OR Today Magazine - March 2016 by MD Publishing

BILL OF RIGHTS PAGE 32

SPOTLIGHT ON

JAVARIS SINGLETON PAGE 54

TAKE GOOD CARE

NURSES • SURGICAL TECHS • NURSE MANAGERS

PINBOARD

NEWS & PHOTOS PAGE 68

MARCH 2016

www.ortoday.com

HANG 10 AT AORN Your Guide To The 2016 Conference

READ OUR CORPORATE PROFILE ON PAGES 42-44

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CONTENTS

features

OR TODAY | March 2016

GUIDE TO AORN

CORPORATE PROFILE: RUHOF

OR Today interviews Ruhof Healthcare to find out the latest developments at the cleaning solutions company responsible for creating the very first enzymatic detergent for cleaning surgical instruments. We asked what makes their products unique and what customers can expect in 2016.

Are you ready for the AORN Surgical Conference & Expo 2016? The annual conference will be held April 2-6 in Anaheim, California. More than 4,600 perioperative nurses expected to attend along with at least 500 exhibitors. We talked to the experts to find out how to plan for the conference to get the most out of your time in Anaheim.

SPOTLIGHT ON: JAVARIS SINGLETON

The first time neurosurgeon Andrew Reisner met Javaris “Terrell” Singleton, Singleton was a 16-yearold emergency-room patient at Children’s Healthcare of Atlanta at Emory. Find out about their unlikely reunion and how that first encounter forever impacted Singleton’s life.

OR Today (Vol. 16, Issue #2) March 2016 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 302691530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2016

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March 2016 | OR TODAY

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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 Jessica Laurain Kara Pelley

ACCOUNT EXECUTIVES

Mike Venezia | mike@mdpublishing.com Warren Kaufman | warren@mdpublishing.com Jayme McKelvey | jayme@mdpublishing.com

Andrew Parker | andrew@mdpublishing.com

ACCOUNTING Kim Callahan

WEB SERVICES

INDUSTRY INSIGHTS 13 18

News & Notes AAAHC Update

IN THE OR 20 23 24 32

Health Fitness Nutrition Recipe Pinboard

70 Index

CIRCULATION Lisa Cover Laura Mullen

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 60 62 64 66 68

Betsy Popinga Taylor Martin

OR TODAY | March 2016

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

PROUD SUPPORTERS OF

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INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

STUDY: WRAPPED INSTRUMENT TRAYS PREVENT CONTAMINATION According to a scientific study published in the December print publication of the American Journal of Infection Control (AJIC), 87 percent of tested sterilized rigid containers – used in the sterilization of surgical instruments – allowed ingress of aerosolized bacteria under the test conditions used. This study calls into question the assumption that rigid containers, regardless of duration of use, can maintain the sterility of their contents post-sterilization. Approximately 300,000 surgical site infections (SSIs) occur annually in U.S. hospitals, resulting in an estimated 9,000 attributable deaths. Maintaining a sterile environment in the operating room (OR) is essential for SSI prevention and may be achieved through the use of sterile packaging systems (SPS). SPS are designed to protect surgical instruments post-sterilization until use in the OR. The two primary types of SPS include rigid containers and sterilization wrap. Rigid

containers are reusable and come in a variety of materials (various metals, aluminum and polymers) and sizes, while single-use sterilization wrap is often composed of polypropylene. The study, “Sterility Maintenance Study: Dynamic Evaluation of Sterilized Rigid Containers and Wrapped Instrument Trays to Prevent Bacterial Ingress,” used a dynamic aerosol test method that allowed for air exchanges to occur in SPSs that may simulate normal air exchanges in hospital settings. The study found that: • Rigid containers, both used and unused, failed to maintain barrier performance under these test conditions: 87 percent (97 out of 111) of the rigid containers failed to maintain barrier performance, allowing ingress of the challenge microorganism. • Rigid containers may be less effective the longer they are in use: Contamination rates of rigid containers increased as duration

of use increased. • Rigid containers with 5-9 years of use were significantly more likely to have bacterial ingress than unused rigid containers (p = 0.04). • Sterilization wraps provided no detectable ingress of bacteria: 100 percent (161 out of 161) of the wrapped trays using sterilization wrap maintained barrier performance, preventing any bacterial ingress and protecting sterility. The study was conducted by Harry L. Shaffer of Sterilization Consulting Services LLC, Highlands Ranch, Colorado; Reid A. Vernon of the United States Air Force Academy, Colorado Springs, Colorado; and Delbert Harnish, Michael McDonald and Brian K. Heimbuch of Applied Research Associates, Panama City, Florida. The study was funded by Halyard Health (formerly Kimberly-Clark Health Care). •

MEDTECH RECEIVES FDA CLEARANCE FOR ROSA SPINE Medtech has received 510K clearance from the United States Food and Drug Administration to market the ROSA Spine robot in the U.S. Obtaining FDA clearance is a major step in Medtech’s development strategy and will allow the company to market the ROSA Spine robot in the United States for minimally invasive surgical procedures on the spine. Around 3 million such procedures are performed worldwide each year. “We are thrilled to have FDA approval for ROSA Spine,” Medtech CEO Bertin Nahum said. “Building on the

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success that ROSA Brain has encountered on the American market, this new key regulatory milestone will allow us to strengthen our position in the world’s leading market for spine surgery. In addition, the FDA approval again reflects our capacity to respect the commitments we made at the time of our IPO, growing as a company while offering innovative robotic technology.” The ROSA platform was previously approved in the U.S. for brain surgery in 2012. There are currently 27 ROSA Brain systems installed in American facilities. •

March 2016 | OR TODAY

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and have connectivity to oneSOURCE™. ScopeTrac Helps: • Save time and increase OR efficiency • • •

Validate inventory data for all endoscopes Ensure compliance with guidelines from the FDA, CDC, Joint Commission and AAMI Reduce reprocessing errors and damage to your endoscope inventory • Provide complete information for audits, trend analysis and benchmarking for process improvement

INDUSTRY INSIGHTS NEWS & NOTES

• Provide the ultimate patient safety/infection control for

endoscope CENSIS SELECTED AS SOLE SOURCE PROVIDER BYinventory UHS

• Create the foundation for Patient Safety in the OR

Censis Technologies announced recently that Universal Health Services Inc. has selected Censis as sole source provider for surgical instrument and asset management software throughout the entire UHS system. The multiyear contract allows all facilities associated with UHS to purchase the Censitrac solution that includes all professional services. Censis Technologies also recently announced that Adventist Health System has selected Censis as sole source provider for surgical instrument and asset management software.

KEY SURGICAL INTRODUCES NEW BONE REAMER BRUSHES

Key Surgical Inc. now offers cleaning brushes for flexible bone reamers. The Key Surgical bone reamer brush features a 31-inch rigid stainless steel handle/shaft with medical-grade nylon bristles designed for effective manual cleaning of a flexible bone reamer – a challenging instrument to clean. Bristle diameters include 3mm (.118”), 5mm (.197”), and 7mm (.276”). Key Surgical’s bone reamer brushes are reusable, can be used to clean other general use instruments, and are available in packages of three. Bone reamer brushes are a new addition to the extensive line of instrument cleaning brushes from Key Surgical. For information about instrument cleaning brushes, visit www.keysurgical.com or call 800-541-7995. • 14

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Scan this tag toin Censis Technologies, based learn more about Franklin, Tennessee, Censitrac®. is a leader in surgical instrument and asset management software. Censis offers multiple solutions, including 888.877.3010 | www.censitrac.com Censitrac, which is a highly advanced, web-based software system focused on maximizing OR throughput and regulatory compliance. Censis Technologies’ software is deployed in hundreds of hospitals in the United States, Canada and Australia. •

ACCESSORY ALLOWS ALTERNATIVE TECHNIQUE IN ANKLE ARTHROSCOPIES

For surgeons who require arthroscopic ankle procedures from a posterior approach or who need to use an alternative surgical technique because of a patient’s anatomy, Innovative Medical Products has designed the De Mayo Ankle Distractor “ladder” accessory. The attachment fits the end of the De Mayo Ankle Distractor frame and consists of six rungs or levels of elevation from which the ankle strap can be attached – the higher the rung or position allows for more distraction of the ankle. Unlike some other ankle distractors, the design of the IMP ankle distractor and accessory helps to prevent patients from sliding off the operating table. The De Mayo Ankle Distractor gives the surgeon a better approach to the surgical site while distracting the joint space to insert the surgical scope and instruments. The distractor is unlike other ankle distractors by reducing the counter pressure placed against the thigh in a typical procedure. Such pressure can lead to postoperative complications. The De Mayo Ankle Distractor is reliable and designed for all patients. Its ergonomic design allows the surgeon to face the ankle at the end of the OR table rather than working from the side of the ankle • WWW.ORTODAY.COM

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NEWS & NOTES

NEXTGEN UV TECHNOLOGY REDUCES INFECTIONS In a peer-reviewed study published in the December issue of American Journal of Infection Control, researchers documented that using Infection Prevention Technologies (IPT) NextGen UV disinfection robots and a dedicated team of trained operators resulted in significant reductions of healthcare-acquired infections. The study was conducted over a six-month period at Hollywood Community Hospital/ Brotman Medical Center Campus. Several factors make the study notable. It is peerreviewed and demonstrated significant reductions in multiple harmful pathogens including a 42.7 percent decrease in the incidence of Clostridium difficile infections, 71.4 percent decrease in Acinetobacter baumannii infections, and a 100 percent drop in Klebsiella pneumoniae infections. The overall HAI

incidence rate was reduced 34.2 percent during the intervention period. “While many studies highlight a disease reduction in a small area of the hospital, this study was conducted hospital-wide,” Tom Kenny, IPT’s CEO noted. “Ninetyfive percent of the rooms in the entire facility were treated. These results are compelling evidence for the efficacy of our state-of-the-art UV robots and the benefits of using skilled robot operators.” “Not only is the ROI demonstrably high but based on the total reduction of HAI incidents and the average cost of an HAI re-admission, the derived cost-savings is nearly $250,000 in just six months. That’s huge,” Kenny continued. “The bottom line is serious cost avoidance and a much safer environment for both patients and staff.” •

HOSPITAL ENLISTS SECOND GERM-KILLING ROBOT Lima Memorial Health System (LMHS) recently welcomed a second Tru-D SmartUVC, a UVC germ-eliminating robot, to its infection prevention team. With the support of PotashCorp, LMHS purchased its first Tru-D SmartUVC robot in August and has been using the technology daily to disinfect patient areas before surgery at the hospital, as well as in the hospital’s isolation rooms, as a part of the terminal cleaning process. Community members rallied together at a recent fundraising event, sponsored by the Lima Memorial Foundation, to fund a second disinfecting robot. “We are committed to patient safety. This innovative technology adds another layer of protection against infection. We are thankful to our community members who share our vision of advancing health care in our region and came together to support the purchase of the Tru-D,” WWW.ORTODAY.COM

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said Mike Swick, president and CEO of Lima Memorial Health System. In October, research leaders in UVC disinfection released the results of the first randomized clinical trial on UVC disinfection, in which Tru-D SmartUVC was the only device used. Overall, results of the landmark “Benefits of Enhanced Terminal Room Disinfection” study, which was funded by the Centers for Disease Control and Prevention, showed that enhanced terminal room disinfection strategies decreased the cumulative incidence of multidrug-resistant organisms by 10 to 30 percent, and the largest decreases were seen when Tru-D was added to the standard cleaning strategy, (Daniel J. Sexton, MD, et al., 2015). It also showed that the process of incorporating Tru-D into hospital disinfection protocols for highest risk rooms was seamless, and adding a cycle of UVC dosing only added up to 10 minutes to the total room turnover. • March 2016 | OR TODAY

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INDUSTRY INSIGHTS NEWS & NOTES

GAUTHIER JOINS SEALED AIR’S DIVERSEY CARE Sealed Air’s Diversey Care division announced that Jim Gauthier, MLT, CIC, has joined the North American healthcare team as senior clinical advisor, infection prevention. In this role, Gauthier will serve as an infection prevention and control resource and an industry organization liaison to assist with the expansion and improvement of environmental hygiene solutions and science-based best practices. Gauthier joins Diversey Care with more than 35 years of experience in medical laboratory technology and infection prevention. His focus has been across many areas including acute care, ambulatory care settings, behavioral health and long term care, and he has played an active role in consulting and sharing expertise with stakeholders across the infection control spectrum. Gauthier has also served as a board member and president of Infection Prevention and Control (IPAC) - Canada, and has delivered lectures and training to numerous institutions and organizations throughout the world. Diversey Care is a division of Sealed Air Corp., a leader in food safety and security, facility hygiene and product protection. • FOR MORE INFORMATION about Diversey Care, visit www.diversey.com.

STERIGENICS INTERNATIONAL EXPANDS IRRADIATION FACILITY Sterigenics International has announced expansion at its Fort Worth, Texas location, with the addition of a new gamma cell that will increase capacity by 30 percent. Expansion will be complete by Q2 2017. “We have committed more than $80 million in capital investments in the past year to support our customers’ growth strategies,” said Michael Mulhern, CEO of Sterigenics International. “In addition to our Fort Worth expansion, we tripled sterilization capacity at the Sterigenics West Memphis, Arkansas location; significantly expanded our Gurnee, Illinois irradiation facility and increased our global service capabilities with the acquisition of leading Latin American sterilization firm Companhia Brasileira de Esterilização (CBE).” “The Fort Worth expansion is the direct result of increased regional demand for Sterigenics irradiation services,” Sterigenics International President Philip Macnabb said. “We are adding gamma processing capacity of up to 5 million cubic feet per year in Texas, with a product overlap system which will provide the capability to process numerous dose ranges and a wide variety of densities.” • 16

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NAVIHEALTH ACQUIRES RIGHTCARE SOLUTIONS naviHealth Inc., a Cardinal Health company, recently announced the acquisition of RightCare Solutions Inc., a health care decision support software service provider specializing in hospital discharge planning software and readmissions management. RightCare’s software is powered by proprietary, evidence-based decision-support technology developed in conjunction with the University of Pennsylvania School of Nursing. RightCare licenses its proprietary software to hospitals and health systems to assess patients for post-acute care needs, determine risk of readmission, and coordinate patient discharges to high-quality post-acute care providers, with the ultimate goal of improving care transitions and health outcomes. The company also licenses its software to post-acute care providers, allowing them to save significant time and money in managing referrals from nearby hospitals by automating many of the administrative tasks involved in accepting referrals. naviHealth has grown rapidly since its founding and currently provides post-acute management solutions in 28 states. naviHealth pioneered a “high tech, high touch” model to manage post-acute care, matching local market clinicians with proprietary decision support technology and analytics. The company serves nearly 2 million health plan members and over 75 hospitals and physician groups.•

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INDUSTRY INSIGHTS AAAHC UPDATE

BY JACK EGNATINSKY, MD

HOW EFFECTIVE IS YOUR IMPAIRED PROFESSIONAL POLICY?

ur standards require – and essentially every organization we survey has this in place – a policy on impaired heath care professionals. But how effective is your policy? Do you educate your staff on the signs to look for which may be early indicators of alcohol or drug (prescription and/or illegal) abuse or dependence? A recent article in Medscape cited several papers indicating that 15.3 percent of physicians surveyed met diagnostic criteria for alcohol abuse or dependence. Additionally, another article was cited which noted that female surgeons had almost twice the rate of abuse or dependence than their male colleagues.

In April 2009, Modern Medicine published an article online titled, “Drug addiction among nurses: Confronting a quiet epidemic,” which quoted the American Nurses Association stating that approximately 10 percent of nurses in the USA are drug dependent. This calculates out to approximately 300,000 nurses. The general population as a whole is estimated to have a drug dependence rate of as high as 10 percent. However, physicians and nurses are more likely than the general population to abuse and/or become dependent on legally controlled substances and other prescription medications. With numbers like those noted above, chances are you will at some point encounter a professional at your center who is in some stage of substance dependence. When a provider shows up with slurred speech or unusual motor activity, you would obviously look into this immediately. But does your staff know what to look for in the early stages? In ASCs, the first clues often come 18

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Is your staff taught that addiction is a treatable disorder with best results when the treatment starts early? Do you educate them on what to look for in fellow staff members? from unusual patterns of drug administration, poor or missing documentation of administration of controlled substances; undocumented “waste;” “lost” ampoules or vials of controlled substances; empty syringes with very fine needles are discovered in lockers; and requests such as, “just get me the medication and syringe and I will administer it myself so I can see how it is working and titrate the dose.” There are many opportunities in the workplace and the list above is not meant to cover all the subtle signs of drug diversion. Certain medications, especially those that come in ampoules, have a small amount of over-fill which is easy to access. Fentanyl is an

excellent example and may be the most abused drug in the ASC setting. A busy anesthesia provider could draw up small amounts of over-fill, or even a little more from many ampoules in any one day, still giving the patients all or most of what they were supposed to receive without drawing suspicion because the patients are not in pain. Is your staff taught that addiction is a treatable disorder with best results when the treatment starts early? Do you educate them on what to look for in fellow staff members? Health care providers are often very good at hiding their abuse. Subtle signs such as unusual episodes of impatient behavior, WWW.ORTODAY.COM

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AAAHC UPDATE

mood swings, sleepiness, irritability, shifting blame or responsibility to another to divert attention from themselves: all these are often early signs that deserve closer attention, indicating that you need to look more closely at their activities. These symptoms are not definitive proof. But they should not be ignored. Impaired performance or unusual behavior does not always mean drug abuse or dependence. But whatever the cause, close follow-up observation is vital and active investigation of atypical performance or behavior should be done. At the start of employment, part of the orientation should be to review with them the corporate impairment polices and their staff responsibilities under those policies. Periodic performance appraisals must take into consideration current behavior and actions. As I mentioned, however, impairment can result from other situations so your policies should leave the door open for this possibility. Based on my experiences over the years, emotional distress and sleep deprivation should be included. The latter is often noted in anesthesia providers who come to the ASC after a night on call for a “short” or “easy” day and, as a consequence, might sometimes be guilty of dosing off during a case. Emotional distress can be short term and situational or WWW.ORTODAY.COM

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part of a more serious problem. Whatever the cause, don’t ignore the signs. Early intervention can help prevent problems from becoming more serious. In this day and age of workplace stress, ready availability of pharmaceuticals, and people tending to not want to get involved, you need to educate your staff on how to recognize the telltale signs of substance abuse – information that goes above and beyond the regular training they receive during orientation as new employees. Impaired providers are more than likely good people going through difficult times. Helping them will help you and your patients. ABOUT THE AUTHOR Dr. Jack Egnatinsky is an anesthesiologist with extensive experience in the ambulatory surgery arena, both HOPD and ASC. He is a Past President of the Board of FASA, a predecessor to the ASC Association, and Past President of AAAHC. He is also the Board Chair of the Accreditation Association for Hospital and Health Systems (AAHHS) and is a representative of Acreditas Global, the international arm of AAAHC. He remains extremely active as a Medical Director for AAAHC, in addition to being a well-travelled AAAHC accreditation surveyor, both in the USA and internationally.

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March 2016 | OR TODAY

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IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

PACU MODERATE SEDATION AUDITS Does anyone know if audits for moderate sedation cases are required to be performed for CMS COP? If so, how often? A: I do believe it is a requirement. On our last Joint Commission survey the team asked us for our policy and the audits to demonstrate that this is monitored. Per our policy, any adverse event triggers an audit. At other facilities, for every moderate sedation event a report was completed even if no adverse event occurred.

STARTING IVS It is not uncommon to lose IV start skills as an OR RN. Patients going to the OR usually arrive with an IV in place. When pediatric cases are booked, an IV usually gets started in the OR, however the patient is more often than not masked down and doesn’t feel the stick. Are there any suggestions on how to help OR RNs keep up their IV start skills? A: Ours, if they need to “refresh” their skills, go out to the pre-/post-op area and start some of their IVs. Also, anesthesia is always happy to do some in-services with the staff.

INTERCOM SYSTEM IN OR Has anyone found a way to communicate with everyone in the OR without using an intercom system? Just wondering if ASCOM phones are an option or if by going electronic soon will help reduce the need? A: Vocera is awesome. A: We use ASCOM phones and this has helped to diminish overhead paging.

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A: Consider rotating them through OPS monthly or quarterly and you could make this part of annual competency programs.

A: We used the Vocera. If set up correctly and enough Vocera’s are purchased, then it works great for the area or the whole facility. If interested, I can share the PPT that was made about it. WWW.ORTODAY.COM

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SUITE TALK

TRANSITION TO ELECTRONIC When transition was made from paper to electronic was the case volume limited during this time to get adjusted? A: We double documented (paper during case and electronic in-between cases) during the testing phase for a month prior to “go live” and did not diminish case loads … by the end of the month the RNs were so happy to go to electronic documentation that it was a smooth transition.

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A: We asked that elective cases be at a minimum the first day of “go live,” it decreased stress for sure.

March 2016 | OR TODAY

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IN THE OR MARKET ANALYSIS

STAFF REPORT

MARKET ANALYSIS Sterilization Wrap Market on the Rise

atient safety and positive patient outcomes are among the many reasons the sterilization sector of the health care market is on the rise. Hospital-acquired infections, readmissions and negative outcomes can impact a health care facility’s reputation and its bottom line under the Affordable Care Act. Sterilization wraps are one tool in the fight against infection. These sometimes overlooked items play a key role in protecting patients and caregivers by ensuring that surgical instruments are kept clean and safe before use. The Centers for Disease Control and Prevention include sterilization wraps in its discussion about infection control. “Packaging materials (e.g., wrapped or container systems) allow penetration of the sterilization agent and maintain sterility of the processed item after sterilization. Materials for maintaining sterility of instruments during transport and storage include wrapped perforated instrument cassettes, peel pouches of plastic or paper, and sterilization wraps (which can be either woven or unwoven),” according to the CDC website. “Packaging materials should be designed for the type of WWW.ORTODAY.COM

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sterilization process being used. Packaging materials also should be appropriate for the items being sterilized. For example, nonpaper materials should be used to package sharp instruments which can easily puncture paper packaging. Avoid using metal closures (e.g., staples, paper clips) that can puncture packaging materials.” A recent report by Research and Markets forecast continued growth in the sterilization and infection prevention market. “The global infection control market is estimated to reach $16.7 billion by 2020, growing at a CAGR

The disposable medical nonwoven market is projected to reach $20 billion by 2017, according to a report from Global Industry Analysts. This is another indication that the sterilization wrap market should see growth. An aging population and other demographics that point toward an increase in surgical procedures bodes well for the sterilization wrap market. “The medical non-wovens segment accounted for the largest share of nearly 45 percent of the global disinfection market in 2014; whereas, endoscope reprocessors is the fastest growing market among disinfectors/ reprocessing equipment market,”

“The global infection control market is estimated to reach $16.7 billion by 2020, growing at a CAGR (Compound Annual Growth Rate) of 6.7 percent during the forecast period (2015 to 2020).” (Compound Annual Growth Rate) of 6.7 percent during the forecast period (2015 to 2020),” according to Research and Markets. “The rise in chronic diseases, increase in the number of surgeries performed, increase in the occurrence of hospital-acquired infections, and aging population are the major drivers for the growth of infection control market,” the report states. “Hospitals and medical devices play a vital role in the infection control market. However, stringent regulations and saturation in developed economies are restraining the growth of the market.”

according to Research and Markets. Hospitals and original equipment manufacturers are fueling market growth. “On the basis of end user, the infection control market is segmented into hospitals, life sciences, medical device companies, pharmaceutical companies, food industry, and others,” according to Research and Markets. “In 2014, the hospitals segment accounted for the largest share of the infection control market, whereas the medical device companies segment is expected to grow at the highest CAGR from 2015 to 2020.” March 2016 | OR TODAY

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IN THE OR PRODUCT SHOWROOM

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IN THE OR CONTINUING EDUCATION CE655B

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BY BY CONNIE GOLDSMITH, MPA, RN, AND DIANA SWIHART, PHD, MSN, DMIN, APN CS, RN-BC

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CONTINUING EDUCATION 472C

THE NURSES’ BILL OF RIGHTS

Do You Know Your Rights?

ost people know about the U.S. Bill of Rights, the first 10 Amendments to the U.S. Constitution, guaranteeing American citizens certain freedoms, such as the right to free speech and assembly, and protection against unreasonable search and seizure. Bills of rights have been developed for patients, such as nursing home patients, dying patients and cancer patients, among others. Most nurses are aware of the Patients’ Bill of Rights. While these rights may vary by state and facility, they generally guarantee patients the right to privacy and confidentiality, and the right to make informed decisions about their own medical care.

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 39 to learn how to earn CE credit for this module. The purpose of this program is to inform nurses about the Bill of Rights for Registered Nurses as developed by the American Nurses Association, how those rights may be reflected in position statements, how they may affect professional practice, and how they affect hospitals seeking American Nurses Credentialing Center (ANCC) Magnet Recognition Program designation. After studying the information presented here, you will be able to: • List the seven rights found in the ANA’s Nurses’ Bill of Rights • Explain how the rights may be used to influence professional practice • Describe how the rights link to ANCC Magnet hospital status

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However, not every nurse is familiar with the Nurses’ Bill of Rights (also called the Bill of Rights for Registered Nurses). The ANA held a nursing staffing summit in Washington, D.C., in 2000. In a survey before the summit, 75% of nurses reported the quality of nursing care at their facilities had declined because of inadequate staffing and decreased nurse satisfaction.1 More than 200 summit attendees called for a document to detail what nurses need and deserve to do the best for their patients.1 This led to the development of the Nurses’ Bill of Rights, which was approved by the ANA Board of Directors in 2001. Then-ANA President Mary E. Foley, MS, RN, stated, “The ANA Bill of Rights is a powerful statement of the rights that every registered nurse must have to provide high-quality patient care in a safe work environment. This is a tangible reminder to employers of what nurses should be able to expect in their workplaces.”1 “Registered nurses promote and restore health, prevent illness and protect the people entrusted to their care,” the ANA said in a statement on the Nurses’ Bill of Rights and workplace safety.2 “They work to alleviate the suffering experienced by individuals, families, groups and communities. In so doing, nurses provide services that maintain respect for human dignity and embrace the

uniqueness of each patient and the nature of his or her health problems, without regard for social or economic status. To maximize the contributions nurses make to society, it is necessary to protect the dignity and autonomy of nurses in the workplace.”2 The Nurses’ Bill of Rights seeks to satisfy that need. PROFESSIONAL RIGHTS The Nurses’ Bill of Rights, which lists seven rights, is a statement of professional rights rather than a legal document. It establishes an informal covenant between nurses and their employing institutions to help guide development of organizational policy and to focus discussions between nurses and employers on issues related to patient care and working conditions. Nurses can advocate more effectively for the rights of patients if they have critical information about their own professional rights. The Nurses’ Bill of Rights supplements other ANA documents, such as the Code of Ethics for Nurses with Interpretive Statements, Nursing’s Social Policy Statement and Nursing: Scope and Standards of Practice.3 In addition, nurses and their employers must be familiar with the nurse practice act and professional practice regulations for their own states, as these documents do set forth the legal requirements for nursing practice in a March 2016 | OR TODAY

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IN THE OR CONTINUING EDUCATION 655B BILL OF RIGHTS FOR REGISTERED NURSES

1 2

Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care.

Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses with Interpretive Statements.

4 5

Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution.

6 7

Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice.

Nurses have the right to fair compensation for their work, consistent with their knowledge, experience and professional responsibilities. Nurses have the right to a work environment that is safe for themselves and for their patients. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.

given state. Nurses should also be familiar with the “2010 Future of Nursing Report,” developed by the Institute of Medicine in conjunction with the Robert Wood Johnson Foundation, as it also addresses some of the barriers nurses face in responding to today’s rapidly evolving complex adaptive health care systems. Overcoming these barriers will ensure nurses are well positioned to lead change and advance health care through academia and clinical practice. READ ME MY RIGHTS The Nurses’ Bill of Rights can help nurses settle work-related issues with employers. The use of such widely recognized consensus documents adds credibility to nurses who need 34

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to discuss difficult situations, such as safety, staffing and workplace violence with administration. Nurse educators can refer to the ANA Bill of Rights when addressing important topics related to professional practice and when seeking guidance in developing nursing school curriculum and continuing education programs inside and outside of hospitals. Employers can refer to the Nurses’ Bill of Rights to ascertain what nurses need to fully meet their professional responsibilities. Many of ANA’s policies and publications are relevant to the Nurses’ Bill of Rights. Following are the seven rights that make up the Nurses’ Bill of Rights:

NURSES HAVE THE RIGHT TO PRACTICE IN A MANNER THAT

FULFILLS THEIR OBLIGATIONS TO SOCIETY AND TO THOSE WHO RECEIVE NURSING CARE.2,3

Two ANA publications delineate these obligations. The first, ANA’s Nursing’s Social Policy Statement, says the authority for the practice of nursing is based on a social contract that acknowledges professional rights and responsibilities. The second document, ANA’s Code of Ethics for Nurses with Interpretive Statements, is a “… succinct statement of the ethical obligations and duties of every individual who enters the nursing profession; it is the profession’s nonnegotiable ethical standard; it is an expression of nursing’s own understanding of its commitment to society.”4 (Nurses might reference this right if there is a dispute with the employer about their obligations toward patients.)

NURSES HAVE THE RIGHT TO PRACTICE IN ENVIRONMENTS THAT ALLOW THEM TO ACT IN ACCORDANCE WITH PROFESSIONAL STANDARDS AND LEGALLY AUTHORIZED SCOPES OF PRACTICE.2,3

The ANA’s Nursing: Scope and Standards of Practice sets forth the professional standards that apply to the practice of all professional nurses. Nurses should have a copy of the practice act, the regulations and any other official documents governing nursing practice for each state where they are employed and/or licensed. These documents define the legal scope of nursing practice and guide and protect nurses in the performance of their duties. The ANA has also published or endorsed standards for specialty nurse practice.5 (Nurses might reference this right if the employer is reluctant to allow nurses to perform jobs for which they are legally authorized and fully trained to perform.) WWW.ORTODAY.COM

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NURSES HAVE THE RIGHT TO A WORK ENVIRONMENT THAT SUPPORTS AND FACILITATES ETHICAL PRACTICE IN ACCORDANCE WITH CODE OF ETHICS FOR NURSES WITH INTERPRETIVE STATEMENTS.2,3

The Code of Ethics for Nurses and its interpretive statements establish ethical standards for the nursing profession and help nurses determine whether their workplaces support ethical practice. (Nurses might reference this right if they believe they are being forced into an unethical plan of care.)

NURSES HAVE THE RIGHT TO FREELY AND OPENLY ADVOCATE FOR THEMSELVES AND THEIR PATIENTS WITHOUT FEAR OF RETRIBUTION.2,3

The ANA’s Code of Ethics for Nurses states the nurse promotes, advocates for and strives to protect the health, safety and rights of the patient as one of its nonnegotiable tenets. Some nurses have experienced adverse consequences for stepping forward with concerns. Some states have enacted whistle-blower laws to protect employees who report unsafe or unethical situations. State nurse practice acts include mandatory reporting provisions that hold nurses accountable for implementing state hospital laws and regulations as advocates for their patients. (Nurses might reference this right if they believe they are being punished for trying to advocate for vulnerable patients or if the safety of a patient is in jeopardy.)

NURSES HAVE THE RIGHT TO FAIR COMPENSATION FOR THEIR WORK CONSISTENT WITH THEIR EDUCATIONAL PREPARATION, KNOWLEDGE, EXPERIENCE AND PROFESSIONAL RESPONSIBILITIES.2,3

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fair compensation (other than federal and state minimum wage requirements), nurses are in an enviable position compared with many other professions. Nurses who do not believe their employer is paying them a wage commensurate with their experience, knowledge and educational preparation can often seek employment elsewhere. Nurses should familiarize themselves with current market wages in their region, as salaries vary greatly from state to state. For example, RNs in California averaged $96,980 annually in 2013, compared with $56,030 in North Dakota for the same year.6,7 It is illegal for employers to artificially control wages by collaborating with other employers in their region. (Nurses might reference this right as they negotiate with employers about salary or benefits.)

NURSES HAVE THE RIGHT TO A WORK ENVIRONMENT THAT IS SAFE FOR THEMSELVES AND THEIR PATIENTS.2,3

The Occupational Safety and Health Act of 1970 requires employers to provide workplaces free from recognized hazards that could cause harm or death to employees.8 Some states have requirements that exceed federal standards. The right to a safe work environment includes many factors, such as sufficient staffing to ensure patient safety, programs to protect staff against infection and needlesticks, protection against workplace violence, adequate training to ensure safe performance of assigned duties, and recognition of the inherent danger of nurses working while overly fatigued. The ANA has even developed a position statement relating patient safety to nurse fatigue.9 Numerous studies over the past few years have shown a strong correlation between better nurse staffing and improved patient outcomes.10, 11, 12 (Nurses might reference this right whenever they believe a patient safety issue or a

workplace safety issue arises, including mandatory overtime.)

NURSES IN ALL PRACTICE SETTINGS HAVE THE RIGHT TO NEGOTIATE, EITHER AS INDIVIDUALS OR COLLECTIVELY, THE CONDITIONS OF THEIR EMPLOYMENT.2,3

Not only do nurses have the right to negotiate terms of employment; they have the right to receive written descriptions setting forth wages, work schedules and how their performance will be evaluated. Under the National Labor Relations Act, employees — including registered nurses — may form, join or assist labor organizations and engage in collective bargaining over wages, hours and other terms and conditions of employment.13 Compared with other occupations (such as manufacturing and industry), nurses came relatively late to collective bargaining and unionization. Many nurses still have mixed feelings about unionization: In 2010 about 23% of RNs reported they belonged to unions.14 Studies have shown that hospitals with RN unions have higher nurse retention rates, but report greater job dissatisfaction, possibly because unionized nurses may be more vocal and less fearful about voicing concerns.15 (Nurses might reference this right if their employer seems reluctant to allow for unionization and collective bargaining.) THE PIONEER The ANA Nurses’ Bill of Rights was not the first such document. The National Student Nurses’ Association (NSNA) developed its Bill of Rights and Responsibilities for Students of Nursing in 1975 and last updated it in 2006.16 As with the ANA Bill of Rights, the rights for student nurses can serve as a basis to resolve issues of concern and to clarify expectations of all parties. The National Student Nurses’ AsMarch 2016 | OR TODAY

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sociation also suggests state student nursing associations use their bills of rights when developing policy and procedure manuals. The first three of the 21 rights and responsibilities set forth in the National Student Nurses’ Association Bill of Rights for Students of Nursing are: 1. Students should be encouraged to develop the capacity for critical judgment and engage in a sustained and independent search for truth. 2. The freedom to teach and the freedom to learn are inseparable facets of academic freedom. Students should exercise their freedom in a responsible manner. 3. Each institution has a duty to develop policies and procedures that provide and safeguard the students’ freedom to learn.16 The list of rights is augmented with a detailed grievance procedure for use among educational institutions that have adopted the rights.16 Such documents can help nurses learn to advocate for themselves early in their careers. RIGHTS OF NURSES, RIGHTS FOR PATIENTS The ANA Nurses’ Bill of Rights helps to protect both the rights of nurses and the right for patients to receive quality nursing care. These rights naturally flow into and enhance standards established by specialty nursing organizations, such as the American Association of Critical-Care Nurses. Implementation of the AACN Standards for Establishing and Sustaining Healthy Work Environments ensures that acute care and critical care nurses have the skills, resources, accountability and authority to make decisions that lead to excellent professional practice and optimal care 36

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for patients and families.17 The six AACN standards are skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition and authentic leadership.17 Some state nursing associations have incorporated ANA’s Nurses’ Bill of Rights into their own professional practice documents. For example, the New York State Nurses Association says on its website that the organization believes the rights must be afforded to registered nurses and they must know those rights. In addition, the association states that to exercise these rights, RNs must assess the assignment, clarify the facts and assess their own knowledge, ability and experience. After evaluating and choosing an option, the nurse must notify the appropriate people of the chosen option in a timely manner.18 These actions, for example, would provide an ethical and professional way in which to handle staffing disparities. The Maryland Nurses Association recommends using the ANA Nurses’ Bill of Rights as a “decision tree” when accepting or rejecting an assignment that appears to preclude safe care or that requires nurses to practice beyond their scope.19 Maryland reminds nurses they open themselves to disciplinary action by accepting an assignment they are not qualified to perform.19 Using the bill of rights in this way may mitigate adverse outcomes for both patient and nurse. Other organizations, such as the Academy of Medical/Surgical Nurses, support the Nurses’ Bill of Rights as a foundation for discussion of patient and worker safety concerns by the nurse and health care employer, while the American Academy of Ambulatory Care Nursing has developed a similar but not identical list of rights

for registered nurses.20,21 Hospital websites may reference or feature the Bill of Rights as well. ATTRACTIVE MAGNETS Hospitals achieving or seeking Magnet designation recognize the importance of the Nurses’ Bill of Rights in fostering a positive work environment. Developed by the ANCC, the Magnet Recognition Program recognizes health care organizations for quality patient care, nursing excellence and innovations in professional nursing practice.21 Hospitals seek Magnet status to help them attract and retain top talent; to improve care, safety and satisfaction; to foster a collaborative culture; to advance nursing standards and practice; and to grow business and financial success.22 According to the ANCC, about 390 hospitals had achieved Magnet status as of February 2012. Eight out of 10 of the toprated medical centers in the U.S. are Magnet facilities.22 The Magnet Recognition Program advances three goals within health care organizations: (a) promote quality in a setting that supports professional practice; (b) identify excellence in the delivery of nursing services to patients; and (c) disseminate best practices in nursing services.22,23 One study of more than 26,250 RNs showed that Magnet hospitals have better work environments, a more highly educated nursing staff, better nurse-to-patient staffing ratios and overall higher nurse satisfaction than do non-Magnet hospitals.24 Hospitals must address five Magnet components in the application process:22,23 • Transformational leadership • Structural empowerment • Exemplary professional practice • New knowledge, innovation and improvements • Empirical quality WWW.ORTODAY.COM

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CONTINUING EDUCATION 655B

The section on structural empowerment references the Nurses’ Bill of Rights. To fully meet the criteria of that section, hospitals must provide a list of continuing education programs and the number of nurses completing the programs over the past 24 months. A program designed to ensure nurses understand the Nurses’ Bill of Rights must be among the program topics.22 A study showed that structural empowerment is positively correlated with nursing job satisfaction and high-quality patient care.24 Studies of attributes of Magnet hospitals — which by definition incorporate the Nurses’ Bill of Rights into their cultures — are measurably correlated with improved outcomes in a number of areas. Studies of Magnet hospitals have provided evidence of improved patient care outcomes and increased patient satisfaction, as well as improved nurse satisfaction and nurse retention.24 The best example of environments supporting professional nurse practice are Magnet hospitals.25 Patients in such optimized environments have lower risks of death and fewer episodes of failure to rescue. Nurses working in healthy work environments rate patient care more highly, with Magnet hospitals being markedly skewed toward excellence.26 A STANDARDIZED STRUCTURE The Nurses’ Bill of Rights provides a standardized and recognized structure within which nurses can advocate for themselves, a fundamental right for any profession. While nurses have always vigorously advocated for their patients, they have not always done so for themselves. Today, nurses are independent practicing professionals with well-defined roles and responsibilities, and accountability and authority for the care and WWW.ORTODAY.COM

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safety of their patients. They work collaboratively with other health care professionals. They advocate for themselves and their patients. Are copies of the Nurses’ Bill of Rights prominently posted where they are readily viewable by staff, such as in nursing stations, the human relations department and nursing administration offices? If not, why not? Do nurses at your facility know about the ANA Nurses’ Bill of Rights and how the rights relate to their professional practice? If not, ask your education department or administration to provide appropriate training as needed. Nurses can more effectively advocate for their patients’ rights if they are familiar with their own rights. RESOURCES American Nurses Association: http://www.nursingworld.org American Nurses Credentialing Center/ Magnet Recognition Program: http://www.nursecredentialing.org/Magnet.aspx Institute of Medicine Future of Nursing Report: http://www.iom.edu/reports/2010/the-future-of-nursing-leading-change-advancing-health.aspx National Council of State Boards of Nursing: http://www.ncsbn.org/index.htm Purchase a poster of the ANA’s Bill of Rights for Registered Nurses: http://www.nursesbooks.org/Main-Menu/ Specialties/Staffing Workplace/Bill-ofRights-.aspx Find Magnet hospitals in your state: http://www.nursecredentialing.org/Magnet/FindaMagnetFacility.aspx

CONNIE GOLDSMITH, MPA, RN, is a freelance health and medical writer and a frequent contributor to Gannett Education.

DIANA SWIHART, PhD, MSN, DMin, RN-BC, APN CS, is the chief executive offi er for the American Academy for Preceptor Advancement and a health care strategist and consultant with the Forum for Shared Governance. REFERENCES 1. Wiseman R. The ANA develops bill of rights for registered nurses: Know your rights in the workplace. AJN. 2001;101(11):55-56. 2. American Nurses Association (ANA). Nurses’ Bill of Rights. Nursing World Web site. http://www.nursingworld.org/NursesBillofRights. Accessed November 26, 2014. 3. ANA. Bill of Rights FAQs. Nursing World Web site. http://nursingworld.org/DocumentVault/NursingPractice/FAQs.aspx. Accessed November 26, 2014. 4. ANA. Revision of the Code of Ethics for Nurses with Interpretative Statements. Nursing Work Web site. http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Revision-of-Code-of-Ethics-Panel. Accessed November 26, 2014. 5. ANA. Recognition of a nursing specialty, approval of a specialty nursing scope of practice statement and acknowledgment of specialty nursing standards of practice. http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/ NursingStandards/3-S-Booklet.pdf. Accessed November 26, 2014. 6. U.S. Department of Labor, Bureau of Labor Statistics. State occupational employment and wage estimates, California. http://www.bls.gov/oes/current/oes_ ca.htm#29-0000. Published 2013. Accessed November 26, 2014. 7. U.S. Department of Labor, Bureau of Labor Statistics. State occupational employment and wage estimates, North Dakota, May 2013. http://www.bls.gov/oes/current/ oes_nd.htm#29-0000. Published May 2013. Accessed November 26, 2014. March 2016 | OR TODAY

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IN THE OR 8. U.S. Department of Labor. Occupational Safety and Health Act of 1970. http://www. osha.gov/pls/oshaweb/owasrch.search_ form?p_doc_type=OSHACT&p_toc_level=0. Accessed November 26, 2014. 9. ANA. Position statements: assuring patient safety: Registered nurses’ responsibility in all roles and settings to guard against

working when fatigued: position statement. http://gm6.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positionsand-Resolutions/ANAPositionStatements/ Archives/Copy-of-AssuringPatientSafety-1. pdf. Accessed November 26, 2014. 10. Aragon Penoyer D. Nurse staffing an patient outcomes in critical care. Crit Care

Med. 2010;38(7):1521-1528. 11. Aiken LH, Sloane DM, Cimiotti JP, et al. Implications of the California nurse staffin mandate for other states. Health Serv Res. 2010;45(4):904-921. 12. Patton RM. Safe staffing s ves lives. American Nurse Today. http:// www.americannursetoday.com/Article.

CLINICAL VIGNETTE The nurses at Jana’s hospital often disagree with management decisions. Nurses have too many patients to care for during their shifts and feel rushed and stressed. Mandatory overtime is common. Meetings between staff and management are contentious and end without resolution. And Jana, a team leader on a med/surg unit, recognizes the incidence of hospital-acquired infections on her unit is higher than it should be. She recently completed a continuing education module about the ANA Nurses’ Bill of Rights. She asks around and learns that many nurses are unfamiliar with the rights described in that document.

Based on the information in this module, what might Jana do first? A. Complain to her state nursing board B. Talk to hospital administration about the Nurses’ Bill of Rights C. Go directly to the hospital CEO to talk about the issues D. Complain to The Joint Commission

Based on the complaints the nurses are making, which right is most germane to the meeting? A. No. 5: the right to fair compensation B. No. 1: the right to practice in a manner that fulfills nurses’ obligation to society C. No. 4: the right to a work environment that is safe for nurses and patients D. No. 7: the right to negotiate the conditions of employment

To help keep the lines of communication between staff and management open, Jana suggests that: A. The hospital educate the nursing staff about the Nurses’ Bill of Rights B. The nurses join a union C. The hospital apply for Magnet status d. The nurses report on their progress to the state board of nursing

3. Correct Answer: A — As neither the nursing staff nor administration seems familiar with the Nurses’ Bill of Rights, it is appropriate for the education department to offer training to all parties on its provisions. 2. Correct Answer: C — While most of the rights have some relevance to the nurses’ current concerns, the nurses can make a strong case for a decline in patient safety because of understaffing, mand tory overtime and the high infection rate on Jana’s unit. 1. Correct Answer: B — In the CE module, Jana learned that the ANA Nurses’ Bill of Rights can facilitate discussions between staff and administration about problems. 38

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HOW TO EARN CONTINUING EDUCATION CREDIT aspx?id=4756&fid= 728. Published April 24, 2010. Accessed November 26, 2014. 13. U.S. National Labor Relations Board. National Labor Relations Act. http://www.nlrb.gov/national-laborrelations-act. Accessed November 26, 2014. 14. Buerhaus PI. It’s time to stop the regulation of hospital nurse staffing dead in its t acks. Nurs Econ. 2010;28(2):110-113. 15. Seago JA, Spetz J, Ash M, Herrera CN, Keane D. Hospital RN job satisfaction and nurse unions. J Nurs Admin. 2011;41(3):109-114. 16. National Student Nurses’ Association. Bill of Rights and Responsibilities for Students of Nursing. https://www.google/#q=Bill+of+Rights+and+Res ponsibilities+for+Students+of+Nursing. Accessed November 26, 2014. 17. American Association of Critical-Care Nurses. AACN Standards for establishing and sustaining healthy work environments: a journey to excellence. Am J Crit Care. 2005;14(3):187-197. 18. New York State Nurses Association. Know your rights. http://www.nysna.org/strength-at-work/knowyour-rights#.VDxFlPnF-So . Accessed November 26, 2014. 19. Maryland Nurses Association. Workplace issues. http://www.marylandrn.org/Main-Menu-Category/ Professional-Resources/Workplace-Issues, Accessed November 26, 2014. 20. Academy of Medical/Surgical Nurses. Position statements: Nurses’ Bill of Rights. https://www.amsn. org/practice-resources/position-statements/archive/ nurses-bill-rights. Accessed November 26, 2014. 21. American Academy of Ambulatory Care Nursing. Position statement. http://www.aaacn.org/sites/ default/files documents/PositionStatementRN.pdf. Accessed November 26, 2014. 22. American Nurses Credentialing Center. Program overview. http://www.nursecredentialing.org/Magnet/ ProgramOverview.aspx. Accessed November 26, 2014. 23. ANCC. Application Manual, Magnet Recognition Program. Silver Spring, MD: American Nurses Association, 2008:39. 24. Kelly L, McHugh MD, Aiken LH. Nurse outcomes in Magnet and non-Magnet hospitals. J Nurs Admin. 2011;41(10):428-433. 25. Spence Laschinger HK. Effect of empowerment on professional practice environment, work satisfaction, and patient care quality. J Nurs Care Quality. 2008;23(4):322-330. 26. Kramer M, Maguire P, Brewer RR. Clinical nurses in Magnet hospitals confirm p oductive, healthy work environments. J Nurs Management. 2011;19(1):5-17

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1. Read the Continuing Education article. 2. Go online to ce.nurse.com to take the test for $12. If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at www.nurse.com/ unlimitedCE for $49.95 per year.

DEADLINE Courses must be completed by 12/15/2016. 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer. 4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test. 5. All users must complete the evaluation process to complete course. You will be able to view a certificate on screen and print or save it for your records.

ACCREDITED ContinuingEducation.com is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Accredited status does not imply endorsement by the provider or ANCC of any commercial products displayed in conjunction with this activity. ContinuingEducation.com is also accredited by the Florida Board of Nursing and the Georgia Board of Nursing (provider # 50-1489). ContinuingEducation. com is approved by the California Board of Registered Nursing, provider # CEP16588.

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CORPORATE PROFILE

RUHOF HEALTHCARE Instrument & Scope Cleaning Solutions

F R O M T H E O R I G I N A L I N V E N TO R S O F E N Z Y M AT I C D E T E R G E N T S

his month, OR Today sat down with Ruhof Healthcare to find out the latest developments at the cleaning solutions company responsible for creating the very first enzymatic detergent for cleaning surgical instruments. Read on to find out more about the company, including what makes their products unique and what you can expect from them in 2016.

OR TODAY: PLEASE SHARE A LITTLE BIT ABOUT YOUR COMPANY’S HISTORY AND HOW YOU ACHIEVED SUCCESS. The Ruhof Corporation was established in 1976 when Frank Bass and Bernard Esquenet became a team. Frank Bass’s role in the company is one of sales, marketing and research while Bernard Esquenet is the chemist behind Ruhof’s success. Prior to the launch of Ruhof, Frank recognized the need for hospitals to use more than simple dishwashing detergent in cleaning surgical instruments. Bernard had created cleaning solutions for the Navy, which were used to clean barnacles and other crustaceous marine residues from the heat exchangers and water evaporators of submarines and other naval vessels. When Frank Bass approached him to develop cleaning solutions for hospital instruments, Esquenet realized that the enzymes he was using to eat away at the marine organism residues would also dissolve proteins off of surgical instruments. Thus, Protozyme, the very first enzymatic cleaner for surgical instrumentation was born 42

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along with Surgi-Stain, a product for refurbishing corroded stainless steel instruments. Today Ruhof has a full line of surgical instrument cleaners and scope care and cleaning products which include our multi-tiered enzymatic detergents, enzymatic foam sprays, rust remover and lubricants, autoclave descalers, enzymatic sponges, and more. We also offer our ScopeValet™ line of products comprised of our PULL THRU™ Endoscope cleaning devices, endoscopy procedure kits, scope transport bags, Eco-Bedside kit, etc. providing a safe, convenient and efficient way to prepare, begin and perform a scope reprocessing procedure while meeting all reprocessing guidelines. New from Ruhof is our channel/lumen flushing devices , the Ruhof InstruFlush™ and Flushtech GI™ for effective pre-cleaning & flushing. We have also recently launched dispensing systems for our

liquid chemistries, Fast Foam™ and DoseValet(TM), which can help Sterile processors increase workflow while achieving high marks for instrument cleanliness. Ruhof not only provides the most effective decontamination products on the market today, we also allow you to verify it with the Ruhof ATP Complete® Contamination Monitoring System and the Clean Check Complete™ Monitor for both automated and manual enzymatic cleaning process. OR TODAY: WHAT ARE SOME ADVANTAGES THAT YOUR COMPANY HAS OVER THE COMPETITION? Ruhof Healthcare sells the only enzymatic detergent on the market (ENDOZIME® BIO-CLEAN) clinically tested to pass the difficult ISO standard 15883 Annex F by dissolving biofilm and exposing underlying bacteria to high-level disinfectants or WWW.ORTODAY.COM

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liquid chemical sterilants. Our products are of the highest quality available and we offer the most complete line of surgical instrument and scope cleaning and reprocessing supplies in the marketplace. In addition the company is innovative, continually developing new technologies to meet the needs of our customers. OR TODAY: WHAT ARE SOME HEALTHCARE CHALLENGES OVER THE LAST YEAR THAT YOUR COMPANY WAS ABLE TO ADDRESS? Recent reports to the U.S. Food & Drug Administration (FDA) of processing errors with flexible endoscopes have brought much attention to the importance of this issue. In general, while flexible endoscopes are inherently difficult to clean effectively due to their long narrow lumens and because they are used in highly contaminated areas of the body, the manual component of endoscope reprocessing appears to be the area most prone to error. As a result newly revised guidelines from both the CDC and the AORN recommend the used of cleaning verification tests such as ATP bioluminescence, which has been shown to be both a rapid and effective method for assessing the efficacy of the cleaning process. The Ruhof ATP COMPLETE® is a quick, simple, and reliable method for verifying the effectiveness of the cleaning and decontamination process for the outer surfaces and internal channels of WWW.ORTODAY.COM

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scopes and cannulated instruments along with all non critical facility surfaces. The ATP Complete® System consists of a lightweight hand held device, sampling tools-- Ruhof Test ® Swab and Ruhof Test® Instrusponge™ —and easy to use software for tracking results. The System can also be used to test the efficacy of the cleaning process for the especially complex Duodenoscope, an endoscope associated with recent outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) infections. OR TODAY: PLEASE EXPLAIN YOUR COMPANY’S CORE COMPETENCIES AND UNIQUE SELLING POINTS. We are the only supplier of enzymatic detergents that manufactures its own product, guaranteeing consistency and quality. Ruhof is a registered ISO 14001 manufacturer and we pride ourselves on the superior products we manufacture. OR TODAY: WHAT PRODUCT OR SERVICE THAT YOUR COMPANY OFFERS ARE YOU MOST EXCITED ABOUT RIGHT NOW? We are most excited about our new Valveafe™and Aquabrush products. Valvesafe™ is a single-use endoscope valve cage for the safe storage of endoscope valves ensuring they remain as part of a unique set with the parent endoscope. Assisting with the traceability of the scope and its valves, Valvesafe enables compliance with national and international recom-

mended guidelines (AORN, ANSI/ AAMI, SGNA, BSG, ESGE) stating endoscope valves (including rinsing valves) stay with the named endoscope throughout the cleaning process. In addition we are very enthusiastic about the launch of the Ruhof AquaBrush™, a rechargeable, completely submersible surgical instrument cleaning brush, which eliminates manual scrubbing for easier, more efficient instrument reprocessing. Available with both large and small brush heads to accommodate various instrument sizes, the AquaBrush™also keeps hands away from sharp instrumentation which helps prevent possible injuries. OR TODAY: PLEASE SHARE SOME COMPANY SUCCESS STORIES WITH OUR READERSONE TIME THAT YOU “SAVED THE DAY” FOR A CUSTOMER. Ruhof often receives positive feedback from customers regarding cost savings. Perioperative and sterile processing professionals regularly tell us that they get better results and more cleaning efficacy using much less of our detergent than other brands. In addition we receive many reports about product effectiveness. Recently a nurse contacted us about how Ruhof really “saved the day” for her. All other detergents failed to remove an unusual yellow/orange oily deposit from the scopes she was cleaning but our Endozime SLR® enzymatic cleaner — which specializes in removing synMarch 2016 | OR TODAY

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CORPORATE PROFILE

thetic lipid residue – did the trick and she has been a loyal customer since. OR TODAY: HOW DOES RUHOF SUPPORT ITS CUSTOMERS? Ruhof has a most knowledgeable and responsive customer service department and sales team ready to help our customers with questions, orders, troubleshooting, etc. Our user friendly website and informative technical data sheets/IFUs also provide support. This past year we began a program of free accredited continuing education for nurses and CS/SPD techs, as we understand that ongoing education, training and mentoring are critical to the success of any clinical department. These CE opportunities – offered at both national and local trade shows — were so well received that we now offer multiple CE programs to help our customers continually advance their knowledge. OR TODAY: PLEASE TELL ME ABOUT YOUR EMPLOYEES. MARC ESQUENET Marc Esquenet joined the Ruhof Corp. in 1996 as a quality control and formulation chemist and in 2001 was named chief chemist. It was in this role that Marc formulated the unique and innovative products that have given Ruhof its competitive advantage. Marc has developed new 44

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technologies such as enhanced multi-tiered enzymatics, synthetic lipid removal products, Prepzyme® spray for removing dried on bio-burden, Endozime® SLR Bedside Kit, EndozimeTM Xtreme Power and Endozime APA enhanced detergent, and most recently Endozime® Bio-Clean biofilm solubilization formulations. Marc’s responsibilities in this position included research and development projects in which he now holds several patents. In 2010 Marc was named Vice President of Research and Development, a role requiring him to meet with distribution and customers world-wide in order to better develop new product research, development and commercialization for the company. DOUG MACKAY Joining Ruhof in 1993, Doug Mackay, Vice President of Sales & Marketing, has been instrumental in providing strategic leadership for the company. In 2009 Doug successfully launched ATP Complete, which then represented the first ATP system used in North America to test the cleanliness of scopes and surgical instruments. In 2012 he also launched ScopeValetTM as well as a complete line of new endoscopy care products. His innovative product launch has been received extremely well by the market and has further strengthened Ruhof’s standing in the endoscopy and medical communities. JOSE OBREGON A Ruhof employee since 1984, Jose Obregon became International Sales Manager in 1990 and Chief Operating Officer in 2000. It was during this time that he successfully took part in opening new markets in South America, Europe and Asia and participated in the launch of more than 20 new

products and four new product lines. Moving forward, Jose’s goal is to continue to grow both the international and domestic markets for Ruhof with the aim of developing product lines which improve the quality of instrument care and patient safety. JACK KINVILLE A 20-year veteran of the Ruhof Corp., Jack Kinville has played a major role in generating sales for the company while also assisting the president with many aspects of marketing. Over the years, he has been featured in many trade publication articles for his expertise regarding instrument and scope cleaning. Jack’s experience, skills and successful sales record recently landed him a promotion to the position of Ruhof Sales Manager. “Jack is a strong leader who’s been working closely with our sales team to motivate them to ever greater achievements” stated Doug Mackay, Vice President of Sales & Marketing. OR TODAY: WHAT IS YOUR COMPANY’S MISSION STATEMENT, OR IF YOU DON’T HAVE A SPECIFIC ONE, WHAT IS MOST IMPORTANT TO YOU ABOUT THE WAY YOU DO BUSINESS? At Ruhof we understand the importance of cleanliness in the healthcare field and are guided by our commitment to excellence. We demonstrate this by offering reliable solutions and individualized service to help healthcare facilities meet and exceed their decontamination and infection prevention challenges. We are always finding new solutions and new ways to help fight HAIs and to provide a safe work environment for patient and staff. We value our customers as much as the patients that they care for. WWW.ORTODAY.COM

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HANG 10 AT AORN Your Guide to the 2016 Conference By Don Sadler

“This presents a great opportunity to meet new people, share experiences, and bounce around new ideas.” - Renae Battié, MN, RN, CNOR,

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The them e for the AORN Surgical Conferen ce & Exp o 2016, wh ich will b e held April 2-6 in Anahe im, California , is “Thriv ing Through Transform ation.” Indeed, t his year ’s AORN conferen ce will pr esent a unique o pportunit y for attendee s to be tr a n sformed their pro in fession a t t he larges internatio t nal gathe r in g of periopera tive regis t e r e d nurses in the world . The 2016 AORN co nference looks to be one o f the biggest in recent m emory, with mor e than 4,6 00 periopera tive nurse s expected to attend . In addition, at least 5 00 exhibitor s will set up shop on the 120,0 00 square fe et of exh ibit hall spac e.

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“There’s something here for every perioperative nurse, regardless of your role or the type of facility you work in.” - Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN

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BROADENING YOUR ROLE “Perioperative nurses today are expected to do more and more in their jobs,” says Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, the Executive Director and CEO of the Association of periOperative Registered Nurses (AORN). “Whether they’re staff, managers or educators, they are expected to broaden their roles within the facility. We’re striving to help them do this at the AORN Surgical Conference & Expo.” “The myriad changes occurring in the health care field – from new regulations to changing financial objectives and reimbursement schedules – are all affecting perioperative nurses,” adds AORN President Renae Battié, MN, RN, CNOR. “The AORN Surgical Conference & Expo is designed to support perioperative nurses by providing outstanding education, training and networking opportunities during four intensive days.”

“There’s something here for every perioperative nurse, regardless of your role or the type of facility you work in,” says Groah. “Attendees will have the opportunity to deep dive into each one of these specific areas.” In addition, the conference will once again feature the popular OR Executive SummitTM and Leadership Development SummitTM. The Executive Summit will bring together a highly tuned mix of the brightest and most-respected leaders in the industry. It will offer the opportunity for leaders to collaborate with peers about the most pressing and urgent issues currently facing health care. The Leadership Development Summit, meanwhile, is designed for today’s perioperative leaders and those new to leadership roles. It will teach the necessary skills and provide the resources required for attendees to be successful and efficient perioperative leaders.

AORN CONFERENCE DETAILS At this year’s AORN conference, you can choose from among 65 different educational sessions organized along eight different tracks: 1. Ambulatory 2. Clinical 3. Educator 4. Evidence-Based Practice/ Research 5. Infection Control/Infection Prevention 6. Leadership/Management 7. Professional Development 8. Quality Indicators

A UNIQUE EXHIBIT HALL The exhibit hall at this year’s AORN conference will be unlike any other exhibit hall. It will have a beach theme and attendees are encouraged to “Surf the Hall,” riding the party wave through the hall to discover new products, hot jobs and CE credits while meeting face-toface with exhibitors so you can better understand how their products might fit into your facility. While surfing the hall, attendees will be able to collect points from exhibitors via the conference’s mobile app to win hourly give-

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2016 AORN Keynote Speakers Amy Purdy inspired a nation on the hit TV show “Dancing with the Stars.” She will reveal the intimate details of her triumphant comeback from the brink of death to making history as a Paralympic snowboarder.

Astronaut Mike Mullane will recount his near-death experience in a fighter jet to describe individuals’ roles in keeping themselves and their teams safe in hazardous environments.

Mark Thompson an expert on executive leadership and business strategy, will share valuable and practical advice for leaders at all levels of any organization, including health care facilities.

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“Attending the conference was amazing and opened my eyes to new opportunities and best practices for myself, my staff and our patients. I have implemented several new practices with my co-workers. The AORN conference was an amazing opportunity!” - Linda Gardner, MSN, MED, BA, RN, CNOR

aways and then chill out at “The Shore,” where lifeguards will be serving refreshments. “This presents a great opportunity to meet new people, share experiences, and bounce around new ideas,” says Battié. The new expanded mobile app for this year’s conference will serve as an interactive conference management tool. It will give you access to the entire conference schedule as well as games, quizzes, prizes, networking opportunities and important AORN Congress information – all from the convenience of your smart device. Simulation learning is another popular returning feature at this year’s AORN conference. Attendees are able to explore dynamic learning experiences at several different simulation stations set up in the exhibit hall. “This way, you can practice new skills in an environment where you can make mistakes without actually harming patients,” says Groah.

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PRE-CONFERENCE CERTIFICATION PROGRAMS Once again, the AORN conference will offer a number of different pre-conference certification programs during the two days prior to the official conference launch on April 1 and 2. These will include: • CCI’s Fundamentals of OR Management – This “miniMBA” course will provide current and aspiring perioperative leaders with the tools needed to effectively and profitably lead a surgical services department. • TeamSTEPPS® Master Training Course – This evidence-based program will offer strategies, techniques and tools to help individuals teach others the TeamSTEPPS system to improve patient safety and communication. • Perioperative Medical Malpractice Mock Trial – This interactive, all-day workshop will encourage audience participa-

tion in a mock medical malpractice trial involving a hospital/ASC and a perioperative registered nurse. Groah says that given the intensity of the four-day AORN conference, it’s important to work in a few opportunities for fun and relaxation. This year’s conference will feature the AORN Foundation Silver Soiree, a celebration of the 25th anniversary of the AORN Foundation; the AORN Foundation Zumba Fitness Class; and a 5k Run/3k Walk Race for Patient Safety through the streets of beautiful Anaheim. ATTENDEE TESTIMONIALS Linda Gardner, MSN, MED, BA, RN, CNOR, attended the AORN Surgical Conference & Expo for the first time last year in Denver. “I returned to my facility energized with new ideas and excellent educational resources,” she says.

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“Attending the conference was amazing and opened my eyes to new opportunities and best practices for myself, my staff and our patients,” Gardner adds. “I have implemented several new practices with my co-workers. The AORN conference was an amazing opportunity!” When asked about the greatest takeaway from last year’s AORN conference, returning attendee Karen Rustermier, BSN, RN, CNOR, replies: “I was particularly interested in the products and education sessions that dealt with pressure ulcer prevention. I also learned that some of the ‘sacred cows’ of patient positioning have been proven otherwise through research.” “After returning from Expo, my staff discussed the adoption of a pressure risk scale in our pre-op assessment,” Rustermier adds. “I have also changed some of my routine positioning as well.”

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START PLANNING NOW If you’re planning to attend the 2016 AORN Surgical Conference & Expo, Groah suggests that individuals not wait until arriving in Anaheim to start planning out a conference agenda. “Use the new expanded mobile app to plan out the sessions you want to attend ahead of time,” she advises. “Also start thinking about how you will bring everything you learn at the AORN conference back with you to share with your colleagues to help make positive changes in your OR environment.” Get complete details and register for the 2016 AORN Surgical Conference & Expo online at http://www.aorn.org/ surgicalexpo.

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DONâ&#x20AC;&#x2122;T MISS THESE BOOTHS! AAAHC Booth #2454 www.aaahc.org

Healthmark Industries Booth #1219 www.hmark.com

Action Products, Inc. Booth #1639 www.actionproducts.com

Innovative Medical Products, Inc. Booth #622 www.impmedical.com

C Change Surgical LLC Booth #631 www.cchangesurgical.com Censis Technologies, Inc. Booth #1601 www.censis.net Censis Technologies, Inc. Booth #1601 www.censis.net Dabir Surfaces Booth #449 www.dabir-surfaces.com David Scott Company Booth #2233 www.davidscottco.com Encompass Group, LLC Booth #1611 www.encompassgroup.net Enthermics Medical Systems, Inc. Booth #219 www.dabir-surfaces.com

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Kapp Surgical Instrument, Inc. Booth #2239 www.kappsurgical.com

VISIT YOUR FRIENDS FROM OR TODAY AT BOOTH #2673 AND RECEIVE A PRIZE!

Pacific Medical LLC Booth #2347 www.pacificmedicalsupply.com Ruhof Corporation Booth #2301 www.ruhof.com Ruhof Corporation Booth #2301 www.ruhof.com Sealed Air Booth #1367 www.diversey.com Summit Medical Inc. Booth #214 www.summitmedicalusa.com

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March 2016 | OR TODAY

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Edward McKay, Jr. Surgical Technician, Johns Hopkins Hospital Pediatric OR

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FULL CIRCLE Pediatric technician works with doctor who treated him as a teen SPOTLIGHT ON: JAVARIS SINGLETON By Matthew Skoufalos

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SPOTLIGHT ON

JAVARIS SINGLETON

he first time neurosurgeon Andrew Reisner met Javaris “Terrell” Singleton, Singleton was a 16-year-old emergency-room patient at Children’s Healthcare of Atlanta at Emory. A CT scan revealed a significant tumor that had caused hydrocephalus (a medical condition in which there is an abnormal accumulation of cerebrospinal fluid [CSF] in the brain), and doctors placed a shunt in Singleton’s brain to drain the fluid. Once the pressure was relieved, “He woke right up,” Reisner said. “That gave us time to get an MRI, which revealed a fist-sized tumor in the middle of his brain.” Singleton remembers that period of his life as confusing and debilitating. He was suffering through headaches that wouldn’t resolve on their own. He thought they came from having pushed himself at football practice, or that they were migraines that his Excedrin was no longer addressing. “My mother said I was walking funny and my steps were not in line,” he said. “Every time I would walk, I would jump, but I didn’t pay attention, so I didn’t know. I was failing my classes because I wasn’t doing my work. I would come right home from school and sleep all the way through to the next morning.” Reisner cleared out the tumor with microscopic surgical tools, as well as a second “nubbin” that recurred a year or so later, but Singleton had a long road to recovery. The tumor had paralyzed the left side of his body, and he had to learn to walk and use his arms again. Third and fourth surgeries

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helped revise the positioning of the shunt that flushes the fluid out of his head, but by the time Singleton turned 21, he had undergone five surgeries and six weeks of radiation on top of the physical rehabilitation sessions. By 21, Singleton was symptomfree, and Reisner, who specialized in pediatrics, stopped following him as a patient. As Singleton’s physical recovery got underway, he also battled depression, anger, and frustration over the time he’d lost. “I didn’t know what I was going to do with my life,” he said. “It was very tough.” Singleton’s friends at Centennial High School in Roswell, Georgia would probably have remembered him as being sick, throwing up, or passing out, he said. His illness had kept him behind in classes, and pulled him off the same graduation track as other students in his peer group. Yet Singleton was

When I got that diploma, it was a relief. I couldn’t really enjoy my high school.” At 19, Singleton had saved up enough money from working to get his first car. He attended a technical college for two semesters, and was paying his own way through school with a part-time job. But the days and weeks Singleton had spent in the hospital had acquainted him intimately with the needs of the staff and patients, and it made him eager to pursue a career in health care. He wanted to start working at Children’s Hospital of Atlanta, but was denied repeatedly for a lack of relevant work experience. Undaunted, Singleton continued to apply, and finally landed a job. “I never thought I would ever get to that,” he said. “It’s all I wanted to do.” In his role as a pediatric technician, Singleton’s responsibilities include setting up operating rooms

“My mother said I was walking funny and my steps were not in line,” he said. “Every time I would walk, I would jump, but I didn’t pay attention, so I didn’t know.”

determined to rally because of all that his mother had done to care for him. He pulled himself together to finish high school with a general diploma. “I failed the graduation test five times,” he said. “I had two chances in the 11th-grade year, two more in the summer, and I was able to come in that 12th-grade year and do it again. I was trying to graduate with everybody.

for doctors and technicians, providing patient transportation and engagement, and assisting physicians as needed. He said he gets the most patient calls of any of his cohorts, but takes particular care in building a rapport with children headed into neurosurgery. “I tell some of the kids my story whenever I see them, and to the WWW.ORTODAY.COM

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parents when the patients go in the back,” Singleton said. “I sit down with them for a few minutes and tell them my story and just to relax. Some of the kids, when I was sick, they didn’t make it. I remember that, too, being in the hospital. I felt bad about it. That’s why I wanted to really come here and give back.” Singleton said he’s been told by his coworkers that he may be the first patient to have completed a pediatric course of recovery and return to work at the hospital as an adult. He is certain, however, that he is the first of Dr. Reisner’s patients to return to work with him in that setting; a happy coincidence that was realized last year, nearly 10 years after having undergone surgery at Reisner’s hands. “It was remarkable to see him in that context,” Reisner said. “It was such a great reunion, and it was just nice to see him, but it was not a huge surprise that he grew to be a very productive person. He was such a level-headed, calm, thoughtful young man to everybody.” Reisner also described Singleton as being “fabulous in the OR; as good as anybody I’ve worked with.” But he gave “99.9 percent of the credit” to Singleton and his “incredible fighting spirit.” WWW.ORTODAY.COM

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“He was wonderful, kind to the patient, very attentive,” Reisner said. “He has a very kind disposition to all.” If Singleton had any nerves about working alongside his former physician, they evaporated on the strength of his daily routine. When the job was done, he allowed himself to feel the excitement of the moment, he said. “I finally made it,” Singleton said. “I had been saying it since I was 16 that I wanted to work at Chil-

dren’s, but even better [to be] with my doctor who’s been working with me for all those years. It was like teacher and student.” “A lot of people think the toughest part of our job is surgery, and it certainly is technically challenging,” Reisner said. “The hardest part of my job is to give bad news to decent folks like Terrell’s mom. I saw her recently and it was gratifying to see such a nice lady relieved of what could have been a huge

tragedy in her life.” Far from being a tragedy, Reisner said, Singleton’s recovery “has turned into a wonderful blessing times three,” as the 26-year-old is now happily married and expecting his first child. “Unfortunately, I think back to the many patients who didn’t have such a happy ending,” he said. “It is nice to have a story end like this, although I would like to say, in his case, I think it’s just the beginning.” March 2016 | OR TODAY

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March 2016 | OR TODAY

1/28/16 8:57 AM

OUT OF THE OR HEALTH

BY MARILYNN PRESTON

10 WAYS TO FIND YOUR BALANCE AND DITCH YOUR PAIN

ches and pains are part of life. You wake up one morning and your back is tight, your knee is pinched, your neck is jammed between two stone pillars. We usually accept these limitations and move on the best we can, with or without an Advil. But here’s the good news. Many of the aches and pains we live with are caused by muscular imbalance. And muscular imbalance is often curable. By us, no prescription required.

Without spoiling your day with anatomical details, muscle imbalance is what happens when you use one set of muscles too much, and the opposing muscles a lot less. The overused muscles – over time – become inflamed and irritated. The underused muscles weaken and become vulnerable. The combo 60

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leads to sore joints, nagging pain and visits to doctors, all of which could have been avoided if you paid attention to muscular imbalance and learned to prevent it. Here are 10 everyday habits that create muscular imbalance, compiled by fitness expert Beverly Hosford for the American Council on Exercise website. Read and observe. Once you realize how locked in you and your body are to repetitive patterns, you can begin to reprogram. It takes intense body awareness – also known as somatics training – which is probably why attention rhymes with prevention:

Sleeping on the same side every night If you always sleep on one side, or on your stomach with your head always turned the same way, switch sides. At first, it will feel odd. Explore that feeling. Remind yourself that you’re on a path to a

more balanced body. Then let go into dreamland.

Always leading with your dominant side when climbing It’s all about awareness. What foot leads going up stairs and what foot leads going down? Pay attention, and do what we’re always doing in yoga to stay in balance – switch to the opposite foot.

Crossing your legs with the same leg on top If you cross your knees or ankles when you sit, notice which leg sits on top. Do the old switcheroo.

Carrying bags on the same shoulder Which shoulder do you normally use to carry stuff – groceries, kids, man bags? Consciously shift your load to the other shoulder. What does that feel like? If you WWW.ORTODAY.COM

1/28/16 9:19 AM

HEALTH

ever feel pain, stop. If you feel your shoulder is hunched and tense, release. Experiment with smaller loads, both sides.

Using the same hand to hold things Which hand holds your phone, your fork, your toothbrush? Switch from time to time. This cross over trick is also good for your brain, breaking up old patterns, sparking new pathways. It will feel weird. Accept that and move on with enthusiasm.

Always putting your weight on one leg while standing You’re not an ostrich. Where is your weight when you’re standing or leaning? Muscle Imbalance Alert! Stand tall, your legs hip width apart, maybe close your eyes. Shift your weight left and right, front to back, and settle into balanced, relaxed weight distribution from your feet to your head.

Locking your knees. Keep your knees soft when standing Locking means you’re blocking the flow of energy. Unlocked knees are happy knees, juicy knees, and when they’re connected energetically to your feet, ankles, hips and shoulders, alignment happens effortlessly. Relaxed and balanced muscles allow for more energy to flow throughout your body.

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Holding your phone or tablet at waist level Text Neck is the next big thing in preventable, debilitating injuries. We all do it to see the screen – head down, neck scrunched, shoulders slouched – and we all will suffer the consequences ... UNLESS we lift the screen to eye level and relax our neck and shoulders.

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One-sided training in sports For this one, just picture Venus William’s right forearm. Tennis, golf and bowling are sports that obviously overdevelop one side of the body. Assess your sport for one-sidedness and correct the imbalance with focused weight training.

Too much driving You may not be able to put a stop to your driving schedule but you can learn to proceed with caution. Take stretching breaks. Make adjustments – mentally and physically – so your body is doing the driving in a balanced, alert way.

Marilynn Preston – healthy lifestyle expert, well being coach and Emmywinning 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.

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March 2016 | OR TODAY

1/28/16 9:19 AM

OUT OF THE OR FITNESS

BY HARVARD HEALTH

START MOVING WITH A FITNESS TRACKER

ou’ve probably seen people wearing digital fitness trackers, small gadgets that come in wearable styles such as wristbands and pendants or handheld versions you can slip into a pocket. Why are they popular? The devices record your workout data, and they track your progress on those measures. “We’ve seen them make a big difference in people’s workouts,” says Linda Arslanian, director of rehabilitation services at Harvardaffiliated Brigham and Women’s Hospital. ACCURACY, ACCOUNTABILITY AND MOTIVATION Unlike logs, journals or standard pedometers, fitness trackers accurately record objective data about your workout, including the pace, distance, intensity and duration of your exercise. 62

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They send the information to a software application on your smartphone or computer, where you can view it in graphs and even compare activity day by day on calendars. And there are benefits to knowing that something is following your every move, namely motivation and compliance. “When you can see what your activity levels are, there’s accountability, and you’ll want to stick with a workout,” explains Arslanian. “It motivates you to keep building on what you’ve accomplished.” ANOTHER BENEFIT Some fitness trackers can also record your heart rate, which is important for determining the intensity of your workout. “If you’re doing aerobic exercise, you want to exercise at 60 percent to 80 percent of your maximum heart rate for at least half an hour, three to five times per week,” says Arslanian. “Do that, and your endurance will improve.” Having a device that gives you that information, or alerts you if

you’re below or over your established training heart rate, can make workouts more effective. It can also make workouts safer, especially if you have heart problems or other medical conditions. The most accurate way to determine your maximum heart rate is to undergo a stress test. But for healthy individuals, it is possible to simply estimate your maximum heart rate. To calculate an estimated maximum heart rate, subtract your age from 220. (For example, if you’re 60 years old, your maximum heart rate is 160 beats per minute.) You’ll want to exercise at 60 percent to 80 percent of that number: • 60 percent of 160 (0.60 x 160) is 96 beats per minute. • 80 percent of 160 (0.80 x 160) is 128 beats per minute. So, when exercising, you’d want to keep your heart rate between 96 and 128 beats per minute. WHAT YOU SHOULD DO Arslanian warns that you shouldn’t embark on an exercise program without advice. WWW.ORTODAY.COM

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FITNESS

“You need the OK from your doctor first, and you need someone to craft an exercise program that is in your training range and your safety zone, with a range of intensity and duration that will have the greatest chance of being effective,” she says. Using a fitness tracker can make it easier to stay within that training range. WHERE DO I GET ONE? You’ll find fitness trackers wherever fitness equipment is sold, such as big box stores, electronics stores, sporting goods stores and Internet sites. Features may be simple – counting the number of steps you take or calories you burn – or they

may be more sophisticated, using sensors to capture your heart rate, perspiration, skin temperature and sleep patterns. Prices increase with the amount of bells and whistles available. The majority are in the range of $50 to $200. Best bet: Look for something that’s easy to use and charges quickly. And decide in advance how much information you want and whether you want to wear the device on your wrist or clip it onto your clothes. Once you start using it, share the information with a partner for extra accountability and motivation. And tell your doctor about your progress at your next visit.

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March 2016 | OR TODAY

1/28/16 11:03 AM

BY CLARE TONE, M.S., R.D. ENTRÉE

OUT OF THE OR NUTRITION

BY CLARE TONE, M.S., R.D.

DIETARY GUIDELINES FOR EGGS, CHOLESTEROL RE-EVALUATED

ecommendations on egg intake have lightened up, but eggs Benedict for breakfast every morning still isn’t a good idea.

Scrambled, fried or baked into pastries, Americans love their eggs. But what about all that cholesterol? One large egg has about 200 milligrams of cholesterol. Until last year, the Dietary Guidelines (DG) placed a 300 mg cap on daily cholesterol intake, but the new

2015 DG Advisory Committee Report dropped that recommendation, stating cholesterol is no longer a nutrient of concern. So is that a green light for eggs Benedict every day? A closer look at the DG Advisory Committee report, along with guide-

EGG

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PER DAY

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ONE, M.S., R.D. ENTRÉE

NUTRITION

lines from the American Heart Association and the American College of Cardiology, reveal a shift away from focusing on single nutrients, like cholesterol, toward diet patterns such as the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. These well-researched diets – rich in fish, whole grains, vegetables and fruits – naturally contain lower cholesterol levels. It’s easy to think that eating foods high in cholesterol will lead to high blood cholesterol, but research suggests it is actually a pretty weak link for most people. A meta-analysis (American Journal of Clinical Nutrition, 2001) that pooled results from 17 studies on the relationship between dietary cholesterol and blood cholesterol concluded that for every additional 200 mg cholesterol consumed, LDL (“bad”) cholesterol in

the blood increased by about four points. A recent 12-year prospective study found that daily egg consumption was not associated with risk of heart attack or stroke (American Journal of Clinical Nutrition, 2015). However, among people with diabetes there may be a stronger link. Among women with diabetes, each increase of 200 mg cholesterol per 1,000 calories resulted in a 37 percent increased risk of developing heart disease (American Journal of Clinical Nutrition, 2004). And eating eggs daily was associated with 77 percent increased risk of developing type 2 diabetes (Diabetes Care, 2009). A 2013 meta-analysis concluded that egg consumption may be linked with an increased risk of type 2 diabetes among the general population and cardiovascular disease among people with diabetes.

THE BOTTOM LINE The best advice is to eat eggs in moderation. For healthy adults, that’s no more than one egg a day; if you’re at higher risk for type 2 diabetes limit yourself to four to five per week. But instead of focusing on eggs, aim for a Mediterranean or DASH eating style, which reduces red and processed meats and emphasizes vegetables, legumes, whole grains, fruits and plant-based oils like olive oil.

Environmental Nutrition is the award-winning independent newsletter written by nutrition experts dedicated to providing readers up-to-date, accurate information about health and nutrition in clear, concise English. For more information, visit www.environmentalnutrition.com.

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March 2016 | OR TODAY

1/28/16 8:58 AM

OUT OF THE OR RECIPE

BY DIANE ROSSEN WORTHINGTON

BRAISED LAMB SHANKS FILL THE BILL FOR A RUSTIC DINNER

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RECIPE

amb shanks are perfect for a slow cooked meal. They may be the toughest part of the lamb, but braising them slowly yields a tender, fallingoff-the-bone result.

shanks first so they take on a rich color and give extra flavor to the sauce. Once browned, vegetables and herbs are sautéed along with red wine and dried fruit for a slow braise. This is best prepared up to two days ahead, covered and refrigerated. Remove the layer of fat before reheating. This is one of those dishes that I crave when it’s cold outside and I am looking for

The longer they cook, the more tender they become. It’s important to brown the

cozy comfort. The couscous is my recommended accompaniment for a satisfying meal. I also like the toasted slivered almonds in the cooked couscous for a welcome crunch. I always like to serve a similar wine that I used for cooking as the accompanying beverage. A full-bodied merlot will do the trick. Some crusty bread will be welcome to soak up any extra sauce.

BRAISED LAMB SHANKS SERVES 6 INGREDIENTS: • 1/4 cup olive oil • 6 (3/4 to 1 pound) lamb shanks • All-purpose flour for dusting

METHOD:

Preheat the oven to 325 F. Dredge the lamb lightly with the flour and season it with salt and pepper. Heat 2 tablespoons of oil in a large Dutch oven on medium-high heat. Add the lamb, in two batches, and brown on all sides, about 8 minutes per batch. Transfer to a large roasting pan.

Reduce the heat and add the remaining olive oil to the Dutch oven. Add the carrots, onion, celery, basil and thyme and sauté for about 6 to 8 minutes or until the vegetables are tender, stirring occasionally. Add the garlic and cook another minute.

• 2 medium carrots, peeled and finely chopped • 1 medium onion, finely chopped • 1 rib of celery, finely chopped • 3 tablespoons finely chopped fresh basil • 2 tablespoons finely chopped fresh thyme • 4 cloves of garlic, minced • 1 1/2 cups chicken stock • 1 1/2 cups dry red wine, preferably merlot • 1/2 cup dried apricots • 1 (9-ounce) container moist packaged prunes (sometimes called dried plums), cut into bite size pieces

Stir in the stock, wine, the apricots, prunes, crushed tomatoes and tomato paste. Bring to a simmer. Pour sauce over the lamb in the roasting pan. Cover tightly with foil and place in oven. Cook the lamb until the meat is very tender and beginning to fall off the bones, about 2 hours. (Adjust the cooking time for larger or smaller lamb shanks).

Transfer the lamb to a platter and tent it with foil to keep warm. Pour the pan juices into a saucepan and bring to a simmer. Reduce the sauce by half to make a thick sauce-like consistency, about 15 to 20 minutes on medium-high heat. Watch toward the end. Taste for seasoning.

Pour the sauce over the lamb. Garnish with parsley and serve immediately with couscous.

• 1 cup canned crushed tomatoes • 3 tablespoons tomato paste • 2 tablespoons parsley, for garnish • Salt and freshly ground black pepper

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

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March 2016 | OR TODAY

1/28/16 8:58 AM

OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS •MARCH• ARE YOU IN THE KNOW? Send us a photo of yourself or a colleague reading a copy of OR Today magazine to be entered in a contest to win a $50 Subway gift card! Snap a photo with your phone and email it to Editor@MDPublishing.com to enter. It’s that easy! Good luck! •

THE WINNER GETS A $50 SUBWAY GIFT CARD

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ENJOY CURRIED POPCORN This treat was served at an office party by Chris, our vice president of sales development. It was crazy good, and we all wanted the recipe. Unfortunately, Chris made it up as he went and there wasn’t a recipe. A group of us worked together to replicate it. It’s spicy, sweet and warming all at once – but watch out – it will stain your fingers yellow! (A good time to practice eating popcorn with chopsticks.)

Sweet & Salty Curried Popcorn Freshly popped popcorn 1/4 cup unsalted butter 2 tablespoons curry powder 1 teaspoon salt 1 tablespoon turbinado or demerara sugar, plus more to taste

Win Lunch!

OR TODAY | March 2016

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Warm the butter in a small saucepan over medium-low heat. Add the curry powder and salt and stir to combine. Keep warm while popcorn pops. Pour the popcorn into a large bowl. Stir the sugar into the warm butter and pour immediately over the popcorn. Stir thoroughly. Serve warm. By Faith Durand TheKitchn.com WWW.ORTODAY.COM

1/28/16 11:03 AM

PIN BOARD

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“There is a humanitarian impulse that one aspires to and there are days when one doesn’t do it very well.” – Ralph Fiennes WWW.ORTODAY.COM

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Source: EatingWell (www.eatingwell.com)

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Surgical Power …………………………………… 40 HAND/ARM POSITIONERS Innovative Medical Products, Inc …… BC HIP SYSTEMS Innovative Medical Products, Inc …… BC INFECTION CONTROL/PREVENTION Censis Technologies, Inc ……………… 29, 31 Encompass Group, LLC ……………………… 40 Ruhof Corporation ………………… 2-3, 42-44 Sealed Air …………………………………………… 30 INTERNET RESOURCES MedWrench ………………………………………… 58 INSTRUMENT TRANSPORT Censis Technologies, Inc ……………… 29, 31 Key Surgical Instrument, Inc. ……………IBC MAC Medical ………………………………………… 22 KNEE SYSTEMS Innovative Medical Products, Inc …… BC LABORATORY TBJ, Inc. …………………………………………………… 17 LEG POSITIONERS Innovative Medical Products, Inc …… BC MONITORS Coast 2 Coast Medical, Inc…………………… 4 Jet Medical Electronics ………………………… 31 OR TABLES/ ACCESSORIES Action Products, Inc. …………………………… 21 Coast 2 Coast Medical, Inc…………………… 4 Dabir Surfaces……………………………………… 63 Innovative Medical Products, Inc …… BC ORTHOPEDIC Surgical Power …………………………………… 40 OTHER Action Products, Inc. …………………………… 21 AIV Inc. ………………………………………………… 65 Coast 2 Coast Medical, Inc…………………… 4 Encompass Group, LLC ……………………… 40 Key Surgical Instrument, Inc. ……………IBC SMD Waynne Corp. …………………………… 58 TBJ, Inc. …………………………………………………… 17 PATIENT MONITORING Coast 2 Coast Medical, Inc…………………… 4 Gopher Medical …………………………………… 40 Pacific Medical LLC ……………………………… 6

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

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

US Patent No. 8,001,635

Untitled-1 4

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

2/2/16 9:23 AM

MARCH 2016

HANG 10 AT AORN — YOUR GUIDE TO THE 2016 CONFERENCE

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