OR Today - September 2016 by MD Publishing

CE ARTICLE

LEADERSHIP PAGE 34

SPOTLIGHT ON

CINDY PISA, RN PAGE 54

TAKE GOOD CARE NURSES • SURGICAL TECHS • NURSE MANAGERS

NUTRITION

SUGAR PAGE 64

SEPTEMBER 2016

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CONTENTS

features

CORPORATE PROFILE: GELPRO MEDICAL Let’s Gel Inc., an Austin, Texas-based privately held corporation, is the leading manufacturer and provider of innovative ergonomic flooring products in the home, medical, and commercial flooring categories. Founder Robb McMahan explains how he invented the product, how a surgeon’s interest has helped the company grow and plans to introduce operating room positional aides in 2017.

OR TODAY | September 2016

SPOTLIGHT O 48

BUILDING BLOCKS OF: HOW BLOCK SCHEDULING PROMOTES EFFICIENCY

When it comes to effective OR management, it’s all about maximizing efficiency in order to realize cost savings. A growing number of hospitals today are turning to block scheduling to make these objectives a reality. OR Today interviewed experts to learn more about the benefits of block scheduling.

SPOTLIGHT ON: CINDY PISA, RN

As the single parent of a child with disabilities herself, Cindy Pisa decided to enter nursing as pathway to take control of the delivery of care that she saw being provided to her family. Today, she is an inhome service nurse at the Life at Lourdes senior citizen center in Pennsauken, New Jersey.

OR Today (Vol. 16, Issue #7) September 2016 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2016

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September 2016 | OR TODAY

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

26 11

EDITOR

John Wallace | jwallace@mdpublishing.com

ART DEPARTMENT Jonathan Riley Jessica Laurain Kara Pelley

ACCOUNT EXECUTIVES

Warren Kaufman | warren@mdpublishing.com Jayme McKelvey | jayme@mdpublishing.com

Chandin Kinkade | chandin@mdpublishing.com

ACCOUNTING Kim Callahan

WEB SERVICES

INDUSTRY INSIGHTS 11 16 18 20

News & Notes AAAHC Update OR Today Webinar ASCA

Taylor Martin Adam Pickney Cindy Galindo

CIRCULATION Lisa Cover Laura Mullen

IN THE OR 22 25 26 34

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 60 62 64 66 68

Health Fitness Nutrition Recipe Pinboard

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INDUSTRY INSIGHTS NEWS & NOTES

SUNTECH MEDICAL DEVICE FEATURES MASIMO SET PULSE OXIMETRY TECHNOLOGY Masimo and SunTech Medical have jointly announced the integration of Masimo SET pulse oximetry technology into SunTech’s CT40, a next generation spot-check vital signs device. Masimo Signal Extraction Technology (SET) Measurethrough Motion and Low Perfusion pulse oximetry measures oxygen saturation (SpO2), pulse rate, and perfusion index. Masimo SET has been shown to significantly reduce false alarms and accurately monitor for true alarms and is estimated to be used on more than 100 million patients in leading hospitals and other health care settings around the world. The SunTech CT40 is an affordable solution for clinicalgrade spot-check measurements of blood pressure, temperature and pulse oximetry in hospitals and clinics. Ambulatory care, long-term care and low-acuity hospital departments can implement this vital signs device that

offers advanced features and digital connectivity. The modular design allows clinicians to easily make adaptations to the device while in the field, adding thermometry, SpO2 and Wi-Fi as needed. Other advanced features include the ability to transmit measurement data directly from the device, in accordance with HL7 messaging protocols, as well as BP Averaging Mode – an increasingly important component of accurate blood pressure measurement, as evidenced by the recently published SPRINT Study from the National Institutes of Health (NIH), which specified that a mean of three office BP measurements would be used to establish target BPs for Standard Group participants. The SunTech CT 40 with Masimo SET technology has a CE Mark. It is not FDA cleared and is not available for sale in the United States.•

3M INTRODUCES BIOLOGICAL INDICATOR FOR VAPORIZED HYDROGEN PEROXIDE STERILIZATION 3M recently introduced the new Attest Rapid Readout Biological Indicator System – providing biological results for vaporized hydrogen peroxide sterilization in just four hours. With BI results in just four hours, information is ready while there is still time to act. Sterile processing staff can alert surgical personnel while a patient is still in the OR, or even stop a contaminated instrument from being used at all. Results can be documented on the sameday, during the same shift, and perhaps with the same operator – helping to standardize release practices and simplify workflows. Connectivity to popular instrument tracking systems helps teams streamline record keeping and WWW.ORTODAY.COM

avoid documentation errors. “Sterilization of surgical instruments is absolutely critical, but monitoring every load with a conventional 24-hour biological indicator has very little practical value,” said Mojdeh Poul, president, 3M Infection Prevention Division. “This new 4-hour rapid BI technology for vaporized hydrogen peroxide sterilization means that all loads can be monitored with a BI, and even quarantined until the BI result is known, regardless of the sterilization modality – enabling health care professionals to provide the same high level of care to every patient.” 3M’s rapid BI system, consisting of the 3M Attest Rapid Readout Biological Indicator 1295 and the 3M Attest Auto-reader 490H is

cleared for use with all current cycles in three models of STERRAD Sterilizers: the 100S, the 100NX, and the NX. These sterilizers represent the majority of vaporized hydrogen peroxide sterilizer models in use in the U.S. health care market today. • FOR MORE INFORMATION, visit go.3M.com/VH202.

September 2016 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

NEW ENDOSCOPE CLEANING BRUSH

Healthmark Industries has announced the addition of the Endoscope Cleaning Brush CC-025-600 to its GI product line. Endoscope reusable brushes are often costly and are unintentionally discarded. For this reason the single-use 6 mm diameter brush has been developed as an alternate option purposed for the channels of flexible endoscopes that have a diameter between 2.0 and 3.2 mm. Endoscope Cleaning Brush is used to brush inside of the suction channel in the control section, the instrument channel junction, the forceps/irrigation plug (isolated type), the luer-split, and the inside of the suction and biopsy valves, depending on which type of endoscope is used. The nylon bristle brush tips connect to a stainless-steel wire, which joins to a versatile white thermoplastic tubing, ensuring adequate debris removal without causing scope damage. • Visit www.hmark.com or call 800-521-6224 for more information.

NEW PROTOCOL REDUCES HOSPITAL-ACQUIRED PRESSURE ULCERS Smith & Nephew has announced the publication of a new research paper showing how a comprehensive ulcer prevention program, which included the use of ALLEVYN LIFE, can significantly decrease hospitalacquired pressure ulcers (HAPUs). The study was conducted in an adult intensive care unit (ICU) at Eskenazi Health, Indianapolis, Indiana, U.S., between 2012 and 2013, and published in the American Journal of Critical-Care Nurses. The research emphasizes that hospitals who adopt a standardized protocol for the prevention and treatment of HAPUs may see potential cost benefit of such prevention. At the end of the first year, the prevention program demonstrated a 69 percent decrease in HAPUs. The estimated potential cost saving for the Eskenazi Health ICU was nearly $1 million, and the convincing results in the ICU have led to the approval of a hospital-wide rollout of the HAPU prevention program.

OR TODAY | September 2016

ALLEVYN LIFE, a silicone foam dressing also indicated for the treatment and prevention of pressure ulcers, developed by Smith & Nephew, was introduced to the protocol as part of the standard prevention method three months into the program. Rachel Culpepper, Registered Nurse at Eskenazi Health stated, “This study validates the need for a comprehensive, proactive, collaborative prevention program in hospitals. Although it is difficult to isolate the effects of individual program components, silicone foam dressings can complement an existing pressure ulcer prevention program, and are believed to contribute to the reduction in HAPUs.” Additional components to the HAPU prevention program include educating Eskenazi Health staff members and a focus on adherence to protocols for patient care. Both have proven to be part of an effective programme for reducing the incidence of HAPUs in the ICU, according to the study results. •

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TRIM 4.5”

NEWS & NOTES

TRIM 4.5”

DIVERSEY CARE LAUNCHES CONTINUING EDUCATION PROGRAM Sealed Air’s Diversey Care division has announced the launch of a continuing education programPUBLICATION for nurses and infection prevention MEDICAL DEALER TECHNATION personnel. The initial program BUYERS GUIDE OTHER includes five free courses, each providing one hourMONTH of continuing nursing education credit. J F M A M J J A S O The continuing education content and resources are DESIGNER: JL designed to address the ever-changing needs in health care settings, while using evidence to help facilitate improved practices and processes, with the goal of enhancing capabilities and improving patient safety. •

ORTODAY

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September 2016 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

JUSTRIGHT SURGICAL RECEIVES FDA CLEARANCE FOR USE OF DEVICE IN PEDIATRIC PATIENTS JustRight Surgical LLC has received FDA clearance for specific use of its 3 mm JustRight Vessel Sealing System in pediatric surgery. JustRight Surgical is the first and only company to secure clearance from the FDA for an electrosurgical device to be used specifically for pediatric patients. To achieve the additional clearance from the FDA, JustRight subjected its 3 mm vessel sealer through rigorous testing. The final data was presented at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) clinical congress in May 2016. The JustRight Sealer was shown

to be safe to use in extremely tight or small spaces found in teens, children, infants and neonates. The new, low-power vessel sealing technology was found to permanently fuse vessels while using significantly less energy and was therefore determined to be safe to use in the smallest patients without risk of damaging critical, adjacent structures. The company’s devices are five to nine times smaller than previously available. Demand for JustRight Surgical’s instruments are currently in use for general and thoracic procedures in over 100 children’s hospitals in the U.S. and Europe. They are the only

company in the world to have developed a 5 mm stapler using the classic titanium wire staple in a clinically accepted “B” shape and a 3mm vessel sealer.•

MEDROBOTICS CORP. WINS ‘BEST-IN-SHOW’ Medrobotics Corp., a surgical products company with core competencies in medical robotics, has announced that its Flex Robotic System was named the sole best-inshow award winner at the 2016 Medical Design Excellence Awards (MDEA). Earlier in the evening, the Flex Robotic System had been named the only Gold Medal Winner in the Surgical Equipment, Instruments and Supplies category. The Medical Design Excellence Awards competition honors achievements in medical product design and engineering that improve the quality of health care delivery and accessibility. Each year, a panel of jurors comprised of designers, engineers, and clinicians award bronze, silver, gold, and best-in-show honors to the most innovative products on the market in nine categories. “Medrobotics is thrilled to receive this recognition for the Flex Robotic System,” said Samuel Straface, Ph.D., President and CEO of Medrobotics. “Our engineers and colleagues have crafted a unique product platform that could dramatically expand and improve minimally invasive procedures. We’re excited about its potential to improve health care around the world by helping thousands of patients.” Medrobotics’ Flex Robotic System was designed to 14

OR TODAY | September 2016

provide an affordable, easy-to-use robot-assisted surgical platform for hospitals and surgeons seeking to provide minimally-invasive treatment options to the broadest number of patients. Minimally invasive surgery has demonstrated advantages for patients and providers, such as shorter hospital stays and faster recovery times. • WWW.ORTODAY.COM

TRIM 2.25”

NEWS & NOTES

NEED HELP MANAGING VENDOR ATTIRE?

KEY SURGICAL LAUNCHES ADDITIONAL PRODUCTS IN RESPONSE TO DEMAND

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Key Surgical has responded to an increased demand for singlesource suppliers with the addition of several products that are sterile, ready-to-use and designed for use during surgical procedures. The ability to source a comprehensive line of products from one vendor presents a significant financial and logistical advantage for hospital supply chain and purchasing departments. The new products include needle counters designed to help surgical teams account for blades and suture needles, cautery tip cleaners to keep electrosurgical pencil tips clear of debris during use, a specially formulated anti-fog solution for endoscopes, and innovative magnetic technology that enables hands-free transfer of surgical sharps. All products address a pervasive challenge in the hospital industry: How to keep patient care and safety at the forefront without compromising efficiency, efficacy, or cost. Key Surgical specializes in products used in the processes of surgical instrument cleaning and sterilization, instrument protection, identification, and personal protective equipment. “The seven new products significantly expand the depth and breadth of Key Surgical’s offerings,

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

enabling more hospitals and surgical facilities to rely on Key Surgical as a one-source supplier,” said Alana Suomela of Key Surgical. Key Surgical’s legacy products include vascular booties, clamp covers, sterile labels, time out visuals, hand immobilizers, and a wide variety of basins, bowls, and cups. The newly available OR products from Key Surgical are: • Cautery Tip Cleaner • Needle Counters • Magnetic Instrument Drapes • Magnetic Instrument Mats • Surgical Light Handle Covers • Surgical Skin Markers •

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 IN THE OR INSIGHTS AAAHC UPDATE

BY ANGELA FITZSIMMONS

THREE STEPS TO INFORMED CONSENT “I

nformed consent” is the name given to the idea that a patient has a legal and ethical right to direct what happens to his/her body. The specific term appears in only a limited number of AAAHC Standards* relating to anesthesia, surgical services, dental services, behavioral health services, research activities, and radiation oncology services, but it is the philosophical basis for placing patient rights and responsibilities as the first chapter of the AAAHC Accreditation Handbook. The goal of informed consent is that the patient has the opportunity to be an active participant in his/her health care decisions. The inherent imbalance of power in the providerpatient relationship can make this goal difficult to achieve. Patients may feel vulnerable and reluctant to ask about a proposed procedure or course of treatment. Or, they may lack the needed vocabulary or basic process knowledge to formulate clarifying questions to help them understand. In short, patients don’t know what they don’t know and that places the burden of obtaining meaningful informed consent squarely on the shoulders of health care providers. Because providers sit on the up side of this power imbalance, they may be unaware of the patient’s hesitation to press for explanation or express anxiety. This means that a patient-centered approach to communication is essential in order to achieve true informed consent. Explaining the nature of the proposed treatment or procedure, the relevant associated risks, and any alternative options along with the attendant risks of these is only the first (and perhaps the simplest) step in a three-step process.

OR TODAY | September 2016

COMMUNICATION MEANS SHARED UNDERSTANDING

Step two of the process is transforming information into communication. The provider must take the initiative to confirm that the patient (or his or her representative) has moved from the basic level of knowledge – information – to the level of comprehension at which meaning is attached to knowledge. How do you do this? It may help both sides if the issue is framed as a decision-making partnership. The provider will be providing information and sharing a specific recommendation. The patient must then have ample opportunity to participate in the decision to proceed. A consent form included among a stack of papers to sign does not address the intent of informed consent. In fact, it might signal a problematic lack of patientcenteredness; a “we’re-going-throughthe motions-because-we must” approach that reduces the patient’s agency and results in a response that could be seen as coerced. Prior to seeking that signature (step three), providers must ensure that the consent is voluntary and intentional. Ask questions. Has your patient understood the information well enough to restate it? For example, could she explain to a

family member what she consenting to in basic terms? INFORMED CONSENT IN ACTION

When an accreditation survey takes place, informed consent is usually confirmed through documentation. Here are some questions that we’ve received from organizations seeking accreditation with regard to issues of consent. Q: For a surgical procedure, can a single consent form cover both the anesthesia and the procedure? A: The issue is voluntary, informed patient consent. If the provider(s) have fully communicated the options, risks, recommended course of action, and assessed the patient’s understanding and willingness to proceed, it is acceptable to use a single consent document. In cases where the anesthesia provider and the surgeon are individually discussing their roles with the patient, it is more usual to see separate forms. In settings where a surgeon is supervising anesthesia provided by a CRNA, a single consent form is more common. Q: Can documentation that the proposed procedure was discussed WWW.ORTODAY.COM

AAAHC UPDATE

with the patient or the patient’s parents/guardian, and that they consented to the procedure be included in the medical notes without a separate form? A: Some states require a written consent, many do not. However, beginning in 2016, AAAHC Standard 10.H is quite specific on this: 10.H Informed consent for the proposed procedure is obtained. 1. There is documentation that the necessity of the proposed procedure or surgery, as well as alternative treatment techniques, have been discussed with the patient.

2. The organization obtains written informed consent from the patient or the patient’s representative before the procedure or surgery is performed. Written informed consent has always been required in Medicare-certified ASCs, and the Standard now requires it in other surgical/procedural settings as well. To apply 10.H.2 in primary care settings in 2016, surveyors will ask for the organization’s policies or guidelines regarding when written vs. verbal consents are required, assess the rationale of those guidelines, and then confirm compliance through the review of clinical records. The intent is that in primary care settings, some procedures

such as cryotherapy of warts, removal of skin tags, etc. are sufficiently benign that they will not require separate written, signed consents. In this case, a note in the clinical record is sufficient. *Standards cited refer to the identiﬁers in the 2016 edition of the Accreditation Handbook for Ambulatory Health Care. ABOUT THE AUTHOR Angela FitzSimmons is Director, Marketing and Communications for AAAHC and its family of companies. Since 2011, she has focused on bringing best practices to life by developing educational resources for AAAHCaccredited organizations based on the Standards.

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INDUSTRY INSIGHTS WEBINAR

STAFF REPORT

WEBINAR SERIES

OR TODAY SETS WEBINAR RECORDS

he OR Today webinar series set new records in June. The webinar “ABCs of Radiation Safety: Avoidance + Behavior + Control = Dose Reduction” presented by Chintan Shah recorded the highest number of registrations and the high-

est number of attendees in the history of OR Today webinars. The session was also the highest rating OR Today webinar of 2016 with a 4.3 rating on a 5.0-point scale.

Shah manages Americas marketing and sales for the Real-time Staff Dose (RTSD) business at Unfors RaySafe, a Fluke Biomedical brand. During the 60-minute presentation, participants were guided through the risks of prolonged radiation exposure and taught guidelines to help manage their radiation exposure in the work environment. Shah also previewed trends in radiation monitoring, including real-time dose monitoring systems. The webinar concluded with an information Q&A session. Shah opened the floor and answered questions submitted by webinar attendees. He also invited participants to email him questions at Chintan.shah@raysafe.com. Attendees praised the webinar in a post-webinar survey. “The webinar from OR Today is great. I have learned about safety in 18

OR TODAY | September 2016

radiation exposure, risk, manage radiation dose, solutions and technologies for medical personnel and ALARA. Safety first,” Rolando A. shared. “ ‘ABC of Radiation Safety’ showed me the importance of safety resources available to monitor and prevent overexposure, including some after effects of improper/poor safety protocols when working with radiation sources to which health care staff and service personnel are exposed when needed,” Alain A. wrote. “The value of the educational material presented by OR Today are relevant and in time with the concerns of our facility(s). Very much appreciated,” wrote Steve E. “This webinar is relevant not only to clinical staff in these reported settings, but for product vendors/ reps as well. Radiation safety is important for all,” added Mimi P.

“The value of the educational material presented by OR Today are relevant and in time with the concerns of our facility(s). Very much appreciated.” -Steve E.

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STAFF REPORT

OR Today is proud to offer the free monthly webinar series as a way to educate and provide valuable information to the OR professional community. OR Today plans to offer at least one webinar per month, focusing on issues pertinent to OR nurses, managers and techs. The series will include the most sought after and dynamic speakers in the profession. FOR MORE INFORMATION about the OR Today webinar series, or for a recording of this webinar visit ortoday.com/webinars/.

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September 2016 | OR TODAY

INDUSTRY INSIGHTS ASCA UPDATE

BY WILLIAM PRENTICE

ASCs CAN CUT PRIVATE INSURANCE COSTS

esults of a study released in June demonstrate conclusively what ASC professionals have been saying for some time: ASCs can have a significant impact on reducing the cost of outpatient surgery in the private insurance market. In fact, the study shows that by providing a cost-effective alternative to hospital outpatient departments (HOPD), ASCs are already reducing private health insurance spending by $38 billion each year.

The same study concludes that $5 billion of that savings goes directly to patients through lower deductibles and coinsurance payments. It also shows that ASCs have the capacity to save payers and patients much more. The study results come from an analysis of data derived from more than 400,000 de-identified private health insurance claims collected across the country in 2014. Health Care Bluebook, a national provider of quality and cost data for health care services, conducted the analysis, and HealthSmart, the nation’s largest independent administrator of health plans for self-funded employers, supplied the data for the study. ASCA contributed technical assistance and expertise. The $38 billion figure means that, each year, private insurance providers and their beneficiaries save an amount equal to Medicare’s total spending on all hospital outpatient care. What do all of these findings 20

OR TODAY | September 2016

mean for patients and employers across the country? To answer that question, let’s begin by looking at Charlotte, North Carolina, where the average ASC price for a knee arthroscopy was $6,118, while the average HOPD price was more than twice as expensive at $12,493. For a Charlotte patient with a Silver Health Insurance Plan as defined by the Affordable Care Act (including a $2,700 deductible, 80 percent coinsurance and a $5,000 maximum out-of-pocket threshold), the cost savings that the ASC offered was about $1,275. Applying the same plan design to a cataract surgery in Charleston, West Virginia, where annual per capita income is about $35,000, a typical patient saved $566 by choosing an ASC instead of an HOPD. The insurer of that patient realized a savings of $2,264. Clearly, the price variability identified in this study has significant implications for patients,

particularly those with high deductibles. When a patient pays $5,000 for a cataract surgery that is available for $2,500 in another setting, the additional $2,500 comes straight out of his or her pocket. This is money that could be used to keep a car running so a patient can get to work or to pay for food, housing and education. This study also shows that employers across the country can realize savings of up to 4 percent of their total spend by making better use of the more cost-effective providers in their existing networks, but these savings will not accrue without some additional work. To realize these savings, employers have to: • understand their spending data and what is happening in their network in the locations where their employees live and work; • employ benefit designs that encourage consumerism, such as high deductible and consumerdirected plan designs; and • educate their employees and provide them with the price and quality transparency tools they need to be effective health care consumers and even consider rewarding members when they make good, cost-effective choices on care. Although this particular study did not examine the quality of care available in HOPDs and ASCs, recent research and results of Medicare’s WWW.ORTODAY.COM

ASCA UPDATE

Together, we can signiﬁcantly lower the cost of care, increase access to care and help patients lead healthier lives.

national quality reporting program released this year suggest that ASCs provide a quality of care equal to our country’s top hospitals. Also, while this study concerns only privately insured patients, a study conducted in 2013 by researchers at the University of California-Berkeley demonstrates that ASCs also save Medicare and its beneficiaries approximately $2.3 billion each year. With health care spending in the country topping $3 trillion this year, it is hard to find opportunities for savings that don’t rely on rationing or compro-

mising quality. The message is clear: ASCs offer value that can’t be ignored. Patients, physicians, employers and public and private insurers all need to work together to empower patients to make smart choices about where to receive the outpatient surgical care they need. Together, we can significantly lower the cost of care, increase access to care and help patients lead healthier lives. WILLIAM PRENTICE is the chief executive officer of the Ambulatory Surgery Center Association.

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IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nationâ&#x20AC;&#x2122;s Listserv

CODE CART CHECKS Is it absolutely necessary to check the code cards daily? Is it acceptable to check them every week? Also, why is it OK to go the whole weekend without a code cart check? A: My understanding of code cart checks was that they needed to be checked at least once every 24 hours when someone was in the department.

A: Are you Joint Commission certified? You are required to do a check every day that you are open. It is OK to not check it over the weekend if you are closed and there is no opportunity for that crash cart being used.

A: Correct, that is a Joint Commission requirement for certified organizations.

VAGINAL PREPS When doing a vaginal prep, is the vaginal vault prepped with betadine soap and paint? A: We only do paint in the vault. A: Paint only.

A: It is standard of practice to check the crash carts daily. In such critical situations you want to make sure all of the equipment on the crash cart is in good working order along with checking for all supplies. This would be dangerous if it were only checked once a week.

A: We also only use paint in the vagina. What about patients who are allergic to betadine? Is there a standard prep for

these patients? Iâ&#x20AC;&#x2122;d like to find something endorsed by the ACOG group so we could develop that into our policy. A: Not sure if ACOG endorses its use, but Technicare is safe for use.

CROSS TRAINING When other departments are slow, should they be allowed to cross train to the OR? A: The OR has become such a specialized area, that it takes a significant time to orient. Some feel like it is a waste of time to try to cross train other staff occasionally. It seems like extra work with not much of a bang for your buck. A: I think that it can be helpful to cross train in regards to same-day surgery. For instance, if a pre- or post-op nurse is trained in circulating or scrubbing out patient GU procedures it gives them a great insight on what the patient will experience. It can also help with educating the patient and answering their questions more adequately.

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SUITE TALK

PHONE BAN There is an issue with staff brining their smartphones into the OR. Does your facility allow this? What would you suggest? A: We do not allow cellphones in the OR and our hospital policy supports that position. A: No. No exceptions. If someone is expecting an “important call” or is on call elsewhere, they can leave their phones with one of the receptionist/office staff who will take calls and call into the OR with messages. It’s an infection control risk and it’s also a risk for distraction. Typically, our anesthesia providers are the worst offenders. A: We do not allow smartphones in the OR due to infection and distraction concerns. A: It is against our policy to use their phone in the patient care area. Disciplinary action is initiated if we have issues.

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IN THE OR MARKET ANALYSIS

STAFF REPORT

SAFETY AND COMFORT PRODUCTS MARKET GROWS

“T

he global personal protective equipment (PPE) market was valued at $38.38 billion in 2015. Stringent occupational health and safety regulations are expected to drive global personal protective equipment market growth over the forecast period. Mandated policies by agencies such as OSHA, NIOSH and NFPA have been enforcing employers to maintain worker’s safety in industries,” according to a report from Grand View Research that forecasts market growth through 2024. Health care is one segment of the PPE market that is growing. Gloves, scrubs, gowns and other protective textiles continue to be important safety products. A growing market segment deals with personal comfort devices for health care workers. Ralph Basile with Healthmark Industries says recent outbreaks have generated more demand for safety and comfort devices. “With the Ebola crisis and other events raising concern about the health and safety of health care givers, there has been greater demand for impervious gowns and better compliance with PPE gowning standards. More impervious gowning, however, means less comfort. This has increased the need for cooling products and other apparel to keep staff comfortable and created a significant amount of growth for Cool Aids Vest and the product line,” Basile explains. He expects the market to continue to grow based on feedback from health care providers. “There has always been a ‘concern or an awareness’ about issues of comfort and heat retention when wearing protective attire whether in WWW.ORTODAY.COM

“There has always been a ‘concern or an awareness’ about issues of comfort and heat retention when wearing protective attire whether in the operating room or the decontamination area of sterile processing.” the operating room or the decontamination area of sterile processing. There has been a tremendous effort in human factors engineering and staff comfort and work environment certainly falls into this area. This will bring more focus in the area of worker comfort and bring about more innovation,” he adds. “Continued concern for the health,

safety and comfort of health care providers will drive demand for attire solutions. One of the factors that led to the development of the single-use vest, designed for one person, one day, is the challenge of laundering garments. For many facilities, the single-use vest offers a better option than having to manage the laundering and return of garments,” Basile continues. Mike More at Glacier Tek also reports market growth. “Glacier Tek is experiencing rapid growth in health care with our product line, which is focused on safety and comfort. Heat stress has been an issue in other industries and is now gaining more attention in health care by OR staff who are looking to combat the heat created by overhead lights, gowns, and lead protection which is also intensified by the critical nature of their work,” More explains. “Health care sales for Glacier Tek has increased 250 percent in the past 12 months, due to the awareness of our product which enables OR staff to stay fresh and alert while remaining untethered and able to move freely.” September 2016 | OR TODAY

IN THE OR PRODUCT FOCUS

FOOTWEAR AND COMFORT INSOLES CALZURO Prevent contamination! Calzuro is the only footwear that can be sterilized in the autoclave (300˚F), machine washed and disinfected with bleach. Ergonomically designed for medical professionals with a 1.5-inch heel to reduce fatigue, setting the body anatomically correct. Calzuro is slip-resistant and antistatic. Personalize scrubs with 20 colors! There are two accessories; heel straps and comfort insoles. Heel straps add a back to the Calzuro. The Comfort Insoles have a shock absorber and can also be sterilized in the autoclave (154 ˚F) or machine washed. Calzuro is sold in the U.S. on the website Calzuro.com. •

OR TODAY | September 2016

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PRODUCT BY AUTHOR SHOWROOM NAME

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IN THE OR PRODUCT FOCUS

COOL VESTS GLACIER TEK Lightweight, easy to use, completely non-toxic, and with unmatched ease of movement, Glacier Tek Cool Vests are the perfect solution to overheating that many surgeons and operating room staff face. Each vest includes a set of GlacierPacks manufactured to stay cool for up to two and a half hours in 100Â°F with some users reporting up to four hours of cooling in their operating room conditions. The reusable packs recharge in ice water and are ready for reuse in 20 minutes. The vest itself is washable or disposable (depending on variety), and the cooling packs are easy to sanitize. Learn more at Coolvest.com/OR. â&#x20AC;˘

OR TODAY | September 2016

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PRODUCT SHOWROOM

COOL AIDS SINGLEUSE VESTS HEALTHMARK Healthmark Industries has announced the addition of the single-use vest to its Cool Aids product line. Cool Aids Single-Use Vests are designed to manage the core body temperature. Worn under protective barrier attire, they are ideal for use by staff during surgery, reprocessing of devices and other activities because cooling is achieved with reusable cooling packs rather than with a system of hoses and an external source. This innovative design allows for greater freedom of movement without worrying how to get them laundered and returned. Visit www. hmark.com or call 800-521-6224 for more information. â&#x20AC;˘

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September 2016 | OR TODAY

IN THE OR PRODUCT FOCUS

SCRUBS & LAB COATS SAF-T Surround yourself with SAF-T, not staph! This revolutionary line of health care apparel continuously kills 99.9 percent of staph, salmonella, E. coli, Hepatitis A, pneumonia and other harmful microorganisms by harnessing the power of chlorine bleach. The patented fabric binds chlorine molecules to its surface and is proven to kill germs on contact for up to 120 days between wash cycles. Completely reactivated with every wash, SAF-T maintains bactericidal effectiveness at a 3-log rate through 75 industrial washes when laundered as directed using EPA-registered bleach. Made in the USA, SAF-T apparel will not fade in bleach and is tested safe for skin. For details, visit www. saf-t-scrubs.com. â&#x20AC;˘

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IN THE OR CONTINUING EDUCATION CE514G

OR TODAY | September 2016

MAUREEN HABEL, MA, RN

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CONTINUING EDUCATION CE514G

SPREAD YOUR WINGS RNs Have What It Takes to Be Effective Leaders

id you know that when geese fly in a “V” formation, their work is much more efficient than if they each flew separately? By flying in this unique formation, they increase their flying range by as much as 71%. When the goose leading the flight tires, it moves back into formation and another goose takes its place. If a goose falls out of formation, it quickly feels the drag of flying alone and rejoins the flock to take advantage of the power of the goose it follows. Learning how to be in the lead position, how to support and relieve the leader and how to increase work efficiency as part of a team are “goose flight” skills that nurses can learn and use to their advantage.1 If we can learn some of the skills that geese use on their long migratory flights, we can individually and collectively influence future changes in a positive direction. FROM STABILITY TO CHAOS 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 41 to learn how to earn CE credit for this module. The purpose of this nursing leadership continuing education program is to educate nurses about trends in the healthcare industry, discuss skills nurses can learn to influence change and challenge every nurse to become a strong leader and a supportive follower. After studying the information presented here, you will be able to: • Discuss how nurses can gain control of their destinies in response to trends affecting the healthcare industry • Identify five new skills that will help nurses positively influence change in healthcare organizations • Discuss three key characteristics of effective leaders and supportive followers

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Only a few decades ago, our healthcare system was significantly less complicated. The majority of patients were treated at hospitals until they were well enough to function independently at home. The hospital bill was sent to a third-party payer who reimbursed the hospital. An increasing number of hospitals were constructed, each filled with costly technology and increasing numbers of healthcare staff. Expensive life-saving treatments, innovative surgical procedures and noninvasive imaging techniques have resulted in the world’s most sophisticated — and expensive — healthcare system. Many factors have shaped American healthcare. Today, the U.S. healthcare industry faces more challenges than ever before, in large part due to these factors: • Some of the effects of the healthcare reforms of 2010 have yet to be felt; however, look for significant changes for the insurance industry, physicians and other healthcare providers and the phar-

•

• •

maceutical industry. Stresses on state budgets because of decreased Medicaid funding may be dramatic. An aging population will place significant strain on the healthcare system. The first of the 76 million baby boomers (those born in the U.S. between 1946 and 1964) became eligible for Medicare in 2011. The future obligations of Medicare and Medicaid will strain federal and state budgets for decades. We are now entering what is known as the biotech era. Research breakthroughs are being announced at a rapid rate, creating additional financial and ethical challenges. Employers are challenged to find ways of funding health insurance for both employees and retirees. The major causes of death in the U.S. remain cancer, heart disease and stroke. About 70% of healthcare ex-

September 2016 | OR TODAY

IN THE OR CONTINUING EDUCATION CE514G

•

penditures are allocated for chronic disease management while a modest amount of money is spent on disease prevention. Few Americans lead healthy lifestyles that can prevent chronic disease and reduce healthcare costs.2

To survive in this highly competitive environment, the healthcare industry has moved to marketbased strategies that focus on cost containment, patient satisfaction and quality improvement.2 Most nurses have been involved in efforts to streamline care delivery, including work redesign, in which a job role is evaluated with the goal of combining tasks to increase productivity.2,3 There is an increasing realization that nurses who provide direct patient care have a significant potential for providing leadership in the restructuring of healthcare delivery. They also have the ability to have a major impact on educating patients about healthy lifestyles and preventing complications from chronic diseases. But data from hospitals across the country indicate that staff involvement in decisionmaking can be limited and unequally shared with management and administration.3 As a result, healthcare executives have made many financial decisions about how to allocate valuable healthcare resources with limited input from nurses. Nurses and other healthcare professionals may find it difficult to carry out changes imposed from above. Managers bemoan the fact that staff doesn’t share their concern for the organization’s financial viability, and staff complain that management cares only about money. Without effective collaboration, an organization’s stability and financial prognosis continue to deteriorate. 36

OR TODAY | September 2016

THE IMPACT ON NURSING

As organizations undergo rapid change, nurses may feel busier than ever; yet, at the same time may feel frustrated and powerless, or victims of a huge impersonal system. Consumed by daily problems, they may not be capable of talking about — let alone planning for — the future. Those who experience these stresses may question the value of what they do, fracture relationships with colleagues, choose to leave the profession and discourage others from entering it — at the very time when a nursing shortage threatens the health of all Americans. In most healthcare organizations, particularly in acute care hospitals, nursing is the largest and most labor-intensive component, representing about half the annual operating budget.4 In addition, much discretionary spending occurs at the unit level, where nurses are the key decision-makers about the use of equipment, linens and supplies — items that also have a major budgetary impact. Ironically, many nurses have no way of knowing what costs they generate as they provide care and often lack the economic awareness needed to make costconscious decisions. Those closest to a task bring a unique perspective to ways of trimming costs. For example, one institution saved significantly on supply costs by limiting IV starts by inexperienced staff.4 In many organizations, the voices of nurses who have similar suggestions for improving quality and reducing costs are not heard because they often lack critical leadership skills. LEARNING NEW SKILLS

Fortunately, the nursing profession is in a unique position to influence both healthcare delivery and policy.5 In addition to recruiting nurses to

serve on hospital-wide committees, many organizations have established shared governance, a model that places large numbers of staff nurses in pivotal leadership roles to make significant policy decisions affecting education, nursing practice and quality of patient care.6 Nurses must be prepared with a new set of leadership skills that includes analyzing problems, creating solutions, and initiating and supporting appropriate changes, so healthcare organizations can take advantage of the knowledge and expertise staff nurses can bring to governance and healthcare restructuring. Nurses can become futureoriented rather than speculating about the future or adopting a “wait-and-see” attitude.7 What the future will bring can be predicted by looking at demographics, technology and other societal forces. Demographic trends in the U.S. clearly point to an increasing number of older people needing care and a decreasing number of nurses prepared in geriatrics to direct their care. Another major trend is the increasing pace of scientific knowledge. Medical knowledge is now doubling every eight years, and 85% of the information collected by the National Institutes of Health is upgraded every five years.2 Trends that soon will affect nurses’ work include the replacement of traditional patient care “routines” by best practice processes that are outcomes-related and research-based, and an evolution of nursing practice from “fulfilling every patient need” to a model that is realistic and responsive to limited resources. Although every nurse may not end up being a “nurse futurist,” learning more about projected trends will equip nurses to deal more effectively with system changes. WWW.ORTODAY.COM

CONTINUING EDUCATION CE514G

Seeing the big picture is the ability to analyze how a situation is connected to other aspects of a broader situation. Because nurses have not always been included in decisions affecting patient care services, they have a tendency to look for a quick fix without considering the larger picture. Research on nurse staffing shows that the numbers and percentage of professional registered nurses in the skill mix has a significant effect on patient outcomes.8,9 However, focusing only on mandatory staffing ratios does not automatically ensure better patient outcomes or increased nursing job satisfaction. “More” does not necessarily mean “better.” It is important to have a high percentage of registered nurses, but the skill mix and quality of the staff nurses, their clinical competence and their ability to analyze problems critically and make appropriate decisions also have an impact on providing high-quality care. A person looking at a bigger picture is able to look beyond the immediate problem. The shift length, staffing mix, reimbursement criteria and type of delivery system all have a major impact on appropriate staffing. Simply changing the number of staff per patient may not be the only or the best way to provide safe and effective patient care.8 In addition to citing improved nursing ratios, nurses report that their job satisfaction is related to issues such as compensation, information technology, the opportunity to use nursing knowledge to improve patient care and the quality of nursephysician relationships. Sometimes, an action taken without considering a bigger picture may fix the immediate concern, but in the long term will not solve the root issue — or may even create other problems. Leaders are able to see beyond quick fixes; they are more system focused. They’re able WWW.ORTODAY.COM

Staff Nurse Leadership Skills9 • Becoming future oriented • Being proactive rather than reactive • Communicating persuasively • Seeing the “big picture” • Viewing change as an opportunity

to think about the whole, knowing that everything affects something else, and they’ve learned how to ask the right questions.7 People who see the big picture don’t become bogged down in task-oriented practice; instead, they implement tasks and care interventions directed toward specific outcomes. Communicating persuasively: Nurses are often excellent listeners; they listen effectively to patients and families. But when it comes to participating on a shared governance committee or a task force with other professionals or presenting ideas to management, many nurses need help. To be effective patient advocates and change agents, nurses must be able to communicate assertively and confidently.10 In an interdisciplinary group, nurses are often the least verbal even though they may have the most relevant information. To act powerfully, nurses must improve their ability to communicate with administrators and colleagues. Using judgmental words, failing to reason out a position adequately, or speaking too fast or too slowly can all be barriers to effective communication.11 In addressing needs of nurses, they often spend considerable time providing anecdotal information and numerous details about problems affecting patient care while

administrators are listening for a large picture to develop. In addition, effective staff communication has been shown to produce improved patient outcomes.12 Being Influential: A Guide for Nurses (second edition) has excellent suggestions on communication and other skills needed so that nurses can use their influence in a proactive way. Nurses also need to learn how to focus on major issues and give up “sweating the small stuff.” The goal of communication, whether oral or written, is to create understanding, and the level of understanding increases directly in relationship to the clarity of the message and the way it’s delivered. To that end, nurses need the skills to make clear, organized presentations that are delivered confidently and to write memos that get results because they communicate in a way that gains attention and support. Viewing change as an opportunity: Times of great change are also times of great opportunity because organizational resistance to change temporarily lessens. We need to learn how to view the many “problems” of organizational restructuring as challenging opportunities to improve care for patients and nurses’ working conditions. The same emotional responses that patients and families September 2016 | OR TODAY

IN THE OR CONTINUING EDUCATION CE514G go through during personal health crises also apply to nurses when they face organizational change. Fortunately, nurses can learn strategies to see the opportunities inherent in change. They can start by becoming involved with the change so that they have some influence over what will change and how the change occurs. If a nurse has no ability to influence the change, he or she can resolve to focus less on grieving for what he or she is losing, and instead start focusing on positives that will result from the change.5 If the change in question is particularly difficult, consider that no one can control changes that occur naturally in life, and it is not realistic to expect that there will be a return to a more stable healthcare environment. Nurses often react rather than anticipating problems and taking a proactive stance. Instead of taking the initiative, nurses frequently blame those in executive leadership positions or “the system.” Nurses “eat their young,” often don’t collaborate with others, fail to capitalize on their knowledge and experience, and may describe themselves as “just a nurse.” Nurses all have a vision for a better world for our patients, and it’s important that they don’t wait for someone else to make something happen. Each nurse must have passion for his or her little corner of the nursing world. You don’t have to be in a position of authority to advocate for needed change, raise issues, gain support for your ideas and speak clearly and strongly about possible solutions. If you’re not satisfied with an issue in your work setting, you can complain to your colleagues, blame administration or someone else — or create positive change. The professional nurse who is a leader will always do something more than just complain. Practicing 38

OR TODAY | September 2016

nurses all share accountability to create solutions for the problems they encounter. EVERY NURSE AS A LEADER

As new graduates, nurses all begin their nursing careers in a “followership” position. With time and experience, this should change. However, many nurses depend on their nursing administrators to provide all the leadership that the nursing component needs in an organization. Yet this model does not always provide the most effective leadership. Some of the most powerful leaders have no position of authority in an organization, but are able to point the way to both small and large improvements in patient service delivery. Nurses can develop their leadership skills by focusing on how leaders function. Author Steven Covey describes the following eight characteristics of effective leaders:13 • Engage in lifelong learning • Are service-oriented • Are concerned with the common good • Radiate positive energy • Believe in others • Lead balanced lives • View life as an adventure • See events as greater than the sum of their parts Nursing is a people business, and effective leaders have learned how to influence people to work toward a shared goal. Leadership is related directly to “real nursing” — staff nurses must exert leadership to fulfill their responsibility as patient advocates, and to help design a more effective healthcare system that will benefit individuals, families and communities. In the words of one nurse executive, It’s important to view leadership as not about power, but about acting powerfully.1

Leadership is not an inborn ability but a set of skills and qualities that can be learned and enhanced over the course of a career. Different types of leadership skills are needed in different situations. For example, some situations call for fast action while others require time to determine the best way to solve a complex problem. Management training for nurses is important for organizations to be efficient and effective in today’s healthcare environment. To exert influence, nurses must be committed, innovative and involved.14 Nurses can no longer conceive of themselves as “just nurses.” Whether a staff nurse or a vice president of nursing, it’s vital to be self-confident, have high professional self-esteem and be visionary. Individual nurses tend to focus on daily tasks within a designated shift. Because of this focus, some nurses act as passive followers rather than as leaders and remain in positions in the organization that are less powerful. One of the most influential people to take the lead was Florence Nightingale. She had a mission, her timing was right, change was desperately needed, and she had the skills to be a leader. She was also intelligent, resourceful, strong-willed and not willing to take no for an answer — qualities nurses all have. Just like the flying geese, nurses must learn to share leadership and must all take their turn doing the work that will help patients recover, the profession evolve and organizations thrive. Every member of a nursing team has the potential to fly the point position and serve as the leader. THE POWER OF SUPPORTIVE FOLLOWERS

In today’s flatter, leaner organizations, leaders cannot survive WWW.ORTODAY.COM

CONTINUING EDUCATION CE514G

without committed, engaged, contributing followers. Being a leader and being a follower are separate roles that complement each other. There can be no leaders without followers, and there can be no followers without leaders.10 Leaders can develop and communicate a vision, but followers contribute the energy needed to achieve change. Being a good follower takes special talents, just as being a good leader does. Leaders need to count on followers to provide input that focuses on finding solutions, not just identifying and complaining about problems. Followers can support leaders by asking questions, giving thoughtful feedback, working to achieve group goals and providing encouragement when the leader takes a risk on behalf of the group. Being an effective follower is not a passive position; the follower must think critically about the leader’s ideas and opinions, have the skills to advocate with others for those ideas and take an active role in providing support to the leader. Exemplary followers are those who can function independently, think critically about ideas that are proposed or directions that are suggested, and become actively involved.15 Effective followers challenge the ideas and opinions of leaders, suggest alternative courses of action, and invest time and energy to arrive at the best possible solutions for the group.15 Active and engaged followers consider themselves the equals of leaders and are willing to support the leader to accomplish a common goal.6 Effective followers thoughtfully criticize the leader’s ideas, but they don’t just complain and withdraw.15,16 They also heed certain guidelines, such as discussing their disagreements with the leader privately and considering the leader’s WWW.ORTODAY.COM

point of view when exploring alternative solutions to a problem.15,16 ALIENATED, PASSIVE FOLLOWERS

Other types of followers are less supportive. Alienated followers may consider what the leader is proposing, but remain passive and withdrawn. They may continue to complain about the ways things are done, but rarely invest the time or energy to suggest alternative approaches.15 Ineffective followers often have limited vision, are primarily concerned with their own needs and rarely think about the stress that leaders experience.14 “Yes” people are those who are eager to take orders, defer to the leader, and thrive on a great deal of order, predictability and structure. They are often uncomfortable with making decisions and rarely raise questions or challenge the group. Passive people are dependent and go along with whatever they are told to do. Easily led and manipulated, they need a great deal of direction and never go beyond their own work assignment. They are unable to commit themselves to the larger goals of the group. What nursing needs now are more exemplary followers. Blindly following a leader without thinking or questioning, or taking a passive backseat role at work will do little to advance the nursing profession, promote individual growth or enhance quality patient care. Nursing needs followers who have many of the same qualities leaders have: the ability to act as change agents, the ability to challenge ideas, assertiveness, courage, determination, openness to new ideas and perspectives, and a willingness to serve.15

with leaders in other disciplines, with policymakers and with community members to transform healthcare.17 All nurses can have a profound influence on finding the best ways to deliver high-quality healthcare at an acceptable cost. To reach this goal, nurses must ask themselves what they are doing personally to improve themselves as individuals and to improve nursing. Nurses can strengthen leadership skills in many ways. First, keep informed about current issues affecting healthcare access.15 Second, dispel myths about healthcare and the direction it needs to take. Third, be aware of and get involved with the quality and safety initiatives in your workplace. Fourth, be aware of what your elected representatives are doing at the state and national level to improve the healthcare system. Last, talk about nursing and what you do as a nurse to provide patient care. Be enthusiastic and vocal about the role nurses have as valuable caring clinicians and as agents for healthcare reform.15 To develop and exercise your leadership potential, convince your administration that you need a leadership course for staff nurses in your organization and volunteer to be on the committee that organizes it. As you improve your skills in problem solving, critical thinking and communicating, seek out other nurses whom you can mentor. Learn how to lead, how to follow and how to use your knowledge and experience to act powerfully. And the next time you see a goose migration, think of the possibilities for nursing.

TAKING ACTION

The nursing profession continues to need expert clinicians, but the greatest need is for leaders who can collaborate

Maureen Habel, MA, RN, is an award-winning nurse author living in Seal Beach, Calif. September 2016 | OR TODAY

IN THE OR REFERENCES

1. Kirkpatrick M. Storytelling: an approach to teaching leadership values. In: Feldman HR, ed. Strategies for Nursing Leadership. New York, NY: Springer Publishing; 2001:18.

2. Healthcare industry. Plunkett Research Ltd. Web site. http://plunkettresearch.co m/?s=Introduction+to+the+healthcare +industry. Published November 11, 2014. Accessed March 3, 2015.

3. Jenkins LS, Ladewig NE. A self-efficacy approach to nursing leadership for shared governance. In: Feldman HR, ed. Strategies for Nursing Leadership. New York, NY: Springer Publishing; 2001:185.

CLINICAL VIGNETTE Shelly Green is a nurse manager in an organization that is involving more nurses in decision-making. Nursing shared governance and inclusion of staff nurses on more hospital-wide committees are among the strategies being considered. Four staff members Shelly might ask to serve are George, an assertive new graduate who has just completed orientation; Joan, a nurse with 12 years of experience who has worked in two other organizations and who often offers ideas about potential changes; Candice, who has 20 years of experience on Shelly’s unit and who often complains about minor issues; and Rachel, an experienced nurse who is shy in groups and rarely expresses her opinion.

Which staff member should Shelly consider appointing to an interdisciplinary committee whose goal is to look at organizational changes? a. George b. Joan c. Candice d. Rachel

Which staff member might be most appropriate to represent the unit on the nursing practice council? a. George b. Joan c. Candice d. Rachel

Shelly is being encouraged by her supervisor to implement shared governance on the unit level. Which characteristic will NOT be helpful in this situation? a. Being able to let go of daily operations b. Being willing to learn from mistakes c. Helping staff prepare for self-governance d. Adopting a “wait-and-see” attitude to see how shared governance works on other units

To make changes on her unit, Shelly must have the support of effective followers. Which attribute is NOT associated with being an effective follower? a. Giving input that focuses on solutions b. Identifying and complaining about problems c. Giving thoughtful feedback to the leader d. Thinking critically about proposed changes

4. Correct Answer: B – Simply complaining about problems is not a characteristic of effective followers. Supportive followers propose solutions, analyze potential changes critically and give objective and thoughtful feedback to the leader. 3. Correct Answer: D – Being a leader involves taking risks and volunteering to try new ideas. Having a partial commitment or “waitand-see” attitude are not characteristics of a leader. 2. Correct Answer: A – As an assertive person, George is likely to express his views on the practice council. As a new graduate, he will also bring new ideas to the council. 1. Correct Answer: B – Joan is obviously interested in change, and her experience in other organizations will benefit the hospital-wide committee. The other staff members lack experience, may be reluctant to speak up in the group or may be a negative influence. 40 OR TODAY | September 2016

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HOW TO EARN CONTINUING EDUCATION CREDIT 4. Caroselli C. Cost-control heroism: strategies to reduce operating expenses. In: Feldman HR, ed. Strategies for Nursing Leadership. New York, NY: Springer Publishing; 2001:223-230. 5. Grohar-Murray ME, Langan JC. Leadership and Management in Nursing. 4th ed. Upper Saddle River, NJ: Prentice Hall; 2011:2-19. 6. Tomey AM. Guide to Nursing Management and Leadership. 8th ed. St. Louis, MO: Mosby Elsevier; 2009:207, 292-293. 7. Pesut D. Future think. Nurs Outlook. 1997;45(3):107. 8. Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med. 2002;346 (22):1715-1722. 9. Aiken LH. Hospital nurse staffing and patient mortality, nurse burnout and job satisfaction. JAMA. 2002;286:1988-1991. 10. Mattson EH, Polifko-Harris K, Anunciado CJ, Ruthman J, Erickson D. Inter-professional teamwork and collaboration. In: Kelly P, Tazbir J, eds. Essentials of Nursing Leadership and Management. 3rd ed. Clifton Park, NY: Delmar; 2014:152-161. 11. Sullivan EJ. Being Influential: A Guide for Nurses. 2nd ed. Upper Saddle River, NJ: Prentice Hall; 2013:57, 118-130. 12. Gittell JH, Fairfield KM, Bierbaum G, et al. Impact of relational communication on quality of care, postoperative pain and functioning: a nine hospital study of surgical patients. Med Care. 2000;38(8):807-819. 13. Covey SR. Principle-Centered Leadership. New York, NY: Rosetta Books: 2009.

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

DEADLINE Courses must be completed by 3/31/2017. 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.

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

14. Sullivan EJ. Effective Leadership and Management in Nursing. 8th ed. Boston, MA: Pearson; 2012:7-8. 15. Kleefisch K, Hughes RG, Sleeper T. The healthcare environment. In: Kelly P, Tazbir J, eds. Essentials of Nursing Leadership and Management. 3rd ed. Clifton Park, NY: Delmar; 2014;152-161:36-50. 16. Bleich MR, Kist S. Managing, leading and following. In: Yoder-Wise PS. Leading and Managing in Nursing. 6th ed. St. Louis, MO: Elsevier; 2014:2-20. 17. Marshall ES. Transformational Leadership in Nursing: From Expert Clinician to Influential Leader. New York, NY: Springer; 2011:1. WWW.ORTODAY.COM

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LET’S GEL INC. Stand in Comfort

et’s Gel Inc. has a lot to be thankful for in 2016 and it all started on Thanksgiving day in 2002. Robb McMahan completed the tile floor in the kitchen of the home where he and his wife, Lisa, were hosting a family feast. Lisa had spent the day preparing the meal and everything appeared to be great, except for the leg and back pain she was having after standing on the hard tile floor for hours.

Lisa ventured to a home improvement store where she bought some foam mats that helped with the pain, but they were not durable and did not last. Robb, an engineer, decided he could solve the dilemma himself. After countless late nights and hundreds of prototypes, he developed a mat design utilizing soft, shock-absorbing polymer gel as the cushioning element. Fast-forward 14 years and Robb is the founder and CEO of Let’s Gel Inc. Let’s Gel Inc., an Austin, Texasbased privately held corporation, is the leading manufacturer and provider of innovative ergonomic flooring products in the home, medical, and commercial flooring categories. Robb explains how the company expanded from the residential market into the medical industry. “The way we got into this business wasn’t some genius move 44

OR TODAY | September 2016

on my part. We constantly had hospitals contacting us about buying mats,” Robb says. “We had a surgeon, Dr. Jamie Landman, M.D., contact us and he basically said ‘I absolutely love your product. It is wonderful. I won’t do a surgery without it. I want to do a study on your mat. Will you guys supply me with mats to do a study?’ We said, ‘Yes, absolutely.’ ” “We did the study with him and through feedback from Jamie we actually made some modifications to the mat,” Robb says. “We are the first and only manufacturer of ergonomic flooring with gel,” he adds. “Our mats have anti-microbial and anti-bacterial properties. The top surface provides the necessary friction level for use with damp or dry surgical booties. They are compatible with hospital grade quaternary cleaners and are NFPA 260 and Cal 117 compliant. GelPro mats are also certified by the WWW.ORTODAY.COM

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“We had a surgeon, Dr. Jamie Landman, M.D., contact us and he basically said ‘I absolutely love your product. It is wonderful. I won’t do a surgery without it.’ ” National Floor Safety Institute for high-traction.” “The medical mat is a little more cushioned. It is 50 percent thicker than our standard mat that we sell in the residential marketplace,” Robb says. “It’s a little more cushioned because what we found is that a lot of the surgeons and a lot of the surgeries, particularly the orthopedic surgeries, tend to go for a pretty long time. Some of these surgeries go four to eight hours. With feedback through this study, we actually modified the product and made the product better.” According to the randomized control study conducted by Columbia University’s School of Medicine, and led by Dr. Landman, it was concluded that the Let’s Gel products improved surgeons’ comfort and ergonomics during minimally invasive procedures, reducing the number of stretches and postural changes. Robb says it is easy for people to understand how the mats benefit people in health care facilities. He compares it to a shopping trip to the mall. After walking on the hard floor in the mall and then stepping onto a carpet or padded surface relief can be felt almost instantly. “Basically, the mat allows surgeons to stand in a more comfortable position for a longer period of time and have their focus on the work that they are doing as opposed to focusing on the pain they are experiencing from standing,” Robb explains. “As someone who has had knee surgery, and other surgeries in my life, I certainly want my surgeon to be pain free and focused on treating me.” WWW.ORTODAY.COM

September 2016 | OR TODAY

CORPORATE PROFILE

THE SUCCESS OF THE MATS LED TO ADDITIONAL PRODUCT LINES

The entry into operating rooms was a big success, but the need for Let’s Gel products did not stop there. Nurses and other hospital personnel soon began to contact the company for comfort solutions. Soon mats were placed at nurse stations and pharmacies as well as other areas of the hospital. These mats are the NewLife Eco-Pro Anti-Fatigue Mats. They are ergonomically designed to provide comfort and support. The company’s proprietary Cellulon Polyurethane Technology stands up to the tough demands of commercial environments while providing lasting comfort that won’t bottom out over time. Manufactured in the USA, this eco-friendly line of anti-fatigue mats is certified by the National Floor Safety Institute for its high-traction bottom surface. 46

OR TODAY | September 2016

“It is extremely durable, but the great thing about the polyurethane mats is that they have what we call a very high-energy return factor,” he adds. “They are very springy and very bouncy. So, they are super comfortable to stand on and they are great for walking back and forth on.”

health care division. Since bringing Jones onto the team, he has been responsible for growth and brand strategies including the addition of multiple privatelabel medical distributors, attending trade shows and expanding GelPro’s international presence in the medical industry.

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To support the growing medical demand for comfort products, GelPro named Will Jones as vice president of medical sales in 2015. Jones brings 31 years of experience in medical sales, most recently at Barton Medical where he sold and promoted a comprehensive portfolio of safe patient handling equipment and services. Jones will be responsible for expanding GelPro’s

With GelPro’s extensive knowledge of foam and gel, the company will begin offering operating room positional aides by 2017. For additional information about these products, email Will Jones at willj@letsgel.com. For more information visit www.gelpromedical.com or www.gelpro.com. WWW.ORTODAY.COM

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How block scheduling promotes efficiency

hen it comes to effective OR management, itâ&#x20AC;&#x2122;s all about maximizing efficiency BY DON SADLER

in order to realize cost savings. A growing number of hospitals today are turning to block scheduling to make these objectives a reality.

“Block scheduling is gradually becoming a common practice in OR management,” says Lucy C. Lee, RN, MBA, BM, PMP at Hospital Performance Management. “It’s a way to better manage operating room time, which is an OR’s most valuable resource.” WHAT IS BLOCK SCHEDULING?

“Block scheduling is the process of allocating OR resources to a surgeon or group of surgeons for a specified day and time,” explains Michelle Jackson, St. Luke’s Health System’s supervisor of surgical scheduling systems. “Other authors have likened it to a reservation at a restaurant in which the doctor shows up and everyone is expecting him and is ready,” Jackson says. The resources reserved with block time may vary by facility but typically include an identified room, staff and equipment, she notes. “Block scheduling is a tool that allows physicians to have a guaranteed day and time when they know they will have an OR to use and a team of staff to work with on a continued basis,” adds Rachel Le Mahieu, RN, MSN, CNOR, RNFA, the director of surgical services at Spring Valley Hospital in Las Vegas, Nevada. Lee explains in more detail how block scheduling works: “A block scheduling system assigns a block of OR time to an individual surgeon or a group of practicing surgeons for a particular period of time.” “The block is reserved for the owners’ exclusive use,” Lee continues. “When unused, the blocked OR time will be made available to other physicians according to the relevant block scheduling policies of each facility.” 50

OR TODAY | September 2016

BENEFITS OF BLOCK

There are many potential benefits to block scheduling for hospitals and patients. “First, it is a more efficient use of time,” says Jackson. “The same surgeon or service line with subsequent cases results in fewer equipment and instrument changes and room positioning adjustments.” In addition, block scheduling allows the staff and surgeon to establish a routine and then repeat it through subsequent cases, Jackson adds. “Second, block time can be used to entice surgeons to bring cases to your facility,” Jackson continues. “Consistent access to the OR can be an incentive when recruiting new surgeons and a motivator for existing surgeons to maintain their case volumes in an effort to meet established block utilization targets.” “The most significant benefit of block scheduling is increased utilization of OR time,” says Lee. “This improves the operational efficiency and financial performance of an OR. The OR schedule becomes more predictable, which leads to less surgeon and patient waiting time and higher satisfaction for everyone.” Le Mahieu believes that the biggest benefit of block scheduling for hospitals is that “you know your basic volume guarantee and can plan equipment, instrumentation and staffing based on this guaranteed business.” Meanwhile, the only real drawbacks to block scheduling occur when it is poorly managed, says Le Mahieu. “A lack of usage or releasing blocks in advance would prevent other physicians from bringing your facility business and can result in poor OR utilization,” she notes. “This can affect your volume, productivity and revenue.”

“Block scheduling is the process of allocating OR resources to a surgeon or group of surgeons for a specified day and time.” MICHELLE JACKSON, Supervisor of Surgical Scheduling, St. Luke’s Health

BEST PRACTICES FOR BLOCK SUCCESS

According to Jackson, block utilization policies can be “incredibly cumbersome.” Therefore, clear rules and expectations must be laid out in the form of thorough policies. WWW.ORTODAY.COM

“It’s a way to better manage operating room time, which is an OR’s most valuable resource.” LUCY C. LEE, RN, MBA, BM, PMP, Hospital Performance Management

“A clear policy regarding block time allocation, expectations and consequences is essential,” says Jackson. “These policy decisions include how much of the OR’s time can be assigned with block, how block will be assigned, utilization expectations, and consequences for not meeting utilization expectations, to name a few,” Jackson adds. A best practice is to allocate 80 percent block time and leave 20 percent open time, Jackson notes. “Blocking too much time can limit access to the OR,” she explains. Concise data also must be maintained and made available. “This can be a very tedious process,” Jackson says, “which is why an enforcement structure must be established, implemented and followed.” Accurate data is essential when enforcing policies, Jackson stresses. “Data should be reported at least quarterly to the block holding surgeon WWW.ORTODAY.COM

and leadership,” she says. “Constant communication enables everyone to understand the goals of efficient block utilization and help when difficult decisions must be made.” Jackson adds that decisions regarding the amount of block time to be allocated are critical to ensuring access to the OR. “If too much time is assigned to specific surgeons or surgeon groups, doctors without block or those trying to schedule urgent or emergent cases may find it difficult to schedule cases,” she says. MANAGE THE BLOCK SCHEDULE

Le Mahieu recommends actively managing your block schedule. “If a physician is not using his or her time, have a personal conversation with the physician and go over the usage data,” she says. “Give the physician the opportunity to make corrections and adjustments and work with him or her to find the right block time ‘fit,’ ” Le Mahieu

adds. “If still unsuccessful, make an adjustment to the physician’s block yourself.” At Spring Valley Hospital, Le Mahieu says they use a tiered release program based on block usage. In addition, they have a corrective action plan in place for poor utilization that allows them to work with surgeons to get them to the goal of 80 percent utilization. “This ensures that the facility will not need to turn down business and will have time to backfill the time not used,” Le Mahieu says. Lee believes that a successful implementation of block scheduling policies depends on “robust support and governance of executive sponsors, effective communication with the surgeon community, and collaboration of anesthesia and nursing staff leadership.” “Block scheduling policies must be consistently implemented and applied to all block holders,” Lee adds. “Also, blocks should be assigned by the day as opposed to September 2016 | OR TODAY

stints of hourly blocks. No block should be shorter than four hours and blocks should start at the same time as the operation hour starts.” A BLOCK SUCCESS STORY

In 2010, Jackson helped launch an initiative designed to improve block utilization at St. Luke’s Health System. At the time, the facility had an unmanaged system of block scheduling without monitoring and lacked a systematic approach. Since then, block utilization at the campuses where it’s used has increased from the low-70 percent range to the mid-90 percent range.

This exceeds the average target for all physicians, according to Jackson. Surgeons are expected to maintain utilization of 75 percent or greater with less than 25 percent of their available time released. “Failure to do so may result in a reduction of block allocation,” Jackson says. One key to the success of this initiative has been creating a multidisciplinary block committee comprised of surgeons, administration, anesthesia and surgery scheduling personnel. “They all came together to create a new OR scheduling and block utilization policy,” says Jackson. “The

committee reviewed best-practices and formulated a plan they felt would work in our environment.” Another key was obtaining highlevel hospital support for block management and building strong partnerships with surgeons. Jackson defines high-level support as the chief of surgery, COO, CFO or even CEO. “Without this support, the task is impossible,” she says. Increasing OR efficiency and saving money will only become more important in the future. Given this, it’s probably wise to experiment with block scheduling to see if it can help your facility achieve these goals.

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OR TODAY | September 2016

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OUT OF THE OR FITNESS

BY AUTHOR NAME

SPOTLIGHT

OR TODAY | September 2016

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T ON:

Nurse: Cindy Pisa,

Cindy

By Matt Skoufalos

efore she became a nurse, Cindy Pisa spent nine years as an Early Intervention Service Coordinator at a rural hospital in Monticello, Kentucky. As the team coordinator bridging the distance between children with developmental disabilities and the service providers who treat them, her role was to help families navigate the early intervention process and ensure they were able to receive the services they needed.

SPOTLIGHT ON:

CINDY PISA

Cindy Pisa, RN

As the single parent of a child with disabilities herself, Pisa eventually entered nursing as pathway to take control of the delivery of care that she saw being provided to her family. “I was in a rehab hospital with [my child] with this one nurse who was so horrible, and I said, ‘I can do better than that,’ ” Pisa said. “The doctors give the medicines and the treatments; the job of nursing is to help individuals adapt and cope and learn about their health issues,” Pisa said. “I always try to remember it’s their life, not my life. My job is to inform them and support them, and then I can let them make their own choices. I’m not bossing them around. I try to guide them, and if there’s some kind of a barrier they have, see if I can help with those barriers.” As a service coordinator, her skills at forming those interpersonal con-

“ Keep wanting to be a perpetual student of people. Just because you’re a nurse doesn’t mean you have all the answers. In this time where things are so busy, [take] the opportunity to slow down and really connect with another human being.”

nections helped Pisa’s clients understand how to access a complicated health care system. She empowered them to advocate for their children. Indirectly, it ultimately led to her interest in long-term and hospice care, where she found an ability to “really make a difference.” Shifting her focus to supporting a geriatric population didn’t require a sig56

OR TODAY | September 2016

nificant change, she said, because “everybody has the same wants and needs, essentially [and] if you find a way to connect with someone, it’s pretty cool.” “You’re really getting close with the patient and their family,” Pisa said. “[It’s] birth and death, the essence of humanity; a lot of time spent doing the basic, functional needs but also the emotional needs, helping people cope and adapt to the stress and change of the inevitable.” Today, Pisa is an in-home service nurse at the Life at Lourdes senior citizen center in Pennsauken, New Jersey, a component of the Lourdes Health System. The facility provides all-inclusive elderly care, including an onsite day clinic with primary care, access to specialists, transportation, medical needs, and specialized medical equipment. Its mandate is to provide support that allows the individuals in its care to live as independently as possible, ideally in their own homes, for as long as possible. Pisa’s day-to-day experience “usually changes very rapidly,” she said. Every in-home nurse on staff at Life at Lourdes travels to the homes of clients residing anywhere within the 227-square-mile area of Camden County. Several of them are located within Camden City, one of the poorest and most dangerous urban centers in the country, a fact that also bespeaks the need of the residents in their care. “If they’re sick or have an injury, we give them education on how to care for themselves and their disease processes,” Pisa said. “If they can have somebody who can help, we can send in a home health aid if they need some equipment to help them be safer.” Pisa visits a regular rotation of clients daily, including those on an intensive visitation program, but WWW.ORTODAY.COM

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“ I fear that the way health care’s going, we’re getting away from quality and

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connecting with people, and getting into volume and making a profit.”

her schedule can change rapidly. She enjoys the opportunity to connect with the people for whom she cares; to make a difference in the quality of their lives. Despite a general impulse that “health care is all about rush, rush, rush,” the volume of patients with whom Pisa interacts never matters to her as much as the quality of those encounters. “I fear that the way health care’s going, we’re getting away from quality and connecting with people, and getting into volume and making a profit,” she said. “A lot of the people that I go to see really are looking to touch someone else’s life. I might be filling someone’s pill box, but I’m providing that one-to-one interaction that people don’t have so much as they get older. They do need the service, but it’s the interpersonal connection that they get the most out of.” “I never went into nursing to give medication,” Pisa said. “I went into WWW.ORTODAY.COM

it to be a teacher.” Pisa said she prefers visiting care to hospital shifts because she finds the variety of environments in which she works to be more interesting. She also appreciates the flexibility in her schedule, and still interacts with the Life at Lourdes clinical nurses and her fellow visiting nurses to help inform their delivery of care. Pisa’s advice to nurses or to those looking to enter the field is first, to enjoy being with people and interacting with them, and second, to keep a sense of humor. She said her specialty isn’t any one aspect of the discipline; rather, it’s just “people.” “Be ready for anything,” she said. “Keep wanting to be a perpetual student of people. Just because you’re a nurse doesn’t mean you have all the answers. In this time where things are so busy, [take] the opportunity to slow down and really connect with another human being.”

“This was an excellent experience! I would suggest that anyone attend an OR Live conference. I will definitely attend in the future.” Heather Miles, Ortho/ Plastics Clinical Coordinator

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OUT OF THE OR HEALTH

BY MARILYNN PRESTON

PERFORMANCE BREATHING 2-2-4 SETS THE PACE, WINS THE RACE

o matter what you're dealing with – punishing 2. CLEAR BOTH NOSTRILS deadlines, scary headlines – it's the perfect time to A good nose blow will do it, one kick back and take a deep breath ... and then hold nostril at a time. it for a few seconds.s.

Why? Because whatever activity you do these days – walking, running, swimming, biking – you'll do it better and relish it more if you learn to exercise a little control over your breathing. Call it "conscious breathing" or "performance breathing" or don't name it at all. Just do it. It's a semi-secret teaching that will transform your relationship to exercise, because breath is the connection between your mind and your body, and when you tune into it, your inner athlete wakes up, and so do all your forward thrusters. "When you are focused on your breath," says Al Lee, co-author of "Perfect Breathing," "you become intimately in touch with your mindbody and very much in the moment, which improves performance." 60 OR TODAY | September 2016

Performance breathing exercises intensify your focus and deepen your concentration, and with that double whammy, workout boredom leaves you forever. Performance breathing also delivers more oxygen to working muscles and cells. It makes your respiratory muscles stronger and more flexible so you have greater endurance. And yes, it comes free with every set of lungs. So, what are you waiting for? Instruction! Lee's book is an effective starting point, and it opens with four basic guidelines. Don't skip over them. Slow down; take it step by step, breath by breath. 1. PRACTICE YOUR BREATHING

Practice your breathing exercises in a quiet and comfortable space before you incorporate it into your sport.

3. BREATHE IN AND OUT OF YOUR NOSE ONLY

It may feel odd at first but gradually, over time, it gets easier and easier. Know that breathing through your nose is especially nourishing to the brain. (Plus it protects you from having a bee fly into your mouth, which actually happened to a friend of mine out bicycling the other day, and he ended up with a bloody, skinned knee. But I digress.) 4. KEEP THE RHYTHM OF YOUR BREATH SMOOTH AND UNHURRIED

Finding your own relaxed pace will help you slip more easily into that meditative space known as The Zone – and from there the happiness hormones are freed and you get to have the best run, golf game or tennis match of your life. OK. Now for Lee's core instruction, featured in an American WWW.ORTODAY.COM

HEALTH

IT'S A SEMI-SECRET TEACHING THAT WILL TRANSFORM YOUR RELATIONSHIP TO EXERCISE, BECAUSE BREATH IS THE CONNECTION BETWEEN YOUR MIND AND YOUR BODY

Council on Exercise newsletter. The introductory breathing cycle is divided into three parts: • First, inhale for two counts. • Second, hold your breath for two counts. • Third, exhale for four counts, and begin again. That's it. Practice this simple pattern while you're sitting still, until you're completely comfortable with it. If your mind wanders during the count, simply start over. It happens to everyone. No judgment, no blame. Once you've got the two-two-four rhythm down, you get to have the fun of applying it to your sport. In walking, for instance, you inhale for two steps, hold your breath for two steps and exhale for four steps. If you're cycling, you replace pedal strokes for steps, swimming strokes for swimming. If you're a tennis player or golfer, use the breathing cycles before a serve or a putt to airlift yourself into a calmer state. Feel free to experiment with longer counts as the two-two-four cycle becomes second nature – but keep the same ratio. For instance, inhale for four counts, hold for four counts, exhale for eight. Advanced practitioners may try six-six-twelve. It's not a competition. Find your own edge. I've practiced breath control techniques for years, and not only does it improve focus and performance, it's a wonderful way to bring on sleep at night. As I hope you know by now, getting eight hours of sleep is crucial if you don't want to WWW.ORTODAY.COM

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September 2016 | OR TODAY

OUT OF THE OR FITNESS

BY ELIZABETH PEGG FRATES, M.D. HARVARD

EXERCISE: IT DOES SO MUCH MORE THAN BURN CALORIES

f you’re trying to lose weight, you’ve surely heard that you need to “eat less and exercise more.” The more you move, the more calories you’ll burn – and you’ll lose weight. But as it turns out, the effect of physical activity on human physiology may be a lot more complicated than that.

In a report recently published in Current Biology, researchers explored the relationship between exercise and “energy expenditure” (calories burned). This study monitored the physical activity and corresponding total energy expenditure in 322 men and women in North America and Africa. What the researchers found was a little surprising. Physical activity did increase energy expenditure as expected, but only up to a point. Physical activity was monitored by accelerometers, which measure counts (units of “motion”) per minute per day, taking into account motion and velocity. At lower levels of activity, increasing the counts per minute per day did increase 62

OR TODAY | September 2016

energy expenditure. However, with higher mean counts per minute per day, increasing counts did not increase energy expenditure, indicating a ceiling effect. So in this study, after a certain point, more exercise did not equal more energy used. Based on their findings, the study investigators encourage that we reconsider current public health messages that state more exercise equals more energy expended, as this is not always the case. These study results notwithstanding, whether you’ve yet to get in gear on an exercise resolution or you’re already an inveterate exerciser, it’s important to know

that the benefits of regular physical activity go beyond burning calories. For example, 150 minutes of moderate to vigorous intensity physical activity per week can significantly decrease the risk of dying prematurely. How? By lowering blood pressure and resting heart rate, and increasing nitric oxide levels, which serves to open up blood vessels. It also increases levels of beneficial HDL cholesterol and lowers levels of damaging LDL cholesterol. In addition, regular physical activity increases insulin sensitivity. This is especially important for people with diabetes – and it can also help you avoid the disease in the first place. Exercise can also help enhance cognitive skills – it’s true that what is good for the heart is good for the brain. Research demonstrates that regular exercise can actually increase the size of the hippocampus, an area of the brain involved with memory. There are important WWW.ORTODAY.COM

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mental health benefits to be gained as well. Studies suggest that for some people with depression, exercise may improve mood and symptoms just as well as medication can. In addition, a five-minute bout of exercise has been demonstrated to reduce a person’s state of anxiety. If you’re trying to slim down, exercise is an important part of a healthy way to lose pounds. Moderate physical activity can help you burn more calories. And the good news is you don’t need to train for a marathon to get in shape. But perhaps more importantly, regular exercise does so much more than that – no matter the size of your waistline. It would take almost 10 medications to replicate all the benefits encapsulated in the “exercise pill.” That should be good motivation to help you get moving. Elizabeth Pegg Frates, M.D. is an award-winning teacher at Harvard Medical School as well as Harvard Extension School. WWW.ORTODAY.COM

September 2016 | OR TODAY

OUT OF THE OR NUTRITION

BY JUDY THALHEIMER, R.D., L.D.N. ENVIRONMENTAL NUTRITION

SUGAR ISNâ&#x20AC;&#x2122;T SWEET FOR YOUR HEART P eople who consume more added sugars have a higher risk of death from heart disease. Researchers used to think it was the calories in sugary foods that were the problem: sugar made us fat, and obesity raised our risk of heart disease. But a 2014 research review in the American Journal of Clinical Nutrition found that people who consumed more added sugars had more risk factors for cardiovascular disease no matter what size they were. Eating lots of sugary foods or drinking sugar-sweetened beverages has been linked to high triglyceride levels, high total and LDL (bad) cholesterol, high blood pressure and more. SUGAR AND YOUR LIVER

The key to the link between sugar and heart disease may lie in the liver. While one common sugar molecule (glucose) goes into the bloodstream after digestion to be used as fuel by our cells, another (fructose) goes to the liver to be processed. Unfortu64

OR TODAY | September 2016

nately for those of us eating a typical Western diet (high in processed foods), the liver is designed to deal with the amount of fructose in an apple or a sweet potato, not the large amounts we dump on it in the form of colas, confections and coffee-bar drinks. Too much fructose can cause the liver to make fat, and a fatty liver can lead to increased triglyceride and cholesterol levels, inflammation, and maybe even higher blood pressure. In 2009 the American Heart Association, already wary of the association between sugar and heart disease, published recommendations that women limit their added sugar intake to no more than 6 teaspoons (25 grams) a day, and men to no more than 9 teaspoons (38 grams). The average American currently con-

sumes as much as 20 teaspoons of added sugars every day. About 50 percent of these sugars come from sweet drinks like sodas, sports and energy drinks, iced teas, lemonades and fruit drinks. Another 25 percent is from treats like candy, ice cream and baked goodies. IS SOME SUGAR BETTER?

Weâ&#x20AC;&#x2122;ve all heard that high fructose corn syrup (HFCS) is bad for us. But it might come as a surprise to find that most formulations of HFCS have nearly the same amount of liverdamaging fructose as regular table sugar (sucrose), and honey, and maple syrup. The only real outliers are regular corn syrup (which is 100 percent glucose) and agave nectar, which is close to 100 percent liverclogging fructose. The trick, then, is not to switch sweeteners, but to stop eating so many sweetened foods. CUTTING BACK ON SWEETS

The best place to start when trying to cut added sugars is drinks. Try more WWW.ORTODAY.COM

NUTRITION

water, milk, unsweetened tea and black coffee. Switching to diet drinks and artificial sweeteners is an option, but since it seems like the more sweets we eat the more sweets we want, the switch to non-caloric sweeteners may not end up decreasing your overall sugar consumption. Since most processed foods have added sugars, be sure to check Nutrition Facts labels. Even though this number is a total of natural and

added sugars, it is still a helpful guide. (Just divide the grams of sugar listed by 4 to get an approximate number of teaspoons.) The next trick is to rethink our relationship to sweets: Cookies, cakes and candy are supposed to be occasional treats, not everyday snacks and mealtime companions. Try swapping some out for a naturally sweet piece of fruit or a square of very dark chocolate. Just as it’s possible to get used to less

salty foods, it’s possible to wean yourself off sugar. Your heart is waiting. – Environmental Nutrition is the award-winning independent newsletter written by nutrition experts dedicated to providing readers up-to-date, accurate information about health and nutrition in clear, concise English. For more information, visit www.environmentalnutrition.com.

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OUT OF THE OR RECIPE

OR TODAY | September 2016

EATINGWELL ENTREE

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GRILLED KEBABS ARE THE PERFECT GRAB-AND-GO MEAL

teak kebabs get a Southwestern spin with poblano peppers and a creamy sauce spiked with cilantro, chile powder, cumin and vinegar. The potatoes are partially cooked in the microwave before putting them on the grill so theyâ&#x20AC;&#x2122;re done at the same time as fastercooking steak, peppers and onions.

EQUIPMENT: Eight 10- to 12-inch skewers DIRECTIONS: 1. Combine cilantro, vinegar, sour cream, garlic, chile powder, cumin and 1/4 teaspoon salt in a small bowl. Set aside. 2. Preheat grill to high. 3. Place potatoes in a microwave-safe container. Cover and microwave on high until just tender when pierced with a fork, 3 to 3 1/2 minutes. 3. Toss the potatoes, steak and pepper pieces with oil and the remaining 1/4 teaspoon salt in a large bowl. Thread the potatoes, steak, peppers and onion chunks onto 8 skewers. 4. Grill, turning once or twice, until the steak reaches desired doneness, about 6 minutes for medium..

Steak and Potato Kebabs with Creamy Cilantro Sauce SERVES: 4 Active Time: 40 minutes Total Time: 40 minutes 1/2 cup packed fresh cilantro leaves, minced 2 tablespoons red-wine vinegar or cider vinegar 2 tablespoons reduced-fat sour cream 1 small clove garlic, minced 1 teaspoon chile powder 1/2 teaspoon ground cumin 1/2 teaspoon salt, divided 8 new or baby red potatoes 1 1/4 pounds strip steak, trimmed and cut into 1 1/2-inch pieces 2 poblano peppers or 1 large green bell pepper, cut into 1-inch pieces 1 teaspoon extra-virgin olive oil 1 large sweet onion, cut into 1-inch chunk

5. Serve the kebabs with the reserved sauce. Recipe nutrition: Per serving: 275 calories; 9g fat (3g sat, 4g mono); 79mg cholesterol; 18g carbohydrate; 0g added sugars; 5g total sugars; 30g protein; 3g fiber; 381mg sodium; 831mg potassium.

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â&#x20AC;&#x201C; EatingWell is a magazine and website devoted to healthy eating as a way of life. Online at www.eatingwell.com.

September 2016 | OR TODAY

OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

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BERRY GOOD HEALTH Berries (including blackberries, blueberries, cranberries, raspberries and strawberries) often top lists of “superfoods” to include in your diet on a regular basis. And for good reason: They are great sources of phytonutrients, naturally occurring antioxidant compounds, such as anthocyanins, ellagic acid and quercetin, to name a few, that help you resist disease s 2 cups a day, keep and promote good health. That’s in the doctor away! addition to the vitamins, minerals and fiber found in these colorful jewels. Study after study has found a link between diets rich in berries and the compounds they contain and a decreased risk of cardiovascular disease and cancer, and improved bone and eye health. However, the Centers for Disease Control and Prevention has found that only about one in 10 Americans eat enough fruits and vegetables. The 2015 Dietary Guidelines for Americans recommend that Americans eat more. The current fruit recommendation is 1 1/2 to 2 cups (preferably whole) fruit a day. Berries fit the bill beautifully. – Environmental Nutrition

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4 WAYS TO MAKE YOUR HOME COMFORTABLE AND SAFE FOR YOUR PET Pets require time, attention and love. They will return the favor more naturally in an environment that’s comfortable and safe. Consider these tips for creating a pet-friendly home. • A space to call their own: Many pets seek shelter when startled by loud noises. Whether it’s the clap of thunder or a boisterous guest, an unexpected noise can send your animal fleeing (or peeing). Having a dedicated space for your pet provides a safe place for your animal during times of stress. • Pet-friendly ﬂooring: Carpeted flooring can be a challenge for pet owners. Carpet traps unpleasant odors and is diﬃcult to clean. Hardwood, bamboo, laminate and other alternatives – when properly maintained – offer a surface that’s easier to clean, doesn’t trap allergens and doesn’t hide fur or other debris. Experts, like Lumber Liquidators, offer a wide selection of flooring options, so you’re sure to find a style and look that will complement your home and is perfect for your pet. • Protect your curious pet: Pets are inherently curious. If it’s within reach, chances are it will be investigated with a detective’s attention. Even if the food is safe for pets, the packaging may be harmful. Medications, cleaners and cosmetics should also be kept on high shelves or behind a latched cabinet. – Brandpoint

PINBOARD

A+ LUNCHBOX SOLUTIONS These tips and tricks will help any parent whip up something tasty in mere minutes so kids can stay fueled throughout the day. • Smoothies are a great way to incorporate more fruits and vegetables into your child’s diet, plus it’s a special treat that will have them grinning ear to ear when they open their lunch box. The trick is to make smoothies ahead of time then freeze them in silicon or insulated containers. Add them to a lunchbox in the morning and by lunchtime it will thaw enough to enjoy. Bonus: it keep will other foods cool so there’s no need to add a freezer pack. • Sandwiches are an easy go-to that kids love, and with a few simple switches, you can create a more nutritious option that’s also fun to eat. Start by swapping traditional white bread for Nature’s Harvest bread. Create your child’s favorite sandwich. Then, use a cookie cutter to create an unexpected shape. It’s a fun and delicious way to get whole grains in their diet.

ur ways to support yo e, One of the best om es ol pack a wh child’s learning is toed lunch. nc bala

• Fun fruit faces should do the trick. Grab any fruit with a thick impermeable skin such as bananas or oranges and then use a nontoxic marker to make a face. A few fun squiggles and you have a silly fruit friend that will make lunchtime special. • Kids love to dip food for a hands-on eating experience. Start by adding a small container of low-fat dressing or yogurt. Then, cut up fruit, veggies, cheese and meat into long bite-size sticks that kids can easily grab and dip to their hearts’ desire. Include a rainbow of options to tantalize the eyes and taste buds, plus the more colors the more vitamins they’ll be eating. For many fruits and veggies, you can cut up a week’s worth on Sunday and then simply pack each day before school. – Brandpoint

“Happiness is at once the best, the noblest and the pleasantest of things.” - Aristotle

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GENERAL AIV Inc. ……………………………………………………… 19 GelPro …………………………………………………… 44-47 Surgical Power ………………………………………… 59

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OR TODAY | July/August September 2016 2016

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SIDE RAIL SOCKETS Innovative Medical Products, Inc ………… BC

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

STERILIZATION Belimed Inc. ……………………………………………… 43 Specialty Care …………………………………………… 61

LEG POSITIONERS Innovative Medical Products, Inc ………… BC MONITORS Doctors Depot …………………………………………… 4 Jet Medical Electronics …………………………… 13 USOC Medical …………………………………………… 10 ONLINE RESOURCES Medwrench………………………………………………… 59 OR TABLES/ ACCESSORIES Arthroplastics, Inc. …………………………………… 58 Innovative Medical Products, Inc ………… BC ORTHOPEDIC Surgical Power ………………………………………… 59 OTHER AIV Inc. ……………………………………………………… 19 Medi-Dose/EPS ………………………… 13,17,19,21,23 Medi-Kid Co. ……………………………………………… 32 SMD Waynne Corp. ………………………………… 53 Whitney Medical Solutions …………………… 32 PATIENT MONITORING Gopher Medical ………………………………………… 61 Pacific Medical LLC …………………………………… 6 Specialty Care …………………………………………… 61 USOC Medical …………………………………………… 10

SURGICAL Arthroplastics, Inc. …………………………………… MD Technologies ……………………………………… Surgical Power ………………………………………… Whitney Medical Solutions ……………………

58 65 59 32

SURGICAL SUPPLIES Ruhof Corporation ……………………………………2-3 SUPPORTS Innovative Medical Products, Inc ………… BC TELEMETRY USOC Medical …………………………………………… 10 TEMPERATURE MANAGEMENT C Change Surgical …………………………………… 31 Cincinnati Sub-Zero Products, Inc. ……… 53 Enthermics Medical Systems, Inc. …………… 9 MAC Medical …………………………………………… IBC WARMERS Belimed Inc. ……………………………………………… 43 Cincinnati Sub-Zero Products, Inc. ……… 53 Enthermics Medical Systems, Inc. …………… 9 MAC Medical …………………………………………… IBC

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