OR Today - June 2016 by MD Publishing

SPOTLIGHT ON

CLOROX

SCRAPBOOK

LISA ANTENUCCI PAGE 56

ADVICE PAGE 11

AORN 2016 PAGE 71

TAKE GOOD CARE

JUNE 2016

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CONTENTS

features

OR TODAY | June 2016

CORPORATE PROFILE: GLACIER TEK

Find out why Glacier Tek Cool Vest is the perfect solution for surgeons and operating room staff, allowing for unencumbered freedom of movement while helping them stay alert and focused during long, physically demanding procedures and surgeries.

! R O R ER 50

HOW TO AVOID SURGICAL ERRORS

Mistakes can be fatal in the operating room. Experts agree that any tool or advice that can help prevent errors should be used. OR Today looks at “never events” and other surgical errors and how to avoid them.

SPOTLIGHT ON: LISA ANTENUCCI Nurses face stress daily with a high probability of burnout. Temple University Hospital staff nurse Lisa Antenucci discusses the need for caregivers to take care of themselves. She has blended travel and yoga to create a cure for her ills.

OR Today (Vol. 16, Issue #5) June 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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June 2016 | OR TODAY

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

EDITOR

John Wallace | jwallace@mdpublishing.com

ART DEPARTMENT Jonathan Riley Jessica Laurain Kara Pelley

30 62

ACCOUNT EXECUTIVES

Warren Kaufman | warren@mdpublishing.com Jayme McKelvey | jayme@mdpublishing.com Chandin Kinkade | chandin@mdpublishing.com

71 INDUSTRY INSIGHTS 11 13 20 22 24

Clorox Advice News & Notes AAAHC Update OR Today Webinar ASCA

ACCOUNTING Kim Callahan

WEB SERVICES Betsy Popinga Taylor Martin Adam Pickney

CIRCULATION Lisa Cover Laura Mullen

IN THE OR 26 29 30 36

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 62 64 66 68 71 73

Fitness Health Nutrition Recipe Scrapbook Pinboard

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

PROUD SUPPORTERS OF

74 Index

OR TODAY | June 2016

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Quality built, American made

Medical Equipment

MAC Medical, Inc. manufactures the highest quality healthcare equipment available. Our engineering capabilities allow us to custom design any specific product your facility may have. With no project too large or too small for our capability, we are committed to providing solutions for your custom needs with our American made products. Some of our products include: • Warming Cabinets • Stretchers • Surgical Scrub Sinks • Processing Sinks • Cabinetry • Tables • Carts • IV Stands • Mayo Stands • Solution Stands

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Customer needs are our first priority. June 2016 | OR TODAY

OR TODAY | June 2016

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INDUSTRY INSIGHTS CLOROX ADVICE

BY ROSIE D. LYLES, MD, MHA, MSC; HEAD OF CLINICAL AFFAIRS, CLOROX HEALTHCARE

NASAL DECOLONIZATION IN PRE-OPERATIVE PROTOCOLS AN ANTISEPTIC ALTERNATIVE TO ANTIBIOTICS THE BURDEN OF SURGICAL SITE INFECTION In today’s dynamic healthcare environment, preventing surgical site infections (SSIs) is one of the greatest challenges. SSIs continue to rank as one of the most common types of healthcare-associated infections1, and are associated with significant direct and indirect financial and emotional costs to healthcare facilities and to patients. The majority of SSIs are caused by Staphylococcus aureus (S. aureus),2 and patient colonization with S. aureus is a major risk factor for SSIs.2 DECOLONIZATION STRATEGIES TO REDUCE SSIS Patient decolonization prior to surgery may help to reduce the risk of SSIs. 3,4 Preadmission bathing or showering with chlorhexidine gluconate (CHG) is most commonly used to cleanse the skin. For nasal decolonizataion, the antibiotic mupirocin (brand name Bactroban) applied by the patient to the anterior nares twice daily for the five consecutive days prior to surgery has typically been used. However, concerns that resistance to mupirocin and low compliance may lead to decolonization failure has WWW.ORTODAY.COM

not decolonized.3 Universal decolonization with CHG and povidone iodine has also been shown to be as clinically effective but more cost effective than screening and decolonization with CHG and mupirocin.5 Studies have also shown that bacteria do not develop resistance to povidone iodine.6

ROSIE D. LYLES, MD, MHA, MSC; HEAD OF CLINICAL AFFAIRS, CLOROX HEALTHCARE

prompted the search for nonantibiotic alternatives. Povidone iodine can be an effective antiseptic alternative to mupirocin for nasal decolonization when used as part of preoperative bundle that includes CHG bathing. In patients undergoing orthopedic surgeries, povidone iodine is as effective as mupirocin for nasal decolonization,4 and a bundle including nasal decolonization with povidone iodine, CHG bathing and a CHG oral rinse resulted in lower rates of SSIs compared to patients

AN ANTISEPTIC ALTERNATIVE Clorox Healthcare™ Nasal Antiseptic Swabs are pre-saturated with a sterile povidone iodine gel and can be used for nasal decolonization. The swabs are applied by the healthcare provider one hour prior to surgery which can increase the likelihood of compliance. The gel reduces 99.4% of S. aureus at 1 hour and maintains persistence through 12 hours.7 In a safety and tolerance study, 96% of patients experienced no discomfort and were satisfied with the overall experience.8 An effective decolonization protocol that includes skin bathing and nasal decolonization has been demonstrated to be effective in reducing the risk of SSIs. Clorox Healthcare™ Nasal Antiseptic Swabs, are an antiseptic alternative for nasal decolonization that eliminates the risk and complexity of antibiotic usage. June 2016 | OR TODAY

CLOROX ADVICE

No More

Wheel obstructions FOR MORE INFORMATION about nasal decolonization, visit www.CloroxHealthcare.com/ NasalAntisepticSwabs REFERENCES 1 Sievert DM et al. Antimicrobial-resistant pathogens associated with healthcareassociated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol. 2013 Jan;34(1):1-14. 2 Kalmeijer MD et al. Nasal carriage of Staphylococcus aureus: Is a major risk factor for surgical-site infections in orthopedic surgery. Infect Control Hosp Epidemiol. 2000;21:319-323. 3 Bode LG, Kluytmans JA,Wertheim HF, et al. Preventing surgicalsite infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010;362(1):9â&#x20AC;&#x201C;17. 4 Phillips M et al. Preventing surgical site infections: a randomized, open-label trial of nasal Mupirocin ointment and nasal povidone-iodine solution. Infect Control Hosp Epidemiol. 2014 Jul;35(7):826-32. 5 Torres EG et al. Is Preoperative Nasal Povidone-Iodine as Efficient and CostEffective as Standard Methicillin-Resistant Staphylococcus aureus Screening Protocol in Total Joint Arthroplasty? J Arthroplasty. 2016 Jan;31(1):215-8. 6 Lanker Klossner B et al. Nondevelopment of resistance by bacteria during hospital use of povidone-iodine. Dermatology. 1997;195 Suppl 2:10-3. 7 Clorox Study #9550-005 (in vitro) 8 The Clorox Services Company Study Number: 2015-002/2015-003. 12

OR TODAY | June 2016

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INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

OLYMPUS INTRODUCES BIG SCREEN SURGERY IN 4K Olympus recently unveiled the Visera 4K UHD System, its big screen surgical system, at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2016 annual meeting in Boston. The Visera 4K UHD System delivers four times the resolution of HD with better light and wider color spectrum, promising to help surgeons operate with increased precision and confidence. The only fully integrated 4K imaging chain available for health care use, Visera 4K UHD allows operating room (OR) personnel to get closer to the operating field as they view cases live on a 55-inch operative display that magnifies anatomical features to deliver more visual information to the entire surgical team. While bringing more efficiency to the hospital, it has also been shown that minimally invasive surgery can

provide significant improvements in morbidity and mortality over open surgery, with benefits to patients including less post-operative pain and faster recuperation. Visera 4K UHD, the first of many products from the Sony Olympus Medical Solutions joint-venture, is enhancing minimally invasive surgery in a range of surgical specialties including general surgery, gastroenterology, gynecology, thoracic and urology for an estimated 20 million procedures annually. Olympus’ first customers began using VISERA 4K UHD during the first week of March 2016. “The color and contrast in the Olympus 4K image provides superb clarity, unlike any operative video image I have seen before,” said Dr. Ninh Nguyen, Professor and Interim Chair, Department of Surgery at the University of California Irvine

Medical Center. “The image is so clear that I was able to see down to the capillary level. [Seeing the capillary level] is important for improved dissection of tissue and evaluating the perfusion of the tissue.” Each component of the Visera 4K UHD System is built by Sony Olympus Medical Solutions. For information, visit medical.olympusamerica.com/ products/VISERA-4K-UHD-System.•

INNOVATIVE MEDICAL PRODUCTS UNVEILS ESTAPE TRENMAX Innovative Medical Products has announced the Estape TrenMax positioning system that provides OR staff an alternative to foambased solutions and a more secure way to position patients for Trendelenburg surgical procedures. The new system was displayed at the 2016 AORN Conference and Expo. The key component of the TrenMax Positioning System is IMP’s proprietary Phase 4 adhesive gel pad. Combined with other TrenMax anchoring mechanisms, the sticky pad, positioned on top of the system’s WWW.ORTODAY.COM

base pad, prevents patients from moving or sliding off the OR table. For maximum stability and patient safety, the TrenMax system also includes: eight straps, four on each side, extending from the base pad to lock the pad into place on the OR table rails; strips of hook material for attaching the gel pad to the base pad for superior holding power; four patent-pending clamps that tightly secure the base pad straps affixed to the OR table; and a simply designed strap arrangement for holding patients’ arms securely at their sides

during surgery. This last component allows access for leads and IVs. • For more information, visit www.impmedical.com.

June 2016 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

BUFFALO FILTER CELEBRATES 25TH ANNIVERSARY In 1991, Buffalo Filter was founded on the belief that there was a need to rid the world’s surgical environments of the hazards associated with surgical smoke plume exposure. Over the course of the last 25 years, Buffalo Filter has set the standard with state-of-the-art surgical smoke plume evacuation products and technologies; its education program has changed the way the global health care community sees surgical smoke. “We have achieved this milestone through the hard work and commitment of our employees; together we have dedicated ourselves to 25 years of product innovation and excellence, consistently providing our customers with cutting edge technologies. We have taken the company from design-

ing and producing the world’s most effective and intuitive smoke evacuators to now leading the industry in the design and development of surgical smoke evacuation pencils, non-powered laparoscopic smoke evacuation solutions and laparoscopic visualization technologies. I’m proud of our 25-year journey and where we are today, but this is only the beginning of a very exciting future for Buffalo Filter in surgical safety technologies” states Samantha Bonano, president and CEO of Buffalo Filter. Buffalo Filter’s 25th anniversary will be commemorated with a variety of events and promotions and the company has a new brand identity symbolizing its continued

growth and transformation as part of Filtration Group. “We have modified our logo to be in sync with who we are, where we are going and to better symbolize a dynamic future as part of Filtration Group,” states Bonano. “While the logo is changing to better communicate who the company is today, Buffalo Filter’s core mission remains the same – to improve health care safety through the management of environmental risks and become a recognized brand in surgical safety.” •

REPSCRUBS FIGHTS ‘STREET-SCRUB” INFECTIONS An increasing population of vendors are visiting multiple facilities throughout the day often wearing a single pair of “streetscrubs” which contributes to possible cross contamination among facilities, and an increased risk of SSI. RepScrubs was developed by medical sales veterans recognizing the need for a solution to reduce infection risk associated with the unlimited and sometimes problematic access of sales reps to the core of the hospital’s clinical operations. The RepScrubs program was recently awarded a Premier Contract. RepScrubs offers vendor management and cost reduction solutions. The RepScrubs program provides assurance that every vendor entering a sterile department is wearing clean prepackaged dispos14

OR TODAY | June 2016

able polypropylene scrubs dispensed onsite, while shifting the expense of providing those scrubs back to the vendor. The RepScrubs system offers hospitals a unique way of improving infection prevention and adherence to regulatory guidelines, reducing costs, and enabling hospitals to better control and manage vendor access. RepScrubs places a webbased cashless ScrubPort in the hospital. Vendors register on the RepScrubs website, create a PIN and vend a complete scrub outfit each time they enter a member facility. RepScrubs are made from an advanced SMS material that is strong, comfortable and completely recyclable. Each RepScrubs set includes shoe covers, a red bouffant cap and an expiring vendor identification badge that turns red after 8 hours. RepScrubs software and

Are “street scrubs” CONTAMINATING

YOUR OPERATING ROO

YOURfurther SOLUTIONallows FOR web-based reporting Infection Prevention hospital staff to monitor and manage the vendor’s access to ORs Expense Reduction and clinical staff areas. $ •

To learn more aboutVendor RepScrubs, Management visit www.repscrubs.com. PATIENT SAFETY, COST REDUCTION & VENDOR MANAGEMENT WWW.ORTODAY.COM

NEWS & NOTES

PRODUCTS RECEIVE AORN SEAL OF RECOGNITION Unplanned hypothermia remains a significant concern for patients undergoing surgery. The updated AORN Guidelines for Prevention of Unplanned Patient Hypothermia identifies “considerations for selecting a warming method which include: planned procedure, patient positioning and warming equipment constraints that could limit access to the surgical site and/or skin surface area contact.” Furthermore, “the collective evidence suggests that using a combination of methods for patient warming may be the most effective approach.” The Thermoflect Heat Reflective Technology Recommended Practice Program has earned the AORN Seal of Recognition for the third consecutive year. It is essential to evaluate each patient and determine an individual care plan for attaining and maintaining normothermia before, during and after surgery. This program is part of an Evidence-Based Outcome Evaluation (EBOE) process to simplify patient warming and help ensure each patient receives the best method, or combination of methods, based on their individual needs. Thermoflect Heat Reflective Technology banks the patient’s radiant heat by capturing and reflecting it back to the cutaneous layer (skin) as well as preventing convective heat loss (windchill). Patients are covered with Thermoflect products preoperatively to pre-warm the skin and continue with the patient throughout the surgical process to maintain normothermia. Thermoflect products are easily integrated into to a facility’s warming protocol, using no wires or external heat source, just proven reflective warming that works immediately for

the patient. Thermoflect Heat Reflective Technology products are cost-effective and available in a wide range of products, including blankets, caps, patient gowns, pediatric products and staff apparel. Thermoflect Heat Reflective Technology patient warming products are available from Encompass Group LLC. For information, visit www.thermoflect. com or call 800-826-4490. Samples and photos are available by request. For the fourth consecutive year, PerfectCLEAN Operating Room Processing & Checklist System developed by UMF Corp. received the AORN Seal of Recognition. For the PerfectCLEAN OR Processing & Checklist System, the AORN Seal of Recognition confirms that the content of the program has undergone thorough review by AORN and meets the guidelines of the “AORN Guidelines for Perioperative Practice.” While not an endorsement, the Seal of Recognition is confirmation that the PerfectCLEAN Operating Room education materials meet AORN’s guidelines for excellence in providing a safe patient environment. The specific components of PerfectCLEAN program that have been recognized by AORN are the “PerfectCLEAN Hygiene Specialist OR/ASC Handbook,” and a series of checklists – “Terminal OR Cleaning Checklist,” “Between Procedure OR Cleaning Checklist,” “24-Hour Idle OR Cleaning Checklist,” and “OR Pre-First Procedure Checklist.”

SURGERY CENTER INNOVATES NEW USES FOR RTLS Versus Technology Inc., in cooperation with Ronco Specialized Systems, has announced a successful go-live of a real-time locating system (RTLS) at Memorial Sloan Kettering’s Josie Robertson Surgery Center (JRSC) in New York, New York. Versus helps JRSC manage a busy census of 40-50 patient cases per day. Versus Advantages OR closely monitors patient flow through 12 operating rooms and over 40 perioperative beds. The system also integrates 30 points of data from six ancillary systems, including Epic and Allscripts. Thirty-nine Glance-and-Go electronic whiteboards throughout the facility automatically display past, present and future surgery schedules to improve visibility to all staff; communicate a patient’s wait or alone time to proactively WWW.ORTODAY.COM

enhance the patient experience; monitor OR and bed availability to assist with dynamic room assignment; deliver alerts when rooms are ready for turnover, improving overall utilization of valuable space; and display name and role as staff members enter or exit a room to put patients at ease. Three additional solutions are the first of their kind for an RTLS implementation: • Bi-directional integration with Epic OpTime to automate documentation and reduce data entry. • Visualization of patient progress on the clinical care pathway using data from Epic & Allscripts. • Estimation of patient walking distances to document post-operative ambulation. •

June 2016 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

MÖLNLYCKE HEALTH CARE ENHANCES DOUBLE-GLOVING SYSTEM Mölnlycke Health Care is enhancing its Biogel PI Micro range to offer the Biogel PI Micro Indicator Underglove for use with the Biogel PI Micro surgical glove – creating the next-generation puncture indication system. The system offers a thinner, more comfortable, synthetic double-gloving solution, giving the best possible protection without sacrificing tactile sensitivity, according to a study. With Biogel PI Micro Indicator Underglove, Mölnlycke Health Care is building on the success of the 20-percent-thinner profile of Biogel PI Micro to provide continuous improvement for customers. A recent user evaluation showed that 85 percent of Operating Room staff preferred the new Biogel PI Micro Indicator Underglove to the existing Biogel PI Indicator Underglove. The Biogel PI Micro Indicator Underglove is available through most medical product distributors. •

ENCOMPASS GROUP OFFERS INNOVATIONS IN REUSABLE OR TEXTILES Through a partnership with Canadian based Lac-Mac, Encompass Group LLC is offering significant innovations in reusable OR gowns and drapes in the U.S. Paragon style level 4 and level 3 surgical gowns are uniquely designed and incorporate R-MORTex liquid-proof or liquid-resistant barrier fabric in critical zones and features a distinct neckline that wicks away moisture and eliminates chafing. Lac-Mac has an industrial design patent in Canada and the U.S. for this gown. Reusable drapes which can be made to mimic single-use drape features offer an opportunity for facilities currently using disposable drapes an easy way to transition into a more complex reusable product. The OR is the biggest user of

OR TODAY | June 2016

medical supplies in any facility. The decision to use disposable or reusable gowns, drapes and mayo covers can impact cost and provider comfort. “In selecting drapes and gowns for a facility’s OR, there are six major considerations: safety, performance standards for barrier protection, comfort, cost, environmental impact, and evaluation process,” said Angie O’Connor, RN, BS, CLLM, Director Clinical Resources, Acute Care, at Encompass Group LLC. “All OR drapes and gowns are considered by the U.S. Food and Drug Administration to be medical devices, and as such are held to AAMI and ANSI standards for protection against fluids and pathogens.” •

WWW.ORTODAY.COM

NEWS & NOTES

AORN LAUNCHES CAMPAIGN TO REMOVE HAZARDOUS SMOKE FROM THE OR The Association of periOperative Registered Nurses (AORN) has announced the “Go Clear” campaign, a three-year national health education effort to help surgical team members and hospital administrators reduce and eliminate surgical smoke in operating rooms. Surgical smoke, also known as plume, can be a byproduct of electrosurgical and laser devices which are used in over 85 percent of 24 million procedures performed annually. The campaign is sponsored by Medtronic through the AORN Foundation. The need to evacuate and appropriately filter surgical smoke is being recognized around the world as countries move to provide a safer environment for both perioperative personnel and patients. Using an electrosurgery device on one gram of tissue is akin to inhaling the smoke from 6 unfiltered cigarettes in 15 minutes. While the long-term effects for health care workers exposed to surgical smoke is still unknown, there is an extended list of short-term effects. For example, perioperative nurses experience twice the

incidence of many respiratory problems as compared to the general population. “We created the Go Clear Award program to give surgical team members and administrators the tools they need to establish and maintain a safe surgical setting,” said Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, Executive Director/CEO, AORN. “At this time, there is very little awareness about smoke hazards and there is too little consistency in safe practices. We need to turn that around.” AORN’s evidence-based Guidelines for Perioperative Practice recommend “potential hazards associated with surgical smoke generated in the practice setting should be identified, and safe practices established.” There are currently no specific OSHA standards for laser/electrosurgery plume hazards but the agency recommends employers be aware of this emerging problem and advise employees of the hazards of laser smoke. According to OSHA law, all workers have a right to a safe workplace and the law requires employers to provide their employees with safe and healthful workplaces. •

ACTION EXPANDS INTO FLUID WASTE MANAGEMENT Launched in April under the Action umbrella of OR-focused offerings is the DryMax line of fluid management absorbent floor mats. Ensure a safe work environment with easy clean up, single-use mats. All four styles keep floors dry, protect staff, compliment different working conditions and can conserve resource consumption for items such as linens and labor. The company offers the following four options: • 2.4 Superabsorbent Mat – Small footprint, low profile design with max capacity of 9 L of water or 3.5 L of NaCl. Dual-side absorption in convenient, fit anywhere size. • Triple Superabsorbent Mat – 3-segment, tablelength design offers maximum coverage and capacity, absorbs 15 L of water or 6 L of NaCl. Create a flexible fluid barrier for troubled areas. • CombiMat – Totally unique hybrid of anti-skid mat with superabsorbent “splash guard” that can easily fold to protect feet or equipment. Max capacity 15 L of water and 7 L of NaCl. • XL Absorbent Mat – Anti-skid design ideal for standing/stools with single-side absorbtion. WWW.ORTODAY.COM

“Action has always been supportive of the perioperative nurses and these products protect them from slips and falls, as well as decreases clean-up and turn-over times,” says Rick Olin, National OR Sales Manager of Action Products Inc.-Medical Products Group. • For information, visit www.4yourOR.com.

June 2016 | OR TODAY

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{

AAAHC ACCREDITATION

}

It’s validation of how well you deliver care. We send physicians, nurses, administrators – professionals whose opinion you can respect. Their mission is to help your organization be the best it can be. • We are the leader in ambulatory accreditation.

Improving health care quality through accreditation

• Our Standards are nationally-recognized. • Our surveys are consultative not just a checklist.

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June 2016 | OR TODAY

INDUSTRY INSIGHTS AAAHC UPDATE

BY ANGELA FITZSIMMONS

QUALITY IMPROVEMENT IN THE ACCREDITATION PROCESS IT’S NOT AS DIFFICULT AS YOU THINK.

uality improvement is fundamental to AAAHC accreditation. The aim is simple but far-reaching: to promote a consistent, pervasive drive toward making things better across an organization.

Quality improvement is fundamental to AAAHC accreditation. The aim is simple but far-reaching: to promote a consistent, pervasive drive toward making things better across an organization. As a means of documentation, AAAHC asks each organization seeking accreditation to provide examples of two completed quality improvement (QI) studies at each three-year survey. These studies demonstrate that the organization is meeting a minimum requirement, but what we really hope to see is that accredited organizations are engaged in continuous action to achieve measurably better outcomes — in clinical care, patient satisfaction and administrative efficiency. Still, we find that organizations struggle with QI. And much of the struggle seems to come from a tendency to look at the “two studies” requirement as something that stands apart from the day-to-day business of providing care to patients. 20

OR TODAY | June 2016

Imagine that you work in an ASC that specializes in ophthalmology. Your center is performing lots of cataract cases and your goal is to improve visual acuity for your patients. Your center is successful. Business is humming along and patients are happy. Who has time to look around for a topic so that you can submit a couple of QI studies to AAAHC? DRIVE QUALITY WITH SYSTEMS THINKING

What if, instead of thinking about quality as the job of solving problems, you thought of it as the job of finding the next best step? This would be a systems thinking approach that could start by looking at the people, structures, and processes that you have in place (and are probably already measuring in some way) and considering how successfully they work. Going back to our ophthalmology center, let’s say the cost of Dr. A’s cases and Dr. B’s cases are very similar. Dr.

C’s cases, however, cost 15 percent more on average. You know this because your director of nursing is already tracking and reporting this information. Instead of thinking of this as a discrete administrative activity relating to finance, think of it as internal benchmarking. We know that standardization is an indicator of efficiency, so if two surgical teams are establishing the benchmark, why is the third an outlier? Variations like this can be indicators of opportunities for improvement. Sometimes there are good reasons for variation: perhaps Dr. C’s cases are consistently more complex, taking longer and using more resources. By identifying what makes Dr. C’s cases different, you may find something that can be changed (a corrective action) to yield improvement. Perhaps s/he uses more than one of an item, a more expensive or larger amount of medication, a more expensive intraocular lens, takes longer to do all cases, or has a slower turn-over time. When change is an option, the impact of that change can be evaluated the next time your administrator reports on the cost of cases. If the change yields improvement, write it up: it’s a QI study. WWW.ORTODAY.COM

TRIM 2.25”

AAAHC UPDATE

NEED HELP MANAGING VENDOR ATTIRE?

BENCHMARKING KEEPS YOUR ORGANIZATION ON THE ROAD TO QUALITY

MAKE USE OF AAAHC RESOURCES

You can use Quality Roadmap to get a high-level overview of how your organization is performing relative to the Standards that many find challenging. For instance, with the Quality Roadmap in hand, an organization looking at allergy documentation could see that 22 percent of the primary care organizations surveyed had issues with the Standard that relates to this topic (6.F). That means 78 percent of surveyed primary care settings were successful in providing prominent, consistent notes in clinical records regarding reactions to drugs or materials. Based on our hypothetical organization’s 70 percent performance, there’s room for improvement to meet or exceed that external benchmark and an opportunity for a QI study. And by the way; you don’t have to be accredited to benefit from QI studies! They can help us all to deliver higher quality care. ABOUT THE AUTHOR Angela FitzSimmons has focused on developing educational resources for customers, particularly relating to quality improvement, since 2011. Prior to joining the AAAHC Marketing and Communications department, she was a consultant serving the organizational development teams for corporate clients including Gap Inc., Kraft and Sara Lee, and the leadership teams of small non-profit education and arts organizations.

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Comparison is the essence of benchmarking. You have to understand current performance and desired performance in order to set a realistic goal for improvement. That’s why benchmarking is so important. You may know, based on chart audits, that your primary care patients’ medical records include an update on allergies and untoward reactions 70 percent of the time. Is that good or bad? Internal benchmarking will tell you whether your performance is improving or declining over time, but what about a bigger picture? Each time you undergo an accreditation survey, you are participating in an external benchmarking activity. Quality Roadmap, a publication released annually by AAAHC and the AAAHC Institute for Quality Improvement, charts compliance with AAAHC Standards on surveys conducted in the prior year. The report identifies which Standards are most commonly rated partially- or non-compliant by AAAHC surveyors. We look at this in the aggregate across all types of organizations, and also by broad segment (ASC, office-based surgery, primary care).

Infection Prevention • Maintain regulatory standards among vendors • Reduce risk of cross contamination

Cost Reduction • Eliminate costs associated with vendor attire • Reduce lost and stolen inventory

Vendor Management • Enhance visibility and tracking reports • Reduce vendor traffic

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INDUSTRY INSIGHTS WEBINAR

STAFF REPORT

WEBINAR SERIES

OR TODAY WEBINAR DISCUSSES COMPETENCY

lmost 200 people registered for the latest OR Today webinar. Webinar presenter Jim Stobinski, Director of Credentialing and Education at The Competency and Credentialing Institute (CCI), discussed the issue of competency assessment in the OR setting. The webinar was sponsored by the CCI. Participants were eligible for 1 continuing education hour by the State of California Board of Registered Nursing. The objectives of the webinar as outlined by Stobinski were: • relate recent developments in the operating room environment regarding public perceptions and accountability; •d ifferentiate between competence and competency; • e xamine the three components of competency; and • i dentify one theoretical framework that can be used to examine competency and skill acquisition among health care professionals. The 60-minute webinar addressed the issue of competency assessment in the OR setting. Stobinski compared and contrasted education and training for three professions working in the OR – Central Processing Professionals, Surgical Technologists and Perioperative Nurses. Stobinski discussed the new reality in health care with an expanded knowledge base, more mobile nurses and an increased emphasis in building skill sets and 22

OR TODAY | June 2016

“Today’s webinar on competency was very interesting. All surgical nurses need to think about their overall role in providing patient care” -Nancy C.

credentials. Some other changes Stobinski discussed include a greater public awareness of what happens in operating rooms, an increased call for accountability from a variety of organizations (AAMI, CMS, The Joint Commission) and the pervasiveness of media access. The presentation concluded with an informative Q&A session. Stobinski took time to give informative answers to questions submitted by webinar attendees.

Attendees shared positive reviews of the webinar in a postwebinar survey. “This speaker provided a comprehensive review of the driving forces behind increased requirements for competency assessment,” Linda G. wrote in her survey. “Today’s webinar on competency was very interesting. All surgical nurses need to think about their overall role in providing patient care,” Nancy C. shared. “This was a great way to explain WWW.ORTODAY.COM

STAFF REPORT

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1.800.763.8423 • www.polarproducts.com CONFIRM THAT THE FOLLOWING ARE CORRECT certification and the role itPLEASE plays in www.facebook.com/polarproducts @polarproducts LOGO PHONE NUMBER WEBSITE ADDRESS SPELLING GRAMMAR assessing competency,” Sherry W. wrote in her survey. Participants, and those interested TRIM 4.5” in this topic, can download a whitepaper and more information at http://ortoday.com/webinars/ events/lets-talk-about-the-big-ccompetency/. Webinar sponsor CCI is a leader in credentialing, nursing competency assessment, and education for the perioperative nursing community. CCI has developed and maintained the CNOR, CSSM, CRNFA, and CNS-CP credentials for more than 35 years. The organization currently certifies more than 33,950 nurses. CCI supports these credentialing programs with a suite of publications, exam preparation resources, certificate programs and CE offerings, including those being offered at the OR Today Live! Surgical Conference (www.ORTodayLive.com). Visit www.cc-institute.org to learn more about CCI.

INDUSTRY INSIGHTS ASCA UPDATE

BY WILLIAM PRENTICE

ASCA RELEASES NEW RESOURCES FOR ASCS T

rue to its mission of providing resources that assist ASCs in delivering the high-quality, costeffective ambulatory surgery they provide, in the first half of this year, ASCA has released two new tools designed specifically for ASCs and introduced important upgrades in another.

CLINICAL AND OPERATIONAL BENCHMARKING The tool we upgraded is ASCA Benchmarking, our popular clinical and operational benchmarking program that we introduced as an entirely online program almost three years ago. Last year, more than 1,000 ASCs subscribed to this program. ASCs that subscribe receive valuable data reports that allow them to quickly compare data from their own facility with national and specialty performance statistics on clinical outcomes, staff indicators, billing performance and more. Enhancements introduced this year include dynamic filtering capabilities that allow users to customize their online reports to focus on the data they find most meaningful, real-time data review that helps users ensure the accuracy of the data they provide and MS Word and PowerPoint reports that are easy to print and share. 24

OR TODAY | June 2016

You donâ&#x20AC;&#x2122;t have to be an ASCA member to participate in this program, but you do have to represent an ASC since data reports from hospital outpatient departments and other entities are not included. The final reports are available only to participants. ASCA members participate at a deep discount. For more information or to purchase a subscription, go to www.ascassociation.org/benchmarking or call 703-836-8808. HIPAA WORKBOOK FOR ASCS The first of the two new tools ASCA released this year is something that many in the ASC community have been asking for: a HIPAA Workbook for ASCs. ASCA developed this useful resource specifically to help ASCs comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Along with an in-depth review of all of the requirements associated with that rule, the book

contains downloadable and customizable forms and worksheets that make designing, evaluating and strengthening an ASCâ&#x20AC;&#x2122;s compliance program easier. This workbook is available for free to all ASCs enrolled as facility or corporate members of ASCA. Nonmember ASCs can purchase it for $399. A Spanish translation of the HIPAA Sample Privacy Notice, or Privacy Form B, that the workbook contains is also available to all for an additional $25. As talk about increasWWW.ORTODAY.COM

ASCA UPDATE

ing HIPAA compliance audits begins to turn into reality this year, this workbook becomes an even more valuable resource for all ASCs.

others who are interested in learning more about having surgery in an ASC ask. To view “What Is an ASC?” now, visit www.advancingsurgicalcare. com/whatisanasc. This video is available free on ASCA’s YouTube channel, www. youtube.com/theASCAssociation, to all ASCs that would like to post it, or a connection to it, on their website.

“WHAT IS AN ASC?” VIDEO The other new tool ASCA released this year is part of a broader effort that ASCA has undertaken to provide ASCs with more resources and information that they can use CHANGES to PROOF APPROVED NEEDED NEXT STEPS educate the public about the many benefiSIGN–OFF: ts that ASCs offer. To help reach If you are interested in any of the CLIENT resources mentioned above but are that goal, ASCA produced a video unable to find what youCORRECT need using that,PLEASE in under two minutes, clearly CONFIRM THAT THE FOLLOWING ARE the contact information provided, and concisely answers the question LOGO NUMBERplease call WEBSITE ADDRESS Mykal Cox, Assistant “What Is an ASC?” AsPHONE it does, the Director of Membership Engagement, video also answers some of the most at 703-636-0623 for assistance. By common questions that patients and

year’s end, ASCA is set to release even more new resources that ASCs can use to improve their internal operations and the services they provide to their patients. If you are interested in learning about those as they are released, please make sure that we have your email address by subscribing to our weekly ASCA News Digest e-newsletter at www.ascassociation. org/NewsDigest. As always, if you have comments on these resources or ideas about other tools and information you would like ASCA to provide, please let us know by calling ASCA at SPELLING or sending GRAMMAR 703-836-8808 an email to asc@ascassociation.org.

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June 2016 | OR TODAY

IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

CERTIFIED SURGICAL TECHNOLOGISTS I am trying to convince our finance folks that staffing sterile processing department with surgical technologists will increase patient safety and decrease case delays. Can you tell me if the certified surgical technologists have a role in your sterile departments? A: I need to respectfully disagree. While surgical techs may know their instruments well, there is much more to our profession than the instruments. Your money would be better spent by paying your sterile processing techs more, certifying them and including them in every aspect of “surgical services.” We are critical in the fight for infection control, as is environmental services. Here at our facility, new OR nurses and scrub techs must spend days in the sterile processing department to get a better understanding of how vital our working relationship is to surgical services and how best we can work together as a team and make no mistake, we are a team. Every day I meet with the OR director, the OR clinical manager and materials management. We go over the OR schedule three days out to review instrument needs, conflicts in equipment needs and incoming loaners. We are well respected and included in decisions that

OR TODAY | June 2016

affect the day, as we should be. Truthfully, every director of surgical services would be smart to spend one whole day in SPD and I implore you to do so. I apologize if I sound like I am preaching, that is not my intent. Again, your money would be better served in sterile processing. A: Our sterile processing utilizes certified surgical technologists and we have a lead to help streamline processes and stay compliant. A: We do not use certified surg techs in sterile processing. We do ask that our sterile processing staff get certified within two years of hire. A: Our SPD is staffed with certified SPD personnel. Our surgical techs only scrub at our facility and are not trained in sterile processing.

A: We do not, but our CPD specialists are certified. A: I don’t believe this will solve your problem. Probably a certified CSP manager and an educator would be a better solution. A: I agree, we have the same set-up at our facility. Our perioperative clinical nurse leader supports the educational needs of the department and we hired a certified manager of CSS with all staff certified upon hire or mandatory certification within one year. The manager attends our weekly OR Operations meeting, and our monthly Surgical Services meeting is attended by physicians, nursing managers, directors, COO, etc. This team is integral to the business of surgery and must sit at the table.

A: We use certified sterile processing technicians and they perform at a very high level! We rarely have any issues due to their work performance. WWW.ORTODAY.COM

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BLOCK CHARGES Some anesthesiologist prefer to place blocks pre-operativerly in the holding area. Other times blocks are performed in the surgical suite. When the blocks are done in the suite this increases OR time. Is there a way to charge for the block pre-operatively? Should the OR time start after the block is placed even if it is done in the suite?

A: If the block is done in the pre-op or holding area, it can be charged for.

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A: OR time is OR time. If the block is done in OR, it is part of the OR time. Most of our blocks are done in pre-op in order to expedite the schedule. Contact us at 321-752-4130 to find out how you could receive a free 30-day trial

A: Agreed – and you cannot charge for it as a separate procedure if it is done in the OR

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POWDER-FREE SURGICAL GLOVE SOLUTIONS

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Powder-free gloves have long been shown to be much safer for both patients and healthcare workers. Now, recent changes in the marketplace mean FDA compliant powdered surgical gloves will no longer be available, and powder-free (PF) will become standard in all hospital environments. Ansell is ready to provide the solutions you need with the addition of the ENCORE® Perry ® Style 42® PF to our already broad ENCORE® PF product range.

So why wait? Let’s move together towards a safer, powder-free world. For more information visit www.ansell.com/powderfree or contact Customer Service at 1-800-952-9916 ® & ™ are trademarks owned by Ansell Limited or one of its affiliates. © 2016 Ansell Limited. All Rights Reserved.

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OR TODAY | June 2016

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IN THE OR MARKET ANALYSIS

STAFF REPORT

MARKET ANALYSIS Temperature Management Market to Exceed $2 Billion

n the basis of type of product, the global temperature management market has been divided into two major segments – patient warming systems and patient cooling systems, according to a PR Newswire news release.

“The patient warming systems segment is further classified into surface warming systems (convective and conductive systems), intravascular warming systems, and patient warming accessories. Likewise, the patient cooling systems segment is further divided into surface cooling systems, intravascular cooling systems, and patient cooling accessories,” according to the news release. “The patient warming systems segment is expected to account for the largest share of the global temperature management market in 2015,” according to PR Newswire. “Furthermore, the patient cooling systems segment is expected to grow at the highest CAGR (compound annual growth rate) in the next five years, primarily owing to technological advancements in the field of intravascular temperature management (IVTM) systems, and numerous growth strategies followed by market players.” On the basis of type of application, the global temperature management market is classified into four major segments, including acute care and perioperative care. Segments also include newborn care and other applications. “The perioperative care applications segment is expected to acWWW.ORTODAY.COM

“The patient warming systems segment is expected to account for the largest share of the global temperature management market in 2015.” count for the largest share of the global temperature management market in 2015. The acute care applications segment is expected to grow at the highest CAGR in the next five years, owing to rising number of technologically advanced new product launches,” according to the news release. A report by MarketsandMarkets predicts continued growth in the temperature management market. “The temperature management market is poised to reach $2,576.8 million by 2020 from $2,302.7 Million in 2015, at a CAGR of 2.3

percent from 2015 to 2020,” according to MarketsandMarkets. New technology and an aging worldwide population are among factors cited when forecasting growth. “A number of factors such as the worldwide development of technologically advanced temperature management systems, increase in aging population (which in turn is increasing the demand for age-related surgeries), and growing prevalence of cancer and cardiovascular diseases is propelling the growth of the global temperature management market,” according to MarketsandMarkets. “However, unfavorable health care reforms in the U.S., product recalls, and rising price pressure on market players are some major factors restraining the growth of this market. In addition to this, the stringent regulatory policy in developed countries is a key challenge faced by market players in the temperature management market.” Among the key players in the temperature management market, according to MarketsandMarkets, are 3M Company, C.R. Bard Inc., Cincinnati Sub-Zero Products Inc., Medtronic PLC, Geratherm Medical AG, Inditherm Plc, Smiths Group Plc, Stryker Corp. and ZOLL Medical Corp. June 2016 | OR TODAY

IN THE OR PRODUCT SHOWROOM

ADVANCED COOLING THERAPY ESOPHAGEAL COOLING DEVICE The Esophageal Cooling Device by Advanced Cooling Therapy is designed to modulate and control patient temperature through a single use, fully enclosed triple lumen system that is inserted into the esophagus. Recent studies have shown its efficacy in warming patients in the OR, particularly for preventing inadvertent perioperative hypothermia. Two lumens attach to existing temperature modulation equipment while a third lumen simultaneously allows gastric decompression and drainage. The ECD can be rapidly inserted by most trained health care professionals, in similar fashion to a standard gastric tube, and can be used to cool or warm patients in the operating room, recovery room, emergency room or ICU. No other products on the market are approved to use the esophageal environment for whole-body temperature modulation.Â â&#x20AC;˘ 30

OR TODAY | June 2016

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PRODUCT PRODUCT SHOWROOM FOCUS

AUGUSTINE TEMPERATURE MANAGEMENT HOTDOG PATIENT WARMING & WAFFLE GRIP TRENDELENBURG POSITIONING Waffle Grip is the only heated grip solution for Trendelenburg. Air-free HotDog Patient Warming uses Waffle-Grip safety technology to defeat high rates of hypothermia in procedures with unique positioning challenges including robotics, GYN, urology and colorectal. Hypothermia is common during Trendelenburg positioning due to the minimal surface area available to warm. This innovative HotDog solution allows complete underbody warming with the safest and best underbody warming system available. Unique waffle pattern evenly disperses grip on the patient using mechanical hold and friction (following AORN recommendations), which reduces localized shearing forces and eliminates risk of brachial plexus injury. HotDog Waffle Grip is less expensive than most Trendelenburg positioners, easy to use and safer than cutting and taping egg crate foam. • WWW.ORTODAY.COM

June 2016 | OR TODAY

IN THE OR PRODUCT SHOWROOM

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ENCOMPASS GROUP LLC THERMOFLECT HEAT REFLECTIVE TECHNOLOGY Thermoflect Heat Reflective Technology from Encompass Group LLC banks the patient’s radiant heat by capturing and reflecting it back to the cutaneous layer (skin) as well as preventing convective heat loss (wind chill). Patients are covered with Thermoflect products preoperatively to pre-warm the skin and continue with the patient throughout the surgical process to maintain normothermia. Thermoflect products are easily integrated into to a facility’s warming protocol, using no wires or external heat source, just proven reflective warming that works immediately for the patient. Thermoflect Heat Reflective Technology products are costeffective and available in a wide range of products, including blankets, caps, patient gowns, pediatric products and staff apparel. Samples are available by request. •

OR TODAY | June 2016

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PRODUCT FOCUS

ZOLL THERMOGARD XP (TGXP) TEMPERATURE MANAGEMENT SYSTEM The Thermogard XP (TGXP) Temperature Management System offers health care providers the power and control they need to rapidly, safely, and effectively manage the core body temperature of critically ill or surgical patients. TGXP offers superior clinical efficiency in reaching and maintaining target temperature 100 percent of the time. A variety of standard central venous catheters (CVCs) and unmatched control – regardless of target temperature – enable clinicians to tailor the treatment to the individual. •

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June 2016 | OR TODAY

HOW TO MAXIMIZE YOUR STORAGE CAPACITY STEP 1: Take advantage of expert consulting and design services. Tell us about your preferences and challenges. At no charge to you, our design professionals will evaluate your storage areas and show you how to optimize your capacity using 3D drawings of your space.

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June 2016 | OR TODAY

IN THE OR CONTINUING EDUCATION CE498D

OR TODAY | June 2016

BY MAUREEN HABEL, MA, RN, DIANA SWIHART, PHD, MSN, DMIN, APN CS, RN-BC

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CONTINUING EDUCATION CE498D

PROMOTING A CULTURE OF SAFETY

TO PREVENT MEDICAL ERRORS

fter successful orthopedic surgery, a 78-year-old woman with a swallowing impairment dies after aspirating the regular diet she is mistakenly given.

A healthy 30-year-old man receives the wrong unit of blood, and develops acute renal failure. A 2-day-old infant is abducted from a postpartum unit. A 68-year-old woman with a spinal cord injury develops a sacral pressure ulcer.

OnCourse Learning guarantees this educational activity is free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See page 43 to learn how to earn CE credit for this module. The purpose of this medical error continuing education program is to inform nurses, pharmacists, physicians, social workers and every other healthcare provider about national efforts prevent medical errors and harm to patients. After studying the information presented here, you will be able to: • Describe how the culture of healthcare organizations affects patient safety • Give three examples of sentinel events • Discuss the role of healthcare providers in providing a safe environment for patients

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Such examples of medical errors and substandard care occur far too often in today’s complex healthcare organizations. As many as 98,000 people in the U.S. die each year of largely preventable medical errors, according to the Institute of Medicine’s 1999 report “To Err Is Human: Building a Safer Health System.”1 A more recent report, from the U.S. Senate in February 2014, put it this way: “Every year between 210,000 and 440,000 Americans die as a result of medical errors and other preventable harm at hospitals ….”2 Several studies have tried to determine just how much medical errors cost. One estimated that medical errors cost from $17 million to $29 million yearly.3 Another found that medical errors account for up to 2.4 million additional hospital days.4 Research studies conclude that errors in clinical practice and healthcare delivery continue at an unacceptably high rate.5 The emotional effect — for the patient, family, and for the healthcare professional whose action or inaction may have caused serious harm — is long-lasting with potentially far-reaching consequences. Although organizations such as the Institute of Medicine, the Agency for

Healthcare Research and Quality, The Joint Commission and the Centers for Medicare & Medicaid Services have emphasized the need for significant improvement, much more progress is needed to ensure that Americans are better protected from unsafe healthcare practices. Healthcare workers across disciplines are frontline managers of patient care and must be involved proactively in the prevention of medical errors. NEVER EVENTS The term “never event” (serious medical errors that should never happen) was introduced in 2001 by Ken Kizer, MD, then CEO of the National Quality Forum. Over time, the meaning came to signify adverse events that are clearly identifiable and measurable, result in death or significant disability, and largely preventable. NQF identified 29 never events in six categories in 2011: surgical, product or device; patient protection; care management; environmental; radiologic; and criminal.4 It is a serious error that indicates a problem with the safety of a health facility and jeopardizes its credibility.4 As the term implies, a never event should not happen. Examples June 2016 | OR TODAY

IN THE OR CONTINUING EDUCATION CE498D include surgery on the wrong body part, a major medical error, a mismatched blood transfusion, a foreign object left in a patient after surgery, serious hospital-acquired pressure ulcers and preventable postoperative deaths.4 These costly and often tragic events have a major effect on the CMS budget. The CMS has stopped reimbursing hospitals for costs associated with specific events that it considers preventable, such as serious hospital-acquired pressure ulcers. In addition, many states have plans — or are considering plans — to deny payments to health organizations for some never events.4 TJC urges healthcare leaders to increase efforts to prevent errors by adopting the zero-defect approach in use by other high-risk industries such as aviation and nuclear technologies. Experts emphasize that most medical errors and poor patient outcomes are preventable; prevention begins with the implementation of evidence-based practice. But studies indicate that 30% to 40% of patients receive care inconsistent with scientific evidence.6 Errors can happen in any setting where providers diagnose and treat health problems. Sophisticated technologies, procedures, complex health problems and responses to interventions — combined with the fact that many different people provide patient care — make hospitals particularly prone to errors. The highest-risk areas are EDs, ICUs and ORs, where there is little time to react to unexpected events and where inappropriate decisions can be life-threatening.1 However, outpatient centers, physicians’ offices, clinics, nursing homes and home healthcare settings are not immune to incidents that can harm patients.1 SOME SAFER THAN OTHERS A wake-up call about preventable deaths, “To Err Is Human” also 38

OR TODAY | June 2016

challenged another assumption: that incompetent or uncaring physicians, nurses and other healthcare providers cause most medical errors. In fact, the way healthcare is organized sets the stage for errors.7 The NQF, with support from the AHRQ, specifies 34 safe practices that have undergone a three-part audit process consisting of review by NQF staff, by an expert panel, and by NQF members and public comment. Based on this updated information, the NQF urges healthcare organizations to establish these practices to provide a safer environment. At the top of this list is the need for leadership structures and systems to create a culture of safety and quality.7 An organization’s culture is based on its history, mission and goals, and past and present leadership.6 The culture of a healthcare setting includes shared values, beliefs, customs and behaviors that determine how healthcare providers of various disciplines carry out their roles.7 The NQF describes two important characteristics of healthcare organizations that develop and maintain a culture of safety and quality. First, the organization encourages and supports people who report any situation that threatens or could threaten the safety of patients or caregivers. Second, the organization views errors and adverse events as opportunities to improve healthcare delivery.7 An organization that promotes a culture of safety focuses on how and why a problem occurred rather than on the person whose action or inaction caused a serious error.1 Experts refer to healthcare organizations with a passion for patient safety as “high-reliability” organizations. In such organizations, monitoring how patients can be protected from harm is part of everyday work life.8 High-reliability organizations have

few adverse events, continually focusing on ways that patient safety may be compromised.8 They view a close call or near miss as a signal to examine more closely those conditions in which a patient might have been injured.8 In organizations that value a culture of safety, quality care is expected and rewarded.6 When a serious medical error occurs, organizations have several choices about how to respond. The quickest and most common reaction is to identify and punish the person responsible. In such an atmosphere, though, staff members are unlikely to report errors.3 Historically, health professionals have avoided openly discussing errors across disciplines because of censure or lawsuits and shame.1 By blaming providers rather than looking more deeply into the causes of errors, the healthcare industry has driven significant problems underground, subverting an open examination of practices that can harm patients.3 Highly bureaucratic organizations tend to view errors as isolated incidents and spend little time examining how their own policies, procedures, processes and work culture may have contributed to an error. Organizations often retrain staff members involved in an error, generally with short-lived effects on reducing the risk of future events, especially if the real cause was not specifically due to a knowledge deficit. BEST CHANCE FOR CHANGE Establishing a safety culture and quality is a challenge, but it offers the best opportunity for permanent change. An established patient safety culture is associated with decreased medication and treatment errors and with fewer falls injuries.9 Healthcare organizations willing to examine how their systems and processes contribute to errors are most likely WWW.ORTODAY.COM

CONTINUING EDUCATION CE498D

to maintain a work environment in which safety for both patients and staff is integrated into the work climate. A major trend in promoting a safer healthcare environment is to view errors from a human-factors approach. Human-factors experts consider human strengths and weaknesses when designing work systems.8,10 Although work systems and processes are often the cause of medical errors, organizations committed to patient safety willingly hold employees accountable when appropriate.10 TJC has been a leader in promoting patient safety through its sentinel event reporting program and national patient safety goals. A “sentinel event” is any unexpected event that involves death or serious physical or psychological injury, or a situation in which a patient was at risk of serious harm.11 Sentinel events signal a need to take immediate action to determine what happened and to explore ways to prevent similar events in the future. Examples of sentinel events subject to TJC review include: (a) an unanticipated death or major permanent loss of function not related to a person’s underlying condition; (b) a patient suicide; (c) the death of a full-term infant; (d) a patient abduction; (e) the discharge of an infant to the wrong family; (f ) rape that involves patients or staff members; (g) major blood transfusion reactions; (h) surgery on the wrong person or wrong body part; (i) unintended retention of a foreign object after a surgical procedure; ( j) severe neonatal hyperbilirubinemia; and (k) prolonged exposure to radiation during diagnostic or therapeutic procedures.11 MOST FREQUENT ERRORS The most common sentinel events that health organizations reported to TJC since 1995 have been patient WWW.ORTODAY.COM

suicide, wrong-site surgeries, operative or postoperative complications, medication errors, delays in treatment, patient falls, deaths or injuries of patients in restraints, assaults, rapes, homicides, perinatal deaths or losses of function, and transfusion errors.8,11 The sentinel events depend on the healthcare setting and the population served. In hospitals, postoperative complications, wrong-site surgeries, medical errors, treatment delays and falls are the most commonly reported sentinel events.8,11 In EDs, treatment delays, medication errors, suicides, restraint-related events and criminal actions are generally responsible for sentinel events.8 Reporting a sentinel event can benefit an organization and help improve patient safety throughout the healthcare industry. TJC adds lessons learned from each sentinel event to its sentinel event database to help other organizations be aware of hazards and put plans in place proactively to prevent similar events.8 A reporting facility can also take advantage of the experience and expertise of TJC staff to investigate the event and design an action plan to reduce risk of recurrence. Healthcare organizations that report problems to the commission also send a message to their clients, informing them they are pursuing steps to address the problem with all due diligence.12 Healthcare organizations also carefully analyze “near miss” incidents as precursors to adverse events.12 Sentinel Event Alert, published periodically by TJC, communicates information about sentinel events. A recent focus of TJC was on reducing errors by eliminating intimidating and disruptive staff behaviors. Such behaviors may include overt actions, such as verbal outbursts, or passive acts of noncooperation, such as

refusing to finish an assignment or not returning pages or phone calls. TJC points out that these problem behaviors are not limited to one sex or discipline.13,14 To help correct this problem, TJC added a new Leadership Standard in 2009 that requires organizations to establish procedures to prevent and respond to disruptive behavior.14 When a sentinel event occurs, TJC expects the organization to conduct a root-cause analysis and develop a plan to prevent recurrence. A root-cause analysis is an in-depth examination of the underlying causes of the event. TJC reports that since 1995, healthcare organizations have found inadequate communication at the root cause of almost 70% of sentinel events, followed by lack of orientation and training and inappropriate patient assessment.15 Traditionally, the focus of medical and nursing education was to develop practitioners with excellent clinical skills rather than expertise as communicators and team members. The American Nurses’ Association publication “Teaching IOM: Implications of the Institute of Medicine Reports for Nursing Education” focuses on the need to provide a major emphasis on patient quality and safety in nursing program curricula.16 Root causes are often interrelated; careful and objective analyses may uncover a deeper root cause. For example, a root cause analysis may show that incorrect labeling of a container was the reason the wrong solution was injected during a surgical procedure. Further analysis may reveal that the culture of a specific OR does not support compliance with new procedures, especially those that add time to an already busy surgery schedule. In fact, TJC that organizational culture may be part of the underlying root cause in June 2016 | OR TODAY

IN THE OR CONTINUING EDUCATION CE498D

2011 AHRQ Patient Safety Culture Focus Areas17 • Communication openness • Feedback and communication about error • Frequency of errors • Handoffs and transitions • Management support for patient safety • Nonpunitive response to errors • Organizational learning — continuous improvement • Overall perception of patient safety • Staffing • Supervisor/manager expectations and actions promoting safety • Teamwork across units • Teamwork within units most sentinel events.12 The Joint Commission also publishes annual National Patient Safety Goals. These goals, some of which the commission develops in response to information in its sentinel event database, describe problems in healthcare safety and provide evidence-based and expert advice on how to make healthcare environments safer.12 TJC also recognizes the important role the public plays in medical error prevention. TJC, in collaboration with the CMS, established The Speak Up Campaign, a national effort to encourage patients to help prevent medical errors by becoming active in and informed about the care they receive. Patients and families need to understand their roles in speaking up to help prevent sentinel events, and healthcare organizations need to support them in fulfilling this important role. The AHRQ publication the “Hospital Survey on Patient Safety Culture” helps hospitals assess how well they have established a culture 40 OR TODAY | June 2016

of safety. The 2011 survey found that “teamwork within units,” described as the extent to which staff support one another, treat one another with respect and work together as a team, had the highest average positive response (80%).17 “Supervisor/ manager expectations and actions in promoting patient safety” described as the extent to which supervisors/ managers consider staff suggestions for improving patient safety procedures and do not ignore potential problems, had the second-highest positive response (75%).17 These two combined processes are considered important strengths for reporting hospitals. The survey also identified two composite areas for potential improvement: “nonpunitive response to error” and “handoffs and transitions.” “Nonpunitive response to error” describes the extent to which healthcare staff believe event reports, and that their own mistakes are not held against them or that mistakes are not kept in their personnel file. This composite for a culture of patient safety culture had the lowest average positive response (44%).17 “Handoffs and transitions” describe the extent to which patient safety information is transferred across hospital units and during shift changes. This composite for a culture of patient safety had the second-lowest average positive response (45%).17 These two areas are identified as having potential for improvement.17 On average, most respondents within hospitals (75%) gave their work area a grade of “A-excellent” (29%) or “B-very good (46%) on patient safety. “Patient safety grade” is an area of strength for those hospitals participating in the 2011 survey.17 “Number of events reported” is identified as a key area for potential improvement. On average,

54% of those responding reported no events in their hospital in the past year.17 Event reporting is identified as an area for improvement in most hospitals because under-reporting of events means potential patient safety problems may not be recognized or identified, and therefore may not be addressed.17 HEALTHCARE PROFESSIONALS’ WORK ENVIRONMENT A 2002 IOM report titled, “Keeping Patients Safe: Transforming the Work Environment of Nurses” examines the relationship between nursing’s work environment and patient safety. The report discusses issues such as shift length, the effects of night shifts and rotating shift assignments on circadian rhythms and work performance, and the effect of temporary staff on patient safety and the quality of care.6 Studies have shown that patients are more likely to develop pneumonia, cardiac arrest, urinary tract infections and upper GI bleeding, and experience longer hospital stays in hospitals with lower nurse staffing levels.3 Specifically, these problems occur when there are few RNs compared to licensed practical nurses or nurses aides, or in situations in which RNs are not able to spend adequate time assessing and monitoring patients.4 Research continues to demonstrate the relationship between adequate staffing and patient safety in all hospital disciplines. POWER IN NUMBERS Registered nurses are members of the largest profession in healthcare and responsible for most direct patient care.9 However, all healthcare workers on the team are equally important in preventing medical errors. Nurses will interact with WWW.ORTODAY.COM

CONTINUING EDUCATION CE498D

other team members who provide patient care, as well as with personnel in other organizations across the continuum of care. Teamwork with other healthcare providers is vital because inadequate and inaccurate communication about patient risk for harm form the basis of many medical errors. The chance of errors increases as patients transfer from one practice setting or environment of care to another. Consider the example of the 78-year-old woman who aspirated and died after surgery. A root cause analysis would have revealed that inadequate communication between the nursing home where the patient lived and the hospital to which she was transferred set in motion an event with tragic consequences. Because of poor dentition and swallowing problems, the patient received only pureed food while in the nursing home. Without this information, the hospital staff provided her with a regular diet after surgery. Her impaired swallowing resulted in the fatal aspiration of foods and fluids.18 This unfortunate outcome could have been prevented if processes had been developed to communicate this type of risk from the nursing home to the hospital and to assess postoperative aspiration risk accurately. Healthcare workers across disciplines are vital gatekeepers in promoting quality of care and preventing medical errors. Those in direct patient care areas and practice settings are often in an ideal position to raise awareness of errors waiting to happen. All healthcare workers must be empowered to speak up to keep patients safe. It is true there are barriers that may make a healthcare worker reluctant to speak up. The traditional hierarchical reporting structure of healthcare, risk of conWWW.ORTODAY.COM

frontation, a perception that safety problems are simply part of healthcare, a concern about support from coworkers and a fear of retaliation may all be barriers for workers to identify risks to patient safety and quality.9 Healthcare providers must also overcome a historically held belief that good providers do not make mistakes. Healthcare organizations should recruit workers to serve on policy and procedure and safety committees where patient care perspectives on patient safety and quality are essential. When safety risks occur that cannot wait for committee action, healthcare providers must find a way to speak up to fulfill their roles as patient advocates. TJC requires hospitals to inform their staff that any employee who has concerns about safety or the quality of care may raise these concerns to TJC without retribution.9 Healthcare workers should also consult their state boards to learn about whistle-blower protections for healthcare professionals who raise patient safety issues. In every environment of care, healthcare workers are in an excellent position to identify errors, and to explore the systems and processes behind the errors. Healthcare providers have many resources to help them fulfill their safety advocacy role. The three-volume AHRQ publication, “Patient Safety and Quality: An EvidenceBased Handbook for Nurses” is invaluable. Volume 1 focuses on patient safety and quality, evidencebased practice and patient-centered care. Volume 2 addresses the effect of the nursing work environment on patient safety, and highlights critical opportunities for making patient care safer. Volume 3 provides tools for quality improvement and patient safety. The handbook also summa-

rizes the latest research in vital patient care management areas, including fall prevention, pediatric safety and quality of care, pain assessment and management, reduction of the functional decline in the elderly, and the medical management of community-dwelling adults. These volumes can benefit healthcare workers across all disciplines. TJC’s publication, “Front Line of Defense: The Role of Nurses in Preventing Sentinel Events” describes real-life sentinel events and nursing’s role in identifying root causes and implementing prevention strategies. TAKING THE LEAD In response to research showing the effects of organizational culture on patient safety and quality, TJC has established new leadership standards requiring organizations to establish and maintain a culture of safety, conduct quality evaluations and use evaluation results to make changes to improve healthcare safety and quality. Organizational leaders must involve all healthcare workers in evaluating care and designing ways to promote and maintain a culture of safety. All healthcare workers continue to advocate for organizational practices and public policies supporting safer work environments, including adequate staffing ratios, the elimination of mandatory overtime and the institution of whistle-blower protections. By participating in safety initiatives in their employing agencies, healthcare workers as a team can offer vital perspectives that can help build cultures of safety throughout U.S. healthcare systems. Healthcare organizations can help lead this effort by providing adequate resources needed to enable workers to protect patients under their care.2,19

June 2016 | OR TODAY

IN THE OR REFERENCES

Reports. Vol. 62, No. 6, December 20,

4. Eliminating serious, preventable and

1. Donaldson MS. An overview of To Err is

2013. In: Medical errors: a report by the

costly medical errors — never events. In:

Human — re-emphasizing the message of

staff of U.S. Senator Barbara Boxer. http://

Patient Safety Primers. Never Events.

patient safety. In: Hughes RG, ed. Patient

www.boxer.senate.gov/en/press/related/

Patient Safety Network Web site. http://

Safety and Quality: An Evidence-Based

Medical_Errors_Report.pdf . Published

psnet.ahrq.gov/primer.aspx?primerID=3.

Handbook for Nurses. Rockville, MD:

February 4, 2014. Accessed December 18,

Published October 2012. Accessed

Agency for Healthcare Research and

2014.

December 18, 2014.

Quality; 2008:1-9.

3. Clancy CM, Farquhar MB, Sharp BA.

5. Brady AM, Redmond R, Curtis E.

2. Centers for Disease Control and

Patient safety in nursing practice. J Nurs

Adverse events in health care: a literature

Prevention, National Vital Statistics

Care Qual. 2005;20(3):193-197.

review. J Nurs Manage. 2009;17(2):155-164.

CLINICAL VIGNETTE Wendy Garcia, a healthcare worker, is relocating to a different state. She has worked in bureaucratic organizations where she had concerns about patient safety. She is interested in working in an environment in which she can have an effect on improving patient safety and the quality of care. As part of an interview process, she meets with the department manager of an organization where she is considering employment.

If Wendy wants to focus on patient safety, which staffing issue should she be sure to ask about?

Wendy is interested in how the organization responds to medical errors. Which response from the department manager is consistent with a culture of safety?

A. Eight-hour shifts B. Weekend rotation C. Mandatory overtime D. Student observers

A. We provide remedial training for all staff on the unit when there is a medical error. B. We report any serious error to The Joint Commission and use its experts to help us find the root cause of the problem. C. We immediately identify the person responsible for the error and take corrective action. D. We make sure that we don’t have any errors in this unit.

Which comment by a department manager would BEST indicate that the organization places a high value on patient safety? A. We encourage patients and families to participate in The Joint Commission’s Speak Up program. B. We have monthly safety inservices. C. All employees are required to update their knowledge of safety practices each year. D. We have safety posters throughout the hospital that encourage people to report problems.

Wendy wants to promote patient safety and quality. Which strategy would be LEAST effective in helping her achieve this goal? A. Participating as a representative on hospital policy and procedure committees B. Supporting colleagues who report safety issues C. Sharing the results of evidence-based practice D. Keeping a journal of safety problems she observes

1. Correct Answer: C—Mandatory unplanned overtime and long shifts have been shown to have a negative impact on patient safety. Staff who work long shifts are at higher risk for making errors.. 2. Correct Answer: B—A culture of safety is characterized by reporting and open discussion of errors, with the goal of preventing similar errors. Automatically providing retraining or punishing the person most associated with the error — together with denying that errors occur — is most likely in a bureaucratic organization. 3. Correct Answer: A—An organization that encourages patients and families to participate in The Joint Commission’s Speak Up program is making an active effort to involve patients as partners in helping ensure the safest care environment possible. This approach is one of the characteristics of an organization that places a high value on safety. 4. Correct Answer: D—This is the most passive of the activities mentioned. The other strategies place Wendy in a proactive role where she will be most likely to have a positive impact on patient safety and quality. 42

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WWW.ORTODAY.COM

HOW TO EARN CONTINUING EDUCATION CREDIT 6. Hughes RG. Nurses at the sharp end of patient care. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008:1-30. 7. NQF safe practices and related processes. National Quality Forum Web site. http://www.qualityforum.org/

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

Publications/2014/02/NQF_Safe_Practices_and_Related_Processes.aspx . Published May 2014. Accessed December 18, 2014. 8. Rich VL. Creation of a patient safety culture: a nurse executive leadership imperative. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008:1-11. 9. Sammar CE, Lykens K, Singh KP, Mains DA, Lackan NA. What is patient safety culture? A review of the literature. J Nurs Scholarship. 2010;42 (2):156-165. 10. Henriksen K, Dayton E, Keyes MA, Carayon P, Hughes RG. Understanding adverse events: a human factors framework. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008:1-19. 11. Sentinel event information. The Joint Commission

DEADLINE Courses must be completed by 1/15/2017. 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer. 4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test. 5. All users must complete the evaluation process to complete course. You will be able to view a certificate on screen and print or save it for your records.

Web site. http://www.jointcommission.org/topics/hai_ sentinel_event.aspx. Accessed December 18, 2014. 12. Porche RA Jr. Front Line of Defense: The Role of Nurses in Preventing Sentinel Events. 2nd ed. Oakbrook Terrace, IL: The Joint Commission; 2007:2-19. 13. Beyea SC. Promoting a culture of safety by address-

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

ing bad behavior. AORN J. 2008;88(4):637-639. 14. Sentinel Event Alert, Issue 40: behaviors that undermine a culture of safety. The Joint Commission Web site. http://www.jointcommission.org/sentinel_

Accredited status does not imply endorsement by the provider or ANCC of any commercial products displayed in conjunction with this activity.

event_alert_issue_40_behaviors_that_undermine_a_culture_of_safety/ . Published July 9, 2008. December 18, 2014. 15. Benner P, Sheets V, Uris P, et al. Individual, practice and system causes of errors in nursing: a taxonomy. J Nurs Adm. 2002;32(10):509-523.

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

16. Finkelman A, Kenner C. Teaching IOM: Implications of the Institute of Medicine Reports for Nursing Education. 2nd ed. Silver Spring, MD: American Nurses Association; 2009:46-67. 17. Sorra J, Famolaro T, Dyer N. Hospital Survey on Patient Safety Culture: 2011 User Comparative Database Report. AHRQ Publication No. 11-0030. Rockville, MD:

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

Agency for Healthcare Research and Quality; 2011. 18. Aspiration pneumonia: hospital did not check dietary orders. Legal Eagle Eye Newsletter Nurs Profession. 2007:3. 19. Kohlbrenner J, Whitelaw G. Cannady D. Nurses critical to quality, safety, and now financial performance. J Nurs

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

Admin. 2011;41(3):122-128.

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June 2016 | OR TODAY

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WHEN PHYSICIANS STAY CALM AND FOCUSED,

GOOD THINGS HAPPEN. There are few places on earth that can match the pressure of an operating room. It’s an environment where intense focus and attention to every detail are absolute musts. Distractions are unwelcome, and unfortunately, there is no shortage of them. One such issue that consistently presents itself is the very real threat of heat stress. Because physicians are frequently called upon to stand under a bank of hot operating lights for hours at a time, they can often find their optimal body temperature compromised, making it challenging to maintain the peak mental and physical performance necessary for their profession. That needn’t be the case, however. Because to help mitigate the effects of heat stress, Glacier Tek TM has developed a cooling vest – a selfcontained, lightweight personal cooling system – to keep the wearer comfortable while working in harsh or challenging environments. From a physician’s perspective, the result 46

OR TODAY | June 2016

is a simple but critical one: Glacier Tek Cool Vests enable them to remain cool, calm and focused on delivering the best possible outcome to their patients.

allowing for unencumbered freedom of movement while helping them stay alert and focused during long, physically demanding procedures and surgeries.

THE NEED FOR IMPROVING PHYSICIAN COMFORT AND PATIENT OUTCOMES With about 99 million combined inpatient and outpatient surgeries in the U.S. each year, physicians and support staff face discomfort from overheating on a constant basis. The nation’s 18,000 surgeons and 100,000 operating room personnel endure bright lights, sterile gowns, lead aprons, physical exertion and time stress as they perform highintensity procedures. Simply turning down the temperature in the operating room isn’t an ideal solution for the patient, either. Research indicates that overly cool ORs can lead to experiencing greater blood loss, longer recovery times, and vulnerability to postsurgical, hospital-acquired infections. Even when patients are warmed with forced air, body temperatures decrease during the first hour of surgery, leading to hypothermic patients who are more likely to require blood transfusions. Which is why the Glacier Tek Cool Vest is the perfect solution for surgeons and operating room staff,

HOW GLACIER TEK COOL VESTS WORK While other cooling vests rely on less than ideal methods like ice, evaporation or even expensive tethered circulating systems that heavily restrict mobility in order to help maintain a comfortable body temperature, Glacier Tek takes a different approach. Each of the Glacier Tek Cool Vests include a set of GlacierPacks – cooling packs that are manufactured using the only phase change material on the market to carry the USDA Certified BioPreferred label. This means the packs are free from hazardous ingredients or materials, giving Glacier Tek Cool Vests the distinction of being the only cooling vests on the market that are completely safe for the wearer as well as the environment, making them ideal for use in health care applications. The patented Phase Change Material (PCM) used in Glacier Tek’s Cool Vests is superior to water-based personal cooling solutions in several ways. Worn around the body’s core in an easyon, easy-off vest without tubes or WWW.ORTODAY.COM

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Glacier Tek Cool Vests enable surgeons to remain cool, calm, and focused on delivering the best possible outcome to their patients

tethers, Glacier Tek Cool Vests cool the body safely to a comfortable temperature. Water freezes at a low 32°F/0°C, which is too cold to be exposed to bare (or even thinlycovered) skin for more than a few minutes. But the PCM used in Glacier Tek Cool Vests turns to a frozen solid at 59°F/15°C, a perfect temperature to bring relief. It also avoids the uncomfortable wetness caused by water condensation. COOL VESTS FOR THE MEDICAL COMMUNITY FLEX VEST

Designed to provide cooling comfort in unpleasantly warm conditions, the Flex Vest is styled to look like everyday casual wear, with 12 cooling packs that tuck discreetly into specially designed pockets. An expanded range of sizes provides increased comfort and a more customized fit. CONCEALABLE COOL VEST

With adjustable sizing that makes ordering easy, the Concealable Cool Vest fits easily under lab coats, scrubs or gowns and provides increased privacy and mobility WWW.ORTODAY.COM

while maintaining a cool and comfortable temperature. DISPOSABLE COOL VEST

Developed to assist those providing aid during the Ebola crisis, the Disposable Cool Vest was designed for limited use and can be easily disposed in a common landfill. The durable GlacierPacks are reusable, and the ultra-lightweight garment means increased stamina. THE GLACIERPACKS

After charging for as little as 20 minutes in ice and water, GlacierPacks will remain at a comfortable 59°F/15°C for up to two and a half hours in 100°F/38°C heat. Additionally, the packs can be reused indefinitely. In fact, GlacierPacks have been recharged 10,000 times in Glacier Tek’s lab with no measurable change in performance. OVERALL BENEFITS OF GLACIER TEK COOL VESTS GLACIERPACKS

• Recharge in just 20 minutes in ice and water, an hour in the freezer or a few hours in the average refrigerator (basically anything

colder than 59°F/15°C). • Contain no hazardous ingredients. The packs can be safely disposed in a landfill. • Can be easily cleaned, sanitized and reused indefinitely. In fact, GlacierPacks have been recharged 10,000 times in Glacier Tek’s lab with no measurable change in performance. • Manufactured using 100% biobased phase change material which has higher efficiency than salt hydrates and petroleum-based PCMs. • Proudly made in the USA. VEST

• Durable (made from sturdy fabrics) and lightweight (weighs about four pounds with cooling packs) and depending on model, disposable (bio-based products are environmentally friendly). • Maintains a dry, comfortable 59°F/15°C for approximately two and a half hours in 100ºF/38ºC heat, whereas ice or gel based systems are too cold at 32°F/0°C or less. • Operates effectively in enclosed environments and underneath June 2016 | OR TODAY

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protective garments (unlike water-soaked evaporative products which fail in these environments). It is self-contained, portable and unpowered, containing no cumbersome hoses, tubes or tethers. • Proudly made in the USA. THERE’S NO SUCH THING AS HAVING TOO MUCH LIFEIMPROVING TECHNOLOGY IN A HOSPITAL Retailing from $189 to $279, Glacier Tek Cool Vests are available in several varieties to help ensure a perfect fit, and can be easily worn over or under other garments. Each set of removable GlacierPacks are manufactured to stay cool for up to two and a half hours in 100° heat, with some users reporting up to four hours of cooling in their operating room conditions. Once the packs are spent, they can quickly and easily be replaced by fresh ones if needed. The reusable, durable packs are rechargeable in ice water and are ready for reuse in 20 minutes. The vest itself is 48

OR TODAY | June 2016

washable or disposable (depending on variety), and the cooling packs are easy to sanitize. Glacier Tek even developed a special disposable Cool Vest for situations of elevated sanitation protocol, for use by workers on the frontlines of epidemic crises. Lightweight and easy to use, completely non-toxic, and with unmatched ease of movement, Glacier Tek Cool Vests are the perfect solution to the problems of overheating that many surgeons and operating room staff often face. ABOUT GLACIER TEK Glacier Tek is focused on helping manage body temperatures in extreme environments through high-tech garments that help defend the wearer from heat stress. We manufacture a selection of cooling vests that feature Phase Change Material (PCM) technology, a thermal energy storage material that is designed to absorb heat generated by the wearer and offers better safety and cooling duration than that of evaporative, ice, or gel-

cooled vests. Founded by a military veteran, our products are 100 percent made in the USA. Our first product, The Original Cool Vest, was among the earliest completely self-contained body cooling vests available on the market; it is now sold in over a dozen countries. Our mission is to make a positive difference in the lives of people who are exposed to temperature extremes at work or play. We do this by providing safe, effective and environmentally responsible products designed to safely help maintain a normal core body temperature in a variety of environments. Our natural, renewable thermal energy storage products simultaneously provide comfort for people in need, while reducing the use of hazardous chemicals in the world and maintaining our ecological principles. ^FOR MORE INFORMATION about Glacier Tek, visit www.glaciertek.com or call 321-752-4130.

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YOUR PATIENT IS PREPPED AND COMFORTABLE. ARE YOU? In an environment like an operating room where there’s no room for error, problems can easily become magnified. But the debilitating and distracting effects of heat stress no longer need be a factor, because Glacier Tek™ Cool Vests are designed to remain at a consistent 59°F, keeping your body cool in hot, stressful conditions. Fitting comfortably over or under scrubs or other garments, its reusable packs charge in just 20 minutes in ice and water. And with the threat of overheating minimized, you can then concentrate on the task at hand–your patient. Which is how it should be.

Prepared To Endure

! R O R R E RO R E AL C I RG U S D VO I A TO W HO

HOW TO AVOID SURGICAL ERRORS BY DON SADLER

It’s probably safe to say that every member of the perioperative staff strives for perfection in the OR. However, every member of the OR staff is a human being, which means that surgical errors do unfortunately occur. MAJOR ERRORS AND NEVER EVENTS

Major surgical errors are referred to as “never events.” According to Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, the Executive Director and CEO of the Association of periOperative Registered Nurses (AORN), a few of the most common never events are: • retained foreign objects or surgical items (such as a sponge or medical instrument) that are left in the patient’s body after the procedure is finished; • wrong-patient, wrong-side and wrong-procedure surgeries; • nerve damage that’s usually related to positioning issues; and • anesthesia errors.

Especially prevalent are wrong-patient, wrong-side and wrong-procedure surgeries, she says. “The Joint Commission reports that 40 of these occur in the U.S. every week,” Groah explains. “This error is not common, although it still happens far too frequently,” says Tejal K. Gandhi, MD, MPH, CPPS, the President and CEO of the National Patient Safety Foundation. Coleen Smith, High Reliability Initiatives Director, Black Belt, for The Joint Commission Center for Transforming Healthcare, adds that wrong-patient, wrong-side and wrongprocedure surgeries are the second most-reported sentinel event to The Joint Commission.

HOW TO AVOID SURGICAL ERRORS

Meanwhile, Gandhi notes that studies estimate that the error of retained foreign objects may occur in as many as one in 1,000 abdominal surgeries and one in 18,000 inpatient surgeries. “The most reported root causes for sentinel events are a lack of leadership, human factors, poor communication, and faulty assessment,” says Smith. She says the Center for Transforming Healthcare has identified a number of contributing factors to sentinel events, including: • OR booking documents are not verified by office schedulers; • time constraints during patient verification that cause staff to rush; • ineffective hand-off communications or briefing processes; • site mark(s) are removed during prep or covered by surgical draping; • the surgical time out is performed without full participation; • senior leadership is not actively engaged; and • there is an inconsistent organizational focus on patient safety. “The Center urges health care organizations to establish a safety culture in which staff are expected to speak up when they have a patient safety concern,” says Smith. “In addition, staff should be educated about the value of standardized processes, including the surgical time out process, and be held accountable for their role in risk reduction.” 52

OR TODAY | June 2016

A CULTURE OF SAFETY

Groah also stresses the importance of establishing a culture of safety where staff feel comfortable reporting a near miss or error and are recognized for coming forward with information to create a safe surgical environment. “Weaving a culture of safety into the fabric of the organization requires members of leadership to allocate resources and provide incentives or rewards for promoting the culture of safety,” says Groah. “Team

ing evidence-based guidelines and practices,” she says. “Responding to the findings of the audit with corrective action and education, either for individual team members or for the team as a whole, is also critical.” MAJOR VS. TECHNICAL ERRORS

Gandhi makes a distinction between major errors or never events and what she calls technical errors. “These include manual errors, like when a blood vessel gets cut inadvertently, as well as errors in

“The Center urges health care organizations to establish a safety culture in which staff are expected to speak up when they have a patient safety concern.” training and the culture of safety promote respect and accountability among all OR team members.” Groah attributes many surgical errors to “a lack of awareness of the next big event that could occur and cause harm or damage to patients. This includes the failure of systems and processes either by omission or commission, as well as assuming that errors ‘won’t happen here.’ ” A lack of proper monitoring is another common cause of surgical errors, says Groah. “This requires auditing how policies and procedures are implemented and whether the team is follow-

judgment that delay a procedure or result in a technique being used that it not advisable, such as laparoscopic removal of a malignant organ or growth,” she says. These incidents do not usually occur due to inexperience or a lack of skill, says Gandhi. “In fact, one study found that they most often involve experienced surgeons but complicated cases, with systems factors usually contributing to the error,” she says. “In another study of closed malpractice claims, it was determined that systems factors were involved in the majority of cases WWW.ORTODAY.COM

where patients were harmed either in surgery or in perioperative care,” Gandhi adds. ADOPTING OTHER INDUSTRIES’ SAFETY PRACTICES

Some hospitals have begun adopting safety practices from airlines and the military to help prevent surgical errors. These practices include checklists, simulations/simulators and debriefings. “Team training simulations with OR staff are very common, especially with anesthesia,” says Gandhi. “Briefings and debriefings as part of the WHO Safe Surgery Checklist and other surgery checklists are also becoming more widespread.” “The checklist is one of several tools or initiatives to support a safe surgical environment,” says Groah. “Simulation centers are also gaining popularity – they are an excellent resource to encourage teamwork and the culture of safety.” According to Groah, AORN has created a comprehensive surgical checklist that includes specific steps to be followed at four key surgical phases: pre-procedure check-in, sign-in, time-out, and sign-out. It includes processes that have been learned in other industries and applied to the OR in order to minimize the chances of surgical errors. The AORN surgical checklist can be downloaded at www.aorn.org/ surgicalchecklist. “Debriefings, meanwhile, are implemented at the end of the surgical case to assess how the team performed,” Groah adds. “They assess what went well and what areas need to be improved the next time the procedure is performed.” “We are firm believers in using WWW.ORTODAY.COM

practices adopted from other industries,” says Smith. “In fact, we use Robust Process Improvement (RPI) methods and tools to help organizations improve the quality and safety of health care. These include Lean, Six Sigma and other change management tools and methodologies for high reliability.”

“This is an online organizational assessment with resources designed to guide hospital leadership throughout the high reliability journey,” she says. “The assessment focuses specifically on the areas of leadership commitment, safety culture and performance improvement.” THE TARGETED SOLUTIONS TOOL

“Team training simulations with OR staff are very common, especially with anesthesia. Briefings and debriefings as part of the WHO Safe Surgery Checklist and other surgery checklists are also becoming more widespread.”

Smith says that the Center for Transforming Healthcare recently released Oro 2.0 to assist with safe practices.

In 2009, the Center for Transforming Healthcare and Lifespan System in Rhode Island initiated the Safe Surgery Project. The goal was to improve safeguards in order to prevent wrong-patient, wrong-site and wrong-procedure surgeries. “As a result of this project, several solutions were identified, resulting in the Safe Surgery Targeted Solutions Tool (TST),” says Smith. The TST is an application that guides health care organizations through a step-by-step process to accurately measure their performance, identify barriers to excellent performance, and direct organizations to proven solutions that are customized to address their particular barriers. The results of the Safe Surgery Project have been impressive in terms of reducing surgical errors and improving patient safety. According to Smith, the Center for Transforming Healthcare was able to help participating organizations reduce the number of cases with risks by 46 percent in the scheduling area, 63 percent in pre-op and 51 percent in the operating room. “The center urges health care organizations to celebrate successes in reducing surgical errors and make everyone on the team aware of improvements,” says Smith. June 2016 | OR TODAY

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OR TODAY | June 2016

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June 2016 | OR TODAY

Recentered Focus

A NEW APPRECIATION FOR LIFE

Spotlight On: Lisa Antenucci STAFF NURSE AT TEMPLE UNIVERSITY HOSPITAL

"Every day is an adventure, I tell young people, ‘Please don’t wait until you’re 40 or 50 years old to go with your heart and your mind. Don’t do things the way you think everybody wants you to do it.'"

Spotlight On: Lisa Antenucci

urnout is a well-known phenomenon in the nursing profession, and amid the highs and lows of a 30-year nursing career, Temple University Hospital staff nurse Lisa Antenucci is as familiar with its signs and symptoms as any condition she’s treated. But when it affects your outlook, it can contribute to long-term concerns; the fact that burnout can be a blind spot to people who are suffering from it only makes it that much harder to resolve. “You almost don’t know you’re in it,” Antenucci said. “In the health care profession, we’re not good at taking care of ourselves at all.” From specialty to shift selection, the variety inherent in the nursing profession and the gamut of opportunities it affords are usually enough to help any nurse break out of a slump. For Antenucci, the challenges of self-care were most easily met with physical activity. A lifelong runner who graduated from halfmarathons to full marathons to CrossFit training (and then certified instruction) a few years ago, she’s long used exercise as an antidote to the stress of work. She recently took up yoga. Antenucci discovered that pairing yoga with travel to a variety of far-flung locales has only amplified its restorative effects. “It was a couple years ago when we had that real bad winter,” she recollects. “My girlfriend started posting pictures online, and I said, ‘Wherever you are, I need to be there.’ She said, ‘I’m at a yoga retreat in Guatemala.’ ” After a trip to Central America, Antenucci booked another to Vietnam, and last year began talking about Belize as a future destination. She said travel has really helped by removing her from the fast-paced

OR TODAY | June 2016

hospital environment and allowing her the breathing room to refocus her intention toward self-healing. It’s also provided an opportunity for novel experiences like zip-lining and stand-up paddleboarding, the impact of which has been visible to herself and her coworkers. “Some of these people know me as a sarcastic, miserable person,” Antenucci said. “I always see the negative in things. [But] in every picture from vacation, I have this ear-to-ear grin.” “[My coworkers are] Lisa Antenucci and Susan Santoro enjoyed seeing a whole different a yoga retreat in Montezuma Falls, Costa Rica. side of me they don’t see because we don’t socialize out of work. They see I can be thanks to her travels. happy and get into “You’ve got to take care of yourself different things.” before you can take care of anybody Antenucci said the twin pursuits of else,” Antenucci said. “You get stuck yoga and travel have afforded her a in cycles, and you do forget that. You chance for greater self-reflection. really have to think, and you really When she’s tempted to pick up have to be in touch with yourself, and overtime, she said she’s had to learn at 51, I’m just starting to learn that.” to say no. Antenucci already keeps a Fighting off the effects of burnout part-time trauma shift at a nearby have also helped Antenucci crystalhospital, which, in addition to her lize the virtues of her profession, training in cardiac critical care, from flexibility to salary to the open-heart surgeries, and transopportunities of making a difference plants, has broadened her horizons, in the lives of injured and ill patients. but added more to her normal Her goal is to leave those for whom workload. Despite the needs of her she cares in better shape than she department and the tendency for found them, which remains a hospitals to be short-staffed, she said challenge when they don’t respond she’s internalized the message of to treatment “and it’s your job to be self-care as an order of priority on the ball why that’s happening.”

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Fighting off the effects of burnout have also helped Antenucci crystallize the virtues of her profession, from flexibility to salary to the opportunities of making a difference in the lives of injured and ill patients.

“Our patients are so sick because they’ve [often] been turned down by many other institutions for surgery,” Antenucci said. “You really have to be on your game. The system is getting so bad nowadays fighting with insurance companies, I feel like I spend 10 hours of a 12-hour shift fighting to get my patients taken care of.” Antenucci turns to her coworkers in solidarity, and for back-up. She enjoys camaraderie with the veteran nurses in her unit as well as the opportunity of working with newly hired staff. The job provides novelty, and despite the consistent pressures, Antenucci believes it’s her calling, which provides no small degree of comfort as she considers her peers. Beyond that, medicine is a family pursuit, too. Growing up, Antenucci thought she might become a veterinarian; her older sister is a doctor, and her daughter is currently amidst a career

WWW.ORTODAY.COM

change into nursing. After an ROTC stint to pay for college and an army officer’s commission during Desert Storm, she relocated from San Antonio to Philadelphia. For someone whose career has taken a lot of twists and turns, Antenucci finds that it still yields no small degree of daily excitement. “Every day is an adventure,” she said. “I tell young people, ‘Please don’t wait until you’re 40 or 50 years old to go with your heart and your mind. Don’t do things the way you think everybody wants you to do it.’ ” “Nursing is a fabulous profession, and I know so many people my age who hate their jobs,” Antenucci said. “I would do it all again. I really like what I do.”

Lisa Antenucci, an animal lover, wanted to be a veterinarian when she was younger.

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June 2016 | OR TODAY

OUT OF THE OR FITNESS

BY MARILYNN PRESTON

GARDENING FOR FITNESS CAN YOU DIG IT?

ardening isn’t a fitness sport – not the way cycling, running and swimming are – but it is a delicious way to cultivate better Think how much money you could save if you grew some of your own food or herbs. It fries me to pay $2.99 for a small plastic container of organic rosemary at my local grocery, when I can pull it out of the ground by the handful for free, and often do – and it always tastes better. When you grow your own food – in a window pot, a community plot, on high-tech horizontal hangers – you also reduce your carbon footprint. No planes or trucks bringing it to market, no car fumes involved in getting it home. At Healthy Lifestyle U, you always earn extra credit for being kind to the planet. One sobering reason home growing is taking root in the U.S. is because it’s becoming increasingly clear how tainted our Big Food supply has become.

OR TODAY | June 2016

All across the country, even people who think jicama is the name of the shortstop for the Cubs are waking up to the fact that lots of the vegetables, fruits, meats and grains we buy every day in legal grocery stores are laced with nasty additives and assorted toxins. Change is in progress, and cleaner food means better health. But it’s not happening quickly, another reason to grab your kids and a shovel and make space for a small plot of spinach, which grows gangbusters in hot summer climates, as does kale. Growing your own food (and let’s not forget the joy of flowers) is also a wonderful way to exercise. Gardenvariety tasks such as digging, lifting, raking and planting – done mindfully and repeatedly – will make you stronger and more supple and will likely increase your longevity. Gardening also weeds out stress. It’s a relaxing activity because it shifts your mind into a more meditative state, and that’s a very good thing to do for yourself, even if it’s just for 10 minutes a day.

Gardening gives us all of the above … and great-tasting Sweet 100 baby tomatoes, too. Allow me to plant a few more seeds with you: injury-prevention tips to make your gardening easier and safer: WARM UP Avoid injuries and morning-after aches and pains, take a few minutes to warm up your muscles and juice up your joints before you put them to work in the garden. The more you tune in and listen to your body in motion, the less likely you are to injure it. PROTECT YOUR KNEES Invest in a kneeling pad or make one out of foam or a pillow. And don’t stay in a kneeling posture too long. To keep your knees happy, stand, breathe and bend your knees from time to time. PROTECT YOUR BACK Cultivate mindfulness when it comes to all your movements. Avoid overtwisting, jerking or straining your side-body or back. The smartest tactic WWW.ORTODAY.COM

FITNESS

is keeping your back strong and flexible throughout the year – yoga and Pilates are super for that – so when you get into the garden, you’re already good to grow. LEARN TO LIFT Before you move a rock or lift a heavy bag of fertilizer, think about the safe way to do it. Bend at the knees, not the waist. Keep your back straight, engage your abs and lift slowly, using your legs to lift and carry the load. When carrying heavy things, keep your arms (and the load) close to your body, not out in front. If you think an object is too heavy, or a task too hard, it is. Get some help. BEND AND BREATHE When you shovel dirt or spread fertilizer, remember to bend your knees and step into the action. Don’t hold your breath and stiffen up. Working in a garden is all about going with the flow. Your breath is your ally. Breathe deeply and fully when you garden and you’ll grow your energy in subtle and superb ways. BE ERGONOMICALLY CORRECT The more effort you put into your gardening, the more calories you burn. So go for manual clippers and trimmers, and push mowers, if possible. Use tools that are ergonomically correct, to lessen the strain. The more you’re able to work at a steady, mindful clip, the better workout it is. 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. WWW.ORTODAY.COM

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April June 2016 | OR TODAY

OUT OF THE OR HEALTH

BY LAINEY YOUNKIN, M.S., R.D EATINGWELL.COM

REFRESH YOUR STORAGE STRATEGY

f you’re on a quest to lose weight, you probably already know that eating right and exercising will be key to your success. But here’s another tip: How you store your food may influence how many calories you consume, and how healthy your choices are.

“You’re three times more likely to grab the first food you see than the fifth food,” says Brian Wansink, Ph.D., author of Slim by Design. In one study, people ate almost twice as much candy from clear versus opaque bowls – 55 extra calories daily, which can add up to five to six pounds of weight gain per year. To make it easier to make the healthy choice, try making healthy foods easier to see and tempting foods nearly invisible. Here’s how to pick the best storage container to support your healthy-eating goals. KEEP HEALTHY FOODS IN CLEAR CONTAINERS Studies suggest that we’re much more likely to eat fruit when it’s sitting out in a bowl on the table in plain sight. The same holds true when you store fruits and veggies in clear containers so they’re the first thing you see when you open the refrigerator door. Make it even easier to make the healthy choice by prepping salad ingredients and cutting up fruits and vegetables the night before while you’re making 64

OR TODAY | June 2016

dinner so you’re not deterred by having to wash, peel or chop produce when you’re in a rush to pack lunches or to grab a quick snack. PUT MORE CALORIE-DENSE– FOODS IN SEMI-SEETHROUGH CONTAINERS. Semi-see-through containers are good for “middle-of-the-road” foods, such as leftover whole-wheat pasta or chili. Both of these options can make a healthy lunch, but if you’re trying to watch your weight, you don’t want to eat as many calories for your lunch as you did for dinner than night before. If you don’t see the container of leftover pasta until after you’ve made a salad for lunch, you might be more likely to take just a small portion of pasta to round out your meal – rather than starting with the spaghetti and making vegetables the afterthought. STORE TREATS IN OPAQUE CONTAINERS The old saying, “out of sight, out of mind” rings true when it comes to leftover treats. Keep chocolate cake

and other calorie-busting foods from calling your name by storing them in opaque containers. Move ice cream to the very back of the freezer (behind the 100-percent fruit popsicles and the frozen berries that you could sprinkle over yogurt), and you might forget it’s there. A small treat can be part of a weightloss plan, but it can be challenging to hold yourself to just one treat when you’re feeling distracted and stressed at your midday meal. CONSIDER PORTION SIZE Organizing your leftovers into clear, semi-see-through and opaque containers is a great way to speed up your morning routine and make it easy to grab the healthy choice – but pre-portioning your leftovers is another effective strategy for keeping calories in check. Rather than trusting yourself to serve an appropriate-sized portion from a larger dish when it’s lunchtime and you’re hungry, consider portion sizes when you’re packing up leftover food after dinner. It’s much easier to exert self-control when you’re still full from dinner than it is at 12:01 p.m. the next day when your stomach is rumbling. – EatingWell is a magazine and website devoted to healthy eating as a way of life. Online at www.eatingwell.com.

WWW.ORTODAY.COM

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April June 2016 | OR TODAY

OUT OF THE OR NUTRITION

BY CLARE TONE, M.S., R.D. ENVIROMENTAL NUTRITION NEWSLETTER

The AcrylamideCancer Link H

umans have been eating acrylamide, a chemical that forms in some foods when they are exposed to high heat, for as long as we have been cooking, but it wasn’t until 2002 that its presence in foods was discovered.

The Maillard reaction, a naturally occurring reaction between specific proteins and carbohydrates when heated, gives breads their golden crusts and potato chips their crispy crunch, but under certain conditions it also gives rise to acrylamide, classified as a “probable carcinogen” by the International Agency for Research on Cancer THE SCIENCE ON CANCER Acrylamide is well established as a carcinogen in rodents, at doses estimated to be 1,000-100,000 times higher than amounts people get in their diet. But research on humans is inconclusive. An exhaustive review of human studies on acrylamide and cancer was published in Nutrition and Cancer in 2014; out of 26 studies, 66

OR TODAY | June 2016

only six showed increased cancer risk with the highest dietary acrylamide intake. A 2015 study published in the International Journal of Cancer found no increase in endometrial cancer risk among 768 non-smoking, postmenopausal women who had the highest blood levels of an acrylamide marker (a new, more accurate measurement of acrylamide intake). Expect more research on the horizon. THE WATCH FOR ACRYLAMIDE Though the science may be confusing, it’s still a good idea to keep your acrylamide intake under control. Acrylamide is found mainly in foods made from starchy plants, like potatoes and grains, when they are

cooked for long periods at high temperatures. Ready-to-eat cereals and highly processed foods, like French fries, potato chips and packaged cookies, are the biggest sources. Roasting coffee beans gives rise to acrylamide, but levels go down when the coffee is brewed. Acrylamide doesn’t generally form in dairy, meat or fish products, raw foods, fruits or low-starch vegetables. Among highacrylamide foods, the actual amount varies widely depending on how the food is processed and cooked. Fortunately, consuming whole, minimally processed foods is one way to limit your exposure. And using lower-temperature methods of cooking, such as boiling, steaming and sautéing, instead of frying or roasting starchy foods can reduce acrylamide too. – Environmental Nutrition is the award-winning independent newsletter written by nutrition experts. For more information, visit www.environmentalnutrition.com. WWW.ORTODAY.COM

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OUT OF THE OR RECIPE

OR TODAY | June 2016

BY DIANE ROSSEN WORTHINGTON ENTRﾃ右

WWW.ORTODAY.COM

RECIPE

A LIGHT LUNCH

PACKED WITH FLAVOR

his is one of my favorite dishes to serve as an appetizer or a main course for lunch. Little cooking is required and it is fun to put together. The recipe combines a simple meat and cheese with ingredients that are added as a seasonal addition.

Once spring comes into full bloom I can’t wait to cook with fresh peas. Look for fresh peas at your local farmers’ market, and use the peas quickly so they retain their sweet flavor. (Some tips: Feel free to open up a pea pod and taste the peas to make sure they are sweet rather than starchy or bitter. Some farmers’ markets even offer peas freshly shucked if you are in a hurry.) Burrata was invented as a way to use leftover curds after making mozzarella. The mozzarella is formed into a pouch and filled with these creamy curds. This is so delicious, but a little goes a long way because it is so rich and DIRECTIONS: Bring a medium saucepan of water to a boil over medium-high heat; add the peas and cook for 2 minutes. Drain and cool under cold running water. Cool and reserve. In a medium bowl, combine the peas, mint, lemon juice, 3 tablespoons of the olive oil, and salt and pepper to taste. Mix gently until thoroughly combined.

creamy. Don’t worry if the burrata doesn’t slice evenly because the interior is very creamy. You can find burrata and packages of sliced prosciutto at specialty shops and some supermarkets. The burrata is worth hunting for, but if it’s not available try a good quality fresh mozzarella. I like to finish this dish with a drizzle of olive oil and a sprinkling of toasted hazelnuts. The nuts add a toasty flavor and coarse texture against the creamy burrata. To drink? I like a California chardonnay or a full-bodied rose. Don’t forget to serve this dish with some crusty French bread.

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Arrange prosciutto slices folded over on a large round or rectangular serving dish. Arrange overlapping slices of burrata on top of the prosciutto in the center. Spoon the pea and mint mixture onto the burrata, allowing a bit to fall onto the prosciutto. Drizzle the remaining 1 tablespoon of olive oil evenly over the top. Sprinkle the hazelnuts evenly on top and season with freshly ground pepper. Serve

INGREDIENTS: 1 1/4 cups fresh peas (about 1 pound fresh pea pods) 1/3 cup medium-size mint leaves, finely chopped 2 tablespoons fresh lemon juice 3 tablespoons extra-virgin olive oil, plus 1 tablespoon for serving 4 ounces thinly sliced prosciutto 1 pound fresh burrata, cut into 16 slices 2 tablespoons finely chopped toasted hazelnuts Salt and freshly ground black pepper

– 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.

June 2016 | OR TODAY

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OUT OF THE OR SCRAPBOOK

OR TODAY AT AORN 2016 More than 5,000 perioperative nurses attended AORN’s annual Surgical Conference & Expo in Anaheim, California, April 2-6, making it the largest educational conference in the world for the specialty. Central to the nurses’ Expo experience is an exhibit floor of almost 500,000 square feet with 500 medical device and equipment manufacturers. On the floor, they can earn education credits and have plenty of time to talk to reps and vendors about their needs in the OR.

3 4

1. MD Publishing President and Founder John Krieg, Vice President Kristin Leavoy and Trade Show Coordinator Lisa Cover say “Aloha” from the exhibit hall floor at the AORN Surgical Conference & Expo 2016. 2. OR Today magazine celebrates a great AORN Surgical Conference and Expo with Maureen Maloney, AVP of Surgical Services, Giesinger Community Medical Center, and Donna Osmon, Clinical Nurse Educator, Lankenau Medical Center, Main Line. 3. The perioperative nurse attendees get very competitive during “Periop Challenge” when their knowledge of evidence-based practice is tested by the experts and authors of the Guidelines for Perioperative Practice. 4. Many of the education sessions are interactive to give the nurses a hands-on opportunity to experience the products as they question session leaders and exhibitors. 5. With quality and quantity time on the exhibit floor, nurses can find solutions specific to their role, practice area, and their facility. There are free presentations and CE credits, recruiters from top health systems and education institutions, simulation areas, and new product demonstrations. Games and props keep the energy going.

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INDEX ALPHABETICAL AAAHC…………………………………………………………19 AIV Inc.……………………………………………………… 27 Ansell Healthcare, Inc.…………………………… 28 AORN Works……………………………………………… 4 ASCA………………………………………………………… 44 C Change Surgical…………………………………… 67 Cardinal Health………………………………………… 63 Checklist Boards Corp.…………………………… 70 Cincinnati Sub-Zero Products……………… 44 Clorox Professional Products……………… 10-11 Encompass Group, LLC…………………………… 72 Enthermics Medical Systems………………… 35 GelPro………………………………………………………… 60

General Hosptial Supply Corp.……………… 25 Glacier Tek…………………………………… 27, 46-49 Gopher Medical………………………………………… 70 Healthmark Industries……………………… 45, 72 Innovative Medical Products, Inc……………… BC Innovative Research Labs, Inc……………………… 12 Interpower Corporation…………………………… 5 Jet Medical Electronics…………………………… 23 Kenall Mfg/Indigo Clean………………………… 55 MAC Medical………………………………………………… 9 MD Technologies……………………………………… 60 Medline Industries, Inc.…………………………… 34 OR Today Live!………………………………………… 63

Pacific Medical LLC…………………………………… 6 Palmero Health Care……………………………… 70 Paragon Service…………………………………………18 Polar Products, Inc.………………………………… 23 RepScrubs……………………………………………………21 Ruhof Corporation…………………………………… 2-3 Sealed Air……………………………………………………61 SMD Waynne Corp.………………………………… 65 Sububan Surgical Company…………………… 65 Surgical Power………………………………………… 72 TBJ, Inc.……………………………………………………… 54 Tru-D………………………………………………………… IBC

GENERAL AIV Inc.……………………………………………………………… 27 GelPro………………………………………………………………… 60 Surgical Power………………………………………………… 72

RADIOLOGY Checklist Boards Corp.…………………………………… 70

INDEX CATEGORICAL ACCREDITATION AAAHC…………………………………………………………………19 ANESTHESIA Checklist Boards Corp.…………………………………… 70 Gopher Medical………………………………………………… 70 Innovative Research Labs, Inc……………………………… 12 Paragon Service…………………………………………………18 APPAREL Healthmark Industries……………………………… 45, 72 ASSOCIATIONS AAAHC…………………………………………………………………19 AORN Works……………………………………………………… 4 ASCA………………………………………………………………… 44 BEDS Innovative Medical Products, Inc………………… BC CARDIOLOGY C Change Surgical…………………………………………… 67 Gopher Medical………………………………………………… 70 CARTS/CABINETS Cincinnati Sub-Zero Products……………………… 44 Encompass Group, LLC…………………………………… 72 Enthermics Medical Systems………………………… 35 MAC Medical………………………………………………………… 9 Medline Industries, Inc.…………………………………… 34 Sububan Surgical Company…………………………… 65 CLEANING SUPPLIES Ruhof Corporation…………………………………………… 2-3 CLAMPS Innovative Medical Products, Inc………………… BC CRITIAL CARE Innovative Research Labs, Inc……………………………… 12 DISINFECTANTS Clorox Professional Products……………………… 10-11 Palmero Health Care……………………………………… 70 Sealed Air……………………………………………………………61 DISPOSABLES Pacific Medical LLC…………………………………………… 6 ENDOSCOPY Clorox Professional Products……………………… 10-11 MD Technologies……………………………………………… 60 Ruhof Corporation…………………………………………… 2-3 TBJ, Inc.……………………………………………………………… 54 FALL PREVENTION Encompass Group, LLC…………………………………… 72 GEL PADS GelPro………………………………………………………………… 60 Innovative Medical Products, Inc………………… BC

OR TODAY | June 2016

HAND/ARM POSITIONERS Innovative Medical Products, Inc………………… BC HIP SYSTEMS Innovative Medical Products, Inc………………… BC INFECTION CONTROL/PREVENTION Cardinal Health………………………………………………… 63 Clorox Professional Products……………………… 10-11 Encompass Group, LLC…………………………………… 72 Palmero Health Care……………………………………… 70 RepScrubs……………………………………………………………21 Ruhof Corporation…………………………………………… 2-3 Sealed Air……………………………………………………………61 Tru-D……………………………………………………………………IBC INSTRUMENT TRANSPORT Medline Industries, Inc.…………………………………… 34 KNEE SYSTEMS Innovative Medical Products, Inc………………… BC LABORATORY TBJ, Inc.……………………………………………………………… 54 LEG POSITIONERS Innovative Medical Products, Inc………………… BC MONITORS Jet Medical Electronics…………………………………… 23 OR TABLES/ ACCESSORIES Innovative Medical Products, Inc………………… BC ORTHOPEDIC Surgical Power………………………………………………… 72 OTHER Ansell Healthcare, Inc.…………………………………… 28 AIV Inc.……………………………………………………………… 27 Encompass Group, LLC…………………………………… 72 SMD Waynne Corp.………………………………………… 65 TBJ, Inc.……………………………………………………………… 54 Tru-D……………………………………………………………………IBC PATIENT MONITORING Gopher Medical………………………………………………… 70 Pacific Medical LLC…………………………………………… 6 POSITIONERS/IMMOBILIZERS Cardinal Health………………………………………………… 63 Innovative Medical Products, Inc……………………………………………………… BC POWER COMPONETS Interpower Corporation…………………………………… 5

RESPIRTORY Innovative Research Labs, Inc……………………………… 12 REPAIR SERVICES Pacific Medical LLC…………………………………………… 6 SAFETY GEAR Cardinal Health………………………………………………… 63 Glacier Tek…………………………………………… 27, 46-49 SHOULDER RECONSTRUCTION Innovative Medical Products, Inc………………… BC SIDE RAIL SOCKETS Innovative Medical Products, Inc………………… BC STERILIZATION General Hosptial Supply Corp.……………………… 25 TBJ, Inc.……………………………………………………………… 54 SURGICAL AAAHC…………………………………………………………………19 Checklist Boards Corp.…………………………………… 70 Kenall Mfg/Indigo Clean………………………………… 55 MD Technologies……………………………………………… 60 Surgical Power………………………………………………… 72 SURGICAL SUPPLIES Cardinal Health………………………………………………… 63 General Hosptial Supply Corp.……………………… 25 Ruhof Corporation…………………………………………… 2-3 SUPPORTS Innovative Medical Products, Inc………………… BC TEMPERATURE MANAGEMENT C Change Surgical…………………………………………… 67 Cincinnati Sub-Zero Products……………………… 44 Enthermics Medical Systems………………………… 35 Glacier Tek…………………………………………… 27, 46-49 MAC Medical………………………………………………………… 9 Polar Products, Inc.………………………………………… 23 TRADE SHOWS AORN Works……………………………………………………… 4 OR Today Live!………………………………………………… 63 WARMERS Cincinnati Sub-Zero Products……………………… 44 Encompass Group, LLC…………………………………… 72 Enthermics Medical Systems………………………… 35 Glacier Tek…………………………………………… 27, 46-49 MAC Medical………………………………………………………… 9 WASTE MANAGEMENT Sealed Air……………………………………………………………61 WOUND MANAGEMENT Cardinal Health………………………………………………… 63 WWW.ORTODAY.COM

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