OR Today - May 2016

CE

SIMULATION BASICS PAGE 32

SPOTLIGHT ON

MARY SALABOUNIS PAGE 48

TAKE GOOD CARE

RECIPE

TORTILLA SOUP PAGE 66

MAY 2016

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CONTENTS

features

53

42

OR TODAY | May 2016

PRESIDENTIAL RECOGNITION

A Recent OR Today article on Surgical Technician Edward McKay resulted in a letter from President Barack Obama. It also provides McKay additional motivation to reach out to today’s youth in an attempt to inspire.

CREATING THE ULTIMATE SURGICAL ENVIRONMENT How does one create “the ultimate surgical environment.” To find out, OR Today interviewed several perioperative veterans to get their thoughts on what it takes to create the ideal surgery center. Leadership is one key ingredient, but what else does it take to develop and maintain the perfect surgery center?

48

SPOTLIGHT ON: MARY SALABOUNIS

Mary Salabounis decided on a career change, went back to college and is currently a charge nurse in Colorado. She loves her new career.

“Even though it’s technically my job, I get to secretly know that I made somebody comfortable; that I kept them safe,” she says. “It’s very satisfying.”

OR Today (Vol. 16, Issue #4) May 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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May 2016 | OR TODAY

7

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

11

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

EDITOR

John Wallace | jwallace@mdpublishing.com

ART DEPARTMENT Jonathan Riley Jessica Laurain Kara Pelley

24

ACCOUNT EXECUTIVES

66 58 INDUSTRY INSIGHTS 11 18

News & Notes AAAHC Update

IN THE OR 20 23 24 32

Health Fitness Nutrition Recipe Pinboard

70 Index

8

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

ACCOUNTING Kim Callahan

WEB SERVICES Betsy Popinga Taylor Martin Adam Pickney

CIRCULATION Lisa Cover Laura Mullen

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 58 60 64 66 68

Warren Kaufman | warren@mdpublishing.com

OR TODAY | May 2016

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

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INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

NEW OR LIGHT FIXTURES KILL BACTERIA

Responding to the needs of health care facilities and growing interest in Indigo-Clean technology, Kenall Manufacturing has introduced a new line of Indigo-Clean light fixtures specifically designed for operating rooms.

Like the original Indigo-Clean fixture that installs easily into the ceiling of any room, the OR version uses safe, visible, light-emitting diodes (LEDs) to automatically, safely and continuously disinfect the air as well as hard and soft surfaces.

“Operating rooms represent one of the biggest challenges because of the procedures being performed, the frequent use of the facilities and the patients’ compromised immune systems,” said Cliff Yahnke, Ph.D., Kenall’s Director of Clinical Affairs for Indigo-Clean.

Indigo-Clean OR light fixtures provide bright, high-quality, white light to illuminate the surgical field, while continuously disinfecting the environment. When the OR is not being used, the lights can be switched

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to an Indigo-only mode, removing the white light and providing a higher degree of safe disinfection.

The Indigo-Clean technology was discovered in 2002 by researchers at Scotland’s University of Strathclyde and has been clinically proven to reduce harmful bacteria up to 70 percent beyond routine disinfection efforts. It has been the subject of more than 30 peer-reviewed journals and conference presentations. The university was granted the U.S. patent on the technology in 2013 and selected Kenall as the exclusive licensee to commercialize it for the North American health care market.

Earlier this year, the ECRI Institute included Indigo-Clean on its list of top 10 technologies that health care executives should watch in 2016.

Clinical evaluations of the technology have been underway at several U.S. hospitals to document the effectiveness of Indigo-Clean.

Froedtert and the Medical College

of Wisconsin, Froedtert Hospital in Milwaukee recently completed two evaluations of the technology in their gastroenterology (GI) clinic’s waiting room.

“During the first phase of our study, where we initially validated the lighting, we saw approximately a 40 percent reduction in bioburden,” said Dr. Nathan Ledeboer, associate professor of pathoglogy at the Medical College. “However, in Phase 2 of the trial, where the lighting deployment was optimized across the room, we were able to improve the bioburden reduction to more than 70 percent.”

Indigo-Clean is available in three configurations, including a Mixed mode (white and 405nm LEDs), Indigo-Only and a Switchable White and Indigo LED, which allows users to conveniently optimize the level of disinfection based upon room occupancy. • For additional information, visit www.Indigo-Clean.com.

May 2016 | OR TODAY

11

INDUSTRY INSIGHTS NEWS & NOTES

TRU-D SMARTUVC ROBOT GIVES PATIENT PEACE OF MIND With his wife’s history of infections and a complicated surgery looming, Jack Gunter wanted to make sure her medical team took every measure available to reduce the chance of post-surgery complications or infections. After learning about Tru-D SmartUVC, Gunter inquired about utilizing the UV technology in the operating room prior to his wife’s leg amputation. As a Tru-D hospital, the staff made arrangements for the germ-eliminating robot to disinfect the room prior to the procedure.

Gunter says his wife is now well on her way to recovery and is successfully using a prosthetic leg after her above-the-knee amputation.

“Having Tru-D was great for our mental framework,” said Gunter.

“My wife’s two prior, major surgeries resulted in two different bacteria in her leg which was the reason for the amputation. We will

never know what caused those infections, but knowing Tru-D was going to be used helped us feel everything was being done to make sure she did not have an infection with the amputation.”

Once a hospital staff member cleans a room using traditional cleaning methods, Tru-D is brought in to complete the process. Its patented Sensor360 technology analyzes the space, including shape, size and contents, to determine the proper UV dose to be administered.

Spending the minimum time necessary to successfully eliminate infectious germs from all room surfaces, including shadowed areas, Tru-D alerts the operator when the disinfection process is complete.

Tru-D has been clinically validated by more than a dozen third-party studies including the recent Benefits of Enhanced Terminal Room Disinfection (BETR-D) study funded by the

Centers for Disease Control. • For more information, visit www.Tru-D.com

AORN PILOTS SIMULATION LEARNING TOOL The Association of periOperative Registered Nurses (AORN) has added PeriopSim, a new simulated learning module, to Periop 101 in a six-month pilot program that will evaluate whether simulation learning is effective as an additional educational approach. By using simulation learning activities in perioperative practice, nurse users, who are new or returning to the profession, can demonstrate their skills before entering the operating room. Periop 101 is an online education program based on the evidence-based Guidelines for Perioperative Practice.

12

OR TODAY | May 2016

PeriopSim was created by Conquer Mobile as an iPad application with input and guidance from AORN. The piloted content includes instrumentation modules and procedure modules for both inguinal hernia and lap-chole.

Instrumentation modules act like flashcards and procedural modules use real surgical video to guide learners step by step through a surgery, prompting for instruments at every stage.

“Our hope is, by adding simulation to this learning platform, our Periop 101 educators and adminis-

trators will observe enhanced performance and, potentially, a reduction in training time,” said Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, AORN’s Executive Director/CEO. “With this pilot, we want to determine if simulation is an effective education technique to move nurses safely from the classroom to their responsibilities as a perioperative nurse actively involved in patient care activities in the perioperative setting.” • Find more information online at https://periopsim.com.

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NEWS & NOTES

HEALTHMARK INTRODUCES STAINLESS STEEL WASHER SLEEVES

Healthmark Industries has announced the addition of Stainless Steel Washing Sleeves to its ProSys Instrument Care line.

Manufactured for effective transportation, washing and storage of sensitive medical instruments, the perforated Stainless Steel Washing Sleeves have a 17mm internal diameter and external diameter of 19mm.

Included with the washing sleeves are two silicone caps that have crossed perforations for alternatively inserting fine tipped instruments, a circular stainless-steel identification tag capable of laser engraving and a stainlesssteel ring-holder that joins the tag to the washing sleeves.

The Stainless Steel Washing Sleeves are heat-resistant up to 275 °F, and are available in four different lengths. • Visit www.hmark.com or call 800-521-6224 for more information.

RTI SURGICAL ANNOUNCES FIRST IMPLANTATION OF UNISON-C ANTERIOR CERVICAL FIXATION SYSTEM RTI Surgical Inc. has announced a limited launch of the Unison-C System, an anterior cervical fixation system. The first human implantation of the UnisonC System took place during an anterior cervical discectomy and fusion (ACDF) procedure in February. The Unison-C System will expand RTI Surgical’s hardware portfolio into the growing standalone interbody market.

The Unison-C Anterior Cervical Fixation System is indicated for standalone anterior cervical interbody fusion for the treatment of degenerative disc disease at a single level of the spine from C2 to T1 in skeletally mature patients. The implant consists of an intervertebral body device made of PEEK-OPTIMA from INVIBIO Biomaterial Solutions with an integrated locking mechanism and two screws. The Unison-C System is designed to be used with autograft and/or allograft.

This standalone device is contained and secured within the disc space, alleviating the need for supplemental fixation, such as an anterior plate and screws. In order to improve surgical efficiency, the system’s instrumentation features an all-in-one implant inserter and guide, which allows surgeons to complete all required steps from insertion to final locking. • For details, visit www.rtix.com.

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GLACIER TEK ANNOUNCES COOL VEST Discomfort from overheating is an on-the-job reality for many workers — and health care professionals like surgeons, who endure bright lights, sterile gowns, lead aprons, physical exertion and time stress as they perform high-intensity procedures, aren’t immune.

The Glacier Tek Cool Vest, an American-made, self-contained lightweight wearable personal cooling system that maintains a cool — but not cold — temperature, is a patented, USDA bio-based cooling solution that is a game-changer for surgeons and staff seeking temperature comfort in the sometimes-trying conditions of a typical operating room. This vest could also lead to better patient outcomes.

“Our product is a perfect solution to a situation many surgeons and operating room staff face. In fact, surgeons first came to us seeking the Glacier Tek Cool Vest because it is self-contained, bio-based and allows unencumbered freedom of movement in the OR,” said David Land, president, Glacier Tek. “Research indicates a low temperature in the operating room can have adverse effects on not only a patient’s comfort, but recovery time as well. The Glacier Tek Cool Vest is one way to help surgeons and OR staff keep cool even during long, physically demanding surgeries.”

Glacier Tek’s patented phase change material (PCM) is superior to water-based personal cooling solutions in several ways. Worn around the body’s core in an easy-on, easy-off vest without tubes or tethers, Glacier Tek cools the body safely to a comfortable temperature. • For more information, visit www.glaciertek.com.

May 2016 | OR TODAY

13

INDUSTRY INSIGHTS NEWS & NOTES

DE MAYO V2 E KNEE POSITIONER USES STERILE EXTENSION ARM The De Mayo V2 E Knee Positioner, from Innovative Medical Products, is designed with the surgeon and patient in mind. IMP’s new positioner uses a patent-pending sterile extension arm that extends the knee positioner base plate off the end of the OR table, enabling the surgeon to stand between the patient’s legs and allows the surgeon the ability to look straight down onto the surgical site.

Surgeons no longer have to lean over the OR table when performing procedures. IMP is the first company in the marketplace to make and sell a sterile extension.

The IMP solution is especially useful for surgeons performing unicompartmental replacements where the surgical site is on the inside of the patient’s knee. When an extension is not needed, surgeons can opt for the De Mayo V2 Knee Positioner for procedures carried

out on top of the standard OR table.

The De Mayo V2 employs the De Mayo V2 E base plate and clamp and the De Mayo aluminum boot with distractor block.

Besides these benefits for the surgeon, the De Mayo V2 E Knee Positioner increases patient safety with new features to the knee positioner’s locking mechanisms. The system’s carriage has been fitted with a sliding bar, the Varus Tilt Control, that prevents a patient’s knee/leg from tilting out, regardless of patient height or weight. Patients stay solidly in place during the entire surgical procedure, while still allowing the surgeon to adjust the rotation, flexion and extension of the knee. The V2 E Knee Positioner also comes with an optional new handle on the carriage for ease of locking the boot.

The De Mayo V2 E Knee Positioner has been made lighter, without

decreasing its positioning strength.

Hospital staff can easily disassemble the system’s carriage for cleaning, as well easily replace the plastic Teflon pad used to slide the carriage back and forth on the positioner. •

ENCOMPASS GROUP INTRODUCES LONG SLEEVE REVERSIBLE UNISEX STAFF APPAREL TOP Encompass Group is introducing a new Synergy Unisex Long Sleeve Reversible Staff Apparel top (style #46831) to meet the needs of hospital staff that require or desire long sleeves to cover bare arms.

“The purpose for creating this top is based on the recommendations from AORN for the circulating nurse,” Tom Inglis, Vice President, Product Management, HTX Apparel Encompass Group LLC said. “This long sleeve top will help contain shed of skin cells to prevent contamination in the periop suite and when performing the sterile prep. We have also found that due to the cold atmosphere created in the OR, this will also provide

14

OR TODAY | May 2016

a layer of warmth to the individual.”

Synergy professional apparel blends durability and value with a variety of styles and colors. The Unisex Long Sleeve Reversible top is constructed of time-tested, high-performance 65 poly/35 cotton, stain-release color-fast fabric. It includes a reversible design with a breast pocket on one side or two hip pockets when reversed, and colorcoded neckline. Staff can wear the top either side out to meet their preference.

It comes in a multitude of colors and in sizes XS-5XL. • For information, call 800-245-4636 or email service@encompassgroup.net.

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NEWS & NOTES

SIX-MONTH INTELLITRAIL TRIAL FREE TO TASKI CUSTOMERS Sealed Air’s Diversey Care division has launched a test drive program for TASKI IntelliTrail, a full-service, intelligent fleet management system that allows facility managers to remotely monitor their TASKI floor care machines with ease. IntelliTrail is part of Diversey Care’s expanding Internet of Clean platform, which includes a variety of connected technology solutions for commercial cleaning.

IntelliTrail combines smart technology, GPS tracking and web applications to provide managers with real-time visibility of fleet performance. A device is physically

mounted on the designated equipment and contains a SIM card and hardware to record and transmit data. Users have access to machine data including geographical position, run time and critical service information such as battery state, which can help reduce total cost of ownership and enhance quality of service.

Beginning March 1, customers who purchase a TASKI scrubber drier can trial the cloud-based fleet management system for free for six months. • For more information, visit www.sealedair.com/intellitrail.

XENEX DISINFECTION SERVICES LAUNCHES LIGHTSTRIKE GERM-ZAPPING ROBOTS The new CDC report points to six antibiotic-resistant threats, which include: 1. Carbapenem-resistant Enterobacteriaceae (CRE); 2. Methicillin-resistant Staphylococcus aureus (MRSA); 3. ESBL-producing Enterobacteriaceae (extendedspectrum β-lactamases); 4. Vancomycin-resistant Enterococcus (VRE); 5. Multidrug-resistant Pseudomonas aeruginosa; and 6. Multidrug-resistant Acinetobacter.

Xenex Disinfection Services has launched its new LightStrike Germ-Zapping Robots, a portable disinfection system that destroys antibiotic-resistant bacteria in a four-minute cycle. More than 300 hospitals, long-term acute care, outpatient surgery and skilled nursing facilities use Xenex’s full-spectrum high intensity pulsed xenon light technology to destroy deadly superbugs before they harm patients.

Numerous hospitals have reported significant decreases in their infection rates after using Xenex’s Germ-Zapping Robots for room disinfection, and published their infection reduction results in peerreviewed journals. LightStrike uses pulsed xenon to create broad spectrum, highly intense light covering the entire germicidal spectrum and is the only ultraviolet disinfection technology shown, in multiple peer-reviewed published studies, to help hospitals reduce infection rates.

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LightStrike robots destroy all of these superbugs, as well as Clostridicum difficile (C.diff ) spores, in a four-minute disinfection cycle.

In addition to its 20 percent faster cycle time, LightStrike includes patented SureStrike technology, which validates bulb ignition and guarantees a proper broad spectrum pulse for every disinfection cycle. Xenex robots also include HAI rate tracking, which correlates use of the robot and the hospital’s own real-time HAI data to track the disinfection program’s effectiveness.

Xenex officials believe that LightStrike’s shortened cycle time provides tremendous value to hospitals, especially in the operating room environment.

Designed for speed, effectiveness and ease of use, hospital cleaning staff operate the LightStrike robot without disrupting hospital operations. Without contact or chemicals, the robot eliminates harmful microorganisms safely and effectively. According to Xenex customers, LightStrike can disinfect 30 to 62 hospital rooms per day, including: patient rooms, operating rooms, equipment rooms, emergency rooms, intensive care units and public areas. • May 2016 | OR TODAY

15

NEWS & NOTES

NIHON KOHDEN LAUNCHES NEUROMASTER MEE-2000A

SEALED AIR, SURFACE MEDICAL FORM PARTNERSHIP

Nihon Kohden has commercially launched its new Neuromaster MEE-2000A, a highly individualized intraoperative monitoring system that allows clinicians to respond to the neurophysiological needs of any patient. Available as a laptop or desktop, the technology allows health care professionals to set patient-specific protocols and tailor monitoring parameters to ensure the highest level of flexibility and responsiveness in any operating room.

The Neuromaster MEE-2000A offers several modules for electrophysiology such as electroencephalography, electromyography, and a variety of evoked potentials that can be configured according to surgical indication and patient need. At the core of the technology is a unique transcranial stimulator, the TcMEPro Matrix Stim, which allows health care professionals to set patient-specific protocols within seconds by tailoring parameters such as duration, interstimulus interval (ISI) and train length. In addition, the laptop system is smaller and lighter than other systems, which allows for enhanced portability.

The Neuromaster MEE-2000A builds upon Nihon Kohden’s Neuromaster MEE-1000A device, which has been integrated into operating room workflows at hospitals across the U.S •

Surface Medical Inc. and Sealed Air Corporation have entered into a strategic partnership to exclusively distribute the CleanPatch branded product line in the United States through Sealed Air’s Diversey Care division.

As part of the multi-year agreement, Diversey Care will lead the sales, marketing and distribution activities of CleanPatch products designed for the safe and effective repair of hospital bed mattresses, operating room tables and stretchers. The focus of this partnership will be in the U.S. health care market, including acute care hospitals, long-term care facilities and ambulatory surgery centers.

CleanPatch is a first-in-class Food and Drug Administration-registered medical surface repair technology that restores damaged hospital mattresses to an intact and hygienic state. Studies have demonstrated that damaged surfaces in health care facilities are common and cannot be properly disinfected, leading to the risk of potential cross-contamination. Already implemented by hundreds of leading U.S. health care facilities, CleanPatch provides the unique benefit of enhancing patient safety while directly reducing health care costs. •

ETHICON TO ACQUIRE NEUWAVE MEDICAL INC Ethicon has announced a definitive agreement to acquire NeuWave Medical Inc. Their products are currently used by physicians in over half of the top cancer centers in the United States. This acquisition is consistent with the Johnson & Johnson Medical Devices’ strategy of advancing innovation and investing in areas of unmet medical needs such as surgical oncology. Financial terms of the transaction have not been disclosed.

NeuWave Medical’s ablation technology was originally developed by physicians and microwave scientists from the University of Wisconsin to maximize energy delivery to tissue, minimize invasiveness and provide physician-friendly 16

OR TODAY | May 2016

workflow. NeuWave Medical’s Certus 140 ablation system’s high-powered computer and intuitive touchscreen interface enables activation of single or simultaneous multiple probe procedures for patients with soft tissue lesions. This allows physicians to effectively tailor ablations for lesions of varying shapes and sizes. NeuWave Medical’s probe family includes conventional probes and the only Precision PR probe to limit the ablation length, allowing precise and controlled ablations.

The closing of the transaction is subject to clearance under the Hart-Scott-Rodino Antitrust Improvements Act and other customary closing conditions. The transaction is expected to close during the second quarter of 2016. • WWW.ORTODAY.COM

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INDUSTRY INSIGHTS AAAHC UPDATE

E

BY JACK EGNATINSKY, MD

NEAR MISSES OR GOOD CATCHES?

verybody, or nearly everybody, experiences a “near miss” at some time or another. AAAHC Standards in both risk management and safety address near misses; and at AAAHC, our surveyors look for how ASCs comply with these standards on every survey.

Incidents that “almost happen” go by many names: medical error, accident avoidance, close call, narrow escape, error-prone situations. It doesn’t really matter what terminology you use. What matters most is that your staff understands exactly what is meant by a near miss; that it should be taken seriously; and that it should be reported freely so the cause can be ascertained and a remedy decided on to make sure it never happens again.

Myself, I prefer to call these incidents “good catches” because of the more positive tone it connotes. It’s more likely that people will report them when they can be congratulated for making a good catch than berated for experiencing or witnessing a near miss that they were reluctant to report or perhaps did not report. Of course, the reason why near misses should be reported is to determine how or why they occurred so that corrective action can be taken to prevent similar, or more serious, incidents from happening in the future. Whatever we call these events – a rose by any other name, as Shakespeare said, still means the same thing – it’s vital that you deal with them quickly, honestly and constructively. They could be caused by missing steps in the procedure chain, lack of support staff at a critical moment, medication errors, ambiguous instructions, 18

OR TODAY | May 2016

hard-to-read labels, lack of doublecheck procedures, or lack of a clear policy, etc.

How do you approach near misses or good catches? How do you encourage your staff to report them?

Do you have an electronic reporting system, or do you require that a paper form be completed? Do you permit reporting to be anonymous?

Who at your center looks at these?

What happens after they are filed?

Do you discuss good catches soon after they happen? Do you trend them and wait to see a pattern before discussing them with the staff and, when appropriate, the physicians who work at your center?

Or do you just collect the data and keep it on file? The main purpose of collecting this data is to use it for staff and physician education so that near misses do not become actual misses with the possibility of patient or staff harm.

Frankly, any good preventive ideas suggested by staff or physicians – or anyone – should be listened to and considered with an open mind. The corrective measure will ultimately help all patients and staff experience a safer environment for care; and a safer environment in which to work!

The most important point is that your organization must foster and encourage a reporting culture. There

must be an environment in which the person reporting is free to announce a near accident without stigma, not pilloried for voicing it or viewed negatively as though he or she is somehow “disloyal” or “not a team player.” Playing an active role in detecting risks to patient safety is not necessarily limited to staff; patients themselves may contribute, for example, by being encouraged to ask questions about their care.

Near miss incidents must be openly investigated to identify the root cause and any weaknesses in the system that led to the near miss.

These are learning and improvement opportunities. Use them to improve safety systems, achieve risk reduction, and heed the lessons learned. If you put a positive spin on the process, it represents a unique opportunity for training, feedback on performance, and a commitment to continuous improvement.

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 on the board 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 in the U.S. and internationally.

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IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

Q

VAGINAL PREPS WITH IODINE ALLERGY What is being used for vaginal preps for patients with iodine allergies? I’ve found literature regarding dilute Hibiclens but it still states on the bottle not to use it for mucous membranes. One colleague heard about using peroxide or baby shampoo or castile soap. I can’t find a legitimate recommendation.

A: We use Techni-Care (chloroxylenol 3%). It was off the market for quite a while but it is back now.

A: Can you share ordering info for TechniCare? I hadn’t heard that it was available.

A: It (Techni-Care) is ordered direct from the company. Care-Tech Laboratories Inc. in Saint Louis, Missouri 63139. The phone number is 800-325-9681. The website is www. caretechlabs.com.

A: This was a recent question for us as well.

Our policy states that if the patient is allergic to iodine to use hibiclens. Hibiclens (CHG) is 4% chlorhexidine gluconate with 4% percent

Q

POST-OP DRAINS FOR LAPAROSCOPIC PROCEDURES Some surgeons have started placing drains after laparoscopic and robotic procedures to help eliminate the CO2 trapped in the body cavity. This has shown to decrease post-op shoulder pain in some patients. The drains are then removed in PACU prior to discharging the patient. Has anyone seen this practice at their facilities?

A: No drains are being used here at our facility.

A: No.

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OR TODAY | May 2016

alcohol. If the patient is allergic to both we are advised to use a product called Shur Clens. I found an interesting article that mentions that the reason “CHG acquired the warning not to use it in the genital area seems to be lost to history. Companies say pursuing a change in the label claim is difficult because the FDA has not established testing criteria for skin antiseptics to be used on vaginal tissue and because of the expense of such studies.”(OR Manager Vol 27, No. 8, p.23) So it sounds as if one of the reasons that hibiclens says not to use on mucous membranes may be simply because its too expense to change the historical label. The same article also mentions a study that suggested that CHG had been more effective.

A: We have a surgeon who has done this his entire career. He uses a 15 fr. round drain with a JP bulb. He pulls it in second stage recovery.

A: We do not use drains, but that sounds like a good idea.

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SUITE TALK

Q

COUNTING When counting laps and Ray-Tec sponges, is it OK to pop the paper tab prior to counting with the circulator? Some scurb nurses will only pop the paper once the pack is counted.

A: How can you properly count without popping the tab? The AORN guideline says that each sponge/lap should be visualized and separated to count. Our policy is not to remove the band until we are ready to count them, that way we know what has/has not been counted. Without removing the tab, if you aren’t separating the sponges, you could have an extra sponge folded and stuck between the sponges that you don’t see during the count.

e Th nal igi r O

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A: We pop the tape and separate the sponges as we count.

A: We pop the tape and count them.

A: The requirement is to separate each sponge when counting. You cannot do that until the tape is broken and each sponge is laid out individually.

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IN THE OR MARKET ANALYSIS

STAFF REPORT

MARKET ANALYSIS Endoscope Reprocessor Among Fast-Growing Markets

D

irty endoscopes made headlines in 2015 for all the wrong reasons. These helpful medical devices become problematic when they are not cleaned properly or completely.

A series of fatal Carbapenem-resistant Enterobacteriaceae (CRE) infections that attracted national media attention in 2014 and 2015 – combined with ECRI Institute’s studies into endoscope cleaning and disinfection practices — prompted ECRI safety engineers to elevate flexible endoscope reprocessing to the top of the organization’s 2016 list of hazards. This year’s top hazard specifically addresses the need to adequately clean flexible endoscopes before disinfection to help prevent the spread of deadly pathogens.

The focus on endoscopes caused by bad news the past two years is expected to help fuel the growth of the endoscope reprocessing and cleaners market in the future.

A report from the market research firm MarketsandMarkets predicts significant growth in the endoscope reprocessing and cleaners market.

The MarketsandMarkets report “Infection Control Market by Disinfection (Endoscope Reprocessing, Disinfectant, Disinfector, Surgical Drapes, Gowns, Disinfectant WWW.ORTODAY.COM

Wipes, Face Mask), Sterilization (Moist Heat, Dry Heat, Ethylene Oxide, E-beam, Contract Services) – Global Forecast to 2020” forecasts that the global infection control market is estimated to reach $16.7 billion by 2020, growing at a compiound annual growth rate of 6.7 percent during the forecast period (2015 to 2020).

The report lists hospital-acquired infections among the reasons for the growth of this market.

“The infection control market witnessed healthy growth in the last decade owing to rising aging population and prevalence of chronic diseases, an increase in the number of surgeries performed, and the rising occurrence of hospital-acquired infections,” according to MarketsandMarkets. “However, stringent regulations and saturation in developed economies will restrict the growth of the market to a certain extent.”

“However, endoscope reprocessors is the fastest growing segment in the disinfection technologies market during the forecast period,” according to MarketsandMarkets. “This market is expected to grow at a highest CAGR of 9 to 10 percent during the forecast period. Growing importance of diagnostic and therapeutic endoscopy procedures and increasing number of minimally invasive surgeries across the globe are some of the key factors contributing to the growth of this market.”

“This market is expected to grow at a highest CAGR of 9 to 10 percent during the forecast period.”

The entire endoscopy market is also expected to grow in coming years thus propelling the reprocessing and cleaners segment of the market.

According to a market report published by Transparency Market Research, “Endoscopy Devices Market (Endoscopes, Endoscopic Operative Devices, and Visualization Systems) – Global Industry Analysis, Size, Share, Growth, Trends and Forecast, 2013-2019,” the global endoscopy devices market was valued at $24.9 billion in 2012 and is expected to grow at a compound annual growth rate of 6.8 percent from 2013 to 2019, to reach an estimated value of $36.9 billion in 2019.

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 MarketsandMarkets.

“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,” according to the research firm’s report.

May 2016 | OR TODAY

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IN THE OR PRODUCT SHOWROOM

EVOTECH® ENDOSCOPE® CLEANER AND REPROCESSOR

The EVOTECH® Endoscope Cleaner and Reprocessor is the first commercially available system that both cleans* and high-level disinfects endoscopes. Developed by Advanced Sterilization Products (ASP), a Johnson & Johnson company, the EVOTECH® System makes endoscope reprocessing a highly automated process, eliminating tedious brushing* resulting in confidence that endoscope reprocessing is effective and consistent.

This can save valuable time, improve health care professional safety and reduce the risk of infection. *Does not eliminate bedside pre-cleaning. Manual cleaning of qualified medical devices (endoscopes) is not required prior to placement in the EVOTECH® ECR when selecting those cycles that contain a wash stage (for those endoscopes qualified for clean & disinfection only). Not all endoscopes can be automatically cleaned, but may be high-level disinfected. The EVOTECH® ECR will only disinfect an EUS scope. The customer will be responsible for the manual leak testing and manual cleaning of the scope per the manufacturer’s instructions for use. Please refer to the EVOTECH® ECR User’s Guide and specific connection diagrams for more detailed information regarding cycle capabilities. •

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OR TODAY | May 2016

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PRODUCT PRODUCT SHOWROOM FOCUS

HEALTHMARK INDUSTRIES ELEVATOR MECHANISM BRUSH Healthmark Industries has added the Elevator Mechanism Brush to its ProSys Instrument Care line. It is uniquely designed for cleaning endoscope elevator mechanisms; the small-scale brush head is comprised of polyamide brush filaments attached to a plastic-coated wire core for efficient scrubbing in and around the endoscope elevator mechanism. The Elevator Mechanism Brush also features an ergonomic handle fashioned from recyclable polypropylene for intentions of controlled grip and precision movement, the adjoining flexible neck provides ease of access when cleaning endoscope elevator wires and the immediate area of the wire channel opening (when present) surrounding it. •

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May 2016 | OR TODAY

25

IN THE OR PRODUCT SHOWROOM

KEY SURGICAL SCOPE TAGS When was the scope processed? Did it pass the leak test? When does it need to be reprocessed? Who performed the pre-cleaning? There are many questions that need answers in regards to scope cleaning and reprocessing. Key Surgical Scope Tags help ensure these questions get answered and that communication is clear and recorded. Available in several colors (blue, shown) with month, day and date to select on one-side or a bright white design that includes more in-depth detail to capture (leak test, air flush, scope model, hang time, etc.) as well as a place for a barcode if necessary. These self-looping tags easily attach to the scope. Scope Tags from Key Surgical were designed with efficient communication and patient safety in mind. They may be used after processing is complete or during the sterilization process. For information, visit www.keysurgical.com. •

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OR TODAY | May 2016

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PRODUCT FOCUS

OLYMPUS OER-PRO AUTOMATED ENDOSCOPE REPROCESSOR The Olympus OER-Pro Automated Endoscope Reprocessor is designed to comply with the most rigorous industry standards while simplifying and expediting proper cleaning and reprocessing between procedures.

Up to two flexible endoscopes can be simultaneously cleaned and disinfected in 26 minutes. The OER-Pro is FDA cleared to automate seven of the 11 manual endoscope cleaning steps, including the most laborintensive and variable parts of the process: manual flushing of the endoscope channels with detergent, water and air. Its built-in Radio Frequency Identification (RFID) management system automatically traces the endoscope serial and model numbers, operator and time of reprocessing for additional time savings and improved accountability, eliminating cumbersome manual input from a keypad or barcode. •

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May 2016 | OR TODAY

27

IN THE OR PRODUCT SHOWROOM

RUHOF SCOPEVALET™ VALVESAFE™ 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. It helps meet national and international recommended guidelines (AORN, ANSI/AAMI, SGNA, BSG, ESGE) stating endoscope valves (including rinsing valves) stay with the named endoscope throughout the cleaning process. Valves (including rinsing valves) should stay with a named endoscope as a set, to prevent cross-infection and enable full traceability. This is a single-use product which cannot be reused and thus aids in the reduction of cross-contamination. For more details, visit ruhof.com. •

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OR TODAY | May 2016

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Is that

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Check the cleanliness of flexible endoscopes with EndoCheck™ from Healthmark Flexible endoscopes are notoriously difficult to clean. More EndoCheck™ is a miniature chemistry kit that is simple to use and interpret. Simply swab the biopsy channel of the scope with

check for a color change. Depending on the type of test used, a color change indicates that blood residue or protein residue remains in the channel, and should be reprocessed.

Visit www.HealthmarkGI.com reprocessing of your endoscopes.

Healthmark and our GI products help the Endoscopy center manage the reprocessing of their scopes. We do this through organize and track the steps in reprocessing (accessories, including labels). If it is not clean, it can not be considered high-level

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IN THE OR CONTINUING EDUCATION CE664B

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OR TODAY | May 2016

BY SUSAN PAULY-O’NEILL, DNP, RN, PPCNP-BC

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CONTINUING EDUCATION CE664B

SIMULATION BASICS GETTING READY FOR THE REAL THING

I

n the same-day-surgery recovery area, Mr. Shapiro awakens from anesthesia after a minor surgical procedure to repair an inguinal hernia and complains of new onset chest pain. He has a history of hypertension but has not had trouble with angina in the past. He takes a small daily dose of a diuretic and exercises regularly. He is extremely anxious, calling for the nurse. The RN notes diaphoresis, cyanosis and an irregular heart rhythm, and hits the code button.

Within minutes the team arrives: a charge nurse, a resident and a respiratory therapist. The patient deteriorates quickly into V-fibrillation, and the team springs into action. They begin chest compressions at a ratio of 30:2, but nobody remembers to place a backboard under Mr. Shapiro. The RT effectively opens the patient’s airway but soon realizes that the oxygen tubing is not attached to the ambu-bag. While trying to secure the tubing, the facemask falls to the floor.

The charge nurse begins to draw up epinephrine at the resident’s request, but notices that Mr. Shapiro has a shockable rhythm. Why hadn’t the MD called for the defibrillator? The RN chimes in: “Can we please start over?”

Fortunately, this was a simulated interprofessional exercise in which mistakes cause no harm and practice makes perfect.

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 goal of this simulation continuing education program is to provide nurses with an overview of simulation as an instructional strategy not only for nursing education, but also for interprofessional training. After studying the information presented here, you will be able to: • Explain the potential benefits of augmenting healthcare education with simulation • List three professions that have found interprofessional simulation training helpful • Describe the advantages and limitations of this state-of-the-art technology

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When simulated clinical experiences recreate the dynamics of real encounters, learning is sure to take place. This strategy is not new. In fact, in aviation and the military it has been a widely accepted format to train both novice learners and experienced personnel. Simulation is an immersive technique used to replace or amplify experiences found in real life. In healthcare, it improves patient safety and enhances care not only by refining individual skill and decision-making, but also by honing the performance of clinical teams.1 It’s a time-efficient, cost-effective method to teach healthcare providers to recognize and avoid errors.

Simulation can be used to enhance readiness for practice, teamwork and collaboration, communication, and leadership. It can take a variety of forms, from simple to complex.2 Anatomical models, also known as “task trainers,” replicate a portion of the body and can be used to practice skills. An anatomical model of an arm, with realistic-looking veins filled with red liquid, are used to teach IV line insertion, for example.

Another strategy is the use of a

standardized patient. These simulated patients are actors playing the role of a patient so that a student may perform a physical assessment, take a history and practice communication techniques.

Much more advanced technology – “human patient simulators” (HPSs) – are state-of-the-art mannequins equipped with realistic physiologic functions, and they closely resemble humans. What the educator is trying to accomplish determines the equipment to use. Learning to administer an IM injection may require only a task-trainer. Improving a nurse’s ability to gather a patient history may require a standardized patient while teaching a team to resuscitate a patient quickly and effectively may require an HPS. The term “fidelity” is used to illustrate the model’s believability.

The higher the fidelity, the greater the realism. A low-fidelity item, such as a static mannequin with no response capability (similar to a doll), may be used to teach simple psychomotor skills, such as nasogastric tube placement or body positioning. High-fidelity HPSs can simulate May 2016 | OR TODAY

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IN THE OR CONTINUING EDUCATION CE664B breathing, bowel sounds, heart sounds, pupil reaction and urinary drainage. Because the HPS interfaces with a computer monitor, users can see parameters on a screen, such as cardiac rhythm, continuous blood pressure, oxygen saturation and even more complex waveforms, including central venous pressure. The values can be changed with a few taps on the computer keyboard, recreating the responses likely to occur when interventions are used. When oxygen is applied, the educator or technician can raise the oxygen saturation reading, for example. Conversely, when the correct action is not taken, vital signs can be quickly turned to life-threatening levels.

These top-of-the-line human lookalikes are available from newborn to adult. But the equipment is only part of the technique. Case scenarios are what illustrate the potential course of events, often replicating a high-risk, low-occurrence event, such as postpartum hemorrhage or cardiac arrest. In nursing programs, students may rotate into the simulation laboratory and participate in increasingly more complex cases from well checkups to septic shock. Some users purchase preprogrammed scenarios; others develop their own. In either case, working in small groups, participants are assigned roles before the simulation begins. Typically, one team member becomes the leader and directs others as the simulated scenario unfolds.

During the simulated scenario, the team members collect assessment data, prioritize care, provide treatments and communicate with one another. The case scenario typically runs for 20 to 30 minutes depending on the complexity of intervention and teamwork required. After the scenario is completed, the participants spend additional time debrief34

OR TODAY | May 2016

ing, which allows them time to talk as a group, reflect on their reactions, share their observations and discuss their evaluation of personal and team performance. Faculty present during debriefing can help lead the discussion, correct misconceptions, review best practices and help students work through their emotions.

WHY SIMULATION?

Traditionally, students in the healthcare professions have learned by doing: See one, do one. However, concerns about patient safety have given us a push to reassess this largely unstructured apprenticeship approach. An alarming rate of morbidity and mortality among patients in the hospital has intensified the scrutiny placed on healthcare providers, including nurses.2 Quality and safety initiatives in both practice and academia demand top-notch competency and performance from healthcare providers and teams. The pressure is on to find a way to reduce errors and minimize patient risk. This has spilled over from the practice setting into the world of nurse education. How can we educate students with the least risk for patient harm?

In addition, there is a severe shortage of clinical sites for qualified students.3 Student learning is restricted by this limited availability and access to patients coupled with an apprehension about medical errors.4 Placing nursing students into clinical settings in which by random opportunity they provide whatever care they can during a shift may no longer suit the needs of healthcare.

In addition, the inconsistency in what is available allows some students to fall through the cracks.

Many students may complete an entire rotation without participating in activities critical to mastering

important competencies. As students are typically assigned to a single stable patient on a medical/surgical unit, they may not witness significant cardiac dysrhythmias, hemorrhage, shock or seizures. Here’s where simulation comes in: Students can be exposed to events in which they are expected to be competent yet do not often participate in during a clinical rotation. For example, an employer would expect that a new graduate nurse would be proficient in recognizing and responding to a deteriorating patient condition, such as impending respiratory failure. If a student completed all clinical rotations without ever having witnessed this event, the student would be unlikely to react effectively when it occurs on the patient care unit. Simulation can fill in that gap, offering a realistic recreation of that event, with repetitive practice in how to respond quickly and accurately.

Nursing education is retooling to better prepare students for complex care, using simulation as an important component. Rehearsing responses to challenging events is a vital contribution of simulation in the promotion of patient safety, development of decision-making skills and refinement of interprofessional communication. Students can use their time in simulation to assess both the patient and the environment, isolate the important information that should be communicated to other healthcare providers and practice that communication.2 It provides an arena comparable to the clinical setting where students can learn to delegate.

Simulation allows legitimate practice without patient risk.

Students are free to make errors and learn from their mistakes while causing no patient harm. In addition to the safety benefits, the expansion WWW.ORTODAY.COM

CONTINUING EDUCATION CE664B

of simulated clinical experiences may reduce the time students need to spend in hospital settings, thus relieving some of the pressure on available clinical sites.3 Nurse educators may substitute a percentage of clinical hours with simulation hours based on the regulations stipulated by the state’s board of nursing. Clinical groups of up to 10 students may split into two groups: one in acute care and the other in the simulation laboratory, rotating back and forth. This allows for smaller groups in the clinical arena at any given time.

WHO USES SIMULATION?

It’s easy to imagine why incorporating simulation into nursing education makes sense, from learning basic nursing skills, such as IV fluid management, to perfecting advance practice competencies, such as anesthesia induction and airway management. Simulation is used widely in prelicensure nursing programs across the nation to practice skills and decision-making before applying knowledge to real patients. A mixed educational model that combines classroom lectures, traditional clinical rotations and simulation is becoming a popular approach to basic nursing education.

In fact, a large study by the National Council of State Boards of Nursing of 10 prelicensure nursing programs across the country supported the use of simulation as a substitute for up to 50% of traditional clinical time.5 Simulation has also been useful after graduation in nurse refresher courses, advanced cardiac life support training and critical care reviews, to name a few possibilities.

Many healthcare facilities use simulation to validate competencies and help in the transition from student to newly employed nurse during orientation programs. The WWW.ORTODAY.COM

anesthesia community uses the HPS to teach not only technical skills but also crisis management.6 But what about teamwork? We know that performance is strongly influenced by the interaction between the task, the environment and the behavior of team members.7 Everyone has a role to play. In simulated exercises involving teams, members learn how not to step on each others’ toes. In practicing together, they become aware of their synergistic roles.7 Learners from several disciplines can practice relating to one another while providing safe care.

A variety of teams use simulation as a training tool. Student teams comprising pharmacy, medical and physician assistant students found success in a simulated interprofessional rounding experience in which they provided comprehensive medical care for a simulated patient in an inpatient setting.8 At the University of Washington, fourthyear medical, nursing and pharmacy students joined by second-year physician assistant students participated in scenarios developed to help integrate interprofessional team training into the curriculum.9 Simulation holds promise in the area of professional regulation. While variability, validity, cost and difficulties in standardization may be barriers to using simulation as part of regulatory programs such as licensing and certification, some experts believe that simulation-based assessment may be integral in ensuring that the public is cared for by competent practitioners.10 The Institute of Medicine report “The Future of Nursing” proposes that simulation scenarios be used for professional assessment.10 In addition, the report suggests that simulation should be considered whenever new procedures and equipment are introduced.2

IS SIMULATION EFFECTIVE?

When the human patient simulator is used to teach basic skills and even crisis management, the benefits have been widely recognized.5 The literature suggests that simulation makes a valuable contribution to healthcare education and training.

Among its many positive effects, simulation has been shown to improve nursing students’ critical thinking, skills performance and knowledge; enhance their ability to care for a deteriorating patient; increase their confidence in personal abilities to perform in a given situation; communicate critical information to interdisciplinary team members; and boost medication calculation and administration abilities.11 ,12-15 Students benefit from observing one another’s successes and errors.2 Nurse educators in academic and practice settings have been using simulation to help improve learning, clinical competency, communication and confidence.16 The deliberate and repetitive practice available during simulation has been shown to improve nursing competence. But the positive effects transcend nursing. Interprofessional team training using high-fidelity simulation in advanced life support has been shown to improve proficiency better than clinical experience alone.17 In fact, hospital resuscitation teams trained in advanced life support using simulation improved patient outcomes after cardiac arrest.18 After interdisciplinary training with both nursing and medical school students, participants had more knowledge of team skills with a statistically significant improvement in attitudes toward teamwork. Several studies demonstrate that simulation training does transfer into measureable benefits for patients.10 May 2016 | OR TODAY

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IN THE OR CONTINUING EDUCATION CE664B

Real improvement in clinical performance as a result of simulation is beginning to be established in the literature. A recent study involving nursing students revealed that those who participated in simulation had higher performance scores than those who did not participate. The higher performance levels were maintained on the clinical unit, where faculty observed that these students acclimated more quickly and achieved performance expectations faster than the control group.19 In a study of medical/surgical nurses trained via simulation to react to deteriorating patient conditions, such as cardiac, respiratory and neurologic changes, participants showed an enhanced ability to respond in a systematic way.20 The participants were especially pleased with their increased skills in managing breathing difficulties after this training. This was particularly important as the participants reported using these newly heightened skills between one and five times in the three months after the simulations.20 LIMITATIONS

Simulation is not real. The mannequins may resemble humans, but clearly they are not real patients.

Hence, participants may have trouble suspending disbelief and working through the scenario as though it were an authentic event. The team members’ ability and willingness to engage fully affects the communication that takes place among participants, which may have an effect on learning. While disbelief can be a hurdle, so too can anxiety. Some students worry about their ability to work through a critical event and may fall victim to their own fears.

This is understandable as a student would never be expected to take on a 36

OR TODAY | May 2016

crisis in real life while that is routine in the simulation lab. Anxiety may be heightened further when students are evaluated based on their performance.2 Simulation has been found most effective when using small groups or teams. The logistics of rotating all students through the simulation laboratory can be difficult. Faculty must be present, which may result in the need for additional instructors.

There are faculty training, ongoing technical support and administrative commitment to consider, as well.

Learning to incorporate simulation requires commitment and dedication at a time when faculty workload is already heavy. Equipment in the simulation laboratory can be expensive. Additional laboratory space may not be available, and annual operating costs may be prohibitive.21 While the HPS simulators may cost $20,000 to $60,000 or more, the overall price tag associated with simulation can range widely depending on whether additional space, training and faculty time are included.2 However, experts agree that efficiencies in care and reduced errors can more than offset that cost.1 FUTURE PROJECTIONS

There is little debate: Simulation is indeed useful for reasons of patient safety, standardization of education and assessment of performance.5 The Institute of Medicine report advises us to develop and test new approaches to prelicensure clinical education, including the use of simulation.22 While cost is certainly a big issue, schools of nursing and healthcare institutions can partner to share the cost and benefits of the technology.2 Moving forward, research that helps us know when to use simulation and how to use it most effectively will be key.23 For those who may

worry about losing the human touch, experts seem to be on the same page: Simulation is not expected to replace supervised work with real patients.1 Rather, the test ahead is to learn which combinations produce the best outcomes in the most efficient and cost-effective manner and with the most positive, lasting impacts on safe patient care.24 In a nutshell, finding the right combination of simulation and supervised clinical practice is our next important challenge. That process has been described as the opposite of the Rubik’s cube puzzle, when a player tries to create sides with a single solid color. Rather, successful simulation programs will be multicolored, with a mix of the best components for the goals we want to meet. The combination of the abilities of the instructor, researcher and administrators put into play the best practices for success in what may be called the “simulation puzzle.”24 In light of the need to train and maintain a workforce of highly skilled nurses who can navigate an ever-increasingly complex healthcare arena, nurse educators in practice and academia must be selective in determining which models of training work best.

Learning techniques and activities that promote competence and enhance effective teamwork are surely the ones that should grab our attention.

RESOURCES International Nursing Association for Clinical Simulation and Learning http://www.inacsl.org/i4a/pages/ index.cfm?pageid=1 Society for Simulation in Healthcare http://www.ssih.org/

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CONTINUING EDUCATION CE664B

The National League for Nursing, Simulation Innovation Resource Center http:// sirc.nln.org University of Washington Center for Health Science Interprofessional Education, Research and Practice http://collaborate.uw.edu/facultydevelopment/teaching-with-simulation/teaching-with-simulation.html-0 Susan Pauly-O’Neill, DNP, RN, PPCNP-BC, assistant professor at the University of San Francisco School of Nursing and Health Professions, has developed a program of fully integrated clinical rotations using high-fidelity simulation throughout the BSN curriculum and conducted research on using simulation to improve patient safety.

REFERENCES 1. Gaba D. The future vision of simulation in health care.

Quality Safe Health Care.

2004;13(suppl 1):i2-i10.

2. Durham, C, Alden, K. Chapter 51. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043. Rockville, MD: Agency for Healthcare Research and Quality; 2008.

3. MacIntyre R, Murray T, Teel C, Karshmer J. Five recommendations for prelicensure clinical nursing education. J Nurs Edu. 2009;48(8):447-453.

4. Shreve J, Van den Bos J, Gray T, et al. The economic measurement of medical errors. Agency for Healthcare Research and Quality Web site. http://psnet. ahrq.gov/resource. aspx?resourceID=18975. Published 2010. Accessed January 15, 2015.

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5. Hayden J, Smiley R, Alexander M, Kardong-Edgren S, Jeffries P. The NCSBN national simulation study: a longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education.

J Nurs Regul. 2014;5(2 suppl):S2-S64.

6. Hawkins R, Bendickson L, Benson P, et al. A pilot study evaluating the perceptions of certified nurse anesthetists toward human patient simulation. AANA J. 2014;82(5):375-384.

7. Lateef, F. Simulation-based learning: just like the real thing.

J Emerg Trauma Shock.

2011;3(4):348-352.

8. Shrader S, McRae L, King W, Kern D. A simulated interprofessional rounding experience in a clinical assessment course. Am J Pharm Educ. 2011;75(4):61.

9. Taibi D. SIM 101: Introduction to clinical simulation. University of Washington Web site. http:// collaborate.uw.edu/facultydevelopment/teaching-withsimulation/basic/sim-101/ sim-101-introduction-to-clinicalsimulati. Accessed January 15, 2015.

10. Holmboe E, Rizzolo M, Sachdeva A, Rosenberg M, Ziv A. Simulation-based assessment and the regulation of healthcare professionals. Simulation Healthcare. 2011;6(7):S58-S62.

11. Lapkin S, Levett-Jones T, Bellchambers H, Fernandez R. Effectiveness of patient simulation manikins in teaching clinical reasoning skills to undergraduate nursing students: a systematic review. Clin Simulation Nurs.

2010;6(6):e207–e222.

12. Fisher D, King L. An integrative literature review on preparing

nursing students through simulation to recognize and respond to the deteriorating patient. J Adv Nurs.

2013;69(11):2375-2388.

13. Bambini D, Washburn J, Perkins R. Outcomes of clinical simulation for novice nursing students: communication, confidence, clinical judgment. Nurs Edu Perspectives. 2009;30:7982.

14. Liaw S, Zhou W, Lau T, Siau C, Chan S. An interprofessional communication training using simulation to enhance safe care for a deteriorating patient. Nurs Educ Today. 2014;34:259-264.

15. Harris M, Pittiglio L, Newton S, Moore G. Using simulation to improve the medication administration skills of undergraduate students. Nurs Educ Perspect.

2014;35(1):26-29.

16. Kaddoura, M. New graduate nurses’ perceptions of the effects of clinical simulation on their critical thinking, learning and confidence. J Continuing Educ Nurs. 2010;41(11):506-516.

17. Wayne DB, Butter J, Siddall VJ, et al. Simulation-based training of internal medicine residents in advanced cardiac life support protocols: a randomized trial.

Teach Learn Med. 2005;17(3):210-216.

18. Moretti MA, Cesara LMA, Nusbacher A, et al. Advanced cardiac life support training improves long-term survival from inhospital cardiac arrest.

Resuscitation. 2007;72,458-465.

19. Meyer M, Connors H, Qingjiang H, Gajewski B. The effect of simulation on clinical performance: a junior nursing student clinical comparison study.

Simulation Healthcare.

2011;6:269-277.

May 2016 | OR TODAY

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IN THE OR 20. Buckley T, Gordon C. The effectiveness of high-fidelity simulation on medical/surgical registered nurses’ ability to recognise and respond to clinical emergencies. Nurs Edu Today. 2011;31:716-721.

21. Hanberg A, Brown S, Hoadley T, Smith S, Courtney B. Finding

funding: the nurse’s guide to simulation success. Clin Simulation Nurs. 2007;3(1):e5-e9.

22. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health.

Washington, DC: National Academy Press; 2011.

23. Cook D. One drop at a time:

research to advance the science of simulation. Simulation Healthcare. 2010;5(1):1-4.

24. Groom J. Creating new solutions to the simulation puzzle.

Simulation Healthcare.

2009;4(3):131-134.

CLINICAL VIGNETTE An instructor presents a simulation scenario to students, who must quickly intervene to avoid impending patient deterioration. A high-fidelity human patient simulator (“Jeff”) is in the bed with a computerized monitor visible. Participants are assigned the roles of primary nurse, charge nurse, resident physician and pharmacist.

Jeff is an 18-year-old with acute lymphoid leukemia. He has been receiving chemotherapy for the last three months and has a triple-lumen central venous access device. He was admitted to the unit with weight loss, fever, fatigue, neutropenia and vomiting. His admission assessment reveals several deviations from normal: temp of 39 C, a productive cough and ulcers inside his mouth. His initial medical orders include neutropenic precautions, blood and urine tests, IV antibiotics, maintenance fluid therapy, antipyretics and pain medication.

1

The medical orders include collection of blood from a central venous access device.

Simulation is an ideal place to practice skills like this because: A. Students have no anxiety when practicing skills in the simulation laboratory.

B. Repetitive practice during simulation has been shown to improve nursing competence.

C. If the student does not know how to complete the skill, he or she can cancel the order.

D. There is no pressure on participants to complete the skill correctly.

2

As the designated leader in any interdisciplinary simulation scenario, the primary nurse should: A. Assign tasks to each participant so that everyone remains active.

B. Wait until the physician tells the team what to do.

C. Instruct the pharmacist to go obtain the medications.

D. Directs others as the simulated scenario unfolds.

3

A high-fidelity mannequin is an excellent tool to use for this simulation scenario because: A. Vital signs on the monitor screen can be manipulated to mimic deteriorating condition.

B. Students can’t cause any pain in a mannequin.

C. There is no risk to an actual patient.

D. Students will not be distracted by any patient conversation.

4

Which statement is TRUE about simulation?

A. Nurses call the attending physician for further instructions if an emergency arises.

B. Nurses ask the charge nurse to prioritize the interventions.

C. Simulation may be important to ensure patients have competent practitioners.

D. Nurses defer to the pharmacist to decide which medications need to be administered first.

1. Correct Answer: B—Deliberate and repetitive practice during simulated scenarios helps to enhance abilities to complete skills.

2. Correct Answer: D—Interdisciplinary simulations are most effective when team members are aware of their synergistic roles.

3. Correct Answer: A—The human patient simulator interfaces with a computer monitor so that users can visualize parameters on a screen that can be set to imitate worsening patient condition.

4. Correct Answer: C—Some experts believe that simulation-based assessment may be integral in ensuring that the public is cared for by competent practitioners.

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OR TODAY | May 2016

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C R E AT I N G T H E

ULTIMATE SURGICAL ENVIRONMENT

BY DON SADLER

Perioperative leadership needs to clearly define a commitment to excellence. OR staff needs a leader they can trust who is engaged in the daily challenges of the unit.”

T

he word ultimate gets thrown around a lot these days. Whether it’s the ultimate sub sandwich, the ultimate sports car, the ultimate big-screen TV or ultimate Frisbee, it seems like everybody wants to call their favorite whatever-it-is “the Ultimate.”

So we thought we’d focus our cover feature article in this issue on creating “the ultimate surgical environment.” To find out how, we spoke with several perioperative veterans to get their thoughts on what it takes to create the ideal surgery center.

It Starts With Leadership Everyone we spoke with said the same thing when first asked what it takes to create the ultimate surgical environment: great perioperative leadership.

“It starts at the leadership level,” says Virginia Chard, the director of surgical services at Pen Bay Medical Center in Rockport, Maine. “Perioperative leadership needs to clearly define a commitment to excellence. OR staff needs a leader they can trust who is engaged in the daily challenges of the unit.”

C R E AT I N G T H E

ULTIMATE

SURGICAL ENVIRONMENT

Jan Davidson

“Having a smooth-running OR has a lot to do with the leadership capabilities at the top of the organization,” adds James X. Stobinski, Ph.D., RN, CNOR, the director of credentialing and education at the Competency & Credentialing Institute.

“Leaders need to balance the needs of OR staff with the increasing demands for efficiency in health care delivery,” says Stobinski. “There are a lot of balls that have to be kept up in the air.”

Jan Davidson, MSN, RN, CNOR, CASC, the director of the Ambulatory Surgery Division for the Association of periOperative Registered Nurses (AORN), notes that there are many different leadership styles.

“However, great leaders are able to adapt their leadership style to the demands of the situation or challenges that the organization may face,” Davidson says.

There are pros and cons to all leadership styles, says Davidson.

“Unfortunately, the classic model of military-like leadership is the model most often used in the OR — and this is probably the least effective leadership style,” she explains.

“If employees are rarely praised for 44

OR TODAY | May 2016

their good work, this will eventually lead to low job satisfaction and low employee morale,” Davidson adds.

“And this, in turn, leads to low physician satisfaction, poor teamwork and poor communication. It can even impact surgical outcomes.”

Stobinsky points to the ability of OR leadership to help staff navigate all of massive changes health care organizations are facing today as critical to creating the ultimatesurgical environment.

“Invest in ongoing education and training for your staff, including your managers,” he says. “By taking good care of your people, you’ll create a better OR environment and get better results.”

If employees are rarely praised for their good work, this will eventually lead to low job satisfaction and low employee morale.”

–Jan Davidson “Having clearly defined goals and practicing constant communication with your front-line staff will drive both the morale and efficiency of your team,” adds Chard.

Quality Over Quantity Another change OR leadership and management has to deal with today that they didn’t in the past

is the increased focus on quality over quantity.

“The old saying that volume cures a lot of ills no longer holds true,” Stobinsky says.

“Managing the OR today is about much more than just maintaining a high-utilization rate,” he adds.

“With the shift to accountable care organizations and changes in health care reimbursement, quality outcomes are more important than ever in creating the ultimate surgical environment.”

Having a patient-centered focus is critical.

“Everyone on the OR team should share one common goal: to support patients with safe, high-quality care in a cost-effective and efficient model of practice. This requires a commitment to cost awareness and finding safe ways to improve efficiency,” Chard says.

Stobinsky echoes her sentiment about being patient centered.

“For example, what are patients’ expectations for how long they should have to wait for surgery?” he asks. “Many ORs need to change the way they do things so the focus is on the patient and not the surgeon. Otherwise patients will go somewhere else — they have choices today.”

Addressing Key Concerns In the 2015 OR Today Reader Survey, issues listed among perioperative nurses’ biggest concerns include dealing with difficult personalities and creating accountability in the OR. All of the perioperative veterans we spoke with agreed that addressing these concerns is one of the keys to creating the ultimate surgical environment.

“Difficult personalities and a lack of accountability in the OR can be demoralizing and lead to WWW.ORTODAY.COM

low morale among staff,” says Davidson. “But while staff members need to be held accountable for their actions, this doesn’t mean mistakes have to be punitive.”

“Instead, mistakes should be viewed as a learning opportunity for everyone and a chance to make improvements,” Davidson adds.

“In fact, statistics show that the majority of medical errors occur due to a flaw in the system rather than human error.”

Stobinski notes that in the past, many hospitals tolerated abusive behavior on the part of surgeons because they brought in volume and revenue.

“But not anymore,” he says. “Creating the ultimate surgical environment requires dealing head-on with difficult personalities in the OR, including difficult surgeons.”

One simple step that Davidson recommends to help create a more relaxed and productive OR environment is to allow everyone on the team to be called by their first name.

“This tends to put everyone on an equal playing field, removing the hierarchy and making each team member feel valued,” she says.

“In front of patients and family members, it should still be the expectation that physicians be called ‘doctor,’ ” Davidson adds. “But otherwise, allowing everyone in the OR to be on a firstname basis will do a great deal to raise the morale and improve teamwork.”

A Few Best Practices Chard lists a few best practices followed at her facility that help as they strive to create the ultimate surgical environment.

“For one thing, we have a review of our operating room dashboard data every month at our staff WWW.ORTODAY.COM

meetings,” she says. “In addition, we have clearly defined performance goals and benchmarks. And, we utilize data driven key performance indictors in our Lean Daily Management within the unit.”

Davidson acknowledges the challenges staff face in room turnover between cases, especially in ambulatory surgery centers.

“A consistent surgical volume equals a profitable surgery center,” she says.

She recommends ensuring that there’s adequate help with room turnover.

“Having an extra person to ‘float’ can be invaluable,” she says.

“This extra person can not only help with room turnover, but also with covering during lunch and other breaks. Also, staff is less likely to cut corners if they have adequate help and don’t feel so rushed.”

“With enough help, you might even be able to add an extra case or two, which will more than pay for the extra staff person,” she adds.

Virginia Chard

“Whether this be that you exceeded your volume from the previous month, you had no surgical site infections, or your patient satisfaction scores continue to rise, it’s important that everyone on the team be included in the recognition,” Davidson says.

“Creating the ultimate surgical environment is all about communication, shared goals and shared purpose,” Chard stresses in summing everything up. “It’s the people who make a great OR.”

It’s the people who make a great OR.” –Virginia Chard

Celebrate Success!

Finally, Davidson strongly recommends that OR leadership and staff celebrate success every month.

May 2016 | OR TODAY

45

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OR TODAY | May 2016

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Spotlight on: Mary Salabounis RN, Aspen Valley Hospital

"A few nurses stood out as having made a difference in the world and being patient and kind. They inspired me that I could work just as hard, but rather than changing a corporation’s bottom line, I could change someone’s life."

WWW.ORTODAY.COM

May 2016 | OR TODAY

49

W

hen Mary Salabounis arrived at Aspen Valley Hospital in Aspen, Colorado, it was as a travel nurse. In the mountains, health care workers count ski seasons instead of years, and Salabounis is on her third, having relocated for good after two prior seasons interrupted by a summer tour of duty in Bozeman, Montana. She’s flourished in Aspen, having taken home a Colorado Health Care Stars Award in February for her work educating surgical staff on LEAN methodology and earning a promotion to charge nurse along the way. It seems only fitting that Salabounis should be lauded for bringing her peers up to speed on best practices; after all, she said, it’s how she was brought up in the field.

Mary Salabounis is seen with her nursing staff.

About 13 years ago, Salabounis was in the middle of successful a sales career in Chicago. Looking for a way to give back in her down time, she discovered that the nearby Advocate hospital in Libertyville, Illinois, broadcast an inpatient bingo channel on its closed-circuit network.

Salabounis thought it would be fun to be a caller, but discovered that the Advocate bingo network only aired during business hours, while she was working. The only alternative

50

OR TODAY | May 2016

volunteer opportunity available was in the emergency room, which Salabounis “just really couldn’t wrap [her] brain around.”

“I really was not familiar with the environment,” she said. “I had never been around people with an illness or an emergency. I just wanted to be the lady that provided the fun. I said I would try it once.”

When she arrived, Salabounis saw how hard the floor staff was working; how anxiety and anticipation

weighed on patients waiting to be seen. She decided to come back for a second day, armed with crossword puzzles and coloring pages. The nurses started sending her on kitchen errands to fetch meals for patients who were being admitted.

Suddenly, an unenviable chore became an opportunity to make people comfortable, and Salabounis found herself making a routine of her three-hour Monday night visits.

Along the way, the examples of a few hard-working staffers motivated her to take up nursing full-time.

“A few nurses stood out as having made a difference in the world and being patient and kind,” Salabounis said. “They inspired me that I could work just as hard, but rather than changing a corporation’s bottom line, I could change someone’s life. At 32 years old, I quit my job in sales and entered nursing school.”

One of those was nurse Karen Turel, who set an example of kindness and professionalism, Salabounis recalled, particularly in treating inmates, the homeless, or patients with fetid wounds. Another ER nurse, whom she only remembers as Michael, helped her with a nursing-school paper on anaphylaxis and told her, “You’re going to be great at this.”

“The whole crew of doctors and nurses who were there on a Monday night inspired me to open that door,” Salabounis said. “Had I been somewhere else, I don’t know if I would have been so welcomed into the profession.”

From those early moments, or perhaps in deference to them, Salabounis still takes inspiration from the variety of challenges she encounters in the nursing field, be they from coworkers, patients, or difficult

WWW.ORTODAY.COM

Tiehack/ is seen on is un bo rado. la a Mary S spen, Colo ountain, A M ilk m r e butt

Fall Hike o n Tiehack overlookin Maroon in g the Bells, Aspe n, Colorado .

Sydney en above se is is n bou alia.

Mary Sala in Sydney, Austr Harbor

"Career change can be inspiring. If you don’t have that calling in your initial time in college, don’t be afraid to change." surgical cases. Emergencies have a way of clearing the mind of all distractions, and she appreciates how clearly it crystallizes her attentions and reactions. Salabounis finds that one of the most reliable tests of her nursing acumen is how well she responds to patients at multiple levels of acuity who need things simultaneously, or in balancing the demands of different colleagues in the operating room.

“I know that if we have a situation going on or a patient going in, you turn all those other thoughts off,” she said. “You’re thinking about step one, step two, step three; who do I need to contact, what’s the priority? In the OR setting, you’re really in close collaboration with your anesthesia provider, who is 50 percent of the equation; the other 50 percent is the surgeon. Working with both of them simultaneously, and communicating with your scrub tech to seamlessly make their orders happen while it’s all going on at once, you’re

WWW.ORTODAY.COM

synthesizing all this information coming to you and providing care in the best way that you know how.”

Coming to nursing later in life has its benefits as well, Salabounis said. In the operating room, where a nursing professional must be able to have the confidence of his or her convictions, age has allowed her to keep from being easily intimidated. She entered the field with a variety of problem-solving experiences from a previous career.

Even enrolling in nursing school as a change-of-life student gave her a level of comfort in the classroom that her classmates didn’t necessarily possess.

“Any life experience brings confidence,” Salabounis said. “I wasn’t quite as fearful of tests; I wasn’t as burdened by homework. I knew I had a solid goal. I had been in the working world for a time. With changing technology and advancing disease processes, nursing is something that I will always continue to learn to stay current with my

career and to enhance myself as a person and a nurse.”

“Career change can be inspiring,” she said. “If you don’t have that calling in your initial time in college, don’t be afraid to change. Nursing programs are very accommodating. It’s a second chance to have a great career.”

Some lessons aren’t learned in the classroom, however: the way it feels to comfort a nervous patient, or the look of relief on the face of a frightened patient who opens his or her eyes to find a procedure has been completed. In those moments, Salabounis finds the ability to take pride in her work, “because even though you’re getting paid, you’re still making a difference in someone’s life.”

“Even though it’s technically my job, I get to secretly know that I made somebody comfortable; that I kept them safe,” she said. “It’s very satisfying.”

May 2016 | OR TODAY

51

CONTINUATION FROM JANUARY SPOTLIGHT ON ARTICLE

PRESIDENTIAL RECOGNITION

By John Wallace, Editor

M

aking the most of an opportunity while giving back to the community isn’t something most people do. It’s not easy and it doesn’t happen as often as it should. Edward McKay isn’t like most people.

McKay, the surgical technician in the pediatric operating room at John Hopkins University Hospital who was featured in the January/February issue of OR Today, is no stranger to powerful individuals. He works with surgeons and that includes working alongside presidential hopeful and surgeon Ben Carson for almost a decade earlier in his career.

McKay grew up in the Latrobe projects of East Baltimore and was one of the few people in his group of friends to complete high school. From there, he was able to obtain a job in the John Hopkins University Hospital’s environmental services department. He later found out about a program that helped with education costs while he continued to work. He applied and, through dedication and hard work, was able to obtain a degree from Baltimore City Community College. It was that degree that empowered him to become a surgical technician.

A biographical video on McKay that is used as part of the hospital’s orientation program has been seen by thousands and prompted the OR Today feature story that ran earlier this year.

The OR Today story written by Matt Skoufalos was well received by McKay and the hospital staff. It also received recognition from President Barack Obama. McKay, interested in the My Brother’s Keeper initiative started by Obama, emailed the President of the United States, Vice WWW.ORTODAY.COM

Edward McKay, Jr. is seen with a framed letter from President Barack Obama. (Photo: Cathleen Hannah, RN)

President Joe Biden and the White House to share his story because of his interest in the program and a desire to get involved.

“It’s a program where you mentor young black men from the inner city. I thought it would be cool to join the Program and share my story of overcoming my obstacles growing up in the projects with the program,” McKay said.

“I was reading online and I saw President Obama talking about it in a couple of different interviews. One was with Charles Barkley and the other one was with Kendrick Lamar,” he added. “I was interested in joining it while I was listening to them discuss what the program was about.

I felt like it is a program that was needed. I like sharing my May 2016 | OR TODAY

53

“I used to watch Ben Carson do speaking engagements every year and he also had the Carson Scholarship Program to help get more children to read and think big. I would like to do the same thing.”

PROOF

TRIM 4.5”

story with young people from different backgrounds to “I bring that letter from President Obama with me when I PROOF APPROVEDspeak CHANGES NEEDED show them that you don’t have to be a product of your to children and they love it. The adults get gooseenvironment.” bumps when they see it, too,” McKay said. “That video that CLIENT SIGN–OFF: McKay was shocked when he received a response I did opened up a lot of doors for me and now the magazine PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT from one of his emails. article has helped take things to a new level.”

LOGO PHONE NUMBER WEBSITE ADDRESS SPELLING GRAMMAR “When I first started sending emails, I never thought that I would get a response. I had just begun sending READ THE LETTER them the week before and I’m sure that the White online at www.ortoday.com/presidential-recognition.

TRIM 3.25” House gets thousands of emails and letters each day,” McKay said. “I was sending emails to Joe Biden, President Obama and the White House, itself. The day that I received the email, I had just finished working out at the gym and I stopped to check my messages before I left. It completely blew me away. I never thought that I would see my name and the president’s name on the same piece of paper.”

“When you send the email you can choose your heading,” he continued. “You can choose from civil rights or health care or education, but the My Brother’s Keeper campaign wasn’t an option. So, that tells me that somebody really did read my article and watch my video.”

The letter from Obama has motivated McKay to do YOUR PATIENT IS PREPPED more outreach to youth in the community.

AND COMFORTABLE. “My plans now are to move forward and help out with programs like this as much as I can. I’ve been doing ARE YOU? speaking engagements with fourth-graders, high schoolers and some community colleges. I love talking to young kids and telling them about my background and taking questions,” McKay said. “My ultimate goal is to write a Prepared To Endure book and further tell my story to help inspire the youth of America. I used to watch Ben Carson do speaking engagements every year and he also had the Carson Scholarship Program to help get more children to read and think big. I would like to do the same thing.”

Knowing that Obama has his back helps. McKay said Contact us at 321-752-4130 to find out how you could receive a free 30-day trial coolvest.com/OR even the adults in attendance at his talks have a positive reaction to his letter from the Oval Office.

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OR TODAY | May 2016

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OUT OF THE OR HEALTH

BY GINA ROBERTS-GREY EATINGWELL.COM

A SPLASH OF VINEGAR OFFERS SURPRISING HEALTH BENEFITS

V

inegar’s not a magic elixir – but it may be able to help your waistline, cholesterol and more! Research suggests that a splash of vinegar may give your weightloss efforts a small boost, as people who added raspberry vinegar or apple-cider vinegar to their diets daily for at least four weeks slimmed down more than those who didn’t get vinegar. Who knew? Here’s a little more information about some common vinegars, plus some ideas for how to work vinegar into your daily diet.

APPLE-CIDER VINEGAR Apple-cider vinegar helped increase “good” HDL cholesterol in animal studies. Plus, it contains a polyphenol, chlorogenic acid, thought to reduce “bad” LDL cholesterol.

Apple-cider vinegar has a pale- to medium-amber color and can be found filtered or unfiltered. Applecider vinegar can help draw out flavors in recipes, and is often used in salad dressings, apple-based desserts or to make a glaze for pork chops.

RED-WINE VINEGAR Acetic acid, which gives red-wine and other vinegars their sour taste, helps you stay satisfied after eating by minimizing blood sugar spikes. As you might expect from its name, 58

OR TODAY | May 2016

red-wine vinegar is made from fermented red wine. It’s commonly used in vinaigrette salad dressings, or stirred into a bit of butter to dress wilted or sauteed greens.

BALSAMIC VINEGAR The antioxidant quercetin, found in grape-based vinegars like balsamic and apple vinegars, may help tame high blood pressure, says research in the Journal of Nutrition. True balsamic is made from cooked and pressed Trebbiano or Lambrusco grapes, which are aged in barrels.

Check your label to be sure sugar hasn’t been added to mimic the inherent sweetness of a high-quality aged balsamic. Balsamic vinegar is delicious in salad dressings, or can be

reduced by boiling and drizzled over pork chops or even ice cream.

RICE VINEGAR Vinegars contain phenols, naturally occurring plant compounds linked with reduced cancer risk. One type of rice vinegar, kurosu, boasts more than any other. Rice vinegar is typically a very pale yellow color, and is most commonly used in Asian cooking because of its mild acidity and slight sweetness.

You’ll also find seasoned rice vinegar on grocery shelves, but regular rice vinegar is typically a more versatile choice to keep in your pantry, as you can choose what seasonings to add yourself.

RASPBERRY VINEGAR Raspberry vinegar is made by filling a jar with whole, fresh raspberries, and adding enough good-quality red-wine vinegar to cover the berries. After sitting for about a week (covered), the raspberries are strained out, leaving behind a fruity-tasting vinegar that can be drizzled over ice cream or used in vinaigrettes. A bottle of raspberry vinegar should be used within six months.

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59

OUT OF THE OR FITNESS

BY MARILYNN PRESTON

HOME WORKOUTS ARE GYM DANDY

L

ooking to boost your well-being? I’m a big believer in home gyms.

You wake up, throw on what passes for workout clothes ... or nothing ... and before you can find an excuse to skip it, you’re walking the treadmill or pumping the weights and spreading joy throughout your body.

Yes! What could be better? No time-sucking commute to the gym.

No monthly dues. No comparing yourself to the thinner and more buffed in your spinning class. (Never ever do that.)

At home, it’s just you and the practice and your growing awareness that regular exercise is the rock solid foundation of a healthy lifestyle.

60 OR TODAY | May 2016

You’ll gain strength, reduce stress, and duh, you’ll make your body great again. Exercising at home burns pounds of calories. But keep in mind: You can’t outrun your fork. If weight loss is your goal, a home gym is a dear friend, but it’s no substitute for smaller portions and a personal ban on processed foods and sweetened cola drinks, especially the ones with fake sweeteners. So make space, even if it’s the corner of your bedroom or a portion of the family room, and need I mention ... far from the fridge.

MAKE IT INVITING Your workout space can be small, but if it’s nasty – a dirty basement, a stuffy attic, a chilly garage – you’ll find a reason to avoid it. Treat it like the sacred space it is. An area with natural light, fresh air and no clutter is the feng shui ideal, but if that’s

not possible, start with what you’ve got. Make it clean and appealing. A yoga mat and a fresh flower in your living room can work wonders on your mind and body. Your space doesn’t matter nearly as much as your intention.

FEEL GOOD ABOUT WHAT YOU SPEND I don’t know what your budget is for home gear, but two things I do know for sure: First, investing in your own wellness is money well spent. And second, don’t buy cheap stuff. It will feel junky, and you won’t use it. If you’ve got $5,000 or more to outfit an entire room, be thankful, but you can get just as fit for $500 or less, using free weights, stability balls, jump ropes, resistance bands, etc. It’s easier than ever to find high-quality used gear – online, in specialty stores WWW.ORTODAY.COM

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MAKE IT USER-FRIENDLY PLEASE Equip your space with whatever it takes to make your CONFIRM THAT THE FOLLOWING ARE CORRECT LOGO PHONE NUMBER WEBSITE ADDRESS workout enjoyable. Music can be a great motivator.

Watching TV or reading a book while you work out are options, but exercise purists think these distractions TRIM 3.25” make your workout less effective. To get into the zone of peak performance, focus your attention on your inner body, your breathing. If you prefer to be distracted, no blame.

Retreating to a workout space you’ve created mindfully – embellishing it with photos you love, stones you’ve ARE PROVEN TO kept, quotes that inspire you – will exert a powerful influence on your willingness to come back to it. And don’t forget to add a meditation pillow to the mix, even if you’re not sure what to do with it. Someday, if you keep your brain healthy and curious, you’ll want one.

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MARILYNN PRESTON is a healthy lifestyle expert, well-being coach and Emmy-winning producer. She 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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It’s fine to keep it simple. Keeping track in a journal helps you develop the habit of a daily exercise practice. I promise you that when that happens, your whole life will change in remarkable and delicious ways.

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OUT OF THE OR NUTRITION

BY JUDY THALHEIMER, R.D., L.D.N. ENVIROMENTAL NUTRITION NEWSLETTER

CALCIUM CONTROVERSY A

mericans are encouraged to get more calcium to build and maintain strong healthy bones. But recent headlines suggest that too much calcium could actually be bad for your health and may not, after all, do much to protect your bones. So, what should you do? Until new research provides clear answers, ditch those supplements in favor of calcium-rich foods … and don’t overdo it.

CALCIUM IS KEY Muscles, nerves, veins and arteries, enzymes and hormones all depend on calcium to function properly. If we don’t get enough calcium in our diets to do these important jobs, our bodies take some from our bones. It stands to reason that if we don’t take in enough calcium, our bones will eventually become weak and easily broken. But how much is enough? Is there such a thing as too much? And what is the best way to get calcium?

The Institute of Medicine (IOM) recommends most adults should aim for 1,000 milligrams (mg) per day, and women over 50 and men over 70 should get 1,200 mg. Since vitamin D is necessary for calcium absorption, the IOM recommendations include guidelines for vitamin D intake as

64

OR TODAY | May 2016

well: 600 to 800 International Units (IU) a day for adults.

While lots of experts, like the National Osteoporosis Foundation, the Dietary Guidelines, and the American Society for Bone and Mineral Research agree with the IOM’s recommendations, a number of researchers think the recommendations are too high. They cite numerous studies that fail to show any relationship between calcium intake and bone density or fracture risk. To make matters worse, calcium supplements make a lot of people constipated, and some studies suggest they may increase risk of kidney stones and heart attacks.

Supporters of the recommendations counter that a lot of these studies are inconclusive or flawed.

While all of this confusion gets sorted out, here is what we know for sure: • Food is better than supplements.

Everyone is in agreement that we should get our calcium from food first. If you are unable to get enough calcium through food, then use supplements to make up the shortfall.

• Don’t overdo it. There is no benefit to eating or taking more calcium than the recommended daily amount, and too much may even be harmful.

• Got D? Vitamin D is added to milk and a number of other foods, and it’s found naturally in some fatty fish like salmon, but spending 15 minutes outside two or three times a week (without sunscreen) may be all you need. (In colder climates, increase vitamin D dietary intake from October through March, since the sun is weaker.)

• Phosphorus for us. Other nutrients, like phosphorus, also are critical to bone health. Phosphorous is found in foods like fish, dairy, poultry, meat, lentils, nuts and whole-grains.

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NUTRITION

• Dairy plus. Dairy foods are an excellent source of

calcium, but they are far from the only source. Nondairy foods such as tofu, greens and brown rice are good sources of calcium.

• Grin and bear weight. Exercise doesn’t just build muscle it also builds bone. People of all ages should do weight-bearing exercises, like running, brisk walking, climbing stairs or dancing for a total of 30 minutes a day, and do muscle-strengthening exercise two or three times a week.

• Hold the salt. The more sodium you eat, the more calcium you excrete. If all that calcium came from your bones, you could lose up to 1 percent more bone a year for each extra gram of sodium you eat a day.

We need more research to work out the inconsistent and inconclusive information we have on calcium. Until then, aiming for – but not above – the current recommendations (preferably from food), eating a healthy balanced diet and staying active are the best.

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– Environmental Nutrition is the award-winning independent newsletter written by nutrition experts. For more information, visit www.environmentalnutrition.com.

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65

OUT OF THE OR

66

RECIPE

BY EATINGWELL

OR TODAY | May 2016

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RECIPE

TURN UP THE HEAT

HEARTY TORTILLA SOUP IS SPICY AND COLORFUL

T

ortilla soup is a signature Mexican dish, and there are about as many versions of it as there are cooks.

In Mexico you can find any style you like: with only vegetables, no vegetables, no chicken, a chicken leg, shredded chicken or a combination of all of these ingredients. Sometimes you’ll even find corn or tomatillos in the ingredient list. Tortilla soup can also be very spicy or rather mild, depending upon what chilies are included. In this recipe a crumbled, dried chile is sprinkled on top to control how much heat you want in your bowl.

In a medium soup pot heat the oil over a medium heat. Add the onion and sauté until golden brown, making sure the mixture does not burn, about 7 minutes. Add the garlic and cilantro and sauté another minute. Add the tomatoes and cumin and cook another 5 minutes, stirring occasionally, until thickened.

Add the broth. Remove from the heat and puree until smooth in the pot using a hand immersion blender.

Return the soup to the heat. Add the carrot and zucchini, and simmer, partially covered, over medium low heat for about 15 minutes, stirring occasionally or until the soup is slightly thickened and the vegetables are tender. Add the chicken slices and simmer another 2 to 3 minutes or until just cooked through. Taste for seasoning.

While the soup is cooking prepare the toppings. To toast the tortilla strips: Preheat the oven to 400 F place the tortilla strips on a baking sheet, spread them evenly over the pan. Bake for 7 to 8 minutes or until crisp and beginning to brown.

Reserve for the garnish.

Place the chile in a nonstick skillet over medium high heat and toast for about 2 minutes on a side or until it

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is fragrant and puffed but not burnt.

Remove the stem and the seeds (squeeze seeds out through the top); crush the chile in a mortar or with the side of a heavy knife and reserve for the garnish.

To serve: Ladle the soup evenly into each bowl. Squirt some lime juice over the soup. Garnish with the toasted tortilla strips, cilantro, crushed chile, avocado and cheese.

Serve immediately.

TASTY TIPS Try to find fresh, handmade tortillas for a more authentic flavor. Cut them as directed, and dry them out by leaving them on the counter for an hour before cooking.

While the tortillas are toasted in this recipe, you can fry them in vegetable oil for a richer result. Heat about 1/2 cup of vegetable oil in a medium skillet on medium-high heat. Drop a tortilla strip in the oil and see if it begins to fry. If so, drop handfuls of tortilla strips in the oil and fry, turning with tongs, until crisp and brown, about 3 minutes.

Drain on paper towels.

To make this vegetarian, substitute vegetable broth for chicken broth, and omit the chicken.

INGREDIENTS: 2 tbsp vegetable oil 1 onion, thinly sliced 3 garlic cloves, peeled and left whole 2 tbsp chopped fresh cilantro 1 14 1/2-ounce can diced fireroasted tomatoes, or regular diced tomatoes, with juice 3/4 tsp ground cumin 4 cups chicken broth 1 medium carrot, peeled and cut into 1/2-by-2-inch strips 1 medium zucchini, cut into 1/2-by-2-inch strips 1/2 pound skinless, boneless chicken breasts (or tenders), 1/2-by-2-inch strips Salt and freshly ground black pepper For the topping: 2 tsp fresh lime juice 4 corn tortillas, preferably stale or at least dry, halved crosswise and sliced into thin strips 1/4 cup chopped cilantro leaves 1 dried chile, such as pasilla 1 ripe avocado, peeled and cut into 1/4 inch cubes 1/4 cup shredded Monterey Jack cheese or Pepper Jack cheese

– Diane Rossen Worthington is an authority on new American cooking.

She is the author of 18 cookbooks, including “Seriously Simple Parties,” and a James Beard Award-winning radio show host. You can contact her at www.seriouslysimple.com.

May 2016 | OR TODAY

67

OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • MAY • DO YOU LIKE TO SHARE??

Do you share your OR Today magazine with coworkers? Email a photo of a colleague reading OR Today magazine to Editor@MDPublishing.com to be entered to win lunch for your department. We will share your photo with our readers and select one lucky person to win a $50 gift card to Subway!

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smile at u o y e im t y r e v “E n action of a is it , e n o e m so hat person, a t o t t if g a , e v lo .” beautiful thing –Mother Teresa

68

OR TODAY | May 2016

s Way Better Nacho ‘A NACHO ABOVE’ DEBUTS AT FOOD SHOW Live Better Brands’ new tortilla chip variety A Nacho Above made its debut at the Winter Fancy Food Show in San Francisco earlier this year.

It is the first new everyday flavor to be added to Way Better Snacks’ tortilla chip line since March 2014. The new flavor’s moniker, A Nacho Above is made with only the highest quality ingredients, such as sprouted chia, flax seed and quinoa. The new chip gets its nacho-rific flavor from organic cheddar cheese and a blend of herbs and spices including pure sea salt, onion, garlic, paprika, black and red pepper.

The new variety was borne out of CEO Jim Breen’s desire to make a favorite flavor “way better.”

“When Way Better Snacks launched in 2011, we showed snackers that flavorful chips don’t have to be greasy and fake,” Breen said. “Our new flavor A Nacho Above is evidence that you can enjoy a deliciously cheesy chip that’s made from simple, sprouted ingredients.”• FOR MORE INFORMATION, visit gowaybetter.com.

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PINBOARD

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CONTEST WINNERS

lee Murray e D o t s n io t la u t a r Cong Center l a ic d e M re o sh y a & the B

ENERGEMS CHOCOLATE ENERGY HITS WALMART STORES NATIONWIDE The dark chocolate energy supplement Energems are now available in select Walmart stores across the country in mint and dark chocolate flavors.

At only 50 calories per serving, three Energems are equivalent to 133 mg Energems Chocolate of caffeine (i.e., a large cup of coffee) and contain antioxidants naturally found in dark chocolate.

“We’re excited to partner with an American staple like Walmart,” said General Manager of Energems, Kristopher Trust. “We appreciate that Walmart shares our goal of putting healthier, cleaner energy into the hands of consumers, and this partnership gives us both the capacity to do just that.”

Energems recently closed a successful year that included acceptance into the Council for Responsible Nutrition as well as recognition as Best New Product by the National Association of Chain Drug Stores and Best New Product of 2015 by Vitamin Retailer Magazine. • FOR MORE INFORMATION, visit www.energems.net

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May 2016 | OR TODAY

69

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OR TODAY | May 2016

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The complete positioner…. for small to obese

Discover the De Mayo Hip Positioner Systems The hip positioner you can customize for any patient ®

Stop breaking your back positioning patients. Now there’s a simple, adjustable positioning alternative for any OR table. The doctor-designed De Mayo Hip Positioner is a complete system that gives you everything you need to secure any patient – obese or small – with unobstructed access to the surgical site. Latex-free, single-use Patient Protective Pads provide superior protection and added stability to the overall construct. Move up to the positioning alternative that’s better for every body. Visit www.impmedical.com or call 800-467-4944 to order your complete system today.

®

The operative word in patient positioning.

The smarter positioner you build around your patient Secure obese patients without lifting

Foam pads protect patients securely

Security without abdominal pressure

Unobstructed access to surgical site

De Mayo Hip Positioner® US Patent No. 6,820,621

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