governing body that assumes full legal responsibility for determining, implementing, and monitoring policies governing the ASC’s total operation. The governing body has oversight and accountability for the quality assessment and performance improvement program; ensures that the facility policies and programs are administered so as to provide quality health care in a safe environment; and develops and maintains a disaster preparedness plan. WHAT DOES THIS SAY IN TERMS WE CAN ALL UNDERSTAND: The ASC must have a designated governing body that oversees and assesses all ASC activities and is responsible for: 1. Establishing the ASC’s policies 2. Making sure that the policies are implemented 3. Monitoring internal compliance with the policies 4. Assessing those policies periodically to determine whether they need revision. 14

OR TODAY | September 2015

In particular, the governing board must have direct oversight of: 1. The ASC’s quality assessment and performance improvement (QAPI) program 2. Quality of the ASC’s health care services 3. Safety of the ASC’s environment 4. Development and maintenance of a disaster preparedness plan WHAT IN PARTICULAR DOES THE GOVERNING BOARD NEED TO DO? • The governing board must determine the mission, goals and objective for the organization. • It must assume financial management and accountability. • It must develop a risk management plan and accountabilities. • It must delegate leadership and management roles. This is no minor responsibility – take a look at a list of the usual suspects: ° Administrative/leadership roles ° Human Resources ° Medical staff credentialing and granting of privileges ° Management of surgical services ° Management of nursing services ° Management of pharmaceutical services ° Management of laboratory (if applicable) and radiologic services

° Management of the ASC’s physical plant ° Quality Assurance and Performance Improvement ° Medical records maintenance ° Infection control • Along with designation of responsible employees, items that need to be reviewed annually include: ° Rights of patients ° Delegated administrative responsibilities ° Quality of care ° The quality management and improvement program ° The organization’s policies and procedures ° The medical staff’s appointment/reappointment process ° The infection control program ° The safety program. ° Compliance with all other applicable Standards • Most importantly, all of these jobs can be done by one or many; the key is the activity of delegation and a plan of recognition of accountability for each assigned task through a reporting mechanism. WHAT ARE SOME OF THE OTHER ACCOUNTABILITIES OF THE GOVERNING BOARD • It must formally adopt the organization’s policies and procedures, including the medical staff bylaws. WWW.ORTODAY.COM

AAAHC UPDATE

Keys to success include: having physicians that are passionate about the surgery center on the board; have leadership staff that wants to be the best; and inform the staff [all the staff – physicians to nurses to clerical] of the role of the governing board, its duties and responsibilities, and expectations. • It must have oversight of all contracts. • It must assist in the development of a Disaster Preparedness Plan. 1. This is so important that it has its own CMS standard §416.41(c) Standard: Disaster Preparedness Plan. CMS has been very descriptive with this particular standard. It states: “The ASC must maintain a written disaster preparedness plan that provides for the emergency care of patient, staff and others in the facility in the event of fire, natural disaster, functional failure of equipment, or other unexpected events or circumstances that are likely to threaten the health and safety of those in the ASC.” 2. The ASC coordinates the plan with state and local authorities, as appropriate. The ASC conducts drills, at least annually, to test the plan’s effectiveness. The ASC must complete a written evaluation of each drill and promptly implement any corrections to the plan. 3. Lastly, the Governing Board must have control of the financial well-being of the surgery center. THE NEXT QUESTION IS HOW • Perhaps the easiest and best way to meet the governance requirements is to create really good governing board meeting minutes. How do we do that? WWW.ORTODAY.COM

° Start with a good template for the agenda, have consistent topics for review, clarifications and new considerations. Use the same agenda every time, it helps consistency. ° Identify what the Board wants to assess at meetings and develop a document that will review the required and specific topics in regards to your surgery center and open it for discussion at the meetings. Remember, this is your surgery center: fine tune what needs to be discussed; the minutes don’t need to review the specifics of the discussion only the high points. • Hold regular meetings. A governing board must meet at least once a year. This type of frequency is common with single specialty, one-owner facilities. Some governing boards meet as often as monthly. Basically, the governing board should meet as often as needed to accomplish the routine work defined above. The governing board must make sure that “policy” is being followed; often this is done through quality reporting data that will be reviewed at the board meetings. • Maintenance of contracts is easily accomplished by adding the line item “contracts” to the agenda. If you’re undergoing an accreditation survey, the surveyors don’t necessarily need to know the nitty gritty of these contracts; they just need to verify documentation that they were discussed by the

governing board and quality is being maintained. • Lastly, benchmarking is a great way to review financial well-being of your surgery center; there are several resources available for benchmarking statistical information. In conclusion, the governing board’s responsibilities are extensive and varied. Keys to success include: having physicians that are passionate about the surgery center on the board; have leadership staff that wants to be the best; and inform the staff [all the staff – physicians to nurses to clerical] of the role of the governing board, its duties and responsibilities, and expectations. And keep a copy of the accreditation standards on your desktop for review. SANDY BERRETH has been a RN for over 35 years in multiple areas of the healthcare arena, the last 15 years as an administrator in a freestanding ASC. She holds a master’s degree in business organization and management, a CASC certification, and is a member of the BASC board for the promotion of the CASC certification. She is also a member of the ASCA Board and Minnesota’s ASC Association Board. One of her greatest pleasures is her career as an AAAHC surveyor; she believes this opportunity has developed her understanding of federal regulations and sharpened her awareness of the accreditation processes and ASC policies and procedures. September 2015 | OR TODAY

{

THE AAAHC SURVEYOR

}

Helping you raise the bar on patient care. AAAHC surveyors live the same world you do because they’re providers, nurses, medical directors and administrators. It means your survey is collaborative, not prescriptive. • AAAHC accredits more than 6,000 organizations. • W e’ve been helping organizations for more than 35 years. • O ur surveys are always conducted onsite – where it counts.

Improving health care quality through accreditation

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INDUSTRY INSIGHTS THE HEAT IS ON!

BY LINDA HUNTZBERRY, BN,CNOR; ANABEL VARNER, BSN; ALLIE KNIGHT, BSN; JENNIFER KING, RN; KAROL SANTOVIN, RN,CNOR

THE HEAT IS ON! The Value of Simulation in Managing a Malignant Hyperthermia Crisis

alignant Hyperthermia (MH) is a rare inherited hyper metabolic skeletal muscular disorder, which can occur when a susceptible patient is exposed to anesthetic triggering agents, such as Isoflurane, Desflurane, Sevoflurane, or the depolarizing muscle relaxant Succinylcholine. It is a life-threatening event that results in hypercapnia, tachycardia, muscle rigidity, acidosis, hypoxemia, hyperkalemia, and hyperthermia. Malignant Hyperthermia may affect all races and ethnic backgrounds; it is mainly seen in children, adolescents and young adults. In the United States the highest incident of MH is seen in Wisconsin, Nebraska, West Virginia and Michigan.

Preparedness and immediate recognition of symptoms and efficient response with interventions by team members is essential for positive patient outcomes. Through simulation drills, perioperative staff can develop the knowledge and skills to respond efficiently and effectively should a MH crisis occur. “Practice makes perfect” is one reason simulation is such a wonderful training option. Through repeated simulation drills of a malignant hyperthermia crisis, and post simulation debriefing we have come 18

OR TODAY | September 2015

to realize that it’s “perfect practice that makes perfect.” Simulation can be used for team training and developing or enhancing communication skills, as well as practice and assessment of specific psychomotor skills. It is an opportunity to assess and certify competency of learners in an environment without endangering a patient. It improves staff confidence and critical thinking skills and provides an opportunity to assess problem solving and decision making skills.

Prior to the first MH simulation drill, staff was educated and tested regarding their knowledge of MH. The first MH simulation drill was conducted by the perioperative service in the fall of 2011, guided by the nurse educator at the VA Medical Center in Lake City, Florida. As our department discovered debriefings have become the most effective tool for improving efficiency, streamlining processes, and reinforcing skills needed to ensure optimal patient outcome. At the conclusion of the WWW.ORTODAY.COM

THE HEAT IS ON!

simulations, debriefings were conducted and several important impediments to timely and effective care were revealed. These included: • Need for interdisciplinary team approach, to include anesthesia, nursing, lab, pharmacy, respiratory therapy and ICU. • Need for role definition with assigned tasks lead by anesthesia provider. • Effective closed loop communication among the team based on the American Heart Association code team protocols. Having a suggested scenario and assigned tasks with constant re-evaluation has allowed the unit to organize, plan and conduct an effective MH Drill in preparation for an actual event. MH is an WWW.ORTODAY.COM

example of why the perioperative team needs to have a plan and practice managing a complex medical emergency. Since timely diagnosis and intervention is of the essence, repeated simulations increase proficiency and positive patient outcome. Utilizing lessons learned has increased staff member’s ability to perform critical interventions and decreased the time it takes to mix and administer Dantrolene according to the guidelines of the Malignant Hyperthermia Association of the United States (MHAUS). Since prognosis is related to the timing of Dantrolene administration, it is recommended that patients start receiving Dantrolene within 10 minutes of a suspected MH episode. Our facility uses a fluid dispensing system with a mini spike

to facilitate and decrease mixing time of Dantrolene verses mixing with a syringe and needle. Two or three designated staff members are needed to mix and administer Dantrolene quickly and effectively. Through MH drills, staff becomes knowledgeable about the disorder, its rapid progression, the importance of prompt recognition of signs and symptoms and immediate delivery of Dantrolene. The mere presence of a fully equipped malignant hyperthermia cart is not enough; time and staff development is a major determinant of patient survival. REFERENCES 1. Safe and Unsafe Anesthetics. . Accessed July 22, 2014. 2. FAQs: General MH Questions. . Accessed June 16, 2014. September 2015 | OR TODAY

INDUSTRY INSIGHTS WEBINARS

STAFF REPORTS

SUMMER SESSION SETS NEW WEBINAR RECORDS

nventory management is a popular topic in health care, especially when it comes to the operating room. Operating rooms are facing significant pressure to reduce costs, increase revenue and provide the best in patient care. Challenges such as improving workflow efficiency, optimizing inventory and having access to real-time data are essential to achieving those goals. But it has not been easy.

The July 16 OR Today webinar “Successful Inventory Management in the OR: Taking it from a possibility to a reality” sponsored by Cardinal Health broke records. Marvella Thomas, RN, MSN, the Senior Clinical Manager at Cardinal Health had 230 people register for her webinar and a total of 93 attended the Thursday afternoon session. Thomas is an expert on the topic and shared her knowledge with attendees. She has more than 17 years of experience in clinical management with a bachelor’s of science and a master’s of science in nursing from the University of Missouri in Kansas City. Thomas discussed new technology that is enabling operating rooms to integrate inventory management in a single department or across an entire IDN. The result is true visibility and control to easily manage supplies from low cost to high value from the point of manufacture to the point of use. During the webinar, Thomas addressed key areas and offered various tips, including how inventory 20

OR TODAY | September 2015

management can aid in increased visibility to product usage and charge capture, while improving clinical workflows and patient safety.

session in which Thomas fielded questions and shared her expert insights. Attendees gave the webinar a 3.9 rating on a five-point scale in their post-webinar survey. Several attendees complimented Thomas’ presentation. “I really enjoyed today’s webinar. It gave me more data to take to my director in the hopes of getting our inventory under control,” Christy B. wrote in her survey.

“ The webinar was very beneficial from the standpoint of the OR room inventory management and also the Q&A brought up questions that never crossed my mind working in an warehouse facility.” — Anh L She also illustrated how to identify significant savings opportunity through product utilization and how to increase revenue through patient charge capture. Webinar attendees learned how to decrease variation through product standardization and how to reduce time spent by nurses on inventory management through Lean Six Sigma practices. Tapan Shah, a director of marketing and product management at Cardinal Health, joined her during the presentation. Another highlight of the webinar was an informative Q&A

“The webinar was very beneficial from the standpoint of the OR room inventory management and also the Q&A brought up questions that never crossed my mind working in an warehouse facility,” Anh L. said. The 2015 OR Today webinar series is growing more popular with each session. Almost 1,000 people have registered to attend webinars thus far this year. FOR A RECORDING OF THE WEBINAR and a schedule of upcoming webinars visit ortoday.com/webinars. WWW.ORTODAY.COM

INDUSTRY INSIGHTS ASC UPDATE

BY WILLIAM PRENTICE

RECOGNIZING NATIONAL ASC DAY ALL YEAR THROUGH

ugust 19 was National ASC Day 2015. On that day, ASCs across the country invited policy makers and other members of their communities into their facilities to learn more about the services and benefits that ASCs provide. ASCs have been recognizing this day each year for more than a decade. As a result, thousands have shared in these events, including many who learned about outpatient surgery and ASCs for the first time.

As the number and types of outpatient surgery procedures performed in the U.S. continue to grow, patients and policy makers are much more likely to be familiar with outpatient surgery and ASCs than they were when this program began. Still, ASCs have more work to do to make certain that those involved in national and local health policy decision making fully understand the reasons that so many patients and physicians prefer the ASC setting and all that ASCs have to offer them. The story behind ASCs today is simple but often overlooked or ignored: ASCs offer cost savings, high-quality outcomes and outstanding customer service. In other words, ASCs are economical providers of top-quality, patient-focused outpatient surgical care. In general, when patients get the outpatient surgical care they need in ASCs, patients, government programs like Medicare 22

OR TODAY | September 2015

and private insurance providers all save money and see top patient outcomes and high patient satisfaction scores. ASCs are also small businesses that offer employment opportunities to residents of their local communities and pay taxes. In many cases, they also provide free support services for community events that include free sports physicals for students, free vision screenings, health care support teams for outdoor events and, in some cases, free surgery to those in need. A number of studies and patient satisfaction surveys demonstrate the value that ASCs provide. As I mentioned in an earlier column in OR Today magazine, recent policy changes adopted by the California Public Employees Retirement System (CalPERS) that provide opportunities and incentives for patients to consider the cost of the health care services they need and to participate more fully in selecting the site of service for that care take another step forward. That program demonstrates that when given the choice and the knowledge they need to make an informed decision, patients will choose the lower cost, high-quality ASC setting. What’s more, those who studied the results of the changes that CalPERS made found that many of the hospitals that originally offered the same services at a higher price actually lowered their prices in response. This is a message that all health care policy decision makers need to hear. ASCs can deliver low-cost, high-quality care and promote

changes in the marketplace that can reduce the overall cost of care. At ASCA, we encourage all ASCs and ASC professionals to recognize National ASC Day each year. If August is not the right time for a particular ASC to host visitors, we encourage that facility to consider another date during the year. For ASC professionals who are not able to host visitors in their ASC, we suggest investing the short amount of time it takes to write a few letters to their representatives asking them to support some of the important legislation pending in Congress that is designed to protect and promote the ASC model of care. ASCA members can get help with those letters at www.ascassociation. org/takeaction. For ASC professionals who work in an ASC that cannot provide facility tours for policy makers, another way to make an impact this year is to reach out to the representatives of the insurance providers that you work with each day. Share the good news about the cost savings and quality of care your ASC provides and, then, take the next step. Show them a way that they can help their beneficiaries reduce the cost of the outpatient surgical care that they need by sharing the news about the CalPERS program. A short summary of that program that appeared in The Hill’s Congress Blog is available on ASCA’s website at www.ascassociation.org/ opedjuly092015. A free abstract of that study is available from Health Affairs at http://content.healthaffairs. org/content/34/3/415.abstract. Just as the early ASC tours and open houses conducted more than WWW.ORTODAY.COM

ASC UPDATE

10 years ago helped promote an understanding and awareness of the value that ASCs provide, these individual outreach efforts can go a long way toward educating insurance providers about their options for reducing costs without compromising care. It is also important to remember that this kind of outreach needs to be conducted all year long, not just on National ASC Day.

This is a message that all health care policy decision makers need to hear. ASCs can deliver low-cost, highquality care and promote changes in the marketplace that can reduce the overall cost of care.

ASCA supports a number of other initiatives that help individual ASCs and ASC professionals share the good news about ASCs and reach those who make the policy decisions

that determine how outpatient surgical care, and all health care, is provided. To learn more, contact Jack Coleman at jcoleman@ascassociation.org.

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IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

STAND-BY CALL PAY It’s the “age-old” question my friends. Do you all have exclusive pay rates for your heart team or any other exclusive call team? A: No. A: No we don’t have an

the additional days of call they are responsible for because of the small staff number. •

PEST CONTROL IN THE OR

I am wondering what other facilities are doing related to bug control in their facility. I am in a high mountain area in Colorado and usually bug control is not an issue, but I have had four separate incidents in the last month and a half where someone has found a bug in the OR. Does your facility have a company like Terminix come and spray the OR department on a scheduled basis? Would love ideas on what to do regarding this issue. A: We are located in south central Pennsylvania. This year we have had no pest issues, but last year was awful. We contract with a pest control company. The company sprays based on health care facilities regulations. We also placed a bug light at entrances surrounding the OR, day surgery, staff entrances. (The pest control company cleans the lights on a regular basis.) We also painted a bug repellant on the frames of outside doors. This triple play approach dramatically reduced the pest

exclusive pay rate for specialized teams. Our CVOR team has premium call rates due to

OR TODAY | September 2015

issues we were experiencing. A: We do not have them spray; however, there is a product that can be mixed with the mop water that serves the same purpose. I would contact your local exterminators for suggestions. A: Our facility does use a pest control company but it is important to spray at the right time. Building and grounds also has to make sure there are no weeds or high grass around the foundation or all the spraying

in the world will not keep them away. I think EVS does it every spring and probably as needed. We had these teeny tiny red spiders and were told they came from the roof so we have that sprayed as well. Hope this helps. A: Do you know the name of the paint that repels bugs? A: Yes. I am interested as well. Have not heard of that before. Also, another response stated there was a solution to add to the mop water. What is that? • WWW.ORTODAY.COM

SUITE TALK

SECOND SURGEON FOR C-SECTION

Does anyone know if there is a standard that states there needs to be a second physician as the surgical assist during C-sections? We are a small rural hospital and have been having a surgeon assist during all C-sections for many years but not sure if that decision was based on evidence or just an organizational decision that was made in the past. The need for a surgeon assist is being questioned. A: We used to have a MD assist at all C-sections. (Not all were surgeons, some were FPs). We now have nurse midwives assisting as well as a certified first assist scrub technician. A change in allied health privacy and medical staff bylaws was necessary for this to happen. A: I don’t believe so. They do on occasion for difficult cases, multiple births, etc. We use surgical PAs,

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RNFA and midwives as assists. A: We use an RN first assistant on our C-sections. A: I have never heard of that. We always just had a circulator and two scrubs – one to pass and one to assist. A: We use scrub personnel, not a surgeon. There is a pediatrician present for all C-sections though.

A: Curious, do you have two scrubs on call at all times? We also use scrub personnel but that requires me to have two on call. We are a small rural hospital and that causes people to take a lot of call since our staff is so small. A: Yes, I have minimally two persons on-call at all times – usually three, and yes, this creates a lot of stand-by call for my people.

September 2015 | OR TODAY

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IN THE OR MARKET ANALYSIS

STAFF REPORT

MARKET ANALYSIS

Patient Positioner Market on the Rise

echnological advancements have brought a lot of change in the way surgical procedures are carried out compared to just a decade ago. Operating rooms are becoming more spacious with new and advanced equipment, including patient positioners and surgical table accessories developed to hold a patient in the proper position throughout a surgical procedure. These devices, and others, have become an indispensable part of modern hybrid operating rooms.

The patient positioner and surgical table accessories market is expected to be impacted by an increase in the number of people who are living longer thus increasing the number of surgeries performed each year. Some additional factors expected to drive the market include the increasing number of ambulatory surgical centers (ASCs) across the nation. According to the U.S. Medicare Payment Advisory Commission (MedPAC), the number of Medicare-certified ASCs increased by an average annual rate of 3.6 percent in the country from 2006 to 2010. The continuous increase in the number of ASCs is likely to contribute to an increasing demand for surgical table accessories, according to PRNewswire. An increase in the number of WWW.ORTODAY.COM

obese patients undergoing surgical procedures has created a demand for new patient positioners designed to accommodate larger patients. This is a growing segment of the market. The popularity of hybrid operating rooms that include patient positioners and surgical table accessories is another reason industry insiders forecast market growth. Janet Kaplan, Director of Marketing, Action Products, Inc.-Medical Products Group, said the industry is growing because of the demand for patient positioners to assist with advanced procedures. Hybrid ORs are another reason cited when it comes to market expansion predictions. Hybrid operating rooms offer surgeons and

health care professionals greater operational flexibility by enabling easy access to various types of surgical and imaging equipment such as CT and MRI scanners. “Radiolucent products are a must in a hybrid OR to accommodate the CT and MRI scanners,” Kaplan said. Proper patient positioning is also an important aspect of robotic surgeries and as these procedures have become more common the demand for patient positioners has increased. Manufacturers are working to accommodate the needs of health care facilities. “The industry is challenged to create products to accommodate robotic surgeries’ extreme positions. The biggest complaints are: patients sliding, pinched extremities and severe eye pressure,” Kaplan said. The patient positioners and surgical table accessories market is a segment of the larger operating room equipment market. The global operating room equipment market was valued at $2.67 billion in 2012 and is expected to grow at a compound annual growth rate of 6.2 percent from 2013 to 2019, to reach an estimated value of $4.05 billion in 2019, according to Transparency Market Research. September 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

ACTION PRODUCTS DOME POSITIONER Patient positioning devices used under the knees should run the entire width of the surgical table pad. Most dome positioners are 14-inches long and are used under the knees during supine surgeries. In order for this positioner to cover the entire table many nurses put two positioners together. This solution hangs off of the edge of the table, may slide during surgery and cause pressure sores if skin falls between the cracks. The new Action® Dome Positioner (40603L) solves this problem, with 20-inches of Akton® polymer gel to cover the table end to end and redistributes the weight across the entire table. It is only available from Action Products. • 28

OR TODAY | September 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

ALIMED SECUREFIT™ TRENDENLENBURG POSITIONING SYSTEM (TPS) The Alimed SecureFit Trendenlenburg Positioning System(TPS) is a novel, reusable positioning system for Trendelenburg procedures. Developed and tested in conjunction with Massachusetts General Hospital, the SecureFit TPS’ proprietary design combines a uniquely contoured surface geometry to resist sliding with a viscoelastic gel pad to redistribute pressure and protect the patient. No bindings provide unobstructed chest and IV access, and the scapula region is cradled to protect the brachial plexus. The convenient reusable unit offers a simple, consistent, positioning method for laparoscopic, open and robotic procedures, takes less than a minute to set-up and is easy to clean to speed OR turnover. •

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September 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

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

OR TODAY | September 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

KAPP SURGICAL INSTRUMENTS INC. SURGICAL KNEE IMMOBILIZERTM The Kapp Surgical Knee Immobilizer is an economical solution for secure flexion and extension stabilization during knee surgery. With easy to use hook and loop adjustments, it frees the surgical practitionerâ&#x20AC;&#x2122;s hands to retract soft tissue. It is made from polyester/nylon material and is supplied in sealed sterile packaging. For single use only, it is disposable.

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September 2015 | OR TODAY

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IN THE OR CONTINUING EDUCATION 443D

OR TODAY | September 2015

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

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CONTINUING EDUCATION 443D

ANESTHESIA IN THE PERIOPERATIVE SETTING

he number of inpatient surgical procedures performed annually stands at 51.4 million, according to the Centers for Disease Control and Prevention.1 About 60,000 people undergo surgery daily under general anesthesia.2 Although anesthesia has been used since the 1840s,3 many anesthesiologists believe that we still do not have a full understanding of how anesthetics operate on the body. Anesthesia is still as much art as science. Daily, patients place their trust in anesthesia providers when they come to the OR.4 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 41 to learn how to earn CE credit for this module.

The goal of this continuing education program is to provide OR nurses and surgical technologists with information about the principles and practices of anesthesia care in the perioperative setting. After studying the information presented here, you will be able to: • Identify three types of anesthetics • Discuss two nursing considerations when caring for the surgical patient • List two signs and symptoms of malignant hyperthermia crisis • Identify the three stages of anesthesia • Select the correct medication for the treatment of malignant hyperthermia WWW.ORTODAY.COM

Your patients consider anesthesia to be a major risk of surgery4 and expect you to be their advocate by caring for their pre- and intraop needs and providing safe and effective care. This care is affected by anesthetics. This brings up several questions: How can you improve the safety of the surgical team? What type of anesthesia is generally used in the perioperative setting? What is your role during the administration of anesthesia? This continuing education module discusses medications and anesthetics used in the clinical setting; anesthesia-related problems, such as aspiration, injection of bolus anesthetic agents and malignant hyperthermia; and the perioperative team member’s role in dealing with these problems.

this time, physician and author Oliver Wendell Holmes Sr. coined the term anesthesia (from the Greek: an, “without,” and aisthesis, “perception”) to describe the new method of helping patients undergo surgical procedures without the perception of pain. Gone were the days of using opium and alcohol as anesthesia, with their adverse effects of vomiting and even death. The new discovery led to more invasive procedures with greater success and fewer deaths. By 1878, anesthesia with the use of an orotracheal tube was perfected. In 1898, the first spinal anesthetic was successfully administered. Today, technological advances in anesthesia have allowed patients to undergo more extensive procedures without pain, with fewer adverse effects and with no recall of the event (amnesia).4,5

THE DEBUT OF ETHER The first documented successful use of anesthesia is attributed to William Morton, a dentist at Boston’s Massachusetts General Hospital. In 1846, Morton demonstrated that ether induced a lack of feeling of pain. At

THE SETTING Anesthesia is provided in hospital ORs and outpatient facilities such as surgery centers and physicians’ offices. In such settings, the perioperative nurse acts as a patient advocate and caregiver and assists September 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 443D

the anesthesia providers — the anesthesiologist or certified registered nurse anesthetist or the new anesthesia person on the scene, the anesthesia assistant — in providing safe and effective care before, during and immediately after a procedure. To be an effective member of the surgical team, the nurse must be knowledgeable about anesthesia, including how it works and how to help provide the best care to the patient.4 BEFORE SURGERY All surgical procedures pose a risk. Therefore, patients should be in the best possible health before surgery. This optimal state of health includes both physical and psychological status. A patient’s physical and psychological status helps determine the events, issues and outcomes that will occur while the patient is anesthetized. The physical state of well-being can be determined by the health history, initial assessment and diagnostic testing. The baseline findings help the nurse formulate a plan of care with emphasis on an interprofessional approach. The team members include an anesthesiologist or a CRNA, who also performs assessments and documents his or her findings before moving the patient into the surgical area. Depending on the patient’s age, testing may include blood chemistry (such as a CBC), prothrombin time and partial thromboplastin time, an ECG and urinalysis.5 PT and PTT are done to evaluate the blood for its ability to clot and determine any clotting disorders. It is often done before surgery to evaluate how likely the patient is to have a bleeding or clotting problem during or after surgery. Urinalysis is used to detect urinary tract infections, metabolic disorders or kidney disorders. 36

OR TODAY | September 2015

An assessment and preoperative patient education may determine the patient’s psychological status. At this time, the nurse may discover that the patient has fears about the upcoming surgery. In rare cases ( just 0.1% to 0.2% of patients5), awareness, also known as intraoperative awareness, has been reported, with 1% to 1.5% of cases of awareness occurring in highrisk surgical patients, such as those undergoing major trauma and cardiac procedures.4 Years ago, little monitoring equipment was available to alert the anesthesia provider to whether the patient was aware of the procedure being performed. Today, the Bispectral Index System can help

the anesthesia provider monitor the optimal anesthesia level during general anesthesia and, to a lesser extent, the actual analgesia level.4,5 The system uses five electrodes on the patient’s forehead to measure the effects of specific anesthetic drugs on the brain and to track changes in the patient’s level of hypnosis (i.e., the altered state of consciousness or level of sedation).4,5 Before surgery, the perioperative nurse prepares the patient by completing the preop checklist, reviewing the patient’s chart and labs, and verifying the procedure by reviewing the informed consent with the patient, which names the

American Society of Anesthesiologists Physical Status Classification System4,5,7

The assignment of a physical status is based on the patient’s physiological condition and is independent of the proposed surgical procedure. Classification

Definition of patient status

Example

PS 1

A normal healthy patient

No psychological or physical disturbances

PS 2

A patient with mild systemic disease

Asthma, obesity, HTN, diabetes mellitus

PS 3

A patient with severe systemic disease

Cardiovascular disease that limits activity; severe diabetes with systemic complications

PS 4

A patient with severe systemic disease that is a constant threat to life

Severe cardiac, pulmonary, renal, hepatic or endocrine dysfunction

PS 5

A moribund patient who is not expected to survive without the operation

Surgery is a resuscitative effort; major multisystem trauma

PS 6

A declared brain-dead patient whose organs are being removed for donor purposes

Organ donor being maintained by life-support equipment

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CONTINUING EDUCATION 443D

procedure to be performed. Other nursing responsibilities include ensuring that the physician has obtained a consent, ascertaining the patient’s level of understanding with the use of teach-back to repeat the patient’s understanding of the instructions and consent,6 reinforcing teaching, answering questions and identifying any patient allergies, implants and issues with previous surgical procedures. This culminates with formulating the plan of care. At this time, the anesthesia provider discusses the anesthesia options with the patient and classifies the patient into one of six groups that determine physical status.4,5,7-9 The anesthesia provider may use premedication, such as midazolam (Versed), to reduce the patient’s anxiety and provide amnesia.10 Other medications may include atropine to control secretions, metoclopramide (Reglan) to reduce nausea and vomiting and an antacid or H2-receptorblocking agent such cimetidine (Tagamet) to reduce gastric production or decrease the acidity of gastric contents.4 DURING Once all is ready, the patient is brought into the OR, providing time for the perioperative team member to focus on allaying the patient’s fears. Because the room is kept cold, the nurse places a warm blanket on the patient and secures a safety belt around the lower thigh. Body blanket warmers replace warm blankets in many ORs. Before placing ECG leads or a pulse oximeter on the patient, the nurse should explain its use. A calm, quiet environment is essential to an anesthetic induction. The nurse stands by to assist as the anesthesia provider uses a general anesthetic or starts an IV. Propofol (Diprivan), midazolam and thiopental (PentoWWW.ORTODAY.COM

thal) have been used. However, Pentothal now has been removed from the market.9 Muscle relaxants and analgesics are given during the procedure. Gases and vapors, such as desflurane (Suprane) and sevoflurane (Ultane), may also be used during induction.5 Although nitrous oxide may be used for maintenance, it has several adverse effects.10 Other measures, such as the application of cricoid pressure, may be required during induction. Cricoid pressure is applied using the thumb and index finger to provide downward pressure on the cricoid cartilage to prevent aspiration during induction. Opioids are given to alter the response to pain and reduce the sensation of pain. This is done without altering the other sensory responses. Fentanyl (Sublimaze) and other opioids have the adverse effects of nausea, vomiting and respiratory depression, which must be closely monitored to ensure patient safety.4,5 Titration of medication and use of the Bispectral Index System for individualized administration have reduced nausea and vomiting.4 With general or regional anesthesia or sedation, a safe and adequate amnesia and anesthesia and immobility are the anesthesia provider’s overall goals.4,10 HOW DOES GENERAL ANESTHESIA WORK? General anesthesia is administered via inhalation, IV or both. Although it is not fully understood, general anesthesia is explained by several theories. The unitary theory, which correlates to the Meyer-Overton theory, states that all anesthetics work through a common mechanism in which they dissolve into nervecell membranes and produce structural change, such as membrane

swelling, that depresses channels, receptors and enzymes involved in sending nerve signals. The theory is correlated to how well anesthetics dissolve in lipids, as noted a century ago, but does not completely explain the actions of anesthesics.4 Protein receptor theory suggests specific central nervous system proteins serve as receptor cites, which must be occupied before the patient is unable to move.4 In addition, endogenous endorphins suppress pain pathways. However, this does not explain the full extent of anesthesia achieved when inhaled anesthetics are administered.4 Anesthesia is safer than it was years ago, given the current use of monitors for the heart and the brain as well as discovery of new anesthetic agents. Much is known, but more research is needed to understand what is occurring when a patient is under anesthesia.4 EVIDENCE-BASED PRACTICE Researchers are discovering more information about anesthesia. Researchers have found that patients did not generally want a “support person” present during induction, as previous research had found. The support person, usually a family member, was thought to lower patient anxiety, thus promoting wound healing and lowering of postop pain. In addition, researchers discovered that having a support person disrupts the surgical team.11 Not so for pediatric patients, wherein presence of a parent during induction may alleviate anxiety.12 A study of anesthesia adverse events found that general anesthesia has a higher rate of adverse events in inpatients than outpatients. For outpatients, regional and general anesthesia had the highest rate of September 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 443D

adverse events. Adverse events such as airway complications were more prevalent, and the researchers recommended that general anesthesia be more carefully monitored.13 THE THREE PHASES The administration of anesthesia has three phases: induction, maintenance and emergence. Induction begins when the anesthetic is administered and ends when the incision is made. Anxietyrelieving medications such as midazolam block memory of the procedure while propofol, a rapidacting medication, induces unconsciousness. Elderly patients or those with myocardial impairments receive etomidate (Amidate).10 During this phase, an endotracheal tube or a laryngeal mask airway may be inserted to maintain the airway and prevent aspiration. At this time, verification of the ETT placement is done by continuous capnography (endtital CO2 [ETCO2] monitoring) and checking of vital signs and breath sounds to ensure proper tube placement.10 Neuromuscular blocking agents or muscle relaxants such as succinylcholine (Anectine, Quelicin), atracurium (Tracrium) or rocuronium (Zemuron) are used to facilitate exposure of the surgical site and help with intubation.5,8 The nurse is responsible for maintaining vigilance for complications, such as aspiration during a rapid-sequence intubation. The anesthesia provider may need help during intubation to apply cricoid pressure, maintain an open airway or access additional supplies. Suction must be available to help remove any secretions that may obstruct vision during intubation. The nurse or surgical technologist may also serve as an additional set of eyes and ears alert for unanticipated events. 38

OR TODAY | September 2015

The maintenance phase begins with the surgical incision and ends near the completion of the procedure. Gases such as isoflurane (Forane), sevoflurane (Ultane) and desflurane (Suprane) are used for maintenance. Dexmedetomidine (Precedex) is becoming more common as a sedation agent and a supplement to general anesthesia.10 During this phase, the anesthesia provider maintains the level of anesthesia, monitors vital functions and provides sedation. The anesthesia provider may not require assistance from the nurse. Best practice dictates that the team remains alert to the possibility that additional items may be needed. An unanticipated need for medication or supplies unavailable in the anesthesia cart may arise. Usually, no emergent needs come up. At this time, the perioperative nurse may update the patientâ&#x20AC;&#x2122;s record. The emergence phase starts at the patientâ&#x20AC;&#x2122;s wakening and ends when the patient is transferred to the PACU. Reversal drugs may be used or the patient may be allowed to wake up as the medication wears off. The patient must be observed during this time. Researchers have found that women wake up four minutes sooner than men from general anesthesia and may require earlier interventions,14 such as support and reassurance to help them deal with emergence delirium. Emergence delirium occurs in greater frequency in the elderly and children.15 It is characterized by excitement followed by disorientation, kicking and screaming. Flailing and agitation are common, especially in children. Emergence delirium can be easily managed as the team works together to help with extubation and in emergence from general anesthesia.16

REGIONAL ANESTHESIA Patients who cannot tolerate general anesthesia or who undergo procedures such as surgery on extremities have alternatives such as regional anesthesia or local anesthesia with moderate sedation. The anesthesia provider administers regional anesthesia by injecting a local anesthetic along a nerve pathway into clusters of nerves supplying an area that needs numbing.14 The advantage of this agent is that it suppresses the pain impulse without causing a generalized depression of the entire nervous system. These anesthetics include eye block, epidural block, lower and upper extremity block and spinal block. The nurse helps the anesthesia provider with positioning the patient to facilitate the procedure. The drugs of choice include tetracaine (Viractin), lidocaine (Xylocaine), bupivacaine (Marcaine) and chloroprocaine (Nesacaine). Their use is based on the type and length of the procedure.4 The anesthesia provider typically uses an IV regional anesthetic called a Bier block to anesthetize the upper extremity, but a Bier block can also be used on the lower extremity. The anesthesia provider uses a double tourniquet and inserts an IV catheter in the operative arm (avoiding the surgical site). The arm is raised and exsanguinated. The proximal tourniquet cuff is inflated, and local anesthetic is injected into the IV catheter. If the patient feels discomfort, the distal cuff (the one over the injected area) is inflated, and the proximal cuff is deflated. This maneuver ensures the anesthetic remains in place until the tourniquet is deflated. The anesthesia provider and the perioperative nurse monitor the tourniquet inflation time and tell the surgeon the number of minutes the tourniquet has been in place. WWW.ORTODAY.COM

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Lidocaine, bupivacaine, chloroprocaine, ropivacaine (Naropin) or mepivacaine (Carbocaine) is used, and the patient is observed for reactions such as toxicity or overdose.8 The tourniquet is deflated slowly to reduce the possibility of a bolus of local anesthetic entering the systemic circulation. Another method to reduce risks is to deflate the cuff for several seconds during planned cycles at the end of the procedure. A sentinel event can occur when an unexpected loss of anesthesia due to loss of tourniquet pressure exists with a toxic reaction.4,17 During a spinal block, the anesthesia provider injects anesthesia into the fluid surrounding the spinal cord. The anesthesia works quickly to numb the entire lower body; however, it cannot be adjusted like an epidural. The nurse or the nursing assistant may help reassure the patient while providing support for positioning during administration. The patient is observed for hypotension after successful anesthesia. Another complication is a high spinal block (a too high level of block), which can cause depression of the spinal cord and brainstem, resulting in respiratory and cardiac depression. In this case, artificial breathing and maintenance of blood pressure may be required. One complication not as common as in the past is spinal headache. Typically, it is seen in patients under age 40. The size of the hole left by the needle puncture of the dura is often responsible for this problem.4,10 In epidural anesthesia, medication is injected into the epidural space, which is bordered by two adjacent vertebrae, the ligamentum flavum and the dura, that lie just outside the spinal cord. Local anesthetics can be injected in the lumbar, cervical or thoracic region. A WWW.ORTODAY.COM

catheter may be secured in place for hours or days, and medications are regulated to control postop pain. For caudal anesthesia, the epidural space is approached through the caudal canal in the sacrum. It requires a greater amount of anesthetic to fill the epidural space. Caudal anesthesia is often used for pediatric surgery, on the perineum, and in the lower extremities. Accidental dural puncture may cause an intense, incapacitating headache. Treatment is similar to spinal headache and may require strict bed rest, injection of autologous blood into the epidural space (an epidural blood patch), hydration, abdominal binders and caffeine.4 Vascular injection of local anesthetic may cause cardiac arrest, hypotension, confusion or tachycardia. In such circumstances, the patient may receive a benzodiazepine as well as ephedrine or phenylephrine. Anesthesia providers try to avoid adverse events from vascular injection of local anesthetics by using a test dose of local anesthetic with epinephrine to check for spinal or intravascular injection.4

and oxygen supplies. Emergency resuscitative equipment, such as medications, artificial airways, suction supplies and a defibrillator, should be readily available.5,8

MODERATE SEDATION Also called conscious analgesia, moderate sedation is the administration of IV sedatives by a registered nurse who has special training in the administration of the medication and patient monitoring. Best practice dictates that the nurse administering sedation should have no other duties except to administer medication and monitor the patient.18 Medications such as diazepam (Valium), midazolam and fentanyl are used to provide sedation and analgesia. Monitoring equipment includes a blood pressure device, ECG machine, pulse oximeter, and suction

SAFE ANESTHETIC AGENTS FOR MH PATIENTS19 • Diazepam (Valium) • Etomidate (Amidate) • Hexobarbital (Evipal) • Ketamine (Ketalar) • Methohexital (Brevital) • Pentobarbital (Nembutal) • Propofol (Diprivan) • Nitrous oxide • Amethocaine (Pontocaine) • Articaine (Septocaine) • Bupivacaine (Sensorcaine) • Etidocaine (Duranest) • Lidocaine (Xylocaine)

MALIGNANT HYPERTHERMIA Certain patients may have a genetic predisposition that limits the types of anesthesia that they can safely receive. For example, anesthesia agents such as halothane (Fluothane) and succinylcholine chloride can trigger malignant hyperthermia in some patients.5,8,13 MH is a rare, genetic disorder that occurs as a result of a hypermetabolic state, which increases carbon dioxide production, oxygen consumption and muscle membrane destruction. The key characteristics of this life-threatening complication are muscle rigidity, tachycardia, fever, hyperkalemia, myoglobinuria and acidosis.16 An elevation of body temperature is a late manifestation. If a patient has a family history of anesthesia problems and MH is suspected, the anesthesia provider uses nontriggering agents such as propofol (Diprivan).5,8,13,16

Dantrolene sodium (Dantrolene) is seen as a life-saving treatment for September 2015 | OR TODAY

IN THE OR

CLINICAL VIGNETTE Jane is scheduled for a breast biopsy with possible lumpectomy. She is admitted to the preop holding area with vital signs of 142/94 - 98.4 - 100 - 24. Oxygen saturation by pulse oximeter is 98% on room air. Her history and physical are unremarkable except for hypertension; she has been in good health until now. During the preop evaluation, the anesthesiologist has assigned Jane a physical status of PS 2 on the classification system from the American Society of Anesthesiologists, which estimates surgical risk. The patient says she wants to be “knocked out” with no knowledge of what is going on in the OR. Her fear is that she may awaken during surgery to find that her current illness indicates breast cancer. She speaks rapidly during the interview in the preop holding area and asks the same questions repeatedly without waiting to hear an answer. An IV is started, Jane signs the consent form, the nurse completes the preop teaching and checklist, and the anesthesiologist administers metoclopramide (Reglan). During induction in the OR, the nurse stands by the anesthesiologist to help during intubation. The nurse has suction available in the event of regurgitation or difficult intubation. Intubation is uneventful, and the patient is under sedation.

1. When Jane arrives in the preop holding area, the initial nursing assessment should include: A. An ECG B. Vital signs C. A chest X-ray D. An EEG

2. The nurse’s role during intubation of Jane includes: A. Being ready to apply cricoid pressure B. Assisting with epidural administration C. Pouring fluids for the scrub person D. Counting sponges

3. Jane prefers a general anesthetic because: A. The anesthesia provider recommends it B. It has fewer adverse effects than other anesthetics C. She fears being awake during the procedure D. Evidence-based research shows that general anesthesia is safer than other anesthetics

4. Jane’s anxiety level is evidenced by her: A. Repeatedly asking the same questions B. Having the ability to focus when given pre-op teaching C. Asking questions about the consent form D. Asking about pulse oximetry

1. Correct answer: B 2. Correct answer: A 3. Correct answer: C 4. Correct answer: A 40 OR TODAY | September 2015

MH episodes. This drug relaxes the skeletal muscle and may inhibit muscle contraction.16 Dantrolene sodium for injection (Dantrium IV) may be used because of the ease of mixing.20 During a crisis, the nurse and surgical technologist play a vital role in helping anesthesia providers mix and administer dantrolene sodium, cool the patient, insert a urinary catheter, draw arterial blood gases and other blood work, help with nasogastric tube lavage and obtain urine. Two decades ago, this crisis had a low survival rate, with up to 80% mortality. Today, the outcome from an MH crisis is more likely to be successful, with less than 5% mortality rate.21 The perioperative nurse and surgical technologist are an integral part of the healthcare team before, during and after surgical procedures. As team members, they need to be familiar with the theories and principles of anesthesia, anesthesia medications and possible complications of these medications. Knowledge of anesthesia and simulations and drills to prepare staff to respond to untoward events, such as an MH crisis, will help provide a safe and effective experience for the surgical patient in addition to supporting optimal practice and positive patient outcomes. The perioperative team member as an advocate of the patient can be more effective as a result of being competent in providing safe, optimal care. SOPHIA MIKOS-SCHILD, RN, EdD, MSN, MAM/HROB, CNOR, is Magnet coordinator at Presence St. Mary and Elizabeth Medical Center in Chicago. She is also an educator, a program developer, a faculty member of several online nursing programs and an author. REFERENCES 1. Inpatient surgery. Centers for Disease Control and Prevention Web site. http://www.cdc. gov/nchs/fastats/insurg.htm. Updated May 30, 2013. Accessed May 6, 2014. 2. Waking up to anesthesia: learn more before you go under. NIH News in Health Web site. http://newsinhealth.nih.gov/issue/ WWW.ORTODAY.COM

CONTINUING EDUCATION 443D

apr2011/feature1. Published April 2011. Accessed May 6, 2014. 3. Robinson DH, Toledo AH. Historical development of modern anesthesia. J Invest Surg. 2012;25(3):141-149. 4. DeLamar LM. Anesthesia. In: Rothrock JC, ed. Alexander’s Care of the Patient in Surgery. 14th ed. St. Louis, MO: Mosby; 2011:111-143. 5. Moss CJ, Moss R. Assist the anesthesia provider. In: Phippen ML, Ulmer BC, Wells MP, eds. Competency for Safe Patient Care During Operative and Invasive Procedures. Denver, CO: Competency and Credentialing Institute; 2009:150-176. 6. Flowers L. Teach-back improves informed consent. OR Manage. 2006;22(3):25-26. 7. ASA physical status classification system. American Society of Anesthesiologists Web site. http://www.asahq. org/clinical/physicalstatus.htm. Accessed May 6, 2014. 8. Perioperative Standard and Recommended Practices and Guidelines 2013. Denver, CO: Association of periOperative Registered Nurses; 2013. 9. ASA statement on sodium thiopental’s removal from the market. American Society of Anesthesiologists Web site. https://www.asahq.org/For-the-Public-and-Media/ Press-Room/ASA-News/ASA-Statement-on-ThiopentalRemoval-from-the-Market.aspx. Published January 21, 2011. Assessed May 6, 2014. 10. Palmer L. Anesthesia 101: everything you need to know. OR Nurse 2014. 2013;7(4):20-29. 11. Mayne IP, Bagaoisan C. Social support during anesthesia induction in an adult surgical population. AORN J. 2009;89(2):307-320. 12. Woolley T. Parental presence during induction of pediatric anesthesia. OR Nurse. 2012;6(2):48. 13. Fecho K, Moore CG, Lunney AT, Rock P, Norfleet EA, Boysen PG. Anesthesia-related perioperative adverse events during in-patient and out-patient procedures. Int J Health Care Qual Assur. 2008;21(4):396-412. 14. Anesthesia and how to prepare for it. Harvard Health Publications Web site. https://www.health.harvard.edu/ newsweek/Anesthesia_and_how_to_prepare_for_it.htm. Published January 2005. Accessed May 6, 2014. 15. Hudek K. Emergence delirium: a nursing perspective. AORN J. 2009;89(3):509-516. 16. Woolsey, L. Taking the heat out of malignant hyperthermia. OR Nurse 2014. 2013;7(2):36-41. 17. Complications and preventive measures. Tourniquets. org Web site. http://www.tourniquets.org/complications_preventive.php. Updated February 2014. Accessed May 6, 2014. 18 Role of registered nurse (RN) in the management of patients receiving moderate sedation/analgesia for therapeutic, diagnostic, or surgical procedures. North Dakota Board of Nursing Web site. https://www.ndbon. org/opinions/moderate%20sedation%20position%20 statement.asp. Updated October 2012. Accessed May 6, 2014. 19. Safe and unsafe anesthetics. Malignant Hyperthermia Association of the United States Web site. http://www. mhaus.org/healthcare-professionals/be-prepared/safeand-unsafe-anesthetics. Accessed May 6, 2014. 20. Dantrium IV FAQ. Dantrium Web site. http://www. dantrium.com/faq.php. Accessed May 6, 2014. 21. Dixon BA, O’Donnell JM. Is your patient susceptible to malignant hyperthermia? Nursing. 2006;36(12 Pt

HOW TO EARN CONTINUING EDUCATION CREDIT 1. Read the Continuing Education article. 2. Go online to ce.nurse.com to take the test for $12. 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 $49.95 per year.

DEADLINE Courses must be completed by 05/15/2016. 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.

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

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

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

1):26-27. WWW.ORTODAY.COM

September 2015 | OR TODAY

CORPORATE PROFILE

AMERICAN SURGICAL PROFESSIONALS Partnering Together Today to Address Tomorrow’s OR Challenges

id-level professionals combined with an experienced surgical team can have a tremendously positive impact on the flow in an OR, permitting surgeons to perform an extra case or alternatively shortening the OR day. These benefits can mean improved patient care, the potential for increased revenue and greater satisfaction for the surgical team and the patient. Staffing your OR facility with qualified mid-level professionals is a challenge today because it not only involves the costs and management effort of additional personnel but also ensuring that the mid-levels are trained on the correct procedures, equipment and technologies in order to be qualified to assist on the different types of cases that your OR and surgeons handle. That’s why more and more healthcare facilities are increasingly turning to clinical outsourcing with American Surgical Professionals. “We are one of the industry leaders in mid-level professional staffing services, which means we have the quantity and quality of personnel to provide out-

44 OR TODAY | September 2015

standing service in a broad range of surgical procedures and technologies across the country,” according to Tom Kirk, CEO of American Surgical Professionals (ASP). “Our size permits us to have the proper staff available when our clients need support. We feature flexible, proactive solutions that are aligned and synchronized to the conditions our clients face today and will face tomorrow. ” Clinical outsourcing provides the benefits of continuing to access a client’s pool of trained mid-level professionals, building on the current infrastructure and best practices, while introducing them to new technologies and processes which can improve the

outcomes in terms of cost reduction, quality improvement and enhancing patient and surgeon satisfaction. Without the management distraction, OR leaders can focus their energy and resources on other strategic priorities and initiatives. ASP has demonstrated improvements in outcomes for patients and for facilities where mid-levels assist in reviewing the room prior to surgery, positioning and prepping the surgical patients and in turning the room for the next procedure. “Utilizing a skilled first assistant has decreased surgical time in the operating room, which decreases probability of surgical site infections and complications,” says Sherry Lewis, director of surgical services at MetroSouth Medical Center in Blue Island, Ill. “The first assistant knows exactly what stapler to use and how to provide adequate exposure for the surgeon. It’s different from having a tech to just retract for them, it’s providing ongoing visualization, lighting, exposure for them.” WWW.ORTODAY.COM

SPECIAL ADVERTISING SECTION

“Utilizing a skilled first assistant has decreased surgical time in the operating room, which decreases probability of surgical site infections and complications." — Sherry Lewis, director of surgical services at MetroSouth Medical Center.

“Surgeon satisfaction is huge with an experienced surgical first assistant, the surgeon allows the first assistant to close the patient and dress the wounds, so that he can dictate and speak to the family sooner post surgery,” Lewis added. “Having surgical first assistants at our institution have really made a difference in terms of surgeon preference in where to operate.” American Surgical Professionals was formed to serve one city and has grown to serve several major market areas in nine states using a variety of offerings. These staffing solutions can be customized to suit the long or short term needs of the facilities, the specialty and case mix and the current and anticipated strategic and tactical measurement metrics. “We have been working with and listening to OR leaders for over 20 years. By being responsive to their needs, American Surgical Professionals has built an outstanding reputation based on the provision of well-trained, reliable and high-quality surgical assistant services,” according to Kirk. “American WWW.ORTODAY.COM

Surgical Professionals focuses on providing comprehensive solutions to the first assistant needs of facilities and surgeons by adding value, accountability, and flexibility to our client partners in a cost-efficient manner.” “We operate a decentralized model with our headquarters in Houston, Texas, but with local operations centers close to and understanding the needs of the entities they serve in Colorado, Florida, Georgia, Kansas, Illinois, Indiana, Iowa, Texas, West Virginia and we are currently exploring the possibilities in several other states,” Kirk adds. CRUNCHING THE NUMBERS Utilizing American Surgical Professionals’ staff will positively affect your bottom line by: • Maintaining cost efficiency without sacrificing quality of service • Increasing productivity • Decreasing turnover times • Decreasing staff management concerns and costs such as:

equipment and technology training, updating clinical proficiency on new procedures and employee scheduling. These value-added benefits allow surgical teams to handle more cases, which increases overall volume throughput, as well as improving asset utilization of the facility. “We have consistently demonstrated cost-effectiveness versus the internal staffing model of mid-level professionals,” says Kirk. CUSTOMIZED SERVICE American Surgical Professionals has adapted to changes in the nation’s healthcare landscape to better service providers and patients. “We are very excited to be able to customize our approach by addressing the very specific and unique needs of each hospital and surgery center, by offering experienced and specialized assistants in surgery on a timetable that meets the demands of our clients,” Kirk September 2015 | OR TODAY

THE JOINT COMMISSION: ACCREDITED FOR EXCELLENCE IN PERFORMANCE American Surgical Professionals was the first surgical assistant company in the nation to earn the Healthcare Staffing Certification by the Joint Commission, ensuring that ASP team members endure the most rigorous of credential standards.

“At our first meeting, I recall that ASP committed to providing service as soon as the next day following an agreement, and you delivered on that commitment. It was impressive and, in my opinion, represents the gold standard in customer service.” – Kathy Suic, Administrator Colonial Heights Surgery Center

says. “We have a strong training program for our mid-level professionals allowing us to provide first assistants for the most technical and advanced surgical procedures.” “We recognize that the new world of healthcare may require the provision of new services and/or traditional services in new ways or alternative delivery mechanisms,” he adds. “American Surgical Professionals welcomes the opportunity to work with all entities and clients in the development of solutions to these challenges. We pledge to do this in a fashion that respects the goals of our partners while preserving the highquality outcomes for our patients.” American Surgical Professionals has expanded and added two additional services, Outsourcing Solutions and Locum Tenens. Outsourcing Solutions offers the potential to reduce the hospital's operating costs by allowing us to employ the current mid-level clinical staff. Our team will work closely with the facility to develop a management plan tailored to its needs, including workforce planning, credentialing, 46

OR TODAY | September 2015

human resources, training, scheduling, daily oversight, and more. Our customized programs, depending on payer mix and other efficiencies, have reduced operating costs from 25-40 percent without sacrificing quality of care. The other new service is Locum Tenens, filling temporary surgical staffing gaps. American Surgical Professionals offers highly qualified and experienced staff such as Physician Assistants, Nurse Practitioners, Operating Registered Nurses, Surgical Assistants and Surgical Technologists on a temporary basis. TRUST AND ACCOUNTABILITY The quality of a hospital is as strong as the staff that represents it, and attracting the best surgeons is vital. Bringing in an outside contractor is never to be considered lightly. The top OR leaders and surgeons demand the support of the best first assistants. And that is what American Surgical Professionals provides. “We appreciate our partnerships and work diligently to earn and keep them by continuously being open to feedback and improvement,” Kirk adds.

COMPLETE SOLUTIONS AND SPECIALIZED FIRST ASSISTANTS American Surgical Professionals provides complete solutions for hospitals, surgeons and healthcare institutions by offering qualified and experienced mid-level professionals. “We specialize in providing outsourced certified and/or licensed mid-level professionals from various healthcare backgrounds to include PAs, NPs, RNFAs, CSFAs, CSAs, and SA-Cs to fill the specific needs of hospitals, surgery centers, and surgeons, while maintaining the highest patient care standards,” Kirk says. “Our outsourced model allows American Surgical Professionals to handle the employment logistics and scheduling issues freeing up the time and resources of our clients to focus on other priorities and aspects of managing the OR.” LEARN MORE TODAY American Surgical Professionals is headquartered in Houston, Texas, with over 20 years of experience and numerous partnerships. Kirk says the company’s mission is “to provide our surgeons, hospitals, payers and patients with valued clinical and administrative services in a respectful and professional manner, while ensuring a rewarding experience for our associates and investors.” TO FIND OUT MORE about how American Surgical Professionals can provide a customized approach to address your facility’s mid-level professional needs please email inquiries to info@amerisurg.com, call us toll-free at 855-816-7112 or visit our website at www.amerisurg.com. WWW.ORTODAY.COM

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WWW.AMERISURG.COM September 2015 | OR TODAY

Measure

…

Define

LEAN SIX SIGMA INCORPORATES A FIVE-STEP APPROACH TO IMPROVE PROCESSES: • DEFINE • MEASURE • ANALYZE • IMPROVE • CONTROL

…

Control

OR TODAY | September 2015

Analyze

Improve

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… ESTABLISHING AN EFFICIENT SURGICAL ENVIRONMENT … BY DON SADLER

fficiency has always been important when it comes to perioperative management, but it’s especially critical in today’s posthealth care reform environment. This makes it imperative that hospitals re-examine every aspect of their OR practices and processes in an effort to increase efficiency wherever possible.

In fact, many hospitals today have adopted the principles of Lean Six Sigma in their efforts to create a more efficient surgical environment and thus reduce costs and improve the patient experience. Lean Six Sigma was originally developed for the manufacturing industry, but its principles are just as applicable to the OR, says Christopher Powers, a Lean Six Sigma Master Black Belt and the system director of process improvement for Summa Health System in Akron, Ohio.

Christopher Powers

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A FIVE-STEP APPROACH Lean Six Sigma incorporates a five-step approach to improve processes: Define-Measure-Analyze-Improve-Control, or DMAIC. “This approach can be applied to any environment that is process-driven, whether it’s manufacturing or service oriented, and this includes the perioperative environment,” says Powers.

September 2015 | OR TODAY

… ESTABLISHING AN EFFICIENT SURGICAL ENVIRONMENT …

According to Powers, Lean Six Sigma is designed to improve the two main measurements that are inherent in all processes: efficiency and effectiveness. “Efficiency has to do with how quickly a process is done, while effectiveness has to do with how well the process is done in relation to the customer’s — or in the OR, the patient’s — expectations.” The biggest distinction between using Lean Six Sigma in a manufacturing verses a service environment like the OR is that service processes are driven by people, not machines. “So behavior change management and getting buy-in from all OR personnel are both essential to getting results from Lean Six

“OR directors tend to focus on OR turnaround time, or the time between one patient out and the next patient in to the OR,” he says. “But that’s not what really affects profitability. More importantly, hospitals should be measuring how many cases are performed in an eight-hour block.”

Alecia Torrance

KEY OR EFFICIENCY METRICS According to Peters, there are six key OR efficiency metrics hospitals ne should measure: fi 1. Patient in De 2. Anesthesia ready 3. Anesthesia start 4. Cut 5. Close 6. Patient out

It takes all OR team members — in particular, surgeons, perioperative nurses and anesthesiologists — working together like a finely tuned orchestra if you want to improve OR efficiency,” she says. “No single team member can do it alone — boosting efficiency requires a lot of collaboration and teamwork.” — Alecia Torrance

Sigma in the OR environment,” he says. “There’s an aspect of behavior change management to everything we do.” Powers says that Summa Health System has implemented between 15 and 20 distinct efficiency-boosting initiatives based on Lean Six Sigma principles. “These range from scheduling and billing to sterile processing and inventory management. We have examined every touch point patients have with the hospital, from the time the case is scheduled until surgery patients are discharged, in an effort to improve efficiency,” he says. 50

OR TODAY | September 2015

“The waste reduction principles of Lean Six Sigma are very applicable in the OR environment,” adds Jeff Peters, the president and CEO of Surgical Directions. “But if you only concentrate on using the methodology, you’ll focus too much on analysis and processes and you won’t get change. So you need to balance Lean Six Sigma principles with the application of practical, proven solutions.” Peters believes that a big barrier to improving OR efficiency is a lack of understanding of which OR performance metrics should be monitored and managed.

“If you focus on measuring, monitoring and managing these six metrics, you will identify opportunities to create a more efficient surgical environment,” says Peters. “You won’t see real improvements in OR efficiency until each surgeon’s performance is compared to these metrics.” Alecia Torrance, MBA, MSN(c), BSN, BS, RN, CNOR, senior vice president for clinical operations and chief nursing executive with Surgical Directions, believes that most ORs are inefficient due to the tendency of OR team members to work in silos. WWW.ORTODAY.COM

Analyze

re su a Me

Control

Improve

Defi

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Improve

Control

e la yz An

Define

Each member of the OR team has a part to play in improving efficiency and eliminating barriers that lead to silos in Define the OR.” — Kaye Reiter Control

Kaye Reiter

l ro t n “It takes all OR team members Co — in particular, surgeons, periop-

erative nurses and anesthesiologists — working together like a finely tuned orchestra if you want to improve OR efficiency,” she says. “No single team member can do it alone — boosting efficiency requires a lot of collaboration and teamwork.” According to Kaye Reiter, MSN, RN, vice president, surgical services with Summa Health System, culture is the biggest barrier to creating a more efficient surgical environment. “It’s human nature that people don’t want to change,” she says. “So we try to create buy-in and a sense of urgency among OR team members when implementing change management plans designed to boost OR efficiency,” Reiter adds. “Each member of the OR team has a part to play in improving efficiency and eliminating barriers that lead to silos in the OR.” WWW.ORTODAY.COM

e Reiter believes that ov most r perioperative nurses p know what Im they should be doing to help make the OR run efficiently. “It’s a function of applying what they know within the right infrastructure,” she says. “Management is responsible for making sure the right processes are in place that are easy to follow and will facilitate OR efficiency.” PARALLEL INSTEAD OF SEQUENTIAL Torrance says that OR nurses have traditionally worked in sequence: moving from step A to step B, then step C, and so forth. “But this doesn’t always lead to the most efficient processes,” she says. “Parallel processes are often more efficient than working sequentially.” Standardization is another important part of most OR costreduction and efficiency-boosting efforts, Torrance adds. “This makes it easier to train OR staff, reduces errors and improves clinical outcomes,” she says. “Conversely, variability in processes contributes to inefficiency and higher costs.” One big impediment to improving OR efficiency that Torrance says many hospitals today are dealing with is the fact that the hospitals are old and have been expanded many times over the years.

Analyze

Improve

“Their design leads to inefficiency — for example, it’s hard to store and access supplies when you need them. OR managers have to be creative when they’re dealing with this kind of challenge,” Torrance explains. Another challenge is dealing with broken and worn out equipment in the OR. “This is a significant issue as broken and worn out equipment can significantly impact OR uptime,” says Alisandra Rizzolo, vice president and general manager of customer care for Stryker Instruments Division. Rizzolo recommends that hospitals implement a robust preventative maintenance plan for all OR equipment to reduce the number of unplanned and emergency repairs needed for such equipment. “Some hospitals have realized reductions in downtime of as much as 32 percent by implementing an equipment repair service program,” she says, citing a recent Gallup survey conducted by Stryker ProCare. “With equipment in good working order, ORs tend to stay on schedule,” Rizzolo adds. “This, in turn, helps decrease OR downtime, minimize patient care delays and keep the OR running at full capacity to serve patients and capitalize on revenue opportunities.” September 2015 | OR TODAY

Contr

… ESTABLISHING AN EFFICIENT SURGICAL ENVIRONMENT …

Alisandra Rizzolo

Some hospitals have realized reductions in downtime of as much as 32 percent by implementing an equipment repair service program.” — Alisandra Rizzolo

IMPROVED PATIENT EXPERIENCES There are obviously cost-saving benefits to creating a more efficient surgical environment. However, both Torrance and Reiter emphasize that improving the patient experience by boosting efficiency is just as important as saving money. “Patients expect their surgeries to happen on time, but there’s a balance between timeliness and safety,” says Reiter. “The more efficient your OR, the better able you are to strike the right balance.” “In survey after survey, patients say that they hate waiting — they want to get their surgeries over with as quickly as possible,” adds Torrance. “Running a more efficient OR not only reduces patient wait times, but it also cuts down on post-op complications and readmissions since the less time patients are under anesthesia, the better the clinical outcomes.”

OR TODAY | September 2015

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Spotlight On: Sarah Matney, RN, BSN, CPON, CNML

ies d famil n a s t n “Patie this o be on t g n i o are g ay, and w y n a y journe e you hav e g e l i v the pri lk is to wa e s r u n as a ou them. Y e d i s g alon y to e abilit have th d empa n a y o j bring d hem ﬁn t p l e h thy to s, le thing t t i l e h joy in t l.” hey wil which t ey h Matn — Sara

OR TODAY | September 2015

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Sarah Matney ﬁnds

DREAM JOB at children’s facility ~ By Matthew N. Skoufalos~

Sarah Matney has always had an ability to relate to children and a passion for their care. As she grew up, she says she was always up for babysitting; always willing to volunteer to help with kids’ activities. But the one career that persisted unwaveringly in her heart was nursing. “I can’t remember ever wanting to be anything else,” she said. “My grandma used to tease me because it was the only thing I ever wanted to be.” So it seemed a natural fit when, in the early days of her rounds at the pediatric inpatient oncology unit of Rush University Medical Center in her hometown of Chicago, Matney took “hook, line, and sinker” when it came to pediatric nursing. Today, the mother of two directs the Center for Cancer and Blood Disorders at Connecticut Children’s Medical Center in Hartford. As challenging as it can be treating seriously ill patients, much less children, Matney said what’s least understood about her work is how the resilience of children lessens its emotional toll.

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September 2015 | OR TODAY

Sarah Matney visits with a patient at Connecticut Children's Medical Center.

“Kids go on with life despite the treatment, and so you just get to help them do it,” she said. Despite the high-stakes nature of the environment, Matney insists that “every day is not sad.” Rather, she said, it’s a combination of challenges to balance the medical and personal needs of young patients with those of the families who share in their struggles. “When a child is diagnosed, a family is diagnosed,” Matney said. “Patients and families are going to be on this journey anyway, and the privilege you have as a nurse is to walk alongside them. You have the ability to bring joy and empathy to help them find joy in the little things, which they will.” Simple activities such as crafts, toys, games, and books can all help establish a sense of normalcy that allows children — and, more importantly, their caretakers — to heal, she said. “What you see happen is as these children start to adjust and be kids and have fun, the whole group takes a deep breath,” 56

OR TODAY | September 2015

Matney said. “ ‘We’re going to do this together. We’re going to be a part of the community.’ That’s the most amazing thing about being part of a long-term care.” Nonetheless, in Matney’s experience, “there are two very different kinds of stories” that emerge from long-term care: those that “are amazing and change you forever,” but in which the patient may succumb to illness, and those of recovery, in which life goes on and the trappings of the disease remain behind with other childhood memories. Obviously, health care workers prefer the latter; however, some of the stories of the former persist beyond the brief years of the patients themselves, she said. “Kids are allowed to be kids, but they have this maturity about them,” Matney said. “I took care of one kid for seven years. He was willing to continue treatment as long as he could make it to school. School was the last thing in his life that was normal; he did that right to the very end.”

There are also those patients who recover fully. Matney recalls caring for a child who was battling a rare leukemia in 2011; his mother emailed her recently to say that the boy is in college and studying abroad for a semester. “Things went amazingly well,” she said. “It’s so rewarding to see kids move on and see life go on.” Creating an atmosphere in which children are allowed to heal, and their families with them, is the job of the staff at Connecticut Children’s Medical Center, and it can be taxing. Although Matney believes the hospital, and the field of pediatric nursing in general, attracts people who are “generally empathetic and playful in nature,” the resilience and innocence of the children in their care “is so rewarding,” she said. To enhance their understanding of the needs of their patients and families, the better to elevate the standard of care delivered, the hospital works to engage its clients as stakeholders, too. WWW.ORTODAY.COM

When Connecticut Children’s Medical Center built its new cancer center, it was done with the input of parents and family members who were invited to sit in with the architect and offer feedback on the design, Matney said. Their perspectives were considered in everything from the layout of waiting rooms to elements of the atmosphere in the building. From there, the hospital also invites families and patients to participate in its monthly

removed from the bedside than it used to be; however, she sets the tone for how the facility handles the treatment of patients suffering from cancers and blood disorders at a higher level of administration. Being tasked with improving the continuum of care at her facility is a departure from direct-care responsibilities, she said. Yet it allows her to elevate the overall quality of service delivered by influencing staff behaviors and policy decisions.

at a very young age, and there is always, to me, a way to sit down in a situation, even if it’s a very difficult conversation, and have two people walk away at the end and know exactly what has to happen and have it not be hard.” “Our one True North is the patient and family experience,” Matney said. “If your staff is happy, the patients are happy.” In the earlier years of her career, Matney said she didn’t appreciate the broad nature

“ The way you talk about errors, near-misses; you have a parent’s feedback on that,” Matney said. “It’s been extraordinarily rewarding for us.” — Sarah Matney

quality and safety meetings, which helps providers to consider everything they do from the perspective of their audience. “The way you talk about errors, near-misses; you have a parent’s feedback on that,” Matney said. “It’s been extraordinarily rewarding for us.” As a nurse leader, Matney’s day-to-day experience is farther WWW.ORTODAY.COM

“You inspire staff to always improve,” Matney said. “We’ve done it structurally, where daily, we talk about where we were yesterday. We’ve established the standards, and what’s risen to the top are things that need more attention. “My motivation has always been to do the right thing,” she said. “My moral compass was set

whereby nurses can improve the patient experience. Now, as a veteran of the field, she said she is “100 percent away from the bedside” but still feel like she has “a major impact” on the patient experience. “We think of it all as, we go to the bedside, we push the meds,” Matney said, “but nursing now is so much broader than that.” September 2015 | OR TODAY

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OUT OF THE OR HEALTH

BY MCKENZIE HALL, R.D.N.

BEWARE OF RESTAURANT ‘MONSTER MEALS’

e’re eating out a lot these days. Americans spend 50 percent of their eating dollars on foods consumed away from home, such as from coffee shops, cafeterias, sit-down restaurants and fast food chains, according to data released by the USDA Economic Research Service.

However, if you forego a homecooked meal for a restaurant entree or even “just” an entree salad, you may unintentionally add unwanted calories, saturated fat, sugar and salt to your day. Some pasta and chicken restaurant meals weigh in at 2,600plus calories! People who eat out at full-service restaurants consume, per day, on average 205 more calories, 2.5 grams more saturated fat, and 451 milligrams more sodium than those who eat at home, according to a 2014 study published in the Journal of Public Health Nutrition. These findings are consistent with several other studies, which find that eating out is linked with obesity, higher body fat, and lower intake of fruits and vegetables. The reason dining out can be a downfall is because restaurants often use excess butter, oil, sugar, salt, condiments, dressings and sauces in the preparation of food, as well as serving super-sized portions. GOOD NEWS FOR RESTAURANT LOVERS There’s no need to sacrifice dining out completely. The pendulum appears to be swinging in the right direction in terms of healthier menu options at restaurants. An overall decline in calories from restaurants has been observed, according to an October 2014 study 60

OR TODAY | September 2015

published in the American Journal of Preventative Medicine, which looked at the calorie levels for more than 19,000 menu items in restaurant chains in 2012, and compared them with levels in 2013. Additionally, a National Restaurant Association survey of 1,300 professional chefs revealed healthfulness among their top restaurant predictions for the year. “It all goes back to consumer demand,” says Joy Dobust, Ph.D., R.D., C.S.S.D., Senior Director of Nutrition at

the National Restaurant Association. “Consumers are demanding healthier options that are very competitive with other items on the menu.” Everywhere you turn, you can find examples of restaurants offering popular menu options that also happen to be healthy. For example, The Cheesecake Factory offers a SkinnyLicious menu with more than 50 dishes under 590 calories, and Olive Garden offers a Lighter Italian Fare Menu with entrees under 575 calories. WWW.ORTODAY.COM

HEALTH

HOW YOU CAN EAT OUT HEALTHFULLY Despite the daunting calorie content of some restaurant meals, you can certainly enjoy dining out healthfully by using these strategies:

Focus on menu items that are steamed, baked, broiled, or grilled. “Anything that’s fried will contribute to the calories in the meal because of the oil involved,” Dobust notes.

2 3

Choose vegetablebased over creambased. Vegetable-based sauces, soups, and condiments are typically lower in calories and saturated fat.

Beware of sauces. Many dipping sauces, dressings, and condiments can be rich in calories, saturated fat and sodium. “Ask for sauces on the side so you can be in control of how much you’re adding,” suggests Dobust.

HAVE A MEDICAL EQUIPMENT QUESTION

4 5

Trim your portion. Share a dish with a friend or portion out half of your entree into a to-go box prior to eating.

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Be mindful of beverages, such as sugary cocktails, sodas or shakes, as they can quickly contribute empty calories.

The Medical Product Support Network. – Reprinted with permission from Environmental Nutrition, a monthly publication of Belvoir Media Group, LLC.

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September 2015 | OR TODAY Medwrench_tps.indd 1

7/30/15 12:59 PM

OUT OF THE OR FITNESS

HARVARD HEALTH LETTERS

YOGA OFFERS A WIDE RANGE OF HEALTH BENEFITS

oga is an ancient practice that combines physical activity, breathing, and focused mental attention. A growing body of research shows that yoga offers a range of health benefits, including a low-impact cardiovascular workout. WHAT IS YOGA? All forms of yoga have some basics in common, but there’s a lot of variety. In Hatha yoga, popular with beginners, you assume a series of physical postures (called poses) that take your joints and muscles through a wide range of motion. You also learn to regulate your breathing in synchrony with the movements. Yoga also emphasizes meditation to attain a calming focus. Yoga practices vary in the number of different poses, how long you hold them, and how you incorporate breathing or mental training. YOGA AND HEALTH Scores of clinical studies have 62

OR TODAY | September 2015

evaluated yoga for its impact on various health conditions. But most findings have been inconclusive, either because of small study size and short duration or flaws in the way the studies were designed. It’s also unclear what types of yoga are most effective and how often you need to practice yoga to see benefits. If you have a serious health condition, it’s wise to consider yoga as something you can do in addition to – not instead of – standard medical treatments. But it’s hard to dispute that yoga promotes strength and flexibility. That makes it a useful form of exercise to relieve general stiffness and pain in your muscles and joints. Some studies show that yoga improves arthritis symptoms, low back pain, and balance. YOGA FOR YOUR HEART A recent review led by researchers at the Harvard School of Public Health summed up the findings of 37 randomized clinical trials involving nearly 2,800 people. Compared with those who did not exercise, yoga

practitioners saw improvements in blood pressure, cholesterol, body weight, and other factors that influence the risk of heart disease. The cardiovascular effects were similar to those a person would get from brisk walking or other aerobic exercise. This is encouraging, but has limits. Yoga may help to improve cardiovascular risk factors, but is not yet proven to prevent heart attacks and strokes. The researchers conclude only that yoga offers a potential benefit for heart health and could be a fitness option for those with limitations on their ability to engage in more vigorous aerobic exercise. IS IT FOR YOU? The percentage of American adults who do yoga has nearly doubled since 2002, to about 10 percent of adults. About a third of those are 65 and older. Many of the converts are women, but Nyer urges men to keep an open mind about yoga. “One thing I hear men say over and over is that they are not flexible WWW.ORTODAY.COM

FITNESS

enough to do yoga,” Nyer says. “A lot of men focus on activities like weights and running, things that don’t involve a lot of stretching. But strength and flexibility actually go together.” TIPS Where: Yoga classes are widely available at health clubs and community or senior centers. Many commercial yoga studios allow you to take a class for free to give yoga a test drive. A typical cost per session is $15 to $20. It helps to have trained guidance, since yoga carries a risk of injuries if you do challenging poses you’re not ready for or overstretch muscles and tendons. What: Among the many styles of yoga, Hatha and Iyengar are very common. You can also find specialized courses, such as “gentle yoga” or “chair yoga,” for people with arthritis, back pain, or other physical limitations. How often: Weekly classes are common, but many people practice yoga at home daily. Do what fits into your schedule, and “start low and go slow” to avoid injuries.

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September 2015 | OR TODAY

OUT OF THE OR NUTRITION

BY PATRICK J. SKERRETT

THE LONG GOOD-BYE: FDA Eliminates Trans Fats from U.S. Food Supply

artially hydrogenated oils, once a workhorse of the food industry, have gotten an official heave-ho from the U.S. food supply. In a long-awaited decision, the U.S. Food and Drug Administration ruled June 16 that partially hydrogenated oils, which are the main source of harmful trans fats, are no longer “generally recognized as safe.” That means any food company wanting to use partially hydrogenated oils must get the FDA’s approval to do so. Companies have until 2018 to stop using partially hydrogenated oils or to petition the FDA for approval. The move is a good one for individual and public health. Trans fats have been a favorite of the food industry because they increase the shelf life of liquid oils and make margarine easier to spread. But those benefits have come at a big cost. Trans fats boost the amount of low-density lipoprotein (“bad” cholesterol) in the bloodstream and lower the amount of high-density lipoprotein (“good” cholesterol). They make blood more likely to clot

OR TODAY | September 2015

inside blood vessels in the heart, brain, and elsewhere, and also ramp up inflammation, which plays important roles in the development of heart disease, diabetes, and other leading causes of death and disability. “This double, triple, or even quadruple whammy from trans fats should translate into higher rates of heart disease,” says Dr. Walter C. Willett, professor of nutrition at the Harvard T.H. Chan School of Public Health. And it does. In a review article published nearly 10 years ago in The New England Journal of Medicine, Willett and his colleagues estimated that removing trans fats from the U.S. food supply would prevent between 72,000 and 228,000 heart attacks each year. The FDA finally agrees. In the blog FDAVoice, Susan Mayne, the director of the FDA’s Center for Food Safety and Applied Nutrition, wrote that “it has become clear that what’s good for extending shelf-life is not equally good for extending human life.” THE LONG GOODBYE Artificial trans fats were developed in the early 1900s by Wilhelm Normann, a German chemist. He pat-

ented a process that used hydrogen gas to turn liquid vegetable oils into solids. This process, called hydrogenation, protected the oil from turning rancid. It also added trans fats. Proctor and Gamble released Crisco, the first partially hydrogenated shortening, in 1911. Soft margarines followed. Over the years, the food industry found hundreds of uses for partially hydrogenated oils, from prepared cookies and pastries to powdered creamer and the oils used for deep frying in fast-food restaurants. Trans fats have been called “stealth fats” because few Americans knew they were in the food supply. Food companies weren’t required to list them on Nutrition Facts labels, and they didn’t show up as “trans fats” in ingredients lists. The only way a shopper could have known a food contained trans fats was to spot the term “partially hydrogenated oil” in the ingredients list. Aware of the potential health hazards of trans fats, the Center for Science in the Public Interest petitioned the FDA in 1994 to require that trans fats be listed on Nutrition Facts labels. It took 12 years for that to happen. WWW.ORTODAY.COM

NUTRITION

In 2004, Fred A. Kummerow filed a citizen petition with the FDA to remove partially hydrogenated oils from the list of foods classified as “generally recognized as safe” (or GRAS). As described in The New York Times, Kummerow, now professor emeritus of food science and human nutrition at the University of Illinois, waged a life-long battle against trans fats. It took nine years, but the FDA eventually announced a preliminary determination to strike partially hydrogenated oils from

WWW.ORTODAY.COM

Trans fats have been called “stealth fats” because few Americans knew they were in the food supply. Food companies weren’t required to list them on Nutrition Facts labels, and they didn’t show up as “trans fats” in ingredients lists. the GRAS list in 2013. The June decision made it final. The move will definitely help reduce the amount of trans fats in the American diet. But many food makers, seeing the handwriting on the wall, have already been working to find trans-fat-free alternatives to partially hydrogenated oils. Chains like Starbucks did away with trans fats in 2007 and others are

following suit. Wal-mart is requiring its suppliers to deliver trans-free products by the end of this year. Keep in mind that 2018 is three years away. So it makes sense to check food labels for trans fats. Your heart will thank you for it.

– Environmental Nutrition

September 2015 | OR TODAY

OUT OF THE OR RECIPE

BY GINA EYKEMANS

HOW TO MAKE

FRUIT SLUSHIES I

always seem to forget how hot it gets here in California, until it happens. I’ve come up with a solution to cool things down: slushies! They’re easy to whip up in a blender, made with real fruit and, best of all, ice cold.

When I was a teenager, I used to drive to 7-11 and dish myself out a Cherryand-Cola Slurpee. The red and brown ice mixed together into a dark brown sugar rush. But as I get older, I find that I can tolerate sugar less and less. I have a feeling that if I tried to suck down a Slurpee now, my heart might explode. But this doesn’t stop the urge for one of my favorite summer treats. I had to create a slushie that didn’t make me feel like I was about to have a heart attack. It all started with a watermelon and mint slushie. Since then, I’ve been experimenting with all kinds of fruits and flavor combos to create a formula that you can easily tweak for your own fruity creations. It turns out that it doesn’t take much to make a healthier, satisfying version of this old summer favorite. It’s a simple ratio of fruit, ice and sparkling water. My favorite part in this process is thinking of fun, creative add-ins once you’ve got your fruits picked out for your base. You can add a few herbs for a flavor pop, some honey to sweeten the deal or a bit of citrus to give it a kick! I’m sure you can think of countless other combos, but I give a few of my favorite add-ins at the end of the recipe below. 66

OR TODAY | September 2015

HOW TO MAKE FRUIT SLUSHIES Makes 1 slushie

INGREDIENTS: 1 1/2 - 2 cups chopped fresh 1 1/4 1/4

fruit cup ice (plus extra, depending on the type of fruit used) cup sparkling water Extra herbs, spices or other ingredients for flavoring (see note)

EQUIPMENT: • Cutting board • Knife • Measuring cup • High-powered blender (or blender strong enough to crush ice)

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RECIPE

Wash the fruit and chop it into manageable pieces. Discard any pits. You can leave peels on or remove them, as you prefer. Measure the fruit to make sure you have 1 1/2 to 2 cups total. Combine the chopped fruit with 1 cup of ice and the sparkling water in a high-powered blender. If you’re using any flavoring extras, like mint or lemon juice, add them now. Blend on high speed until the ice is completely crushed and the fruit is blended. Check the texture and add more ice or more fruit as needed to reach your desired slushie consistency. If the type of fruit you’re using has more water in it (such as watermelon), it might affect the amount of ice needed. The ratio of 1 1/2 cups fruit to 1 cup ice is a really great

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starting point. Slushies are best if sipped right away. They will lose their slushie-like consistency the longer you wait. RECIPE NOTE: You don’t need much to make the flavor pop. If you’re using herbs, a leaf or two will do. If you like things sweet, consider a tablespoon of honey. Here are some other suggestions:

• Mint: Pairs wonderfully with watermelon and other tropical fruits. • Basil: Gives a lovely punch to berries. • Honey: Adds some extra sweetness, especially with tart fruits.

• Lime: Fantastic with mango and pretty much everything. • Lemon: Gives a bit of a frozen lemonade feel to any slushie. • Vanilla: I added this to my mango slushie and it was heavenly. • Ginger: If you love ginger as much as I do, it goes with everything.

Gina Eykemans is a writer for TheKitchn.com, a nationally known blog for people who love food and home cooking. Submit any comments or questions to editorial@ thekitchn.com.

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September 2015 | OR TODAY

OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTE STS • SEPTEMBER • Did you attend the OR Today Live! Surgical Conference? We want to know all about it. They say a photo is worth a thousand words and we believe them. Share your photos from OR Today Live! on our Facebook page or email them to us at social@mdpublishing.com. Your photo could be featured in the next issue of OR Today! Each person who submits a photo will receive a $5 gift card and one lucky individual will win FREE

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

ch! Win Lun “SUCCESS IS NO ACCIDENT. IT IS HARD WORK, PERSEVERANCE, LEARNING, STUDYING, SACRIFICE AND MOST OF ALL, LOVE OF WHAT YOU ARE DOING OR LEARNING TO DO.” — PELÉ 68

OR TODAY | September 2015

Drink More Juice CRANBERRY JUICE MAY HELP PROTECT AGAINST HEART DISEASE

A new study reveals that drinking low-calorie cranberry juice cocktail may help lower the risk of chronic diseases that rank among the leading causes of death worldwide, including heart disease, diabetes and stroke. This research shows that cranberries provide a rich source of polyphenols that support the body’s natural defenses and help individuals achieve a balanced lifestyle to improve health. To discover the extent to which polyphenol-rich cranberries can bolster whole-body health, researchers from the United States Department of Agriculture (USDA) provided eight weeks’ worth of meals to 56 healthy adult volunteers (average 50 years of age). One group drank a glass (8 ounce) of low-calorie cranberry juice twice daily. Meanwhile, the other group drank a placebo beverage with a similar color and flavor. • FOR MORE INFORMATION, visit www.cranberryhealth.com.

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PIN BOARD

OR TODAY

CONTE ST • WINNER • Break it u p LONGER BREAKS BETWEEN SHIFTS PROMOTE NURSES’ RECOVERY FROM WORK

Summer reading list OR Today rreader Diane Crites, RN, is our winner of the July/August contest. She works in the OR as the Neuro coordinator at Holy Cross Hospital in Fort Lauderdale, Florida. •

HAPPY NATIONAL

PEDIATRIC HEMATOLOGY/ ONCOLOGY NURSES DAY • SEPTEMBER 8 •

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Reducing short breaks between shifts helps nurses recover from work, according to a new study from Finland. The study analyzed the effects of longer rest and recovery periods between shifts on heart rate variability, which is an indicator of recovery. Shift work can increase the risk of many diseases, for example cardiovascular diseases. The increased risk is partially caused by insufficient recovery from work, which interferes with the normal function of the autonomic nervous system regulating heart function and blood pressure, among other things. Nurses have too little time for rest and recovery especially in the backwards-rotating shift system, which allows less than 11 hours of rest between the night and the morning shift. According to the researchers, the results show that in order to promote nurses’ coping, ability to work and wellbeing at work, it is recommendable to use a forward-rotating shift system, in which a shift is always followed by a shift that begins later, i.e. a morning shift followed by an evening shift. This leaves sufficient time for recovery in between the shifts. The study was carried out in cooperation between the University of Eastern Finland, the Finnish Institute of Occupational Health, and the city of Helsinki.

September 2015 | OR TODAY

INDEX ALPHABETICAL AAAHC…………………………………………………………………16

David Scott Company…………………………………… 63

Palmero Health Care……………………………………… 32

Action Products, Inc.……………………………………… 10

Enthermics Medical Systems, Inc.……………………17

Paragon Service……………………………………………… 33

American Surgical Professionals……………… 44-47

GelPro………………………………………………………………… 23

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

ASC Association……………………………………………… 59

Healthmark Industries…………………………………… 26

Sage Services…………………………………………………… 65

Bio-Medical Equipment Service Co.…………… 53

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

Shuremed…………………………………………………………… 67

Bryton Corporation……………………………………………16

Jet Medical Electronics………………………………………61

SIPS Consults, Corp.………………………………………… 63

C Change Surgical……………………………………………… 9

Key Surgical, Inc.………………………………………………… 5

SMD Wayne Corp/Calzuro…………………………………13

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

MD Technologies……………………………………………… 25

Surgical Power………………………………………………… 59

Cincinnati Sub-Zero…………………………………………… 6

MedWrench…………………………………………………………61

Tru-D………………………………………………………………………21

Dabir Surfaces………………………………………………… 52

Multisorb Technologies……………………………………… 4

Dan Allen Surgical……………………………………… 42-43

Pacific Medical LLC…………………………………………IBC

INDEX CATEGORICAL ACCREDITATION AAAHC…………………………………………………………………16 ANESTHESIA David Scott Company…………………………………… 63 Paragon Service……………………………………………… 33 SMD Wayne Corp/Calzuro…………………………………13 APPAREL Healthmark Industries…………………………………… 26 ASSOCIATIONS AAAHC…………………………………………………………………16 ASC Association……………………………………………… 59 AUCTIONS MedWrench…………………………………………………………61 BEDS Innovative Medical Products, Inc………………… BC CARDIAC SURGERY C Change Surgical……………………………………………… 9 CARTS David Scott Company…………………………………… 63 CABLES/LEADS Sage Services…………………………………………………… 65 CLEANING SUPPLIES Ruhof Corporation…………………………………………… 2-3 CLAMPS Innovative Medical Products, Inc………………… BC DESICANTS Multisorb Technologies……………………………………… 4 DISPOSABLES Sage Services…………………………………………………… 65 EMPLOYMENT SIPS Consults, Corp.………………………………………… 63 ENDOSCOPY MD Technologies……………………………………………… 25 Ruhof Corporation…………………………………………… 2-3 SIPS Consults, Corp.………………………………………… 63 GEL PADS Innovative Medical Products, Inc………………… BC

OR TODAY | September 2015

GENERAL David Scott Company…………………………………… 63 GelPro………………………………………………………………… 23 MedWrench…………………………………………………………61 SIPS Consults, Corp.………………………………………… 63 Surgical Power………………………………………………… 59 HAND/ARM POSITIONERS Innovative Medical Products, Inc………………… BC Shuremed…………………………………………………………… 67 HEALTHCARE STAFFING American Surgical Professionals……………… 44-47 HIP SYSTEMS Innovative Medical Products, Inc………………… BC INFECTION CONTROL/PREVENTION Palmero Health Care……………………………………… 32 Ruhof Corporation…………………………………………… 2-3 SMD Wayne Corp/Calzuro…………………………………13 Tru-D………………………………………………………………………21 INSTRUMENT TRACKING Censis Technologies, Inc.…………………………………… 6

POSITIONING AIDS Innovative Medical Products, Inc………………… BC POSITIONERS/IMMOBILIZERS David Scott Company…………………………………… 63 Innovative Medical Products, Inc………………… BC Shuremed…………………………………………………………… 67 REPAIR SERVICES Bio-Medical Equipment Service Co.…………… 53 Pacific Medical LLC…………………………………………IBC SHOULDER RECONSTRUCTION Innovative Medical Products, Inc………………… BC SIDE RAIL SOCKETS Innovative Medical Products, Inc………………… BC SOCIAL MEDIA MedWrench…………………………………………………………61 STERILIZATION Key Surgical, Inc.………………………………………………… 5 Tru-D………………………………………………………………………21

LEG POSITIONERS Innovative Medical Products, Inc………………… BC

SURGICAL AAAHC…………………………………………………………………16 Action Products, Inc.……………………………………… 10 Dan Allen Surgical……………………………………… 42-43 David Scott Company…………………………………… 63 MD Technologies……………………………………………… 25 SIPS Consults, Corp.………………………………………… 63 SMD Wayne Corp/Calzuro…………………………………13 Surgical Power………………………………………………… 59

MONITORS Jet Medical Electronics………………………………………61

SUPPLIES Multisorb Technologies……………………………………… 4

OR TABLES/ ACCESSORIES Bryton Corporation……………………………………………16 Dabir Surfaces………………………………………………… 52 Innovative Medical Products, Inc………………… BC

SURGICAL SUPPLIES David Scott Company…………………………………… 63 Censis Technologies, Inc.…………………………………… 6 Cincinnati Sub-Zero…………………………………………… 6 Ruhof Corporation…………………………………………… 2-3

INTERNET RESOURCES MedWrench…………………………………………………………61 KNEE SYSTEMS Innovative Medical Products, Inc………………… BC

ORTHOPEDIC Surgical Power………………………………………………… 59 PATIENT AIDS Innovative Medical Products, Inc………………… BC PATIENT MONITORING Action Products, Inc.……………………………………… 10 Bio-Medical Equipment Service Co.…………… 53 Pacific Medical LLC…………………………………………IBC

SUPPORTS Innovative Medical Products, Inc………………… BC TEMPERATURE MANAGEMENT C Change Surgical……………………………………………… 9 WARMERS Enthermics Medical Systems, Inc.……………………17

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Enhanced Humbles LapWrap Positioning Pad ®

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

Designed to meet

The operative word in patient positioning.

AORN

recommendations

www.impmedical.com

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

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

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

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

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

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

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