OR Today - December 2015 by MD Publishing

IN THE OR

SPOTLIGHT ON

CONTINUING EDUCATION PAGE 30

NUTRITION

DANIELLE HOSTLER PAGE 54

TAKE GOOD CARE

NURSES • SURGICAL TECHS • NURSE MANAGERS

SNACKS PAGE 62

E R U T U F

U S

DECEMBER 2015

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CONTENTS

features

OR TODAY | December 2015

THE FUTURE OF SURGICAL CARE: A LOOK AT THE BENEFITS OF PATIENTCENTER CARE Most perioperative nurses would probably agree that too often, perioperative care plans are variable and fragmented. This can result in more errors and complications, longer patient stays, more readmissions, and more adverse patient outcomes. The Perioperative Surgical Home was created by the American Society of Anesthesiologists to achieve better individual patient health, improved overall health care, and lower health care costs.

CORPORATE PROFILE: HEALTHMARK INDUSTRIES

Healthmark Industries is a family-owned healthcare supplier business founded by Ralph A. Basile in 1969. The business is based on the principles of providing innovative and cost-effective products for customers in order to meet their sterilization, decontamination, storage, distribution and security needs. Healthmark is looking forward to an exciting future with its continued expansion of staff and products.

SPOTLIGHT ON: DANIELLE HOSTLER

Former teacher Danielle Hostler began her heath care career working as a staff nurse in the main operating room at MUSC, and after five years, was promoted to ENT coordinator for ambulatory surgery. Today, she supervises eight nurses, works with 11 doctors, and is pursuing a masterâ&#x20AC;&#x2122;s in informatics.

OR Today (Vol. 15, Issue #10) December 2015 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. ÂŠ 2015

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December 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 Andrew Parker | andrew@mdpublishing.com

ACCOUNTING Kim Callahan

WEB SERVICES

INDUSTRY INSIGHTS 10 News & Notes 16 AAAHC Update 18 CCI Insights

Betsy Popinga Taylor Martin

CIRCULATION Lisa Cover

IN THE OR 20 23 24 30

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 58 61 62 64 67

Health Fitness Nutrition Recipe Pinboard

70 Index

OR TODAY | December 2015

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INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

IT’S BACK: THE HALYARD HEALTH SMART-FOLD WRAP RACE Halyard Health is hosting the third annual Wrap Race. Halyard invites Central Service (CS) professionals to put your wrapping skills to the test. The Smart-Fold Wrap Race is a fun and fast-paced competition designed to test the wrapping skills and speed of CS professionals using SmartFold Sterilization Wrap, an innovative sterilization packaging designed with the toughest tasks in mind and engineered to protect heavy trays and loaner sets from tears and cuts in handling. Practice and perfect your

Smart-Fold tray wrapping skills and have your Halyard Health representative record a video of your fastest wrap time. If your time qualifies, you may be heading to the International Association of Healthcare Central Service Material Management (IAHCSMM) 2016 Annual Conference & Expo in San Antonio, Texas for the Wrap Race Championship. Halyard representatives submit video entries from January 4 through February 1, 2016. Next, round two qualifiers are announced and Halyard representatives

submit video entries from February 8 through March 7, 2016. In the championship round, four Wrap Race finalists are announced and invited to IAHCSMM to compete head-to-head in the final round April 24-27, 2016. CS professionals interested in competing in the Smart-Fold Wrap Race should contact their Halyard Health representative by February 1, 2016. • FOR ADDITIONAL INFORMATION visit http://www.halyardhealth.com/ wraprace.aspx.

AMSN PUBLISHES NEW CORE CURRICULUM FOR MEDICAL-SURGICAL NURSING When it came time to update its core curriculum textbook, the Academy of Medical-Surgical Nurses (AMSN) tapped into the best resource it has: their readers. It was the direct feedback from AMSN member volunteers during conference calls and surveys that helped Editor Heather Craven, Ph.D., RN, CMSRN, and the Core’s contributors concentrate on the areas the nurses felt were most important to their practice. As a result, the new Core Curriculum for Medical-Surgical Nursing, Fifth Edition reflects the rapid-fire changes in the specialty and helps nurses and AMSN itself achieve the ultimate goal of improved patient care. “The Core is the AMSN seminal textbook,” Craven said. “It promotes 10

OR TODAY | December 2015

excellence in medical-surgical nursing by providing a comprehensive foundation for practice. It also drives the specialty forward because nurses use it as a guideline for certification, as a reference for everyday practice, and as a springboard for what they can achieve in the future.” Under Craven’s leadership, the text was written by the country’s top med-surg nursing experts and extensively reviewed by additional experts. It contains 600 pages, 29 chapters, and a detailed reference list. New content includes increased emphasis on surgical procedures and recommended nursing care and interventions. It also includes case studies to stimulate critical thinking and help nurses apply the content in

their day-to-day practice. There are also expanded references that include Internet resources. The Core is designed for new and experienced nurses who practice in a broad variety of settings. As Craven explained, it’s also a guideline for nurses preparing for the Certified Medical-Surgical Registered Nurse (CMSRN) exam and is a template for review courses focusing on medicalsurgical nursing. The Core can be purchased online (www.amsn.org/5thcore). The AMSN member price is $89, and the regular price is $119. • FOR INFORMATION, visit the AMSN website, email amsn-info@amsn.org, or call 866-877-2676.

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NEWS & NOTES

CLOROX HEALTHCARE ANNOUNCES NEW OPTIMUM-UV ENLIGHT SYSTEM Clorox Healthcare, in partnership with Ultraviolet Devices Inc. (UVDI), the Clorox Healthcare Optimum-UV Enlight System at the Association for the Healthcare Environment (AHE) EXCHANGE 2015 annual conference. The Optimum-UV Enlight System kills a total of 31 pathogens and combines powerful UV technology with advanced data collection and reporting capabilities, clinically proven efficacy and affordability to enable facility-wide adoption. “We know that environmental services and infection control professionals are looking for more efficient and easy-to-use ways to implement UV devices and track infection rates across their facilities, which can be a time-intensive process,” said Dr. Katherine Velez, scientist, Clorox Healthcare. “The Optimum-UV Enlight System’s smart data capabilities help do the heavy lifting to improve infection control processes and minimize workflow challenges so that UV can be seamlessly integrated into larger environmental infection control practices.” The Optimum-UV Enlight System kills 31 total pathogens in five minutes at a distance of eight feet, including a 4-log reduction of Clostridium difficile (C. difficile) spores and a greater than 5-log reduction of more than 20 pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE) and carbapenem-resistant Enterobacteriaceae (CRE). The system tracks device usage across rooms, locations, and operators, and provides automated reporting that is accessible in real WWW.ORTODAY.COM

time. The system also provides diagnostic data with automated alerts to inform users about maintenance needs and helps to identify areas for targeted staff training. The enhanced interface features more data storage and a large, easy-to-use color touchscreen that enables users to manage rooms, locations and operators for reporting analytics. New iOS and Android apps allow users to remotely check on UV cycle status as well as start or stop the device. The app uses Bluetooth technology to automatically transfer usage data to the app, which is uploaded via a cellular/Wi-Fi connection for cloud-based reporting. Transporting and storing the Optimum-UV Enlight System is easier with the hard shell case accessory which protects the bulbs and detaches into halves that can be used as free-standing door warning signs. Other tools include the Dose Verify cards which ensure that the appropriate UV-C dose has been received on a target surface. The Optimum-UV Enlight System is designed to supplement manual disinfection efforts with U.S. Environmental Protection Agency (EPA) registered disinfectants. Combining manual surface disinfection with UV technology ensures thorough coverage, especially on areas that may be missed during manual cleaning. However, a comprehensive approach also hinges upon having a welltrained and educated environmental services staff to implement best practices. •

December 2015 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

NEXCARE WATERPROOF BANDAGES ARE PUT TO THE TEST

The team from Nexcare Brand from 3M Company unveiled the winning idea from their “What Will Nana Do Next?” contest. The contest launched in June as part of a larger digital brand campaign and features brave heroine and unexpected product tester, 87-year-old Nexcare Nana. The Nexcare “What Will Nana Do Next?” contest tapped consumers nationwide to determine Nana’s next daring adventure to showcase in extreme ways the staying power of Nexcare Waterproof Bandages. The Nexcare Waterproof Bandages campaign brings the concept of grand prize winner Robbie S. from Indiana to life. The winning idea features Nexcare 12

OR TODAY | December 2015

Nana in a dramatized product test where she rides top down in a convertible braving the spinning, soapy brushes of a car wash and ultimately emphasizes the strength and performance of the bandages against water, dirt and germs. “Showcasing the staying power of Nexcare Waterproof Bandages with our favorite heroine, Nexcare Nana, has been a driving force for us in demonstrating in over-the-top ways how the bandages stand up to active lifestyles,” said Carrie Sazama, Brand Manager, Nexcare Brand. “We enlisted our fans in this campaign and they delivered. We are thrilled with all of the creative submissions we

received and are excited to unveil Robbie’s winning concept as part of this campaign.” Robbie S., was awarded the grand prize for coming up with the challenge of Nana going through a car wash in a convertible. With her trusty swimming goggles at the ready, Nexcare Nana puts the car in drive and fearlessly faces her next adventure. After it all, she points to her Nexcare Waterproof Bandage, still securely in place. To view Nana putting Nexcare Waterproof Bandages to the test in the contest winning video visit nexcare. com/nana. •

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ANSELL CELEBRATES 50 YEARS OF INNOVATION WITH GAMMEX SURGICAL GLOVES Ansell is proud to announce its 50th year designing and manufacturing Gammex surgical gloves. Innovation has been at the core of the brand since its inception, and that commitment will continue in the future, as evidenced by the launch of the company’s new Medical Solutions Innovation Centre in Melaka (Malaysia). In an era where rapid innovation and disruption are a constant, Ansell has achieved five decades of providing health care workers with surgical solutions that offer the comfort, safety and advanced allergy protection they demand. Gammex surgical gloves were first introduced in 1965 by Harvey Ansell, the son of Ansell founder Eric Norman Ansell, who had the innovative vision of creating and packaging disposable gloves already sterilized for use via gamma radiation. In celebration of the 50th Anniversary, Gammex is launching its newest glove with Sensoprene formulation – the non-latex underglove. This surgical underglove sets a new standard for allergy management, and when used in combination with Gammex Non-Latex Sensitive surgical gloves, offers easy identification of a glove breach with its contrasting green color. Ansell also provides Gammex products with Antimicrobial Technology (AMT), which are designed to help address the problem of surgical site infections (SSI) and help reduce the risk of microbial transmission. Though the products are only available for sale in select countries, Ansell is working with regulatory bodies across the globe to bring this innovative technology to market. Ansell also looks to innovate in other ways that will benefit its end users. The company recently launched the newly designed SMART Pack for its Gammex gloves in EMEA. The new packaging will help with overall efficiencies – allowing doctors and nurses to easily grab and go – and is environmentally friendly. SMART Pack is scheduled to roll out globally in the coming months and will expand beyond Gammex into other surgical brands in the Ansell portfolio. The new Medical Solutions Innovation Centre houses approximately 40 scientists and technicians, working in the areas of new product development, as well as product and process improvements for medical gloves. It also has a stateof-the-art pilot line accessible next door that will be used to expedite new product development and commercialization, investigate process efficiency improvements, as well as run trials to better understand the impact of process variables on glove quality. To culminate the 50th anniversary global campaign, Ansell has partnered with Direct Relief to set a goal of donating 50,000 pairs of gloves this year. Every message captured to its global eCard, will equate to a donation of 50 pairs of gloves. To join Ansell in celebrating this milestone and to sign the Anniversary eCard, visit www.gammex50.com. • WWW.ORTODAY.COM

TASKI INTELLIBOT SOLUTION WINS INNOVATION AWARD Sealed Air’s Diversey Care division has been presented with The Association for the Healthcare Environment (AHE) Innovation Award for its TASKI Intellibot SWINGOBOT 1650, a “green,” hands-free robotic floor scrubber. Introduced in 2013, the AHE Innovation Award recognizes and increases awareness of products, processes and technology advancements that empower individuals to improve measured outcomes in the health care environment. “The SWINGOBOT allows health care facilities to easily and consistently achieve the highest levels of clean, and to redistribute labor to drive down costs and focus human assets on high-touch surface cleaning,” said Carolyn Cooke, Vice President Healthcare North America, Diversey Care. “We are honored to be recognized by AHE for this award and to be an instrumental part in maintaining cleanliness and safety for patients, visitors and staff in health care environments.” The environmentally friendly SWINGOBOT uses an advanced four-stage purification system to provide clean, reusable water, and eliminates 85 percent of the water and chemicals used by traditional machines. A built-in UV light kills 99.9 percent of bacteria and viruses from the water used to clean floors to limit the spread of harmful infections. The hands-free SWINGOBOT has nine pre-programmed cleaning patterns to autonomously clean areas such as hallways and lobbies, allowing facilities to reassign employees to other key tasks while floors are cleaned. TASKI Intellibot robotic machines are equipped with a variety of built-in safety features to ensure the safety of machine operators, patients, staff and visitors while cleaning occurs. Ultrasonic sonars allow the machines to detect obstacles and avoid collisions, instant braking allows the machines to stop almost instantaneously if someone walks across its path and touch sensors act as additional safety features to stop the machine if it comes in contact with an object. • FOR MORE INFORMATION about AHE or the Innovation Award, visit www.ahe.org. December 2015 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

SLS APPOINTS 23RD PRESIDENT The Society of Laparoendoscopic Surgeons (SLS), an organization focused on multi-specialty minimally invasive surgery, chose Dr. Maurice R. Chung, a clinical professor of OB/GYN at the University of Toledo School of Medicine and an adjunct professor of pharmacy at Ohio Northern University, to become its 23rd president. Chung is also active in universities of medicine throughout China. The first of two themes of Chung’s presidential year include examining international surgical methods and learning new surgical techniques from other countries. “We can learn from our colleagues around the world,” Chung said. “SLS has so many international connections and meetings throughout the world, that we gain

from those perspectives and benefit from their knowledge. They benefit from us as well.” The new president officially began his position on September 6, 2015. Chung received his medical degree and completed his residency at Tufts University School of Medicine in Boston. He was nominated to be the chief resident during his OB/GYN residency training at Albany Medical Center in New York, completing the standard four-year OB/GYN residency training in an accelerated pace of three years. He is board-certified and a Fellow of American College of Obstetricians and Gynecologists. The Accreditation Council of Gynecologic Endoscopy (A.C.G.E.) certified Chung in 1996 as an Advanced Laparoendoscopic Surgeon.

The Society of Laparoendoscopic Surgeons (SLS), a 501(c)(3) organization, is the nation’s leading group of multi-specialty surgeons, including general surgery, urology, OB-GYN and others. SLS advocates for minimally invasive surgery and improved surgical outcomes for all these specialties. It is a voluntary, nonprofit membership organization of over 6,000 surgeons. •

OLYMPUS SONICBEAT ULTRASONIC TECHNOLOGY FEATURES IMPROVED ERGONOMICS Olympus has announced a new version of its SONICBEAT surgical device. The new SONICBEAT will broaden and enhance the entire Olympus THUNDERBEAT portfolio. SONICBEAT is an innovative ultrasonic energy device with Olympus’ jaw design. It delivers rapid cutting and reliable 5mm vessel sealing from a single multifunctional hand instrument. The surgical instrument’s wiper jaw design distributes 14

OR TODAY | December 2015

pressure evenly along the jaw length for consistent sealing. With excellent tip grasping force, precise dissection via a fine tip design and wide opening aperture, the instrument delivers surgical control in dissection and grasping. SONICBEAT is available in four lengths (10, 20, 35 and 45 cm) and three handle designs to meet a variety of surgical needs. SONICBEAT is intended for use in open, laparoscopic (including single-site) and general surgery. It is used to cut

(dissect) vessels in gynecologic, thoracic, urologic and endoscopic surgical procedures. Energy devices can be used in all forms of surgical intervention, but they play a particularly

important role in today’s minimally invasive surgeries replacing traditional sealing devices such as sutures, clips and staples.

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INDUSTRY INSIGHTS AAAHC UPDATE

BY GEOFFREY CHARLTON-PERRIN

LIVING ON THE EDGE

live on the edge. No, I don’t jump out of airplanes or scale El Capitan for kicks. As the Director of Marketing for AAAHC, a nonprofit organization that accredits same-day surgery centers and primary care practices, I exist on the fringe of a health care environment. While I don’t possess any formal medical training, I rub shoulders daily with a host of brilliant physicians, nurses, anesthesiologists and medical directors who do. So I absorb a lot of medical facts, practice regimens and treatment protocols by osmosis.

You can’t have dinner with someone who regales you with the intricacies of the reactive hyperemia index over a sirloin steak without acquiring some medical wisdom, can you? As Alexander Pope once said – and I paraphrase since Pope expresses the thought more poetically – a little knowledge is a dangerous thing. If this is true, I am possibly lethal. People don’t approach me at cocktail parties with “How about those Cubbies, eh?” They ask me if I know of a good endocrinologist. (I don’t even know of a bad one!) Even if I did, it would be difficult to recommend a doctor whose acquaintance I might have made across a conference table or in a board meeting. Not the surest way to assess a physician’s credentials. Though I did once tell my GP I thought that making patients declare their reason for visiting the doctor in a reception area so cramped you could hear the inmates chew gum, might be in violation of HIPAA regulations on patient confidentiality. Truthfully, I have no idea if it really was a problem, but then doctors have been telling me what to do and what not to do all my life, so I think the fleeting sense of revenge that surged through my veins 16

OR TODAY | December 2015

was almost justifiable. Living on the edge of a world somewhere between infection control and ichthyosis means I absorb all kinds of information that I would once have had no interest in. These days I take to heart the one needle, one syringe, one patient dictum of the Safe Injection Practices Coalition. And whereas a normal person on being admitted for surgery might ask, “Do I have to wear this stupid gown?” my first instinct on being confronted by a nurse holding a syringe was to say, “Do you use single-use needles here?” In retrospect, I can see now that it was like asking a teacher if she knows the alphabet. Which would account for her reaction as she grabbed my arm and stabbed it with such righteous indignation I thought the needle might pin my arm to my chest. My proximity to all things medical is also why I head to the health section of the newspaper first instead of lunging for the sports section before my wife can grab it. And why I now gravitate to an article that declares, “In fifteen years, the number of bariatric surgeries performed in the U.S. has grown

more than sixteen-fold, yet a recent study finds that the stomach-stapling procedure does not provide the societal benefits first hoped for,” instead of checking to see if the Chicago Fire beat the Los Angeles Galaxy. I’m not a hypochondriac. So why do I find “The much higher costs of out-of-network health care,” more compelling than “What’s the deal with Mets fan Jerry Seinfeld wearing a Cubs hat?” (Finally seeing the light, perhaps?) Have I swapped a testosterone-fueled male heritage for a morbid interest in latex allergy and Legionnaires’ Disease, eczema and Ehlers-Danlos Syndrome? There is no doubt that donning scrubs to tour an ambulatory surgery center imbues me with an overwhelming sense of authority. While the head nurse is telling us how the medical records are securely locked away, or the drugs on the crash cart are checked daily, I momentarily have a vision of myself, resplendent in my scrubs, standing at the patient’s bedside, fixing the physician assistant with a steely gaze and saying, “And what, may I ask, makes you so certain that this is a case of esophageal achalasia?” But then the nurse who is showing us around suddenly says, “Please don’t touch that!” and I’m back to reality. On the edge. GEOFFREY CHARLTON-PERRIN is Director of Marketing and Communications for AAAHC. Previously, he was Director of Marketing for the Chicago Convention and Tourism Bureau, and before that President of a major Chicago advertising agency. WWW.ORTODAY.COM

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December 2015 | OR TODAY

INDUSTRY INSIGHTS CCI

BY ELIZABETH GRIGWARE, BSN, RN, CNOR, REGIONAL PERIOPERATIVE EDUCATOR, CHI FRANCISCAN HEALTH

CULTIVATING THE NEXT GENERATION OF PERIOPERATIVE NURSES IN THE PACIFIC NORTHWEST be hardwired. A good way to predict the hardwired traits of a candidate is to utilize a standardized behavioral style interview process with an interdisciplinary panel. The most accurate predictor of future performance is often past performance in a similar situation.7 Panel members should consist of personnel within the department that have been instructed on the interviewing process and exhibit the traits you are looking for.

FORECAST Nurses are exiting the workforce and their facilities and quickly returning as patients. Hiring practices, retention efforts, and programs to ease the transition from school into practice are becoming a prime focus for hospitals.1 Although many nurses are staying in the workforce longer than previously projected, there is still a demand for nurses, and this will continue to grow.2 It is estimated that a facility loses $88,000 each time a nurse leaves a position and many are looking to do so soon.3 The imminent retirement of the largest generation in modern history is creating a significant gap in the health care workforce and strain on facilities as they work to figure out how to adjust. One way to address this problem is easing new nurse transition and increasing nurse retention, identified by the Institute of Medicine in the milestone report “The Future of Nursing,” is the creation of nurse residency programs.4 Experienced nurses are becoming a rare commodity but experienced perioperative nurses are even harder to find. In order to fill the vacancies, hospitals will need to grow their own.

surgeries do not go as planned, the atmosphere in the operating room can become charged and intense, making it difficult for the new nurse to perform. A recent study showed that a one year residency offered the best opportunity for transition into practice for new graduate nurses.6 The perioperative nurse must be well trained and have the necessary support to navigate the many variables that may arise in the surgical setting.

ENVIRONMENT New staff starting in the perioperative specialty have a huge learning curve, from the technical and fast paced envrionment to the complexity of case load.5 These challenges, paired with the high-tech nature of the equipment can seem titanic to the new nurse. If

SELECT THE SEED Just like picking a good strain of seed when planting a crop you want to make sure to select a candidate that has traits that align with the organization’s mission and values. Experience will be gained and skills can be taught, but behaviors, attitudes and values tend to

OR TODAY | December 2015

Elizabeth Grigware

CHURN THE SOIL Once the resident has been selected, the soil must be prepared. Enrollment into a formal residency that has a foundation based on evidenced based practice (EBP) standards developed by the Association of periOperative Registered Nurses (AORN) will provide the necessary groundwork. The Periop 101: A Core CurriculumTM is a nationally recognized online program that sets the core requirements for a perioperative nurse’s education. Nurse residents benefit from classroom time that uses case studies to promote critical thinking along with simulation labs that provide hands on opportunity. Historically learning retention rates from reading and lecture have been found to be as low as 20%, while open discussion and hands-on practice can improve learning retention up to 90% for the student.8 A microclimate of impressive knowledge can be transferred to the resident when classes are taught by experts in the field, such as surgeons, anesthesiologists, risk WWW.ORTODAY.COM

CCI

managers, perioperative leadership, and nurse educators to name a few. Face-toface classroom time provides residents the freedom to debrief with peers, hear insightful stories, and ask questions about information presented. To promote professionalism and acquire experience with EBP, residents should be given time to investigate current practice on their units, using what they have learned about EBP in class. Evidence discovered can be communicated via a formal poster presentation to fellow residents as a cumulative project. The final component that caps a residency program is a scrubbing rotation. The perioperative nurse who has never learned to scrub can be at a disadvantage when managing and coordinating the spectrum of intraoperative duties assigned to this role. The confidence to oversee and support activities at the sterile field is strengthened by the scrubbing experience. FERTILIZE AND NURTURE Residents must be given fertile soil, rich in knowledge and support, to foster the necessary growth and development to become a competent perioperative nurse. With formal training, preceptors and mentors can play significant roles in the development and success of a resident. Preceptors share valuable stories and lessons learned that help guide the formation of sound clinical judgment for the resident. They must have strong communication skills, exhibit a willingness to be a preceptor, understand different learning styles, be effective at delivering constructive feedback, and display a positive supportive attitude. Preceptors help guide, teach, evaluate, shelter and advocate for the resident.5 It takes time for the resident to learn new tasks and become proficient in performing them. The resident and the preceptor must be partnered together, working in collaboration, and reinforcing what has been learned, until the resident WWW.ORTODAY.COM

feels confident and is deemed fully competent to work independently. Mentors also play an important role in the resident’s development by providing professional and social support.5 They can help residents overcome common fears like making mistakes or not fitting in on a new unit. Mentors should exhibit professional demeanor, possess leadership skills, and be good at listening without passing judgment. Novice nurses gain confidence when mentors remain supportive and provide an objective perspective about issues the resident may be struggling with.5 UNIT CULTURE Many conditions may contribute to new graduate nurse turnover: abuse from fellow nurses, inadequate staffing that forces new nurses to be utilized as staff before finishing residency, and a culture that doesn’t adapt to change and continues to do things “like we’ve always done it.”9 The environment around the resident should be the product of a positive and healthy culture, a fair and just culture, one that is transparent and nurturing. The culture should embrace best practices and adapt EBP principles into the work done on the unit.9 Managers play a significant role in regulating the culture on a unit. Joint weekly meetings between the resident, preceptor and manager should take place.9 Meetings provide a formal time where goals can be created and assessed, room schedules and specialty rotations can be planned, and progress or potential problems can be identified and fixed. HARVEST The old saying “you reap what you sow” has never been more relevant than when growing new nurses in the perioperative setting. If the organization is invested in the success of the resident, the harvest will be a success. If a crop does fail, an investigation should be done to identify all the possibilities that could have contributed to the

failure, knowing that one person doesn’t have complete control over all the pieces. It takes dedication, collaboration, exploration and bravery to grow and retain valuable employees.

REFERENCES 1. U.S. Bureau of Labor Statistics. Occupations with the Largest Projected Number of Job Openings Due to Growth and Replacement Needs, 2012 and Projected 2022. N.p., 2012. Web. 10 Oct. 2015. 2. “Nursing Shortage offset by Older Nurses Delaying Retirement” Culture of Health. Robert Wood Johnson Foundation, 8 Aug 2014. Web. 20 Oct. 2015. 3. Krsek, Cathy. “Investing in Nursing Retention Is a Smart Move in Today’s Economy.” American Nurse Today 6.4 (2011): n. pag. 2011. Web. 10 Oct. 2015. 4. The Future of Nursing: Leading Change, Advancing Health. Washington, D.C: National Academies Press, 2011. Print. 5. Persaud, Debra. “Mentoring the New Graduate Perioperative Nurse: A Valuable Retention Strategy.” AORN Journal 87.6 (2008): 1173-179. Web. 6. Kramer, M., Maguire, P., Halfer, D., Brewer, B.,

and Schmalenberg, C. “Impact of Residency Programs on Professional Socialization of Newly Licensed Registered Nurses.” Western Journal of Nursing Research 35.4 (2013): 459-96. Web. 7. Hansen, Katharine. “The Quintessential

Guide to Behavioral Interviewing [Kindle Edition].” The Quintessential Guide to Behavioral Interviewing EBook: Katharine Hansen: Amazon.com.au: Kindle Store. N.p., 2012. Web. 10 Oct. 2015. 8. Dale, Edgar. Audiovisual Methods in

Teaching. 3d ed. New York: Dryden, 1969. Print. 9. Duchscher, Judy and Myrick, Florence.

“The Prevailing Winds of Oppression: Understanding the New Graduate Experience in Acute Care.” Nursing Forum 43.4 (2008): 191-206. Web.

ELIZABETH GRIGWARE, works in the Pacific Northwest for CHI Franciscan Health system. She is a Regional Perioperative Nurse Educator, with over ten years’ of accumulated experience in the perioperative setting. December 2015 | OR TODAY

IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

#NURSESUNITE Have you seen the video of Miss Colorado from the Miss America pageant and the comments made on the TV show “The View”? What do you think about Miss Colorado’s monologue, “The View” and #NursesUnite? A: I think the cast of "The View" was ignorant and disrespectful of nurses. It’s not like any of them would be eligible for Miss America.

aware of what we do. We should do more to let the public know of the important and hard work that nurses do each and every day.

A: One day they will need the assistance of a nurse. Shame on them!!!

A: I guess they understand us now!

A: Actually, I can’t blame the cast of "the view". This is a prime example demonstrating most people are not

A: I agree that the profession could do more to promote awareness of our scope of practice. It is hard for me to believe that at her age, Joy

Behar has never personally seen nurses using a stethoscope. And if she has been fortunate enough not to have had any health care experiences, with all the commercials/infomercials promoting hospital services, new technology, and featuring the degree of compassion and caring within their organizations, some of the nurses must have worn or used a stethoscope. •

NAIL POLISH

There are many rumors floating around, that if there is no visible chips in nail polish, then it is acceptable to wear. Also, the new gel nails are very popular! Is it acceptable to scrub with gel nails? A: This is how we explain to our staff. Fingernails: Fingernails must be neat and trimmed. If polish is used, it must be conservative and well maintained. Length of fingernails must not interfere with job duties. Associates, who perform direct patient care, prepare food or sterile items must have natural fingernails (i.e. natural fingernails without an artificial covering other than traditional fingernail polish. Tips, gels, and shellac are prohibited.) Fingernail tips must be less than ¼ inch in length and must not interfere with job duties. Wearing gloves does not alter this standard. (Evidence-based Guideline for Hand Hygiene in Health-care and Settings. MMWR 2002; vol. 51, no. RR-16) •

OR TODAY | December 2015

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SUITE TALK

VACATION/PTO I am looking to see what other Centers do regarding annual vacation/PTO approval. We have traditionally had requests turned in by January 31 and get them back to staff by February 15. In the past, January-February have not been highly taken months, but this year we are having to turn down vacation/PTO due to others being off. This has been done on a first come, first serve basis. Any ideas for how to cover the beginning of the year? A: At our hospital, those with the most seniority have the option to pick first. We do not grant vacations during the Christmas holidays. If our schedule is light, staff can request a paid day off. This is granted according to a rotation schedule. A: We have a book that is started now for the following year. We allow the staff to keep it

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for 24 hours to decide on PTO/vacation. It is based on seniority. They are allowed to pick 10 days at their primary time. It can be a week or single days. We do not allow more than three people off at a time. If they put their name on the date and already three with more seniority have requested it, they have to wait until the regular requests go in for that month. Sounds confusing, but it works.

December 2015 | OR TODAY

IN THE OR MARKET ANALYSIS

STAFF REPORT

MARKET ANALYSIS

Surgical Instrument Transport Market On The Rise

urgical instruments must remain sterile as they are moved from central sterile processing to the operating room. Trays and carts are among the tools used to maintain the cleaniness of instruments as they are delivered to the operating room. Moving used instruments to an area to be cleaned as soon as possible after a procedure is another factor all health care facilities consider when it comes to how they transport these tools. The surgical instrument transport device market is expected to continue to grow along with other surgical equipment markets. Increases in the number of minimally invasive procedures as well as an aging population are factors pushing the market to new heights. The global surgical equipment market, which impacts the surgical instrument transport device market, is expected to grow at a CAGR (Compound Annual Growth Rate) of 4.2 percent from 2013 to 2019. The global surgical equipment market was valued at $8.43 billion in 2012 and by 2019 it is expected to grow to $11.28 billion, according to a re-

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search report released by Transparency Market Research. The growth in the global surgical equipment market will help fuel continued growth in the surgical instrument transport device market. More advanced surgical tools often require specialized trays and other devices to maintain sterile instruments. This need for specialization, common for robotic surgical instruments, is a growing segment of the market. “The key driver for the global surgical equipment market is an increase in demand for sophisticated surgical tools that help perform minimally invasive surgeries,” according to a news release from Business Wire. “The report says that this demand has increased due to a growing number of accidents – road and other accidents – that require quick surgical assistance. Another factor is an increasing geriatric population, which requires a high level of medical and surgical attention.” An analyst with Allied Market Research echoed the growth predicted by other researchers. “The global surgical equipment market is expected to grow at a healthy CAGR during the forecast period,” the analysts said on the Allied Market Research website. “Inception of modern electronic

technologies such as minimally invasive surgery equipment, and robotic- and power-assisted systems are primarily driving the surgical equipment market. Introduction of da Vinci Surgical System by Intuitive Surgical is one of the significant milestones of the surgical equipment industry and it has provided a platform for robotic-assisted surgeries. Electrosurgical devices and power-assisted systems are also the recent trends that are improving the performance of surgical procedures.” The analyst also commented on challenges the market will face, including the proper sterilization and transport of surgical instruments. “Despite promising growth opportunities, inadequate quality assurance concerning performance, improper sterilization procedures for reusable equipment and the absence of favorable regulatory framework in some regions (such as developing economies) stand as restraints for the market. In the United States, the FDA has enforced strict regulatory guidelines for the manufacture and standardization of surgical equipments,” according to the analyst. “Under these guidelines FDA has enforced general control, pre-marketing control and post-marketing control for surgical devices.”

December 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

SUMMIT MEDICAL INSTRUSAFE INSTRUMENT PROTECTION TRAYS InstruSafe Instrument Protection Trays protect and organize surgical instruments during the sterilization, transportation, storage and OR use. Made of customized silicone instrument holders inside of highly perforated aluminum bases and covers with locking lids. The aluminum construction is lighter than steel yet more durable than plastic, therefore more resistant to breakage, reducing frequent replacement. Providing optimum heat transfer, superior drainage and sterilant penetration, InstruSafe trays can be customized to accommodate virtually any set of surgical instruments. Trays can be used with wrap or in conjunction with rigid sterilization containers and are cleared for a variety of FDA 510(k) sterilization cycles. â&#x20AC;˘

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PRODUCT PRODUCT SHOWROOM FOCUS

HEALTHMARK INDUSTRIES TRANSPORTATION IDENTIFICATION LABEL The Transportation Identification Label is the first of its kind designed for compliance with OSHA standard CFR 1910.1030. It features one perforated tab, a green top tab with “CLEAN” in black text, a fluorescent orange/red bottom tab with “DIRTY” in black text, and the removable OSHA approved “Biohazard Label” adhesive backing. It labels transporting materials considered a biohazard, while acting as an essential communication tool in the process. Furthermore it has a checklist for all departments to ensure adequate delivery of the case cart or container in question. Identification is made easy with this new innovative label. •

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December 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

CENSIS TECHNOLOGIES CENSITRAC Censitrac is the industry-leading SaaS-based software, providing surgical instrument management solutions. The Censitrac solution provides visibility and accountability for your surgical instruments throughout the organization while interfacing with all major OR schedulers, sterilizers, washers and incubators. The Censitrac solution unites more than 10 different modules including scope tracking, mobile equipment tracking, competency management and advanced analytics. The combination of these modules creates an ecosystem focused on improving the overall patient experience, OR throughput and regulatory compliance, which ensures the right instruments are in the right place at the right time and in proper condition. â&#x20AC;˘

OR TODAY | December 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

KEY SURGICAL SILICONE FINGER MAT Protect and organize your delicate instruments within a sterilization tray with a new tray accessory from Key Surgical. The Silicone Finger Mat is designed to be used inside various sterilization trays (plastic sterilization trays, mesh trays, etc). The mat features raised fingers that gently cushion and protect surgical instruments during the process of sterilization, storage and transportation. Perforations along the bottom of the mat help with steam and air circulation, assisting with sterilization and the drying process. The Silicone Finger Mat is available as one 18” x 10” sheet that can be used intact or cut to size to fit your various sterilization trays. •

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December 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

MAC MEDICAL STAINLESS STEEL CASE CARTS MAC Medical Inc. manufactures a full line of stainless steel case carts that feature fully welded construction for strength and durability. Choose from several designs including Open and Closed, Over the Road, and Vertical Handle. Our Vertical Handle Case Carts are ergonomically friendly with vertical handles located on all four corners to help provide increased comfort and efficiency for easy steering and cart control. Our engineering capabilities allow us to custom design any specific case cart to satisfy any need your facility may have. call 877-828-9975 or email sales@macmedical.com. â&#x20AC;˘

OR TODAY | December 2015

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IN THE OR CONTINUING EDUCATION 712

OR TODAY | December 2015

BY ROSALINDA ALFARO-LEFEVRE, RN, MSN, ANEF

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CONTINUING EDUCATION 712

MANAGING YOUR TIME: Work Smarter, Not Harder

o quote efficiency guru Brian Tracy, “Time management is not a peripheral activity or skill. It’s the core skill upon which everything else in life depends.”1 Yet, how often have you felt the satisfaction of saying to yourself, “I managed my time well and got a lot done today”? For many nurses, it’s just the opposite: We’re constantly stressed about managing our time better and feel too overwhelmed to figure out what to do about it. Nursing is a complex, dynamic, time-consuming job. If you don’t learn to prioritize and manage your time, you’re at risk of missing critical aspects of patient care. You’ll also find yourself going home constantly displeased with your ability to meet your patients’ needs. Time management (managing one’s own time and the time of others) is a core skill of 21st century nurses.2 It’s the key to improving outcomes and keeping patients safe. This module guides you to determine ways you can be more productive, more efficient and less stressed: in other words, work smarter, not harder.

ContinuingEducation.com guarantees this educational activity is free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See page 37 to learn how to earn CE credit for this module.

The goal of this program is to help you explore ways to improve your ability to manage time in the clinical setting. After studying the information presented here, you will be able to: • Determine three barriers you tend to have when managing your time • Apply the “five rights” and “four steps of delegation” to save time and keep patients safe • Identify at least three strategies you’ll use to improve your time management skills

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DEFINING TIME MANAGEMENT So exactly what is time management? Time management is the ability to analyze how you spend your working hours, set priorities and organize your work to maximize your efficiency.2 There are four “Ps” to consider when analyzing time management:2 • Productivity and efficiency: How much do you get done and how long does it take you? Do you end up staying later than your colleagues most days? • Performance: How well do you do what really matters? Are you great at talking with patients but always seem behind on physical care? Are you great at technical skills, but not so great at emotional support? • Perception: How satisfied are you, your coworkers and your patients with what you accomplish? • Patient outcomes: Are your patients safe and free from avoidable complications? Do they know what they need to know to be independent?

TIME MANAGEMENT BARRIERS A good place to start when working to improve time-management skills is to gain insight into common timemanagement barriers. What things are getting in your way? Think about the following common barriers in relation to your efforts to manage time: Procrastination. Poor organization and planning. Putting tasks off because you don’t like to do them, because they tend to be time-consuming or because you have more enjoyable things to do. Procrastination can also be a personality trait. Do you like to do things at the last minute, or do you like to work ahead? Having to do everything yourself. Some people have trouble delegating tasks because they need to be in control or because they simply don’t like to ask others to do something for them. Having to have everything perfect. Are you a perfectionist? Can you let things go when they’re done satisfactorily or do you want them to be perfect? Recognizing when “good is good enough” has saved me an

December 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 712

immense amount of time. When you weigh what you have to do against how much time you have to do it all, you have to be realistic. You can’t spend too much time on any one task because you run out of time for other tasks. One nurse I know gains peace over her “perfectionism” by living by the motto “Do your best and leave the rest.” If you’re a perfectionist, this motto can help reduce your stress. Underestimating how much time you need to get things done. This is a common issue that’s usually solved by experience. This is one of the reasons care continuity is important, especially with complex patients. If you’re a manager, work to keep the same caregivers matched with certain patients to overcome this issue. It’s also good to give estimated time frames for finishing certain tasks in procedure manuals and care plans. Interruptions and losing focus. I like to call this the “Oh! There’s a squirrel!” issue, referring to the human tendency to be easily distracted (we could be having an important conversation and suddenly be distracted by a squirrel outside the window). A common example of this in health care is getting on the computer to check something and remembering something else we need to check. We change computer screens and may even move on to a different patient’s data. Once in the new screen, we forget to come back to the priority we began with. Because nurses have to deal with multiple requests from patients, families, coworkers, physicians and so on, losing focus is common. How often do you hear yourself saying, “What was I doing before I was interrupted?” Nurses should avoid interrupting their coworkers, especially during crucial times, such as when they are chart32

OR TODAY | December 2015

ing or giving medications. When you’re interrupted during an important task, learn to say, “I’ll be with you in a moment” or “I can’t stop what I’m doing right now.” If you must stop what you’re doing, write down exactly what you were working on and make coming back to it your next top priority. Interruptions and losing focus are one of the most common barriers to time management in health care. For this reason, it may be wise to have a unit meeting that addresses these issues. Poor organization and planning. If you arrive at work just in time to throw your bag in your locker and head for report, your day is likely to be full of delays and backpedalling. Arriving 10 to 20 minutes earlier and checking on your assignment can make a big difference in improving time management and reducing your stress. Get there a bit early and you’ll have time to assess, organize and plan. Not recognizing time wasters. Leaders must encourage their staff to point out time wasters. For example, if you’re sitting around waiting for medications, linens or transport people, you’re losing valuable time. The same goes for poorly organized units. If you’re wasting steps because of poor unit design or having to document the same things in more than one place, you’re also wasting time. Stress, hunger and fatigue. Working long hours in a stressful environment without breaks or sustenance reduces brain power, concentration and physical abilities. This is a common issue for nurses. I once spoke on a panel that included the U.S. assistant surgeon general and two professionals from Vanderbilt University. We had a 30-minute question-and-answer period. At least 20 minutes were devoted to answering questions from the audience like

“You say that breaks are important, but what do we do when we aren’t allowed to take breaks?” We, as nurses, must acknowledge the importance of taking care of the caregivers. We can’t work efficiently when we haven’t paid attention to basic survival needs (food, water, rest). This really hits home in Jim Loehr’s and Tony Schwartz’s popular 2004 book, “The Power of Full Engagement: Managing Energy, Not Time, Is the Key to High Performance and Personal Renewal.”3 As the authors say, “The number of hours in a day is fixed, but the quantity and quality of energy available to us is not. It is our most precious resource.” A key change I made in my workshops after reading this book was to make sure we had plenty of breaks with healthy food and drinks. You would be surprised how often clients responded, “We’re not doing a morning break” or “We don’t have a budget for refreshments” when I asked what was planned for breaks. After I pointed out the findings in Loehr’s and Schwartz’s work, we found a way to include breaks and food, even if it meant asking the nurses to bring their favorite dish from home. (Nurses are great this way …. I have had some GREAT food!) SETTING PRIORITIES Setting priorities — a skill that comes with knowledge and on-the-job experience — is vital to time management. If you don’t discriminate between what must be done and what’s nice to do, you may endanger your patients because all tasks will be considered equally important. Lots of minor things may get done, while major issues go unaddressed. The 80/20 Rule was developed by Italian economist Vilfredo Pareto in WWW.ORTODAY.COM

CONTINUING EDUCATION 712

1906 and is a great guide for setting priorities.4 Known as Pareto’s Principle, there are many applications of this rule. For example, you wear 20% of the clothes in your closet 80% of the time (think about this the next time you shop or arrange your closet). In nursing, you can apply the 80/20 rule in two ways: • On any given day, you have a 100% of things you need to do for your patients. To prioritize, you need to identify the 20% that MUST get done — here’s where you need to spend most of your time. • Twenty percent of your patients will generate 80% of the work that needs to be done. Setting goals and making a to-do list are key steps in setting priorities. It’s hard for your brain to handle the details and relationships of all your tasks without visual cues that help you see the big picture. Once the to-do list is complete, you can analyze the tasks and decide where they fit into the big picture using the following scale.2 • First-order priority: Must do: important and urgent (e.g., addressing safety risks; assessing unstable patients.) • Second-order priority: Must do — important but not urgent (e.g., routine vital signs) • Third-order priority: Nice to do — not as important and not urgent (e.g., chatting with a patient about his vacation). After organizing your list according to the preceding priorities, ask, “Are there things on this list that I could or should be delegating to someone else? If so, who is the best person to do the task? Keep the tasks that you, and only you, can do; delegate the tasks that someone else can do (see WWW.ORTODAY.COM

next section on delegating safely and effectively). Stephen Covey, author of the classic self-help book “7 Habits of Highly Effective People,” gives an excellent model to set priorities.5 His model, referred to as Covey’s Quadrants, involves drawing a grid with four quadrants. Quadrant 1 is for urgent important activities (e.g., safety risks). Quadrant 2 is for things that are important, but don’t have to be done immediately (e.g., patient discharge teaching). Quadrant 3 is for time-pressured issues. They aren’t really important, but someone wants it now (e.g., a family member who wants the number of a good place to order pizza). Quadrant 4 is for things that really don’t need doing because they don’t have much value (e.g., responding to every text message someone sends). If you search “Covey’s Quadrants Images” online, you’ll find examples of how these quadrants are used. DELEGATING SAFELY AND EFFECTIVELY Virtually every time-management article and seminar addresses the importance of delegation. Delegating tasks that don’t require your detailed attention gives you more time to focus on important priorities that you and only you are qualified to do. Yet delegation is a highly complex skill. As Alice Weydt, RN, MS, points out, “It requires sophisticated clinical judgment and final accountability for patient care. Effective delegation is based on your state nurse practice act and an understanding of the concepts of responsibility, authority and accountability.”6 Knowing what your nurse practice act allows you to delegate — or prohibits you from delegating — is of utmost impor-

tance in keeping your patients safe and protecting you from negligence lawsuits. If you’re unsure about what you may or may not delegate, check your policies and procedures, and double check with your manager or unit educator. You can find your state practice act at https:// www.ncsbn.org/. One of the most helpful documents addressing how to delegate is the American Nurses Association and the National Council of State Boards of Nursing’s Joint Statement on Delegation (https://www.ncsbn.org/ Delegation_joint_statement_NCSBNANA.pdf ). Pointing out that there’s more nursing to do than there are nurses to do it and that many nurses are stretched to the limit, this document addresses 5 Rights and 4 Steps to safe and effective delegation. Keeping in mind that delegation is defined as “authorizing someone to perform a selected task in a selected situation while retaining accountability for results,”7 here’s a summary of what these rights and steps involve. Five rights of successful delegation are as follows: Delegate 1)the right task, 2) in the right situation 3) to the right worker, 4) with the right direction and communication, and 5) the right teaching, supervision and evaluation. Four steps of successful delegation are as follows: • Assess and plan: Consider the patient, the task and worker competencies to make a plan for what tasks you will assign to whom. • Communicate: Give clear, concise, complete directions about what must done, how it must be done, what needs reporting and when to touch base with you (verify that the worker understands directions). December 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 712

• Ensure supervision and surveillance: Monitor the patient and worker performance as frequently as needed based on the above. • Evaluate and give feedback: Evaluate the effectiveness of the delegation by assessing patient response yourself. Decide whether you need to make changes in the patient’s plan of care or how the worker is completing the task. Evaluate the worker’s performance and give teaching and feedback as needed (this helps the worker improve skills, ultimately freeing you for other important work).

about the experience and if there are things he would like to do differently. When you assess your patients directly, not only do you know the results, but your workers are likely to do a better job because they know you will be checking. This helps ensure your patients are safe and ultimately saves you time because you quickly know when things aren’t going well. You do less backpedalling because you’re dealing with facts rather than assuming that all is going well. From a time-management perspective, you’ll stay focused on priorities and be able to identify care issues and omissions early.

RESEARCH ON FACTORS KEY TO SUCCESSFUL DELEGATION11

NINE COMMON CARE OMISSIONS8-10

• Good communication • Positive relationships and attitudes • Realistic workloads • Level of nursing assistant’s competence and knowledge • Supervision and outcome evaluation Some researchers suggests that tasks such as ambulation, turning, oral care and feeding might become so routine that nursing assistants may become complacent in performance and RNs become less vigilant in supervising these aspects of care.

While all of the preceding is important, remember the following rule: Always assess your patients yourself to determine the results of tasks you delegate. For example, if you delegated the task of getting someone out of bed twice a day, ask the patient directly how many times he got out of bed, how he felt 34

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• Ambulation • Turning • Delayed or missed feedings • Patient teaching • Discharge planning • Emotional support • Hygiene • I&O documentation • Surveillance (crucial monitoring)

BEST PRACTICES There are best practices that organizations can implement to save time. For example, Ruth Hansten, RN, PhD, FACHE, principal of Hansten Healthcare, has helped more than 175 hospitals to improve outcomes through focused, effective teamwork. She developed a bundle of 10 best practices to improve outcomes and save time.8,9 There are two practices that are especially important: 1) Better planning and 2) Enhanced team communication that focuses on patient/family expectations/results.

Hansten says that when nurses set up a plan with assistive personnel for communication — including initial communication to set expectations, timelines for getting things done, parameters for what should be reported and planning for specific checkpoints throughout the shift — they report saving up to an hour a shift. This “found” time comes from ensuring that there’s no duplication of work or time wasted searching for colleagues or data by giving direction early in the shift, ascertaining what tasks will be done within a reasonable time. Hansten says, “When we are rounding on patient care units near change of shift, we often discover assistive personnel ready to clock out, when the RNs aren’t certain what the I&Os are or if the vital signs were within normal limits.” (Hansten, R. Email communication. September 1, 2013.) She stresses the importance of shift report at the point of care, with a focus on patient/family preferred goals and priorities. This helps patients feel engaged in the process as the whole team navigates toward individualized desired outcomes. Nonessential and redundant care is avoided while all efforts focus on the patient’s goals. The entire team streamlines its work and initiates a process that means less omitted care; fewer healthcare-acquired conditions, such as pressure ulcers or falls; and reduced readmissions from unplanned transitions. Nurses report saving at least a half hour per day thanks to an efficient point-ofcare handoff process. TIME MANAGEMENT TIPS The following are time-management tips you should consider WWW.ORTODAY.COM

CONTINUING EDUCATION 712

using in your daily nursing practice: Start well. Arrive early so that you can review your assignment, check whom your staff is and get organized. If it seems that you’re not able to arrive early, consider your prework routine. Are there improvements you could make in time management at home? Would simple strategies like setting your alarm clock 15 minutes ahead or not answering phone calls or getting on the computer before work help? Identify major goals for the day and make a to-do list. Revisit your list frequently during the day, deciding what’s been done and what still needs to be done. Focus on “must-do” tasks before “nice-to-do” tasks. You may use paper to-do lists or a recommended time-management app to make sure you don’t miss the things that aren’t addressed in electronic medical records. You can learn more about electronic time management apps at NurseMind, www.nursemind.com. Make charting a high priority. Complete patient records as soon as you can. This is especially important in acute care settings. Charting often triggers you to recognize something important that needs to be done. With some electronic health systems, when you enter in certain data, the system will cue you to consider patient status changes or other things that need to be done. Charting creates records that promote safe patient care. These records may serve in your defense if you’re accused of negligence. If you chart in a rush at the end of the shift, your records are likely to reflect that. You may be an excellent nurse, but if your charting doesn’t show that, you and your patients may be in jeopardy. WWW.ORTODAY.COM

Build relationships with staff at all levels. The saying “credentials on a wall do not make you a decent human being” applies. Teamwork is all about relationships and empowering your coworkers. Involve patients and families. Ask them, “What’s the most important thing you want to get done today?” Let patients know what they are allowed to do for themselves (many will be unsure). Teach them what they need to know to be independent. Set limits. It’s easy to keep adding to your to-do list. If your list keeps growing, you may not have time to focus on your own priorities and patients. Don’t be afraid to say, “I can’t right now. Can you get someone else?” Create routines, such as doing huddles at specific times during the day. Huddles should be less than 10 minutes and can be held at the beginning of the shift or whenever significant changes in work flow arise.10 Getting the team in a huddle to discuss what’s happening and make adjustments improves work flow and aids both patients and staff. Organize the environment. Designate places for specific things (e.g., frequently needed equipment) and tasks (e.g., charting, education). When under pressure, ask, “What’s the most important thing I have to do RIGHT NOW?” Stay focused on this task. Cluster activities before entering a room. Think ahead and anticipate needs (e.g., a need for pain medication). If you feel overwhelmed or “out of your league,” consider whether you should ask for help. For example, you may need to call the pharmacy to answer your questions or notify the rapid response team if you’re concerned about a patient. Delays in

getting help contribute to poor patient outcomes. Reserve time in your daily schedule for unexpected events. Work ahead because a new admission or patient crises may put you behind. Keep in mind that multitasking is risky, especially if you have a lot of interruptions. You may end up doing a little bit of a lot of things, but not complete any one major task. If you’re struggling with time management, ask your preceptor, manager or trusted coworker to give you his or her time management strategies. There are many different work styles and we can all learn from one another. There will always be more than enough requests, demands and distractions to deal with. Time management will continue to be a core skill and challenge of 21st century nurses. As circumstances change, you’ll need to develop new approaches. Developing these skills helps you do more of what you must do faster. It doesn’t mean cutting corners or reducing quality. It means using your resources to get the best results for your patients and health care team. The good news: Gaining control over how you use your time boosts your performance, gives you a sense of satisfaction, reduces your stress and keeps patients safe. ROSALINDA ALFARO-LEFEVRE, RN, MSN, ANEF, is the president of Teaching Smart/Learning Easy (www. AlfaroTeachSmart.com) in Stuart, Florida. She’s known nationally and internationally for her writings and programs on teaching critical thinking and improving personal and professional performance.

December 2015 | OR TODAY

IN THE OR

CLINICAL VIGNETTE Nick is a new graduate RN who used to work as a paramedic. He has been working on a medical/surgical unit for almost a year and continues to be frustrated that every day he goes home feeling as if he hasn’t done all that he wanted to do. He says he always means to arrive early to work to get organized, but so much happens at home that he barely makes it in time for the morning report. On his last evaluation, his manager noted that he often stays late and seems disorganized. Nick is surprised how difficult his first year as a med/surg nurse has been. He thought that with all his experience, he would be able to manage priorities and give good patient care. He asks you for advice on what he can do to maximize his time.

Knowing that Nick wants to get to work early but never seems to do so, you: A. Point out that getting an early start is key to being more organized B. Tell him that you suspect he’s a procrastinator at home and needs to fix this C. Ask him to identify things in his prework routine that may be inhibiting his ability to get to work early D. Discuss whether working a different shift would help him to be on time

Nick tells you that he can’t understand why he’s so overwhelmed when he has so much experience. You tell him: A. The daily schedule on a med/surg unit includes tasks and priorities that are different from those in emergency care. B. He probably would benefit from taking a course that prepares him for med/surg nurse certification. C. It’s possible that he was burned out before he even started the med/surg job. D. It would be a good idea to discuss this with his former paramedic buddies because he would feel “safe” with them.

When Nick tells you he is too overwhelmed with interruptions and tasks to keep track of multiple priorities, you: A. Tell him that his ability to prioritize is sure to improve over time B. Ask if he’s making to-do lists or using an app to help him stay focused C. Ask him if he’s tried applying Maslow’s Hierarchy of Needs to prioritize D. Suggest that he may want to try another specialty because there will always be interruptions in med/surg nursing

When Nick tells you he knows he should be delegating more but has trouble letting go of responsibilities, you: A. Discuss with him the five rights of delegation and the four steps of delegation B. Tell him that he’s been working in this field a long time and he should be more confident in his delegation skills C. Tell him that time management is an essential 21st century nursing skill D. Suggest that he gets an app that helps him decide which tasks to delegate and which ones to do himself

1. Correct answer: A — The five rights and the four steps of delegation set the stage for successful delegation. 1. Correct answer: B — Keeping paper or electronic to-do lists is essential. You can’t rely on memory, especially if you’re multitasking or interrupted frequently. 1. Correct answer: A — Time management requires on-the-job experience. A paramedic has to be good at managing priorities in the moment. A med/surg nurse has to manage priorities not only in the moment and over the course of a day. 1. Correct answer: C — Problems with prework routines contribute to late starts at work. Identifying time-management issues at home is key to getting to work early. 36

OR TODAY | December 2015

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HOW TO EARN CONTINUING EDUCATION CREDIT REFERENCES 1. Tracy B. Time management: why your life

depends on it. Brian Tracy International Web site. http://www.briantracy.com/blog/timemanagement/why-your-life-depends-on-time-

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.

management-personal-goals-increase-productivity/. Published January, 23, 2013. Accessed March 27, 2014. 2. Alfaro-LeFevre R. Critical Thinking, Clinical

Reasoning and Clinical Judgment: A Practical Approach. 5th ed. Philadelphia, PA: ElsevierSaunders. 2013. 3. Loehr J, Schwartz T. The Power of Full En-

gagement: Managing Energy, Not Time Is the Key to High Performance and Personal Renewal. New York, NY: Simon and Schuster. 2004 4. Reh F. Paretoâ&#x20AC;&#x2122;s Principle: The 80-20 Rule

About.Com Management Web site. http://management.about.com/cs/generalmanagement/a/ Pareto081202.htm. Accessed March 27, 2014. 5. Covey S. The 7 Habits of Highly Effective

DEADLINE Courses must be completed by 8/25/2016. 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.

People. New York, NY: Simon & Schuster. 1989. 6. Weydt A. Developing delegation skills. Nurs-

ing World Web site. http://www.nursingworld. org/MainMenuCategories/ANAMarketplace/ ANAPeriodicals/OJIN/TableofContents/ Vol152010/No2May2010/Delegation-Skills.htm. Published 2010. Accessed March 27, 2014. 7. American Nurses Association and the Na-

ACCREDITED ContinuingEducation.com is accredited as a provider of continuing nursing education by the American Nurses Credentialing Centerâ&#x20AC;&#x2122;s Commission on Accreditation. Accredited status does not imply endorsement by the provider or ANCC of any commercial products displayed in conjunction with this activity.

tional Council of State Boards of Nursing. Joint statement on delegation. NCSBN Web site. https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf. Published 2005. Accessed March 27, 2014. 8. Hansten R. A bundle of best bedside prac-

ContinuingEducation.com is also accredited by the Florida Board of Nursing and the Georgia Board of Nursing (provider # 50-1489). ContinuingEducation. com is approved by the California Board of Registered Nursing, provider # CEP16588.

tices: field evidence. Health Care Manage. 2009;28(2):111-116. 9. Hansten R. 10 Best practices for nursing at

the bedside. (Recording of 2/28/13 Webinar). http://rrohc.com/nursesweek2011.html. Accessed March 27, 2014.

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

10. Steward E, Johnson B. Huddles: increased

efficiency in mere minutes a day. TransforMed web site. www.transformed.com/workingPapers/Huddles.pdf. Published 2007. Accessed March 27, 2014.

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

December 2015 | OR TODAY

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Healthmark is looking forward to an exciting future with its continued expansion of staff and products. With almost 50 years of experience Healthmark continues to adapt to the business needs of their customers. Over the years, the company has experienced a great deal of growth with a variety of products and services. Healthmark even offers continuing education opportunities. The company has over 100 employees and is in the transition process of moving their headquarters that is an overall size of around 100,000 square feet in Fraser, Michigan. The latest growth at Healthmark includes the launch of the brand new Bamboo Wicked Wear. “This type of apparel is new to the healthcare industry,” says Ralph Basile, Vice President. “This premium apparel is designed for exceptional moisture absorption. The material is 40

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FUTURE OF SURGICAL CARE a look at the beneďŹ ts of patient-center care BY DON SADLER PERIOPERATIVE SURGICAL HOME Most perioperative nurses would probably agree that too often, perioperative care plans are variable and fragmented. This can result in more errors and complications, longer patient stays, more readmissions, and more adverse patient outcomes. A new clinical care delivery model is out to change this. Designed around the concept of patient-centered care, the Perioperative Surgical Home (or PSH) was created by the American Society of Anesthesiologists (ASA) to achieve the triple aim of better individual patient health, improved overall health care, and lower health care costs.

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December 2015 | OR TODAY

THE FUTURE OF SURGICALCARE

“Our current healthcare delivery system is disjointed, disconnected and there’s no communication. So there’s a chance things will get overlooked and fall through the cracks, which can impact patient safety and outcomes.” — Jane Fitch. PATIENT-CENTERED

COORDINATION

OR TODAY | December 2015

DISJOINTED AND DISCONNECTED The PSH will accomplish this triple aim through continuous improvement for patients undergoing surgical procedures, according to the ASA. It guides the patient through the entire surgical experience — from the decision to have surgery until 30 days post-discharge. “Our current healthcare delivery system is disjointed, disconnected and there’s no communication,” says Jane C.K. Fitch, M.D., ASA immediate past president. “So there’s a chance things will get overlooked and fall through the cracks, which can impact patient safety and outcomes.” For example, the decision of the need for surgery often disconnects patients from their typical medical care. Also, surgical patients may experience lapses in care, duplication of tests and preventable harm. The goal of the Perioperative Surgical Home is to create a better patient experience and make surgical care safer, adds Fitch, thus promoting a better medical outcome at a lower cost. The PSH model creates a unified surgical experience in which the patient’s care is coordinated by a Director of Perioperative Services, additional surgical home leadership and support personnel, all of whom constitute an interdisciplinary team. “The Perioperative Surgical Home is a coordinated, physicianled, multidisciplinary team-based approach that focuses on placing patients at the center of care,” says Lisa Spruce, DNP, RN, ACNS, ACNP, ANP, CNOR, CNS-CP, the director of evidence-based

perioperative practice with the Association of periOperative Registered Nurses (AORN). “It’s one way to help remedy the current costly and fragmented perioperative system of care by shared decision making between health care providers and patients and allowing a smooth transition between levels of care,” Spruce adds. ESSENTIAL ELEMENTS OF PSH According to Spruce, there are five essential elements in the PSH model:

Patient-centered care Unlike the current model of physician-centered care, patient values and preferences are at the center of the PSH model, where patients participate in all decision making.

Comprehensiveness The PSH model provides continuous patient care that transitions patients from the Patient Centered Medical Home (PCMH) to the PSH and back. This helps ensure that all issues of care are handled by each team.

Coordination of care The patient’s care team coordinates all phases of perioperative care. This begins in the surgeon’s office and progresses to the preadmission testing and evaluation process through all three phases of surgical care. Postoperatively, caregivers continue the care process for patients until they are discharged and clinicians continue to follow up with patients for 30 days. WWW.ORTODAY.COM

“It’s all about applying good evidence-based medicine and standardized practices to the surgical process.” — Scott Engwall

Accessibility to care Patients should be able to contact care providers at all times. While the patient is in the hospital, providers should coordinate and integrate all care through an electronic medical record. After discharge, providers should monitor patients closely. If problems arise, PSH members should step in to coordinate the care for 30 days.

Commitment to quality and safety The PSH is based on standardization to improve the quality and safety of patient care. Evidence-based clinical pathways or protocols help optimize and reduce the variability of care while improving outcomes. If evidence does not exist or is unclear, the PSH team should develop a multidisciplinary agreement for a standardized protocol.

series of clinical care pathways defining and standardizing pre-, intra-, postoperative and postdischarge management. In building its PSH model, UC Irvine formed five teams: Pre-op Admissions, Intra-op, Immediate Post-op, Post-Discharge, and Metrics. Each team reports directly to PSH leadership. Scott Engwall, M.D., of UC Irvine’s Department of Anesthesiology & Perioperative Care, lists a number of reasons why the hospital built a PSH model: • To decrease the variability of care through evidence-based standardized practices; • To decrease complications, length of hospital stay and the cost of care; • To increase overall efficiency; • To improve the quality of care and overall outcomes; and • To improve transitions of care, surgeon satisfaction and the overall patient experience.

BUILDING A PSH MODEL In 2012, the University of California Irvine School of Medicine initiated the process of building a PSH model aimed at patients undergoing total hip or knee arthroplasties. Members of the Departments of Anesthesiology & Perioperative Care and Orthopedic Surgery, along with colleagues from all perioperative hospital services, implemented a

“It’s all about applying good evidence-based medicine and standardized practices to the surgical process,” says Engwall. “Implementing clinical care pathways results in standardized practices in the OR in terms of how operations are performed, anesthesia is administered, pain is managed and so forth. This reduces variability and improves patient outcomes and satisfaction.”

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December 2015 | OR TODAY

THE FUTURE OF SURGICALCARE

UC Irvine’s clinical care pathways are service-line specific and patient centered to optimize outcomes, adds Engwall. “This reduces variability in surgical, anesthesia and nursing practices,” he says. “Also, Lean Sigma methodology increases efficiency and reduces waste.” Les Garson, M.D., also of UC Irvine’s Department of Anesthesiology & Perioperative Care, points out some of the ways in which the PSH model is more streamlined than the traditional physician-centered surgical care model. “With the traditional model, there’s minimal pre-procedure planning; variable pre-op assessment, testing and medical treatment; and a lack of standardized protocols,” says Garson. “Post-op, there’s variable support, which often leads to patient visits to the emergency room.” “With the PSH model, everything from the decision to operate through pre-op, intra-op, post-op and post-discharge is seamlessly integrated so that protocolized care is delivered at each phase,” he adds. According to Garson, PSH is saving UC Irvine School of Medicine about $4,000 per joint replacement case. They have reduced the average joint patient’s length of stay from 3.5 to 2.3 days, allowing the hospital to fill the bed with another patient an average of 1.2 days earlier. Since initially adopting the PSH model for hip and knee 50

OR TODAY | December 2015

“With the PSH model, everything from the decision to operate through preop, intraop, post-op and postdischarge is seamlessly integrated so that protocolized care is delivered at each phase” — Les Garson

patients in 2012, UC Irvine has expanded it to total joint replacement, orthopedic spines, orthopedic outpatient procedures (like foot and ankle, arthroscopies and hand procedures), cystectomies, and open and laparoscopic nephrectomies. Engwall’s best advice for hospitals implementing a PSH model? “Build a multidisciplinary team and engage the different departments that are involved,” he says. “Also, you should hardwire and monitor the pathways and re-evaluate them on an ongoing basis. Finally, be sure to involve your patients and their families in the PSH.” EVIDENCE-BASED PRACTICE Spruce says that perioperative care today is based on tradition rather than evidence. “Perioperative services must move from practice based on tradition to practice based on evidence with a focus on quality and safety,” she says. “The PSH is a model that strives to do this." “PSH is beneficial because it emphasizes the patient and coordination of care from the moment the patient makes the decision to undergo surgery until 30 days after discharge,” Spruce adds. “During this time, the PSH team implements standardized evidence-based protocols that have been shown to be effective.” “The Patient Surgical Home is the future of surgical care,” says Fitch. WWW.ORTODAY.COM

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MAKING THE SWITCH Ex-teacher finds the perfect RX for career success

OR TODAY | December 2015

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Danielle Hostler North Charleston, South Carolina

or Ohio native Danielle Hostler, nursing is a second career. When she and her husband moved from the Buckeye State to North Charleston, South Carolina, he was taking a firefighter job at Boeing, and she was working as a seventh-grade English teacher – both jobs that were hard to come by in Ohio. Although she found teaching rewarding, Hostler said she struggled with some of its more bureaucratic demands.

“I had an idealistic idea of what I wanted it to be, but reality didn’t match up,” she said. When Hostler had finally burned out on the classroom, she realized she needed a change – and headed back to school. After earning an associate degree in nursing at Trident Technical College, Hostler worked nights as the unit secretary at the Medical University of South Carolina and attended nursing classes there during the day. In a facility that handles transplants and “quite a bit of trauma,” it wasn’t a ramp-up approach, but it prepared her to manage the responsibilities of her new career. “It was kind of a weird trajectory, but it gave me a feel for the OR,” Hostler said. “Sometimes I was the only one at the desk and you’d have to follow up right away. I think it was a godsend that I got put in that situation.”

By Matthew Skoufalos

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December 2015

December 2015 | OR TODAY

After Hostler graduated, she began working as a staff nurse in the main operating room at MUSC, and after five years, was promoted to ENT coordinator for ambulatory surgery. Today, she supervises eight nurses, works with 11 doctors, and is pursuing a master’s in informatics, which allows her to apply her clinical knowledge base to other areas of her profession. “I do like nursing because I can do something right away and then immediately see the result of it,” Hostler said. “I still really enjoy the education part of it, and that was part of the reason why I went back for my masters.” To Hostler, the OR is an exciting place to work. She enjoys scrubbing in for surgery, has a keen interest in technology, and appreciates the variety of the day-to-day responsibilities. Pretty quickly, she realized

that surgery and surgical nursing were where she was meant to be, amid the steady stream of information and the demands it places on the mind to analyze, process and prioritize. “It can be really stressful at times,” Hostler said. “There’s constantly things coming to you. It’s a lot of putting out fires, troubleshooting on the fly; there’s a technical aspect.” “It’s just a totally different field of nursing than typical floor nursing,” she said. “There’s a certain amp to it all. If everything’s clicking right, it’s a really great experience. It’s also a neat interaction you have with the patients and their families.” The other chief aspect of her position involves integrating and managing the demands of working with several “strong personalities … in a productive way,” Hostler said. When she became responsible for

taking equipment requests to decision-makers, it changed her view of her relationship with doctors, too. “[Doctors are] customers: you want to keep them there,” Hostler said. “You also have to keep in mind what they’re asking for. Some of them want the things with all the bells and whistles without paying attention to the costs; sometimes you have to bite your tongue with some of the things that they say.” Overall, she said, the doctors in her department “respect the nursing staff, and they work really well with us. The nurses are excellent on the team as well, which really helps. It’s nice to work with a good team.” Besides working to coordinate a fluidity of experience among professional staff, Hostler said she enjoys the brief but intense bonds that are formed among caregivers and their

Members of Danielle Hostler's ENT team include, from left, Ramona MacLean, Kathy Ewinga, Laura Gunter, herself and Jennifer Smith.

OR TODAY | December 2015

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patients. Her experience as a schoolteacher also comes in handy in forming connections with pediatric patients; particularly her understanding of educational psychology and child development, which Hostler said has helped her to become a better nurse. “You only see them for a few moments before they go to sleep, and you only have a few minutes to establish trust with them and their families as well,” she said. “It’s interesting to have to build that relationship with parents.” Hostler is a parent herself, too: she’s mother to five-year-old and one-year-old girls and a four-year-old boy. She says her life as a nurse has been broadened by the experience of parenting as much as it has by being an educator. Today, when she works with pediatric patients, she thinks as much about the life-changing effects of successful surgeries as the demands of the surgeons. Hostler said she’s working to “close the loop” between patients as often as she can. One of her favorite applications of that principle has been to send nurses who work on cochlear implant procedures – hearing aids for children born deaf – to their pediatric audiologist’s office when the devices are first activated. “That’s one of the things you always want,” Hostler said; “you wish you could follow up with patients to see what their outcomes are. [The nurses] really love that, and it’s made them a lot more passionate about the work they do as well. They get to talk to the parents. They’re really happy.” As for the burnout that once caused her to switch jobs from the career she believed would be her life’s work, Hostler doesn’t foresee the same risk in the health care business. “If you don’t like a certain area, there’s many other areas you can try out and see what fits you best,” she said. “In my unit, there’s a lot of experience, and they all enjoy their jobs, and it’s refreshing to see that." “I think one of the best things about nursing is that you can change,” she said.

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Danielle Hostler is a ENT coordinator for ambulatory surgery.

Danielle Hostler is seen with her husband, Joe, and their children, Maggie and Jack.

December 2015 | OR TODAY

OUT OF THE OR HEALTH

BY MARILYNN PRESTON

WHEN STRESS TIES YOU UP, GET A MASSAGE

he other day, I suddenly felt something new in the back of my thigh. Pain. “Whoa!” I screamed. What’s going on here? Yesterday everything was working perfectly and today ... this. I decided to investigate. Where is the pain really? I used my rookie proprioceptive skills – selfsensing awareness practices – to dive deep and probe at a subtler level. Is it a little tear in the tissue, or is it coming from my lower back, or does it feel more like a blockage? Clots create blockage, but that’s just one of many possibilities, I said cheerfully. I decided to poke into my discomfort a bit more, pressing my finger into the hot spot in the heart of my hamstrings. Stop. Close my eyes. Consider. Yes! I feel you! I hear you! My body was telling me I need a massage. All medical language aside, something was stuck that shouldn’t be stuck and there’s almost no better

OR TODAY | December 2015

way in the world to relieve it than a session with a skilled body worker. Thank you, Arete. MASSAGE EQUALS PREVENTION In the best of all possible health care worlds, just now coming, massage therapy will be covered, if not required, by everyone’s health insurance. For now, it’s not. So it’s up to you to make it part of your body maintenance routine, like cleaning your teeth or cutting your nails. Skilled body workers do things for men and women that need to be done, especially as we age. They relieve aching muscles, soothe joint pain, help prevent sports injuries and release energy blocks – physical and emotional. Imagine a world where everyone woke up to 60 minutes of tender touching. But I wax lyrical. MANY STYLES, MANY SMILES There is no one best massage technique. Massage could have been where the expression “Different strokes for different folks” originated.

Some of us like deep trigger-point work; others prefer lighter, longer strokes. No matter your choice – from hot stones to deep tissue, from Swedish to shiatsu – here are some things you should consider to make your next massage a sublime experience: • Don’t lie there feeling guilty about the time or the money. That sort of unproductive thought gets in the way of the magic. Instead, open up fully to the experience. You deserve to feel this good. • Before your massage, scan your body for areas that feel tense or strained. Chronic soreness in your shoulder? Stiff neck? Tight quads? Tell your therapist, and then completely surrender to the touch. It’s fine to engage your breath, your mind, but then let your therapist do all the heavy lifting. • Don’t come to the table with a full stomach. The less you have churning in your belly, the more comfortable you’ll be. • Avoid idle conversation. It’s a distraction for both of you. Of course give feedback when it WWW.ORTODAY.COM

HEALTH

But in my mind, and for sure in my body, nothing beats the human touch. After 60 minutes with Arete, I wish it were 90, the pain was gone.

seems appropriate, especially about the amount of pressure. • At the start of your session, take a few deep breaths to get centered. If you begin to feel discomfort, don’t clench or panic. Instead, exhale directly into the area of tension. If it works, great. If not, speak up. A painful massage is counterproductive. • Don’t be shy about going with the flow, inhaling peace and joy, exhaling stress and credit card debt. • After your session, ask your therapist about particular areas where you hold stress, areas of tension or imbalance. It could be your neck and shoulders – a side effect of Internet addiction – or your hips, from too much sitting. That feedback can help you pinpoint areas that you need to open up and explore when you’re away from the table. I know I’m repeating: It’s these tight, tense, stuck places that contribute to body breakdowns later on. DO-IT-YOURSELF MASSAGE WORKS, TOO If your budget is even tighter than your hamstrings, do what plenty of smart athletes do and learn to self-massage. Yoga, qi gong, and acupressure are splendid for that, and so is using a $25 dollar foam roller. But in my mind, and for sure in my body, nothing beats the human touch. After 60 minutes with Arete, I wish it were 90, the pain was gone. MARILYNN PRESTON – healthy lifestyle expert, well-being coach and Emmy-winning producer – is the creator of Energy Express, the longest-running syndicated fitness column in the country. She has a website, marilynnpreston.com, and welcomes reader questions, which can be sent to MyEnergyExpress@aol.com. WWW.ORTODAY.COM

December 2015 | OR TODAY

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OUT OF THE OR FITNESS

5 WAYS TO BOOST YOUR HEALTH IN FIVE MINUTES OR LESS

ou know those days when your normal schedule gets thrown completely out the window? You’re tired, overrun and can barely think about the next thing on your to-do list, let alone work on your larger goals or concentrate on your health. “Luckily, major results can stem from small steps, even if they seem inconsequential. These tiny decisions throughout your day add up to create a gradual shift towards change and transformation when it comes to your health,” says Paul Kriegler, registered dietitian with Life Time – The Healthy Way of Life Company. When you’re flying at rapid speed throughout your day and could use a small win, Kriegler suggests trying a few of these five-minute health commitments:

WHIP UP A SUSTAINABLE ENERGY BOOST Think of food as fuel for your body. When you’re busy and on the run, don’t forget to pack healthy lunches and snacks to keep you nourished throughout the day. • A protein and powdered greens shake is the perfect quick snack or lunch. • Cut up veggies at the beginning of the week to pack for lunch. • Make a 3-ingredient salad. All you need is lettuce, a protein and another veggie. WWW.ORTODAY.COM

• Throw together stew or chili ingredients for a week of healthy dinners and lunches.

DO YOU HAVE FIVE MINUTES? FIT IN A WORKOUT Kriegler says a workout doesn’t have to (and shouldn’t!) disrupt your entire day. If you find yourself with five minutes to spare, get up and move. • Work out your kinks with five minutes of stretching or foam rolling. • See how many pushups you can do in five minutes. • When you’re at work, run up and down the side stairs of your office. • Fit in two sprints up and down your street before dinner. • Do three to six yoga poses to target a particular body part or objective. Find a yoga video that focuses on relaxation or strength. • Head out to your backyard for five minutes of jumping rope, playing tag with the kids or trying a YouTube exercise video that looks interesting.

PLAN FOR THE DAYS AND WEEKS AHEAD Achieving a goal always involves planning. Find five minutes in your day to make sure you have a healthy plan in place. • Plan a healthy menu for dinner tonight or start your healthy shopping list for the week. • Pack your gym bag for tomorrow’s workout.

TAKE TIME FOR YOURSELF “When you’re constantly on the go, remembering to take time for yourself can be a challenge,” says Kriegler. “Whether you have to get up five minutes early or stay up five minutes late, fit in some time to connect with yourself.” • Try a five minute meditation to relax your body. • Walk outside for a few minutes of sun and fresh air. • Pour yourself a big glass of water to take your supplements with in the morning.

CALL SOMEONE IN YOUR SUPPORT NETWORK FOR ENCOURAGEMENT This could be a weight loss coach, workout buddy, friend or spouse. December 2015 | OR TODAY

OUT OF THE OR NUTRITION

BY SALLY KUZEMCHAK, M.S., R.D.

GET YOUR SNACKING BEHAVIOR BACK ON TRACK WITH THESE FOUR RULES

mericans have a love affair with snacking, as 78 percent of us snack daily.

BE CHOOSY The average snack has 226 calories, which means two a day could inflate your week by nearly 3,200 calories (almost a pound of weight gain). To control calories, choose a snack with a natural “physical boundary,” says Yale’s Dr. David Katz, such as a small yogurt or a banana. Or pour a measured amount into a bowl. And be extra mindful if you’re drinking snacks like smoothies. “We don’t compensate for calories in the liquid form like we do for food because they don’t fill us up,” warns EatingWell advisor Rachel Johnson, Ph.D., R.D.

OR TODAY | December 2015

“The number of times we eat each day is far and away the largest cause of increased calorie intake,” says Barry Popkin, Ph.D., a professor of nutrition at the University of North Carolina School of Public Health. About 400-plus calories a day come from between-meal nibbling. All those extra calories add up and can be a major diet derailer – particularly if they’re not the healthiest choices. Done right, though, snacks can improve your diet quality and weight. Here’s how.

SCHEDULE SNACKS Snacks are everywhere – the hardware store, the office, even the gym. To avoid grazing all day, make a plan for when you’re going to snack. Every three to four hours is a good guide. Going longer can trigger a low-blood-sugar response: hunger pangs, fatigue, even irritability. For most people, a late afternoon snack makes sense. “A snack between lunch and dinner can subdue the appetite so you can make better choices and eat less at dinner,” says Katz. Post-dinner snacking is trickier. Research shows there’s a peak wave of cravings at 8 p.m. for salty, sweet and starchy

foods. That nighttime noshing may alter hunger hormones and promote fat storage, leading to weight gain and higher “bad” cholesterol. If you’re a night owl, choose a small, healthy bite (a sliced pear or bowl of sugar-snap peas) to thwart a cupboard cleanout.

INCLUDE PROTEIN Protein has a unique ability to satisfy us on fewer calories and keep hunger at bay longer. In a study from Cornell, a snack of cheese and vegetables helped quell the appetites of children more so than chips – and, as a result, the kids felt full with 72 percent fewer WWW.ORTODAY.COM

NUTRITION

Watch out for savory snacks that contain sugar, such as nuts coated in both sweet and salty ﬂavors. These combos may cause you to eat more.

calories. The same was found for grownups too. Nuts are also a good high-protein snack, especially since researchers say a portion of the calories from almonds, peanuts and pistachios isn’t absorbed by the body. Take a cue from the research: pair nuts or cheese with a veggie to fill you up on fewer calories.

KEEP IT SIMPLE A snack that’s a whole food (a hard-boiled egg or carrots) keeps calories and portions reasonable. But if you’re reaching for something packaged, a short list of ingredients you can recognize and pronounce is a good litmus test. That’s because lengthy lists tend to

STOP

include flavor enhancers and added sweeteners that stimulate your appetite instead of satisfying it. Watch out for savory snacks that contain sugar, such as nuts coated in both sweet and salty flavors. These combos may cause you to eat more.

EatingWell is a magazine and website devoted to healthy eating as a way of life. Online at www.eatingwell.com

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December 2015 | OR TODAY

OUT OF THE OR RECIPE

OR TODAY | December 2015

BY SALLY KUZEMCHAK, M.S., R.D.

WWW.ORTODAY.COM

RECIPE

MACARONI WITH SAUSAGE & RICOTTA A

bit of sausage goes a long way in flavoring the creamy ricotta tomato sauce in this quick, healthy pasta recipe. Serve with a green salad and crusty Italian bread.

Serves 6 Total Time: 35 minutes

INGREDIENTS: 2 tablespoons extra-virgin 6 6 1 1/4 1/8 12 6 10 1/4

olive oil tablespoons finely chopped yellow onion ounces mild pork sausage, casings removed 14 ounce can no-salt-added whole peeled tomatoes, chopped, with their juice teaspoon ground pepper teaspoon salt plus 1 tablespoon, divided ounces thin tube-shaped pasta, such as pasta al ceppo tablespoons part-skim ricotta cheese fresh basil leaves, thinly sliced cup freshly grated ParmigianoReggiano cheese

Put 2 quarts of water on to boil in a large pot. Meanwhile, combine oil, onion and sausage in a large skillet over medium-high heat. Cook, stirring and crumbling the sausage with a spoon, until the onion is golden, 4 to 5 minutes. Add tomatoes, pepper and 1/8 teaspoon of salt; cook until the tomatoes have reduced and separated from the oil, 5 to 10 minutes. Remove from heat. Add the remaining 1 tablespoon of salt to the boiling water, stir in pasta and cook according to package instructions until just tender. Just before the pasta is done, return the sauce to medium-low heat. Add ricotta and basil, and stir until combined. When the pasta is done, drain well and toss with the sauce and Parmigiano-Reggiano. Serve at once.

RECIPE NUTRITION: Per serving:

362 CALORIES 12 G FAT (4 G SAT, 6 G MONO) 16 MG CHOLESTEROL 48 G CARBOHYDRATE 0 G ADDED SUGARS 3 G TOTAL SUGARS 15 G PROTEIN 3 G FIBER 441 MG SODIUM 276 MG POTASSIUM

EatingWell is a magazine and website devoted to healthy eating as a way of life. Online at www.eatingwell.com.

WWW.ORTODAY.COM

December 2015 | OR TODAY

OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • DECEMBER • Win Lunch!

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EACH SUBMISSION WINS A $5 GIFT CARD THE WINNER GETS A $50 PIZZA GIFT CARD

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Are you ready for the new year? What is your New Year’s resolution for 2016? OR Today wants to know. Share your resolution with us and you could win a pizza party for your department. Each person who sends in an entry will receive a $5 gift card. One lucky winner will receive a $50 pizza gift card so they can treat their department to a snack. Email your entry to Editor@MDPublishing.com! •

STYLE TIPS

FOR THE HOLIDAY SEASON This year, more homeowners are thinking beyond the traditional when decorating for winter celebrations. Kirsty Froelich, design director for The Tile Shop, notes top trends to keep in mind when decorating for the holiday season: • Feel festive with florals: Blooms in hues of rich purple, crisp white and even funky fuchsia will add cheerful energy to any room.

Happy Holidays! WWW.ORTODAY.COM

• Beautify with backsplashes – Tiling your backsplash is an easy update that instantly

upgrades a kitchen or bar space, and serves as a great conversation starter for guests. • Get jolly with geometric patterns – Geometric patterns are on trend for the holiday. A gorgeous geometric tablecloth is the ideal backdrop for a big family feast. • Give your fireplace a facelift. A sleek stone makeover will update any fireplace into a stylish focal point. Add candles, flowers and other simple decor on the mantel to make the space feel special. •

December 2015 | OR TODAY

OUT OF THE OR PINBOARD

SMARTPHONE DANGERS It’s true: selfies killed more people than shark attacks in 2015. While death by selfie may be considered a rare occurrence and at the extreme end of the dangers they pose, the health risks associated with smartphones are no joke. Here’s a look at some common problems smartphones can aﬄict on users and how we can all avoid them by being a bit smarter ourselves. PHONE CLAW Perhaps the most common problem people encounter is the cramping and soreness felt in wrists and fingers when using smartphones. Repeating actions, such as using your thumb to scroll on screen or typing on a small keyboard, can cause tenosynovitis (inflammation of tendons). Symptoms start as pain and stiffness in the thumb area but can spread to the forearm and cause weakness in the hand. To minimize pain felt when scrolling or texting, it is recommended you vary the hand you use for completing smartphone tasks, and use a bigger keyboard, such as one 68

OR TODAY | December 2015

on a laptop, for typing longer emails. EYE STRAIN Imagine the pain you feel in your arm muscles after holding something heavy for a long time; that is exactly how your eye muscles feel after staring at your smartphone for a long time. Digital eye strain is made even worse by the harmful blue light emitted by the screens of smartphones that can penetrate deep into the eye. This can damage the eye’s retina which has been linked to macular degeneration – the most common cause of sight loss in the developed world. You can combat this risk with Adlens Interface eyewear. Tinted lenses filter out 80 percent of the most harmful blue light. TEXT NECK Smartphones quite literally are a pain in the neck says Dr. Kenneth Hansraj, whose research published last year demonstrates how the posture we commonly take when looking at our phone increases stress on the neck. Heads tilted at

a 15-degree angle downwards to look at screens increases the effective weight placed on our neck by 27 pounds, while a 60-degree tilt causes a 60-pound increase. This excessive stress may require a corrective operation. To avoid this, people are advised to regularly take breaks from looking downwards and to lift and stretch their necks. Wherever possible, use voice recognition services and swap texts for phone calls. ACCIDENTS If you are looking at your phone, you are more likely to trip over your feet, walk into a lamppost or have a more serious accident – at least four selfie deaths have been caused by falls. Researchers at the University of Washington found pedestrians using their phone are four times more likely to forget to look for traffic before crossing or ignore traffic lights, while a Carnegie Mellon study found drivers even just listening to a phone call have been seen to commit errors as if

Be smart with your phone

Wise words

they were under the influence of alcohol. ¶

“I’VE LEARNED THAT EVERY DAY YOU SHOULD REACH OUT AND TOUCH SOMEONE. PEOPLE LOVE A WARM HUG, OR JUST A FRIENDLY PAT ON THE BACK.”

– Maya Angelou

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December 2015 | OR TODAY

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Healthmark Industries…………………… 40-43 Innovative Medical Products, Inc………………BC Jet Medical Electronics………………………… 44 Key Surgical………………………………………… 238 Knight, LLC………………………………………………… 5 MAC Medical……………………………………………… 6 MD Technologies…………………………………… 63 MedWrench…………………………………………… 69 Pacific Medical LLC……………………………… 29 Palmero Health Care………………………………61

Paragon Service……………………………………IBC Ruhof Corporation………………………………… 2-3 Sage Services Group……………………………… 17 SIPS Consults, Corp.……………………………… 59 Summit Medical……………………………………… 22 Surgical Power……………………………………… 53 TBJ, Inc.…………………………………………………… 45 Tru-D…………………………………………………………… 51

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

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

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

REPAIR SERVICES Pacific Medical LLC…………………………………… 29

INDEX CATEGORICAL ACCREDITATION AAAHC………………………………………………………… 39 ANESTHESIA Check List Boards……………………………………… 60 Paragon Service……………………………………… IBC APPAREL Healthmark Industries…………………………40-43 ASSOCIATIONS AAAHC………………………………………………………… 39 BEDS Innovative Medical Products, Inc………………………………………………… BC

INFECTION CONTROL/PREVENTION Knight, LLC……………………………………………………… 5 Palmero Health Care………………………………… 60 Ruhof Corporation………………………………………2-3 Tru-D……………………………………………………………… 51 INTERNET RESOURCES MedWrench………………………………………………… 69

CARDIAC SURGERY C Change Surgical………………………………………… 9

INSTRUMENT TRACKING Censis Technologies, Inc.………………………………17

CABLES/LEADS Sage Services Group……………………………………17

INSTRUMENT TRANSPORT MAC Medical…………………………………………………… 6 Summit Medical…………………………………………… 22

CLEANING SUPPLIES Ruhof Corporation………………………………………2-3 CLAMPS Innovative Medical Products, Inc………………………………………………… BC DISINFECTANTS Knight, LLC……………………………………………………… 5 DISPOSABLES Sage Services Group……………………………………17 Pacific Medical LLC…………………………………… 29 ENDOSCOPY MD Technologies………………………………………… 63 Ruhof Corporation………………………………………2-3 SIPS Consults, Corp.…………………………………… 59 TBJ, Inc.………………………………………………………… 45 GEL PADS GelPro…………………………………………………………… 53 Innovative Medical Products, Inc………………………………………………… BC GENERAL AIV Inc.………………………………………………………… GelPro…………………………………………………………… MedWrench………………………………………………… Surgical Power…………………………………………… 70

OR TODAY | December 2015

44 53 69 53

KNEE SYSTEMS Innovative Medical Products, Inc………………………………………………… BC LABORATORY TBJ, Inc.………………………………………………………… 45 LEG POSITIONERS Innovative Medical Products, Inc………………………………………………… BC MONITORS Jet Medical Electronics……………………………… 44 OR TABLES/ ACCESSORIES Dabir Surfaces…………………………………………… 59 Innovative Medical Products, Inc………………………………………………… BC ORTHOPEDIC Surgical Power…………………………………………… 53 OTHER AIV Inc.………………………………………………………… 44 SIPS Consults, Corp.…………………………………… 59 TBJ, Inc.………………………………………………………… 45

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39 60 63 53

SURGICAL SUPPLIES Censis Technologies, Inc.………………………………17 Cincinnati Sub-Zero……………………………………… 4 Cygnus Medical………………………………………………21 Ruhof Corporation………………………………………2-3 SUPPORTS Innovative Medical Products, Inc………………………………………………… BC TEMPERATURE MANAGEMENT C Change Surgical………………………………………… 9 Cincinnati Sub-Zero……………………………………… 4 WARMERS Enthermics Medical Systems, Inc.…………… 15

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