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CONTENTS

features

OR TODAY | May 2017

CORPORATE PROFILE: BELIMED Belimed is a leader in the design, manufacturing and distribution of infection control products, serving health care and life science markets worldwide. With its strong focus on research and development, Belimed’s products incorporate global as well as local requirements.

PA S S

AFRICA MERCY

Photo Credit: Debra Bell & Ruben Plomp ©Mercy Ships

ACCREDITATION SURVEYS Accreditation surveys can be a stressful time for health care organizations. To help reduce the stress level at your organization, OR Today asked several experts for tips when it comes to preparing for and passing accreditation surveys.

SPOTLIGHT ON: MISSY BROWN In eight years touring the world with the Mercy Ships, OR nurse Missy Brown has been to countries as far-flung as Togo, Benin, Sierra Leone, Congo and Madagascar.

OR Today (Vol. 17, Issue #04) May 2017 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 302691530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2017

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May 2017 | OR TODAY

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

24 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

ACCOUNTING

Kim Callahan

WEB SERVICES Cindy Galindo Adam Pickney

INDUSTRY INSIGHTS 11 14 16 18

News & Notes ORTL Preview OR Today Live Update Expert Advice

CIRCULATION Lisa Cover Laura Mullen

IN THE OR 20 23 24 32

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 58 Fitness 60 Health 64 Nutrition 66 Recipe 70 Pinboard

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

PROUD SUPPORTERS OF

74 Index

OR TODAY | May 2017

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INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORT

Clorox Healthcare Announces Enhancements to Bleach Germicidal Disinfectants In the fight against healthcareacquired infections (HAIs), today’s health care facilities need proven solutions to kill a broad range of infection-causing pathogens, from deadly hospital pathogens like Clostridium difficile (C. difficile) to new threats posed by emerging viral pathogens. To ensure its disinfectants continue to meet the highest standards of efficacy, Clorox Healthcare voluntarily tested two of its leading ready-to-use bleach disinfectants using updated U.S. Environmental Protection Agency (EPA) recommended standards, which raise the

bar for sporicidal disinfectant efficacy. Clorox Healthcare is proud to announce that Clorox Healthcare Bleach Germicidal Wipes and Clorox Healthcare Bleach Germicidal Cleaners are now EPA-registered to kill C. difficile spores in three minutes, tested in the presence of a

three-part organic soil load, and have gained new disinfection claims for emerging viral pathogens including SARS-associated Coronavirus (SARS-CoV), Middle East Respiratory Syndrome-associated Coronavirus (MERS-CoV) and other common causes of HAIs.

Stapling System Provides Feedback During Surgery Medtronic plc has announced the launch of its Signia Stapling System. The latest addition to the company’s minimally invasive surgery (MIS) portfolio, the Signia system provides surgeons with real-time feedback and automated responses to that real-time data. The Signia system includes Adaptive Firing technology that measures the firing force and adjusts the stapler’s speed based on tissue variability measurements, allowing for consistent staple lines. Human tissue differs in thickness throughout the body and its organ systems. For example, tissue is thinnest at the top of the stomach and thickest at the bottom of the stomach near the small intestine. Adaptive Firing technology can detect the variability of tissue and automatically adjust the stapler’s speed during MIS procedures; this allows surgeons to fire staples consistently and evenly. The Signia system also offers surgeons one-handed staple firing, allowing them to free up their other hand and stay focused on the surgical site. The benefits of MIS procedures are well documented. MIS is less invasive than traditional open surgery and can be used in multiple surgical procedure areas including thoracic, bariatric, colorectal and gynecological. The Signia system is launching initially in the United States, Western Europe, and Japan. It is expected to roll out to additional global geographies during the company’s fiscal year 2018.

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May 2017 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORT

Healthmark Announces New Hanging Tag Healthmark Industries has announced the addition of the new Hanging Tag to its labeling product line. Manufactured to be used with container systems, the white colored tag is 3.5 x 1.9 x 0.78 inches. The Hanging Tag features an ideal surface for barcode labels. Simply slide the tamper evident seal through cross-slot and affix to the container. The Hanging Tags are single-use, non-adhesive and heat resistant up to a temperature of 275˚ F. Since 1969, Healthmark Industries Company Inc. has developed and marketed solutions to aid health care facilities in their delivery of surgical instruments and other life saving medical devices to patients. Healthmark Industries mission is to continue to in-

novate, continue to support and continue to serve the health care provider industry and support services that make it possible to deliver quality health care.

Floseal May Produce Lower Hospital Costs Baxter International Inc. has announced publication of the results of two health economic analyses in the Journal of Medical Economics supporting Floseal Hemostatic Matrix as a cost-effective tool for controlling bleeding during cardiac and spinal surgeries that may contribute to significant cost savings for hospitals. The analyses are based on previously published retrospective studies of a large U.S. hospital billing database that observed fewer complications in surgeries that used Floseal compared to another flowable hemostatic matrix. Complications during surgery, such as the need for blood transfusions or longer times in the operating room, can increase costs for a hospital and impact patient care. In the cardiac surgery analysis, researchers calculated the potential cost savings of using Floseal when compared to Surgiflo to be $1.5 million annually for an average U.S. hospital, assuming Floseal use would result in improved clinical outcomes similar to those observed in the prior retrospective 12

OR TODAY | May 2017

study. Savings would come from fewer major and minor complications, surgical revisions, blood product transfusions and hours of operating time. “Based on the real-world outcomes observed in the earlier study, this new health economics analysis identifies a substantial opportunity for hospitals to realize potential cost savings on cardiac surgery operations, which are among the surgical specialties the most susceptible to the occurrence of intra-operative and post-operative bleeding,” said Domenico Calcaterra, M.D., Ph.D., Minneapolis Heart Institute at Abbott Northwestern Hospital, Minn. Calcaterra co-authored the original retrospective study.

In the second study, researchers identified potential cost savings of $151 per major and $574 per severe spinal surgery when compared to Surgiflo for hospitals with average surgical volume by improving surgical outcomes and efficiencies. The savings would come from a combination of resource use factors, including shorter operative room time, a lower blood transfusion rate and lower product volume use. In addition to reducing a hospital’s costs, addressing bleeding effectively and quickly is critical to avoiding major and minor complications for patients. Floseal is an indicated and approved adjunct hemostatic agent proven effective in a wide-range of bleeding scenarios. WWW.ORTODAY.COM

STAFF REPORT

Disinfecting Port Protector May Reduce Contamination Risk 3M has introduced the 3M Curos Stopper Disinfecting Cap for Open Female Luers to help clinicians ensure all intraluminal vascular access points can be protected through passive disinfection. “3M is committed to helping clinicians reduce infections. We have the science to deliver evidence-based solutions that help protect patient safety, reduce the risks of costly complications, improve patient outcomes and, in turn, reduce care delivery costs,” said Pat Parks, MD, PhD, medical director in the 3M Critical and Chronic Care Solutions Division. “Adding Curos stopper caps to our innovative I.V. care portfolio brings us one step closer to helping clinicians protect every patient’s vascular catheter, from insertion to removal.”

The Curos stopper cap is the latest advancement in the 3M Curos Disinfecting Port Protector family, which includes passive disinfection solutions for needleless connectors, male luers and Tego hemodialysis connectors. Now, with the addition of this offering for open female luers, 3M Curos Disinfecting Port Protectors is the only brand that has a cap that covers each intraluminal I.V. access point, thus providing a full circle of disinfection and protection. Curos port protectors provide time-saving, consistent and reliable disinfection, while keeping ports protected from contamination when not in use. Curos stopper caps can disinfect in one minute. They provide protection for up to 7 days (if not removed). They contain a 70 percent isopropyl

alcohol (IPA) reservoir to disinfect against a number of microorganisms commonly associated with CLABSI. The bright red color of Curos stopper caps help clinicians verify that a port is clean at a glance and make disinfection compliance easy to measure. The Curos stopper caps also come in two formats – singles and strips – so they can be readily available at the bedside. The strips help facilitate staff compliance with port disinfection. The individual caps are excellent for home use, as well as for ancillary areas where I.V. poles are not commonly used. The Curos stopper caps are single-use only and indicated for use only on open female luers such as stopcocks and catheter hubs.

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May 2017 | OR TODAY

INDUSTRY INSIGHTS OR TODAY LIVE! PREVIEW

STAFF REPORTS

SURGICAL CONFERENCE

OR TODAY LIVE GOES TO THE CAPITOL

R Today magazine once again comes to life with the third annual OR Today Live Surgical Conference, supported by the Competency & Credentialing Institute. The conference is scheduled for August 2729 at the Hyatt Regency Reston in the Washington, D.C. area. OR Today Live brings together perioperative leaders for a dynamic event that fosters solutions for the prevailing challenges, regulations and culture changes facing the surgical suite and the professionals called on to manage the business decisions and patient care within the OR. In our current health care era, leaders are being called upon to establish quality-focused practices and strategies. OR Today Live offers a unique opportunity to learn from industry leaders, network with influential colleagues, hone management skills, discover new resources and services, and ultimately deliver solutions to improve the performance of your facility. “OR Today Live strives to provide surgical and nursing profes14

OR TODAY | MAY 2017

“ We understand oftentimes perioperative professionals have to come out of their own pocket to attend conferences for the continuing education they require, so we want to make sure they have the best experience for their investment.” sionals with a unique, intimate and rewarding conference second to none,” said Kristin Leavoy, Vice President of OR Today Live’s parent company MD Publishing. “Our goal is to provide a valuable experience at an affordable price. We understand oftentimes perioperative professionals have to come out of their own pocket to

attend conferences for the continuing education they require, so we want to make sure they have the best experience for their investment.” “We are now in our third year and growing each and every year. It’s exciting to see new faces along with the returning attendees year after year,” she added. WWW.ORTODAY.COM

OR TODAY LIVE PREVIEW

OR Today Live offers a great variety of education, networking and fun!

Attendees at last year’s OR Today Live conference were impressed and plan to attend again in 2017. Kristin Vinson, RN, Assistant Nurse Manager, said the 2017 conference was “excellent” and that she “will definitely attend again!” Perioperative Educator Becky Schlabach was very pleased with last year’s conference and, no doubt, will enjoy the same atmosphere in 2017. “Excellent, excellent excellent! Well worth the money and time spent,” Schlabach said. “Great experience from the time I registered until the time I left. … great price, great learning, great networking, great activities and, let’s not forget, great food!” WWW.ORTODAY.COM

“I loved the small, intimate feeling and personal attention. I know you will grow larger each year as word gets out, but please continue to provide the same excellence in learning sessions and personal, hands-on attention during the conference.” The “excellence in learning sessions” will continue in 2017 as OR Today is licensed to be a Continuing Education Provider with the State of California Board of Registered Nursing; License No. CEP 16623. “This year’s education is topnotch to say the least,” Leavoy said. “We have combed our resources to find the best speakers who are presenting on the most up-to-date topics and challenges facing today’s perioperative professionals.”

Visit the official OR Today Live website at ORTodayLive.com for details about classes, super sessions, the keynote address and amazing networking events. “To make the OR Today Live Conference more accessible to more attendees, we are offering a discounted rate if you bring a friend,” Leavoy explained. “Registration is $300 for one person, or $500 for two!” Visit ORTodayLive.com to learn more and register. OR Today Live Surgical Conference has been approved and is licensed to be a Continuing Education Provider with the State of California Board of Registered Nursing. License #16623 MAY 2017 | OR TODAY

INDUSTRY INSIGHTS AAAHC UPDATE

BY BRIAN SZUMSKY, MA

CYBERCRIME

AND HEALTHCARE IT

ybercrime is a fact of life. We hear with increasing frequency about data breaches across industries. Most recently and infamously, the DNC and Yahoo have been victims of these criminal enterprises executed by entities half a world away. And while these external threats are real, there is also a growing risk of breaches carried out by internal parties. Protenus Breach Barometer tracks data breaches in health care. In November 2016, of the 57 identified breaches, more than half of them involved employees working for the affected organization. AAAHC STANDARDS AND CYBERSECURITY

AAAHC Standards related to Administration, to Clinical Records and Health Information, and to Safety (Chapters 3, 6 and 7) address the importance of maintaining the security of organizational and patient records. In the current environment, these Standards become a critical element of an organization’s emergency preparedness. HIGHLY-PRIZED DATA

Why is health care data at risk? It may be that the medical information is less valuable to hackers than the personal data. Electronic health records (EHR) include names, addresses, Social Security numbers, birth dates, phone numbers, insurance information and email addresses, and that’s before you reach the health information. The primary motive for stealing EHR data is 16

OR TODAY | MAY 2017

financial; the data can be sold on darknet marketplaces for the purposes of identity fraud and theft. In some cases, hackers have demanded ransom from the victimized organization to restore the compromised IT system or as blackmail to prevent the hacker from announcing the breach. The immediate fallout is disruption in day-to-day operations, with potential for a ripple effect on the quality of patient care, such as medication reconciliation and access to medical histories. In many cases, the success of these attacks are predicated on targeting the most vulnerable organizations, ones whose systems have exploitable weaknesses. In its simplest form, a breach may begin with an email attachment containing malicious code. Once the code is activated– for example, by opening the attachment– the code can worm

its way into a computer network, resulting in loss or theft of stored data. WHAT DO WE DO?

Two key requirements of the HIPPA Privacy Rule are: • Health care organizations must have policies and procedures to identify, recognize and respond to threats. • The organization’s governing body must have developed an action/response plan in the event of a breach. On January 13, 2017, CMS published Survey and Certification Letter #17-17, “Recommendations for Providers and Suppliers Regarding Cyber Security,” as an addendum to the Cybersecurity Act of 2015 which required the Department of Health and Human Services (HHS) “to develop a report on the preparedness of HHS and health care industry stakeholders in responding to cybersecurity threats.” CMS recommends: • Review current policies and procedures to ensure adequate plans are in place should an attack occur. • Retrain staff to use non-electronic methods, for example, written discharge instructions. • Familiarize staff with the paper medication administration record (MAR). • Use paper-based requisition forms for transmission of radiology and laboratory orders. • Pre-program telephone and fax WWW.ORTODAY.COM

AAAHC UPDATE

numbers into the fax maCybersecurity companies chine to avoid transmission generally recommend impledelays in the event that the menting regular vulnerability computer network is down scanning and/or penetration or disabled. testing for IT security. HHS now requires that any Data breaches of health organization storing protected care records can affect milhealth information has several lions of individuals, some layers of security in place to studies say as many as 1 in 3 help protect data from cyberAmericans have already been criminals. affected. For accredited orgaAdditionally, the HHS Office nizations, the issue should rise of Civil Rights recommends: to a high level of priority. • Backing up data onto segmented networks or external Brian E. Szumsky is the comdevices and making sure munications project manager backups are current withinPROOF the AAAHC SHEET Marketing • Ensuring software patches and Communication department. HANGES NEEDED and anti-virus are current He has been with the company and updated since 2015 and has worked with • Installing pop-up blockers the consulting arm (Healthcare T THE FOLLOWING ARE CORRECT and ad-blocking software Consultants International) and UMBER • WEBSITE ADDRESS SPELLINGthe AAAHC GRAMMAR Implementing browser filters Institute for Quality and smart email practices Improvement.

SNAPSHOT: DATA BREACHES BY THE NUMBERS 2015 • More than 90% of reported health care data breaches were caused by hackers or unauthorized access and disclosure (Forbes). • The top ten breaches totaled 112 million health stolen records

2016

• In July, HIPAA Journal noted 142 health care data breaches had been reported by midyear, equal to numbers for the same time period in 2015 • 181 heath care breaches were reported ranging in size from 500 to 3.6 million effected individuals (Experian) • Health Solutions, one of the largest diagnostic laboratories in India, was breached and privacy compromised for 35,000 medical records.

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INDUSTRY INSIGHTS EXPERT ADVICE

BY JULIANA MOWER, MSN, RN, CNS, CNS-CP, CNOR

IS THERE A CNS IN YOUR OR’S FUTURE?

s hospitals strive to meet the twin challenges of controlling costs and providing quality patient care, surgical services managers rely on expert practitioners to provide safe patient care. This article describes how adding a Clinical Nurse Specialist to the perioperative department staff is an efficient and costeffective way to improve perioperative patient outcomes. Anyone involved in the care of perioperative patients is aware that the current health care environment requires working with less: less staff, less resources, less budget, less time. At the same time, accrediting bodies, regulatory agencies, insurance companies, and patients are expecting a quality patient care experience at a reasonable cost and with optimal outcomes. Wouldn’t it be wonderful if one person could cover multiple roles that would meet all these expectations? The ideal candidate would need to be an expert clinician, educator, leader, researcher, and consultant. Fortunately, this person already exists as a Clinical Nurse Specialist (CNS). DEFINITION OF CNS

A CNS is one of four advanced practice roles which also include Certified Nurse Practitioners (CNPs), Certified Registered Nurse Anesthetists (CRNAs) and Certified Nurse Midwives (CNMs). CNSs are prepared at either the master’s or doctoral level in one of six population foci: family across the lifespan, adult/geriatrics, women’s health/ 18

OR TODAY | MAY 2017

gender specific, pediatrics, neonatal, or psych/mental health. A significant component of both CNS education and practice is focused on direct patient care. Based on advanced education, training, and experience, the CNS performs assessments, diagnoses and treats patient problems, and prescribes pharmacologic and non-pharmacologic interventions.1 THE VALUE OF THE CNS IN THE PERIOPERATIVE DEPARTMENT

CNSs have the expertise to design and implement interventions that reduce hospital costs by decreasing length of stay; preventing or initiating early treatment of inpatient complications; and increasing patient satisfaction with nursing care.2 Coordinating the care of complex patients, facilitating change at the systems level, and assisting staff in applying best practices to patient care are only three of the many skills that make the CNS so attractive to a perioperative department. Of additional value is the CNS who also functions as a Registered Nurse First Assistant (RNFA).3 The RNFA who is educated as a CNS has the advanced skill set to

care for the patient throughout the entire continuum of the perioperative experience, from completing the history and physical and ordering laboratory and diagnostic tests preoperatively, to serving as the RNFA during the operative procedure, and then facilitating discharge and postoperative recovery. Examples of CNS core competencies and their implications for perioperative practice at the organizational, departmental, and staff levels are provided in Table 1. MAXIMIZING THE EXPERTISE OF THE CNS

In its landmark report on the future of nursing, the Institute of Medicine recommended that organizations remove scope of practice barriers specific to advanced practice nurses which would enable them to practice to the “full extent of their education and training.” 5(p1) Organizational and perioperative department leaders can assist CNSs to reach their full potential as advanced practice nurses by: • Supporting primary population and secondary specialty certification to ensure initial and continuing competency. Many specialty nursing organizations provide a certification for APRNs. The Competency and Credentialing Institute (CCI) offer a CNS-specific specialty certification, the CNS-CP.7 Specialty certification adds additional depth to professional practice beyond that required for practice in the primary population and is strongly recommended.1 • Expanding hospital privileges to WWW.ORTODAY.COM

Table 1. Explications of CNS Core Competencies in the Perioperative Setting CNS Core Competency

Influence on Organization

Influence on Department

Influence on Staff/Patients

Direct Patient Care

Implements strategies to streamline patient care processes

Develops evidence-based clinical interventions to achieve optimal patient outcomes

Resource/role model Expert clinician

Consultation

Serves as subject matter expert as member of multi-disciplinary team

Obtains and coordinates resources for care of complex patients

Communicates evidencebased findings to staff

Systems Leadership

Performs system-level needs assessments

Develops strategies to adopt evidence-based practices

Promotes culture of safety

Collaboration

Assists with accreditation/ regulatory/quality improvement initiatives

Establishes relationships with health care team to promote clinical excellence

Encourages input on strategies to improve patient outcomes

Coaching

Provides leadership in addressing systems problems

Facilitates the development of effective clinical teams

Provides continuing education

Research

Assesses systems barriers to implementation of research findings

Disseminates expert knowledge

Assists in application of best practices at point of care

Ethical Decision-Making

Participates in interdisciplinary teams to address ethical concerns

Promotes a climate conducive to providing ethical care

Fosters professional accountability

Reference: The National CNS Competency Task Force. Clinical Nurse Specialist Core Competencies; 2010: pp. 18-25.

allow CNSs to bill Medicare for patient services.5 â&#x20AC;˘ Advocating for prescriptive authority privileges if allowed by individual state board of nursing.6 Note: Currently not all state boards of nursing approve prescriptive authority for CNSs. CONCLUSION

In our rapidly changing health care environment, the multi-skilled CNS is ideally suited to serve as a change agent to improve the provision of safe, cost-effective, and efficient perioperative patient care. CNS effectiveness can be measured in cost savings and enhanced staff, surgeon, and patient satisfaction. Juliana Mower, MSN, RN, CNS, CNS-CP, CNOR, is a Nurse Manager, Credentialing and Education, Competency and Credentialing Institute. WWW.ORTODAY.COM

REFERENCES 1. APRN Consensus Work Group, National Council of State Boards of Nursing APRN Advisory Committee. Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education. 2008. https:// www.ncsbn.org/Consensus_Model_ for_APRN_Regulation_July_2008.pdf. Accessed March 9, 2017 2. Gordon JM, Lorilla JD, Lehmaan CA. The Role of the Clinical Nurse Specialist in the Future of Health Care in the United States. Perioperative Nursing Clinics. 2012;7:343-353. 3. AORN. Position Statement on Advanced Practice Registered Nurses in the Perioperative Environment. 2014. http://www.aorn.org/guidelines/clinical-resources/position-statements. Accessed March 6, 2017. 4. The National CNS Competency Task Force. Clinical Nurse Specialist Core Competencies. 2010. http://

www.nacns.org/wp-content/uploads/2017/01/CNSCoreCompetenciesBroch.pdf. Accessed March 8, 2017. 5. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington DC: The National Academies Press. 2010. http:// www.nationalacademies.org/hmd/ Reports/2010/The-Future-of-NursingLeading-Change-Advancing-Health. aspx. Accessed March 8, 2017. 6. NACNS. Position Statement on Prescriptive Privilege for the Clinical Nurse Specialist. http://nacns.org/ advocacy-policy/position-statements/ national-association-of-clinical-nursespecialists-position-statement-on-prescriptive-privilege-for-the-clinical-nursespecialist/. Accessed March 9, 2017. 7. Competency and Credentialing Institute. CNS-CP. http://www.ccinstitute.org/cns-cp. Accessed March 10, 2017. MAY 2017 | OR TODAY

IN THE OR SUITE TALK

STAFF REPORT

SUITE TALK

Conversations from the OR Nation’s Listserv

REMOVING JEWELRY Q: What is one to do when a surgeon, PA, midwife or general practitioner scrubs in to assist on an emergency surgery wearing a ring? A: Kindly ask them to remove their rings and state Best Evidence Based Practice, AORN standards and hospital policy. Offer them a safe and secure place for

their belongings. If they are unwilling to comply, complete an incident report under the basis of potential harm and not following standard practice/policy. This way the

incidents can be tracked and the offenders can be counseled by their peers. A: Insist that they remove it.

LASER SAFETY Q: As part of the pre-employment physical for circulators and scrub techs, do you require these employees to have an eye exam? I did not find where AORN recommended an eye exam on hire as part of laser safety protocol. What are you doing for laser safety? A: No, we do not require the eye examination for personnel working with lasers (anyone of our staff may be assigned to a laser procedure). ANSI may have stronger language beyond recommending an eye examination, AORN uses “should” instead of a definitive “will” and allows individual facilities to determine if the eye examination is required or recommended. 20

OR TODAY | May 2017

“Under the Guideline for LaserSafety, Recommendation IV,

tion provides historical information in the event of a laser injury.

IV.d. Medical surveillance (eg, baseline eye exam, post-procedure exposure exam) should be considered for health care personnel where class 3B and class 4 lasers are used, if requested by the employing health care organization. A baseline eye examina-

IV.d.1. The baseline exam should be performed before working with lasers, as directed by the health care organization policy and procedure. A: When I started at Johns Hopkins hospital I had to have an eye exam during the hiring process. WWW.ORTODAY.COM

SUITE TALK

CLEANING RIGID CONTAINERS Q: What is the current practice in your facilities regarding cleaning/disinfection of rigid container systems? For example, if you are setting up a case prior to patient arrival, what is the process for the opened and now empty rigid containers? Do they get sent to decontam along with used instruments, or are they considered to still be “clean” and returned to SPD to be reused? A: Cleaned and sent to central. A: If the container is out of the room before the procedure starts then the container is

returned to SPD and wiped down with alcohol. If it is left in room after the procedure starts the container is sent to Decontam and run through the washer.

A: They get sent down to decontam in our large enclosed case cart with all the other instruments at the end of the case.

THESE POSTS ARE FROM OR NATION’S LISTSERV FOR MORE INFORMATION OR TO JOIN THE CONVERSATION, VISIT WWW.THEORNATION.COM.

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IN THE OR MARKET ANALYSIS

STAFF REPORT

SURFACE DISINFECTANT MARKET EXPANDS

ncreasing health care expenses, the growing number of hospital-acquired infections, and a spike in surgical operations are expected to drive growth in the surface disinfectant market.

The global surface disinfectant market is expected to eclipse $600 million by 2022, according to Grand View Research. The market is growing at an estimated CAGR exceeding 11 percent over the forecast period, according to a 2015 report prepared by the market research and consulting firm. “Strict guidelines along with legislative guidelines such as Affordable Care Act have forced hospital authorities to ensure cleanliness in their facilities. Rising concern regarding healthcareacquired infections, as it affects the base line of existence of these facilities, is expected to drive the surface disinfectant demand over the forecast period,” according to Grand View Research. “Recent Ebola outbreak has highlighted a need for health care facility cleanliness and disinfection.” Surface disinfectants are used to disinfect and sanitize surfaces such as floors, furniture, washrooms, tiles, walls, instruments and clothes. According to the World Bank estimates, global health care expenditure has witnessed remarkable growth from $3.8 trillion in 2003 to $7.4 trillion in 2013, growing at a CAGR of 7 percent over WWW.ORTODAY.COM

the forecast period. In the same period, public health care spending increased at a CAGR of 7.28 percent, from $2.2 trillion in 2003 to $4.4 trillion in 2013. This high growth rate, along with the huge size of health care spending, is expected to drive surface disinfectant market growth,” according to Grand View Research.

“ N orth America holds maximum share in the global surface disinfectant demand and is expected to retain its position over the forecast period.” “Rising awareness regarding home cleanliness and the need for disinfection is also expected to fuel the product demand. Rising disposable income coupled with increasing focus on child health has positively affected the home

disinfectants demand,” according to the report. “Recent infectious disease outbreaks such as Ebola, influenza, and chikungunya are expected to fuel the surface disinfectant demand over the forecast period.” On the basis of product, the market is segmented as quaternary ammonium compounds, peracetic acid, hypochlorite, chlorhexidine gluconate, phenolic compounds, aldehydes, iodine compounds, chlorine dioxide, hydrogen peroxide, and alcohols. “Hypochlorite held the largest market share in 2014 and is expected to lead the market over the forecast period,” according to Grand View Research. “Hypochlorite is primarily used for bleaching, disinfection, and water treatment. Quaternary ammonium compounds are expected to witness fastest growth on account of their more effective and biodegradable nature.” The North American market is expected to remain strong in coming years. “North America holds maximum share in the global surface disinfectant demand and is expected to retain its position over the forecast period,” according to Grand View Research. “High standards of living have driven home cleanliness and other hygienic habits in consumers. Government initiatives and enforcements regarding public health and hygiene have also driven market growth. Asia Pacific is expected to be the fastest growing region over the forecast period.” May 2017 | OR TODAY

IN THE OR PRODUCT FOCUS

RUHOF BIOCIDE DETERGENT DISINFECTANT PUMP SPRAY Ruhof Biocide Detergent Disinfectant Pump Spray is a ready-to-use quaternary germicide cleaner and disinfectant for use in patient rooms, operating rooms, ICU areas, public restrooms, or any other area that needs to be disinfected. It is formulated to be highly effective against a broad-spectrum of pathogenic microorganisms, including bacteria, antibiotic resistant bacteria, viruses, fungi, mold and mildew. Ruhof Biocide Detergent Disinfectant Pump Spray is for use on all hard, non-porous inanimate environmental surfaces: floors, walls, metal surfaces, stainless steel surfaces, bathrooms, shower stalls, bathtubs, cabinets, etc. In addition, this product deodorizes smelly areas such as garbage storage areas, empty garbage bins and cans, basements, restrooms and other places which are prone to odors caused by microorganisms.

OR TODAY | May 2017

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PRODUCT FOCUS

3M C. DIFF SOLUTION TABLETS 3M C. diff Solution Tablets provide a proven, effective alternative to bleach and peracetic acid disinfectants, featuring an NFPA rating of 0,0,0 with no personal protective equipment required at use dilution. EPA-registered to kill C. diff spores in four minutes and effective against Norovirus, the product dissolves in approximately three minutes and can be applied with a cloth, wipe, mop or coarse trigger sprayer. Additionally, 3M C. diff Solution Tablets cost significantly less than ready-to-use bleach, yielding a three-year shelf life in sealed packets, and a seven-day shelf life when diluted and stored in a closed container.

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IN THE OR PRODUCT FOCUS

CLOROX HEALTHCARE BLEACH GERMICIDAL WIPES AND BLEACH GERMICIDAL CLEANERS Clorox Healthcare Bleach Germicidal Wipes and Clorox Healthcare Bleach Germicidal Cleaners are now EPA-registered to kill C. difficile spores in three minutes, tested in the presence of a three-part organic soil load, and have gained new disinfection claims for emerging viral pathogens including SARS-CoV, MERS-CoV and other common causes of HAIs. Clorox Healthcare Bleach Germicidal Wipes are EPA-registered to kill 58 microorganisms in three minutes or less and Clorox Healthcare Bleach Germicidal Cleaners are EPA-registered to kill 50 microorganisms in three minutes or less.

OR TODAY | May 2017

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PRODUCT FOCUS

CONTEC PERIDOX CONCENTRATE SPORICIDAL DISINFECTANT AND CLEANER Combat C.diff, MRSA, and over 42 other dangerous pathogens with Peridox Concentrate broad spectrum, EPA-registered, one-step disinfectant and hard surface cleaner with a 3-minute Sporicide claim at 99.9999% efficacy. Ideal for rapid OR turnover, Peridox Concentrate contains no alcohol or bleach, requires no rinsing, and leaves minimal residue on surfaces. Peridox Concentrate will not damage stainless steel, sensitive OR equipment, or clothing. Proven effective against both non-enveloped and enveloped viruses, Peridox Concentrate is a cost-effective approach for using a high-level sporicidal disinfectant to keep HAI rates in check.

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IN THE OR PRODUCT FOCUS

DIVERY CARE OXIVIR 1 DISINFECTANT CLEANER WIPES With disinfectant claims on 75 key pathogens, Diversey Care’s Oxivir 1 disinfectant wipes are effective against a variety of bacteria, enveloped and non-enveloped viruses, TB and fungi in one minute or less. Powered by Accelerated Hydrogen Peroxide (AHP), the wipes are tough enough to clean and disinfect health care surfaces and equipment in one pass but gentle on staff and surfaces. Oxivir 1 has the best possible safety rating, is non-irritating to skin and eyes and requires no personal protective equipment. The wipes are available in a 6”x7” 160-count canister, 7”x8” 60-count canister and 11”x12” 160-count bucket and refill option.

OR TODAY | May 2017

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PRODUCT FOCUS

PALMERO HEALTHCARE DISCIDE ULTRA DisCide ULTRA is a one-step, quaternary ammonium, intermediate, high-level alcohol-based disinfectant that’s laboratory-proven to kill deadly pathogens in one minute. The series offers a full lineup of fast-acting, hospital-level disinfectants in a spray, aerosol, towelette or economical bulk refill. Palmero’s DisCide ULTRA disinfecting towelettes and DisCide ULTRA disinfecting spray meet stringent federal EPA standards for efficacy against Staphylococcus aureus, Pseudomonas aeruginosa and Mycobacterium bovis, and are also effective against the Ebola virus, Enterovirus D68, and tuberculosis (Mycobacterium bovis or TB) in one minute or less. It is FDA approved and EPA registered. DisCide meets the disinfection requirements of OSHA’s Bloodborne Pathogen Standard 29 CFR 1910.1030. Not only is DisCide designed to be highly effective, it saves time and money by accelerating your operatory turnover!

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IN THE OR CONTINUING EDUCATION CE750

OR TODAY | May 2017

BY THERESA AMERI, DNP, RN, CNE, CPN, FNP-BC

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CONTINUING EDUCATION CE750

ADVANCE PRACTICE NURSES

EDUCATIONAL PATHWAYS FOR THE APRN ROLE 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 40 to learn how to earn CE credit for this module.

The goal of this program is to provide information on the benefits of and strategies for pursuing advanced graduate nursing education. After studying the information presented here, you will be able to: • Discuss the benefits of obtaining graduate nursing education • Differentiate between the roles and programs available for a nurse pursuing graduate nursing education • Identify barriers to and resources available for pursuing graduate education

Pursuing higher education and an advanced degree is a decision that nurses must make for themselves. It may seem daunting, but by taking the time to think through what you want to do and how you can do it, you will feel successful, accomplished, and rewarded by the process. The key questions you should ask yourself as you begin this journey are: • Why do I want to do this? • What role do I want to play? • What type of degree and program do I want? • What barriers may I face? • What resources do I have? This module will provide an overview of the advanced degrees for nursing graduate education and focus on seeking higher education for the clinical role of the advanced practice registered nurse (APRN) as a nurse practitioner. APRNs may also be referred to as advanced practice nurses (APNs), and this module will use the terms interchangeably. WHY PURSUE HIGHER EDUCATION?

Nursing is a profession grounded in life-long learning. Each year, nurses complete continuing education to hone skills, validate knowledge, and build a stronger foundation to professional practice. But why not WWW.ORTODAY.COM

just stop there? Why consider an advanced degree? These are good questions and a place to start in order to move forward. A master’s degree in nursing enables a registered nurse to pursue an area of practice that is meaningful in order to provide professional advancement. The commitment needed to pursue graduate education must be strong and personally validated. It is essential to consider personal motivation. Your motivation may simply be a love of learning and a desire to further develop professional practice. The call to higher education is well supported by several influential organizations, including the Robert Wood Johnson Foundation, American Association of Colleges of Nursing, American Nurses Association, American Organization of Nurse Executives, and National League for Nursing. The Institute of Medicine’s report “The Future of Nursing” set a tone that advancing nursing education is a keystone for the future of healthcare specifically by encouraging nurses to practice at the highest level of their licensure and to pursue higher degrees that would expand that practice.1 Provisions in the Affordable Care Act (ACA) expanded funding for advanced nursing education and highlighted May 2017 | OR TODAY

IN THE OR CONTINUING EDUCATION CE750 the roles of the APN in healthcare delivery.2 Because of the ACA, Mary Wakefield, administrator of the U.S. Health Resources and Services Administration, believes nurses are poised to provide a greater impact on the lives of patients, families, and communities.3 There are financial benefits and projected employment stability as rewards for obtaining an advanced practice education.4 Some organizations provide higher salaries based on education level. There is the potential for a salary increase after obtaining or from having a graduate degree. You may work for an employer or a healthcare system that requires an advanced degree or strongly prefers one for leadership roles. If you want to assume a leadership role that provides higher annual compensation, completing a graduate degree program will put you in the position to advance your career. A graduate degree will also make you more marketable and attractive to organizations that value graduate-prepared nurses. There is job stability in obtaining an advanced nursing graduate degree and becoming a clinically based advance practice registered nurse (APRN). It is projected that APRNs in clinical practice will experience a 25% to 34% increase in employment compared with an 11% change for all other occupations from 2014 to 2024.4 The number of entry-level APRNs has more than doubled between 2002 and 2012 and continues to rise. The Bureau of Labor Statistics reports the mean national salary for nurse practitioners to be $97,990.4 APNs are poised to take a greater role in the provision of healthcare, especially primary care, because of the increased number of insured and increased access to healthcare.5 Becoming an APRN in clini34

OR TODAY | May 2017

cal practice requires a masterâ&#x20AC;&#x2122;s degree in addition to certification and licensure. WHAT ROLES DO APNS PLAY?

Opportunities for an APN are diverse and can encompass both indirect and direct patient care.6 You may choose an educational path based on where you work or what role you would like to assume in your current organization. There are four categories of APRNs:7 Nurse practitioners (NPs) are APNs who deliver primary and acute care in clinics, schools, hospitals, and other settings, where they diagnose and treat common illnesses and injuries, manage chronic disease, and provide health promotion and disease prevention services (physical exams, immunizations, health screening). NPs are credentialed in their clinical practice area. In many states, APRNs can practice unrestricted and with full autonomy. Certified nurse midwives (CNMs) are APNs who deliver prenatal, obstetric, postnatal, and routine gynecological care to women. Certified registered nurse anesthetists (CRNAs) are APNs who administer anesthetics to patients undergoing invasive medical and dental procedures. Clinical nurse specialists (CNSs) are APNs who have completed graduate coursework in a specialized are of a clinical practice setting or within a population. For example, a CNS can have a clinical focus in oncology, pediatrics, gerontology, and wound care. In some states (examples include Colorado, Nevada, Oregon, and New Mexico and also the District of Columbia),8 a CNS can perform many of the duties as a nurse practitioner, including diagnosis and prescribing treatment. A CNS provides leader-

ship and expertise in his or her specialty regardless of where the CNS practices. Other advance nurse practice (ANP) roles include those outside of a clinical practice role once the nurse has obtained a masterâ&#x20AC;&#x2122;s degree. APNs may use their clinical expertise in alternative roles. These roles can include the following: Nurse administrators typically serve in roles that have managerial and leadership capacities within practice environments. APNs in leadership roles generally have strong clinical backgrounds and aspire to be leaders in organizations, shaping policies, procedures, and practice. Nurse researchers explore ways to improve healthcare services and patient outcomes. It is the translation of research and application to practice that aids in innovation and transformation of care. Nurse researchers may lead studies and investigations in their institutions or within larger government entities, such as the National Institutes of Health. RNs interested in quality and patient safety may find that an administrative or research-based education track will provide them with the knowledge to fill that vital role in a number of healthcare settings, both inpatient and outpatient. Nurse educators are those who have clinical expertise and a passion for teaching. Hospital-based nurse educators continue the education for entry-level and experienced nurses. Academic nurse educators provide education to those entering the profession or continuing their education. In addition, academic nurse educators often perform research, contribute to professional publications, serve as leaders in their academic institutions, and serve as resources for healthcare deWWW.ORTODAY.COM

CONTINUING EDUCATION CE750

livery in public and private settings. “Nontraditional” roles for nurses vary but can include politics, public policy, law, and business. CHOOSING AN ADVANCED PRACTICE CLINICAL SPECIALTY

When choosing an advanced practice clinical specialty area, most nurses remain in the field of their professional practice. A pediatric nurse may select an acute or primary care pediatric nurse practitioner program. The curriculum will be grounded in the pediatric and adolescent population. A pediatric nurse practitioner (PNP) typically practices in an ambulatory or hospital setting. PNPs can further specialize depending on the population of patients they care for. It is not unusual to find a PNP focused in critical care, hematology/oncology, gastroenterology, otolaryngology, pulmonology, among other areas. Pediatric nurses who are interested in care of the neonatal population may elect to become a neonatal nurse practitioner (NNP). Adult nurse practitioners specialize in the care of adults, including older adults. Most adult nurse practitioners do not see patients younger than 13. Adult nurse practitioner programs have a generic or an acute care curriculum track. If the goal is to work in critical care or an ED, the acute care track may be a better choice. A generic track will meet your needs to work in primary care or an outpatient setting. Adult nurse practitioners may also specialize outside of primary care. Before December 2015, adult APNs could be credentialed as gerontology nurse practitioners. It is now a combined credential, adult-gerontology NP, with a focus in either acute or primary care. If a broad patient population interests you, a family nurse practiWWW.ORTODAY.COM

tioner (FNP) program may suit you best. A family nurse practitioner has the broadest scope of practice and can see patients from prenatal to end of life. FNPs also receive education on prenatal and obstetric care. FNPs typically work in primary care, but may be found in other care settings, such as the ED or urgent care. Because most FNP programs focus on primary care, it may be considered out of scope for FNPs to practice in an acute care setting unless they have additional education and certification to support that area of practice or they are responsible only for problems that are commonly seen in primary care settings (e.g., otitis media, minor injuries, sprains). As more FNPs are hired to practice in a hospital-based acute care setting, this will be an area of concern for state nursing boards and organizations that sponsor the certification exams.9 Women’s health is another area of practice in which you can study and pursue advanced education and certification. There are both women’s health nurse practitioners (WHNP) and certified nurse midwives. Each program has overlap with the other, but nurse midwives have an emphasis on prenatal, obstetric care, and delivery. Women’s health nurse practitioners have more concentration in primary care, gynecologic disorders, and reproductive concerns. Psychiatric mental-health nurse practitioners (PMHNP) specialize in behavioral and mental healthcare for individuals and families. PMHNPs can assess, diagnose, and treat psychiatric and behavioral disorders across the lifespan. They work in community health centers, prisons and other detention facilities, hospitals, ambulatory care settings, and private practices. PMHNPs provide counseling and psychopharmaceuti-

cal therapy based on the scope of practice within the state in which they practice. A certified registered nurse anesthetist (CRNA) provides anesthesia and pain management to patients during medical and surgical procedures. Some organizations use CRNAs to provide pain management in the acute care setting. CRNAs practice in the hospital and ambulatory setting. CRNAs may work with dentists and oral surgeons. Nurses with strong critical care backgrounds typically migrate to CRNA programs, and most programs require critical care experience. Be sure to check program requirements. CHOOSING A DEGREE

Once you have decided what specialty area or role interests you, you must decide the type of degree to pursue. If you have an associate’s degree in nursing, the first step will be to find a program that lets you complete your baccalaureate degree or bridges you directly to a master’s degree (RN-MSN) or doctorate (RN-PhD/DNP). For those with BSN degrees, you may seek programs that include a doctoral degree (BSN-PhD/ DNP) or choose to focus solely on your master’s degree (MSN). The length of time required for the program, cost, your financial situation, and your overall goals will drive your decision. Knowing the role that you would like to play should influence the decision. For example, if you want to be an APN, but know that you would also like to practice academically later in your career, a doctoral program may be a good choice. You should also consider this if you think you may choose an administrative or leadership role. While completing the requirements for a clinical APN role, you can apply courses within the curriculum toward a May 2017 | OR TODAY

IN THE OR CONTINUING EDUCATION CE750 terminal degree. You may already have a generic MSN that focuses on administration/leadership, population health, public health, or education and wish to take a more clinical role. If this applies to you, look for postmaster’s certificate programs that will allow you to use some of your graduate credits toward another graduate concentration. There are postmaster’s certificate programs in most clinical concentrations. Consider programs that will allow you to use your graduate education and postmaster’s education toward a doctoral degree. CHOOSING A PROGRAM

Three basic types of graduate education programs exist: traditional, online, and hybrid. Traditional programs require attendance in person at a set time and day of the week. Classes are usually held Mondays through Fridays. Some programs offer courses after general work hours in the evenings or on weekends to accommodate working nurses. Traditional programs can feel more “comfortable” to returning students because they offer a familiar style of education. There is immediate interaction with the instructor and peers without delay. The disadvantage is the need to commit to class schedules for prolonged periods of time, typically 15 weeks of a semester. If you are planning on working, it may require that you work weekends or night shifts to accommodate the attendance requirements. Online programs have grown over the past decade primarily due to the flexibility and convenience of “attending” class in a distancebased format. The curriculum is available 24 hours a day, seven days a week and driven by an instructor remotely. Instructors provide a deadline in advance, which means 36

OR TODAY | May 2017

that homework and lectures are self-scheduled and self-paced. Online programs may be asynchronous, meaning that you will not directly interact with your instructor or classmates at the same time. A discussion board or chat platform allows you to post thoughts and ideas. Most feedback is via email, posted in the discussion board or chat platform, or provided when assignments are submitted. Some online programs are synchronous. These programs enable students and instructors to video conference or attend webinars at set dates and times. They may reduce the isolation that some students may experience when in an asynchronous program, but require attendance. Both types of programs are highly technology dependent. They require a level of proficiency with computers and software as well as the web-based applications for content delivery. Online programs require a good deal of self-direction and selfdiscipline, and it may feel awkward initially if you are accustomed to traditional styles of education. Hybrid programs combine an online environment (synchronous or asynchronous) with required attendance on a campus. Because some skills cannot be taught online or require direct supervision during demonstration, you may be required to attend location-based classes in addition to the online coursework for the program. Many APN programs have a hybrid component for clinical assessment and procedural skills. This is important to know because you may need to factor in cost for travel and taking time off from work to attend the required activities. BARRIERS TO ADVANCED EDUCATION

The barriers to pursing advanced

nursing education vary based on your personal and professional situation. Nurses that find satisfaction in their current role and career find little to no benefit in returning to school.10 If you have decided to pursue an advanced degree, you have already passed the first hurdle, which is desire. You likely believe that an advanced nursing degree will provide you with opportunities to advance your career. The cost of graduate education can be daunting and a strong deterrent to advanced nursing education.10 Tuition costs can be high depending on the program and do not factor in the cost of textbooks, technology, fees, and travel in some cases. When doing a financial analysis for completing a degree, look at possible changes from full- to parttime employment status. But lost income and wages may be a barrier. Look for scholarships and grants through professional organizations, the state and federal government, and the university you want to attend. If you must take out a loan, consider loan forgiveness programs for providing care in underserved areas after graduation. Some employers will offer tuition assistance; just be sure you research the time of employment required for accepting the funds. Nurses in rural areas may lack access to education in a traditional setting. Colleges and schools of nursing may be far away, making it difficult to attend school, travel, and work. Traditional programs require face-to-face class time. If you don’t select an online program, attending school may prove to be far from reach. Discomfort with technology, on the other hand, may make an online program a barrier. If you choose a distance program, a reliable internet connection may not be available in rural locations, posing WWW.ORTODAY.COM

CONTINUING EDUCATION CE750

an additional challenge. Advanced nursing education requires dedication and commitment. This is also known as “time.” The support of family, friends, colleagues, and your employer is a critical part of success. Failure to have any of these can create challenges and increase stress. During the program, you will need time away from work and family obligations to focus on studying. Exams may be scheduled and require planning to ensure that you can be available to take them. If you have chosen a synchronous online program or a traditional program, you will need to schedule time during the week to attend classes. The clinical components of the curriculum will require hundreds of hours at a clinical practicum site. To complete clinical hours, you may need to travel long distances to meet the requirements, or your program completion may be delayed if there are not clinical sites or preceptors to meet the required concentration of clinical hours. There are also limitations on completing clinical hours at your place of employment. You should research this before starting clinical practicums. Be sure you are aware of the resources available to you for clinical placement. Clinical placement coordinators can be worth their weight in gold, or tuition in this case. Keep this in mind when choosing a program. MOVING FORWARD WITH YOUR DECISION

Once you have made the decision to pursue advanced nursing education and chosen a specialty role and the type of program you would like to complete, the next step is to apply and get accepted. Pay careful attention to deadlines for application; required documentation, such as official transcripts, personal WWW.ORTODAY.COM

statements, and letters of recommendation; and the fees associated with the application process. Some programs may require an interview in person or over the telephone. When you have been accepted, you will need to consider any changes to your work schedule. During the core curriculum, you will probably have some flexibility in your weekly schedule to juggle coursework and family/work responsibilities. When you start clinical rotations, you may be more limited because of the work hours of the preceptors and care setting. For example, most ambulatory practices are open during normal business hours. If you cannot find a practice site that is open on the weekend, you may need to adjust your work schedule to weekends or use vacation time to cover absences from work. Regardless of the type of program, you must ensure that you have the technological resources needed for success. A computer, laptop, or tablet is needed regardless of whether your program is online or in person. Ensure that you have a reliable internet connection and work on developing your skills for navigating the internet if you are not comfortable doing so. Consider taking advantage of free classes available to students through your university that are aimed at improving use of word processing software, spreadsheets, presentations, and search engines to perform literature reviews. These are all helpful skills to have to be successful in graduate school. FINANCING YOUR GRADUATE EDUCATION

Financing your advanced nursing education can be stressful and challenging. There are several ways to consider paying graduate tuition. The first is to determine if

your healthcare organization offers tuition reimbursement. As long as your coursework is within your current practice area, tuition reimbursement can be used. Be sure to review the terms and conditions for accepting tuition reimbursement. Some employers will require a “pay back” if you do not stay with your organization for a specified time. You can pay tuition and associated costs out of pocket using savings or current income. Speak to an income tax specialist to see if tuition paid out of pocket may be a deductible expense based on your individual income tax qualifications. Some colleges and universities may accept credit card payments, but keep in mind you will be paying interest. This may not be the best option long term. Your academic institution probably has a financial aid department with resources that can be used to pay for your tuition. Most loans are offered through the U. S. Department of Education and are managed by your school. Obtaining federal loans and grants require you to complete the Free Application for Federal Student Aid.11 Pay particular attention to the terms and conditions of your loans. Not all interest rates are low, and some loans require payback while you are in school as opposed to after you complete the program. You school may have special scholarships and grants offered to students, as well. These will require an application and in some cases an essay and/or interview. The Health Resources and Services Administration is a division of the U. S. Department of Health and Human Services. HRSA offers nurses pursuing advanced nursing degrees scholarships though NURSE Corps and loans through NURSE Corps and the National Health Service Corps (NHSC).12-14 May 2017 | OR TODAY

IN THE OR CONTINUING EDUCATION CE750 Loans through NURSE Corp and NHSC require employment in underserved areas proving healthcare after you complete a program.15,16 Underserved areas can be found in urban and rural areas of the country. The NHSC has a job portal that has information on sites that qualify for loan repayment. Private organizations and specialty focused organizations offer scholarships to qualifying nurses pursing academic advancement. When researching scholarships, be sure to look at the area in which the scholarship is offered. For example, the American Cancer Society offers scholarships to nurses practicing oncology. MinorityNurse.com offers scholarships to nurses from diverse cultural backgrounds. Johnson & Johnson Campaign for Nursing’s Future17 has a database of financial aid opportunities that can be found at Discovernursing.com. WHAT TO EXPECT IN GRADUATE SCHOOL

Graduate school is very different from community college or undergraduate education. For one thing, you now have experience and a foundation of knowledge on which to stand. Concepts that seemed foreign now make sense. You will find you have a new appreciation for topics that you love and those that you may not have enjoyed. You will learn things that may have been vague or unfamiliar. Try not to focus on your grade entirely. There should be some enjoyment to learning. In all truth, not every student can earn an “A” grade. Some courses will be more difficult than others, and you may not have the time to put into earning an A. What you retain and apply in your clinical practice will be of more value. It just may be difficult to see it this way when you are making 38

OR TODAY | May 2017

the sacrifices to be in school. The first courses that you will take are typically core classes. Every program will have a core curriculum in nursing theory, population health, leadership, health policy, physical assessment, pathophysiology, and pharmacology. The delivery of education will depend on your setting and the instructor. Graduate school is reading, thinking, and discussion. The volume of reading alone can be discouraging and overwhelming. As courses progress, you will determine the style of the instructor and where to focus your time and attention. In truth, no instructor truly believes every student reads every word assigned. Use the syllabus as a guide and ask questions for clarification whenever you need to. Your classmates will be among your greatest resources. The graduate level involves a tremendous amount of writing. This is different from what you may have experienced in nursing school at the associate and baccalaureate level. It can feel uncomfortable and awkward to write at the graduate level. Take advantage of any writing workshops, tutoring, or other resources available to you that focus on writing at the graduate level. Invest in an American Psychological Association guide if used by your program and consider a class or tutorial on APA formatting. If your program uses something other than APA, research it and look for resources. When possible, make connections and build networks while in your graduate program. The people that you meet at clinical sites could be potential employers or colleagues. Seek mentors and preceptors who challenge and inspire you. Learn all that you can by watching and asking questions when doing clinical rotations. Build relationships with your classmates and your nursing faculty.

AFTER THE PROGRAM

The APN program you have chosen will provide you with a list of program completion requirements. This will be a combination of courses and clinical hours completed. After graduation, you will apply to a certification board to sit for your specialty exam. Each certifying body has required documentation and fees. Once you have passed, you apply for licensure in your state or the state that you in which will be practicing in. You will need both an RN and an APN license. Some states also require a separate license for prescriptive authority. Based on your state of practice, you may need a physician collaborative agreement once you are hired. Apply for a national provider identifier number from the Centers for Medicare & Medicaid, which will be used when billing CMS and other insurance companies for services. Ensure you also apply for a U.S. Drug Enforcement Agency number if you will be prescribing controlled substances. During this time, you will likely be looking for employment as a nurse practitioner if you have not secured employment before graduation. Your employer will help you in the credentialing process, but will likely require that licensure and certification is completed before hire. The decision to pursue advanced nursing education is not made lightly. You need to consider many things, including your motivation, goals, and resources. Being an APN is a rewarding profession and one that will build on your professional foundation of knowledge, skills, and abilities. The role of the APN is expanding and being recognized as an integral and vital component of the future of healthcare delivery. Take the time to think carefully and plan for your education, and it will be a rewarding return on your investment. WWW.ORTODAY.COM

CONTINUING EDUCATION CE750

ADVANCED PRACTICE NURSING ROLES NP Nurse Practitioner FNP – Family Nurse Practitioner WHNP – Women’s Health Nurse Practitioner PNP – Primary Care Pediatric Nurse Practitioner CPNP-AC – Certified Pediatric Nurse PractitionerAcute Care NNP – Neonatal Nurse Practitioner AGACNP – Adult Geriatric Acute Care Nurse Practitioner (ACNP [Acute Care Nurse Practitioner] replaced with AGACNP) AGPNP – Adult Geriatric Primary Nurse Practitioner (ANP [Adult Nurse Practitioner] replaced with AGPNP) ENP – Emergency Nurse Practitioner PMHNP – Psychiatric Mental Health Nurse Practitioners CNS Clinical Nurse Specialist Roles Adult Health CNS Adult Gerontology CNS Adult Psychiatric Mental Health CNS Child/Adolescent Psychiatric Mental Health CNS Gerontological CNS Home Health CNS Pediatric CNS Public Health Community CNS CNM Certified Nurse Midwife CRNA Certified Registered Nurse Anesthetist — Jennifer Mensik, PhD, MBA, RN, NEA-BC, FAAN

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Theresa Ameri, DNP, RN, CNE, CPN, FNPBC, has more than 19 years of clinical nursing experience, including pediatrics and nursing education, and as a family nurse practitioner. She has provided educational leadership, support, and professional development to healthcare providers as a staff developer, professor, and clinical instructor. She has developed nursing procedures, performed textbook review, and curriculum development. Her areas of special interest and expertise include health promotion & disease prevention, pediatric & adolescent health, and young adult cancer survivorship.

REFERENCES: 1. Institute of Medicine. The future of nursing: Leading change, advancing health. IOM Web site. http://www.iom.edu/Reports/2010/TheFuture-of-Nursing-Leading-Change-Advancing-Health.aspx. Published October 5, 2010. Accessed May 27, 2015. 2. U. S. Department of Health and Human Services. The Affordable Care Act: section by section. HHS Web site. http://www.hhs.gov/ healthcare/about-the-law/read-the-law/index. html. Updated August 28, 2015. Accessed May 27, 2016. 3. Wakefield M. Nurses and the Affordable Care Act: A call to lead. Reflection of Nursing Leadership Web site. http://www.reflectionsonnursingleadership.org/Pages/Vol39_3_ Wakefield_Obamacare.aspx. Published December 21, 2013. Accessed May 27, 2016. 4. Occupational employment and wages, May 2015. 29-1171 nurse practitioners. Bureau of Labor Statistics Web site. http://www.bls.gov/ oes/current/oes291171.htm. Updated March 30, 2016. Accessed May27, 2016. 5. Van Vleet A, Paradise J. Tapping nurse practitioners to meet rising demand for primary care. Kaiser Family Foundation Web site. http://kff.org/medicaid/issue-brief/ tapping-nurse-practitioners-to-meet-risingdemand-for-primary-care. Published January 20, 2015. Accessed May 27, 2015. 6. Bryang-Lukosius D, DiCenso A, Browne G, Pinelli J. Advanced practice nursing roles: development, implementation, and evaluation. J Adv Nurs. 2004;48(5):519-529. http:// www.ncbi.nlm.nih.gov/pubmed/15533090. Accessed May 27, 2016. May 2017 | OR TODAY

IN THE OR CONTINUING EDUCATION CE750

REFERENCES CONTINUED: 7. American Association of Colleges of Nursing. Expanded roles for advanced practice nurses. AACN Web site. http://www.aacn.nche.edu/media-relations/ fact-sheets/apn-roles. Accessed May 27, 2016. 8. CNS independent prescribing map. National Council of State Boards of Nursing Web site. https://www. ncsbn.org/5410.htm. Updated May 2014. Accessed May 27, 2016. 9. Statement on acute care and primary care certified nurse practitioner practice, 2012. National Organization of Nurse Practitioner Faculties Web site. http://c. ymcdn.com/sites/www.nonpf.org/resource/resmgr/ imported/acpcstatementfinaljune2012.pdf. Accessed May 27, 2015. 10. Warren JI, Mills ME. Motivating registered nurses to return for an advanced degree. J Continuing Educ Nurs. 2009;40(5):200-207. http://www.ncbi.nlm.nih. gov/pubmed/19489518. Accessed May 27, 2016. 11. Get help paying for college. Free Application for Federal Student Aid Web site. https://fafsa.ed.gov/ index.htm. Accessed May 27, 2016. 12. NURSE Corps Scholarship Program. Health Resources and Services Administration Web site. http:// www.hrsa.gov/loanscholarships/scholarships/nursing. Accessed May 27, 2016. 13. National Health Service Corps scholarships. Health Resources and Services Administration Web site. http://nhsc.hrsa.gov/scholarships/index.html. Accessed May 27, 2016. 14. National Health Service Corps loan repayment program. Health Resources and Services Administration Web site. http://nhsc.hrsa.gov/loanrepayment/ index.html. Accessed May 27, 2016. 15. 2013-14 national nurse practitioner practice site census. American Academy of Nurse Practitioners Web site. http://www.aanp.org/images/documents/ research/2013-14nationalnpcensusreport.pdf. Published March 13, 2015. Accessed May 27, 2016. 16. Health professional shortage areas (HPSAs): primary health clinical shortage areas. Rural Health Information Hub Web site. https://www.raconline.org/ maps/66. Published 2015. Accessed May 27, 2016. 17. Johnson & Johnson: The Campaign for Nursingâ&#x20AC;&#x2122;s Future. J&J Web site. https://www.discovernursing.com. Accessed May 27, 2016. 40 OR TODAY | May 2017

HOW TO EARN CONTINUING EDUCATION CREDIT 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 6/30/2018. 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 In support of improving patient care, OnCourse Learning is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. OnCourse Learning is also accredited by the Florida Board of Nursing and the District of Columbia Board of Nursing (provider # 50-1489). OnCourse Learningâ&#x20AC;&#x2122;s continuing education courses are accepted by the Georgia Board of Nursing. OnCourse Learning is approved by the California Board of Registered Nursing, provider # CEP16588.

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CORPORATE PROFILE

elimed is a leader in the design, manufacturing and distribution of infection control products, serving health care and life science markets worldwide. The company is headquartered in Zug, Switzerland and is part of the Metall Zug corporation. Its U.S. headquarters are located in Charleston, South Carolina. The company has approximately 1,200 employees in 10 countries and is represented by a network of sales subsidiaries and authorized partners in more than 80 countries. With its strong focus on research and development, Belimed’s products are designed to incorporate global as well as local requirements. OR Today recently explored the company further with the assistance of Joseph McDonald, President, Belimed U.S.

: What are some advantages that your company has over the competition? McDonald: While we respect all of our competitors, at Belimed, we do feel our approach to addressing the needs of our customers is based on a different approach. • We feel strongly that a singular focus on Sterile Processing gives us an in-depth understanding of our customers’ unmet needs. It is through this 42

OR TODAY | May 2017

focus that we can design products and services that we feel uniquely meets those needs. • We put a tremendous amount of investment in understanding our customer’s changing needs well before we ever consider making an offer. Our Planning and Design teams utilize very sophisticated programs to perform workflow analysis and simulation models to ensure equipment and design meets the needs today and in the future. Through this process, we ensure our products and services add the value our customers expect and require. In addition to providing integrated solutions that drive out cost, and improve efficiency, we feel we play a significant role in improving patient outcomes and quality.

: What are some challenges that your company faced last year? How were you able to overcome them? McDonald: We clearly saw a significant move in the market as the reimbursement landscape was changing. With these changes, came increased scrutiny over all capital expenditures. With all the forces driving change in the market, we recognized having empirical data was critical to demonstrate that our products and services added the right value in this new environment.

: Can you explain your company’s core competencies and unique selling points? McDonald: The Belimed Experience is more than just equipment! We provide thought-leading, evidence-based solutions that are created by experienced Lean Six Sigma trained and certified project engineers, who listen to customers in order to understand each one’s unique needs. Our collaborative approach enables the selection and installation of reliable, space-saving, high-performance equipment on budget and on time. We go beyond expectations to ensure the CSSD WWW.ORTODAY.COM

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“ We provide thought-leading, evidence-based solutions that are created by experienced Lean Six Sigma trained and certified project engineers, who listen to customers in order to understand each one’s unique needs.” staff is trained on clinical best practices, proper equipment operation and preventative maintenance guidelines. We pride ourselves on our responsive team of clinical and technical experts to maintain equipment uptime and efficiency using the most innovative technologies. WWW.ORTODAY.COM

: What product or service that your company offers are you most excited about right now? McDonald: While there are several new products that we will be launching over the next 18 months, we tend to look at how the portfolio provides an integrated solution to our customers. At the beginning, we were like many companies, selling features and benefits and using product innovation to charge a premium price. Our approach today is to provide products designed to work as a system to increase efficiency of the entire process. Having a washer process that moves goods faster through decontamination is only efficient if prep and pack and terminal sterilization are capable of handling the increased throughput. This approach allows us to provide solutions that drive out significant inefficiencies we tend to see in poor layouts. So, while we are excited about our new products, it is the outcome of the combined solution

where we feel we can add real value.

: What is on the horizon for your company? How will it evolve in the coming years? McDonald: For years Belimed has focused our development efforts on creating technologies and services that improve connectivity, workflow efficiency, and cleaning efficacy of the sterile processing department (SPD). Belimed will continue to focus our development efforts in those areas to further improve the throughput, data management, and outcomes in the SPD environment. Of course, we have an active merger and acquisition (M&A) strategy, but you will see those opportunities will be strategic, bolt on products and services to support our focus on sterile processing.

: Can you share some company success stories with our readers? McDonald: During a sales call, May 2017 | OR TODAY

CORPORATE PROFILE

to-day experience with Belimed. Specifically, they provide on-going support for all existing Belimed equipment, consult with customers on replacement equipment solutions as well as deliver valuable education and support services. Belimed is committed to continuous improvement in our efforts to serve our valued customers!

a CSSD manager mentioned that they desperately needed another sterilizer. They simply could not get the instrument sets into sterile stores fast enough. We spent some time observing their process workflow and, along with utilizing our Site Assessment Tool, determined that there was a significant bottleneck at the prep and pack tables. The root cause of the issue was not the lack of sterilizers, their utilization analysis indicated there was excess capacity, but rather those sterilizers could not be loaded when available due to the under capacity at prep and pack. We reviewed the findings and recommendation with the CSSD manager who was thrilled that her issue could be resolved less expensively and very quickly through the simple addition of one more table.

: Have there been any recent changes to your company? McDonald: It is with great enthusiasm that we recently announced some exciting news taking place at Belimed. To better serve our 44 OR TODAY | May 2017

customers, we made a significant investment in our customer support teams. The U.S. operation has expanded our sales and service teams in an effort to further enhance our customers’ experience with Belimed. The growth in our service team included a significant number of new field specialists and systems operating specialists combined with a major investment in our infrastructure directly tied to dispatch, training and education, and parts availability and distribution. Our sales team has reorganized to better serve our customers’ current and future needs. We created a consultative team approach that consists of a Business Development Manager (BDM) and an Account Executive (AE). Our BDMs are highly experienced Belimed experts who spend their time supporting our customers’ large construction and major renovation projects. Their expertise is in design, development, and solutions creation. Our AEs are responsible for supporting our customers’ day-

: How would you describe Belimed’s employees? McDonald: Our employees are truly vested in the success of our customers, living out a concept called Customer Intimacy -– truly knowing your customer’s environment and needs. The entire Belimed team is focused and dedicated to the sterile processing department. To demonstrate that, we require 100 percent of our sales team to be IAHCSMM vendor certified within 6 months of being hired. Also, our entire planning and design team is Six Sigma certified and are well versed in lean manufacturing practices. Belimed is one of the few global suppliers to have its own workforce in all regions. Demand for infection control, with the corresponding medical and pharmaceutical systems and services, is growing worldwide. The Belimed customer base ranges from global/multinational pharmaceutical manufacturers to local hospitals and large medical practices. The aim is to provide each client with the bestpossible solution, be it machines from the standard product range or large-scale systems planned and realized specifically for the customer. Through additional services such as planning, simulation, validation and support in optimizing overall costs and consumables requirements, Belimed delivers genuine added value to its customers. For more information about Belimed, visit www.belimed.com. WWW.ORTODAY.COM

Accreditation Surveys Working Together To Achieve Success By Don Sadler

PA S S

“ It take sa entire o n ffi team to ce success fu become lly accredi ted.” -M ic h a e l K u lc z y c

ccreditation surveys can be a stressful time for health care organizations. To help reduce the stress level at your organization, we asked several experts for their top tips when it comes to preparing for and passing accreditation surveys.

GO BY THE BOOK

The experts were unanimous in stressing the importance of studying your accreditation handbook. “Know all the core chapters and any adjunct chapters that are relevant to your facility,” says Jan Davidson, MSN, RN, CNOR, CASC, the Director of the Ambulatory Surgery Division of the Association of periOperative Registered Nurses (AORN). Davidson also encourages health care organizations to drill their staff on

standards so they will be prepared if they are asked questions by the surveyor. “If a standard says you need a policy, have the policy ready to show the surveyor,” she says. “Stay current with the most recent accreditation standards handbook,” adds Raymond E. Grundman, MSN, MPA, FNP-BC, CASC, External Relations and Business Development, the Accreditation Association for Ambulatory Health Care (AAAHC).

cre Su ditati rve o ys n By

adle

Michael Kulczycki, Executive director for the Ambulatory Care Accreditation Program at The Joint Commission

of teamwork when preparing for an accreditation survey. “It takes an entire office team to successfully become accredited,” he says. “Accreditation success begins with leadership support, guidance and direction.” “Don’t leave the entire implementation of the accreditation standards up to the assigned accreditation coordinator,” Kulczycki adds. “This work can be parsed out to team members and aligned with them according to their areas of expertise, from infection control to environment of care.”Davidson agrees. “Preparation for your accreditation survey isn’t something you can do alone,” she says. “Ideally, you should start preparing three months before the survey. Preparation should be something you work on every day and keep updating as needed.” GET YOUR LOGBOOKS IN ORDER

Michael Kulczycki, the executive director for the Ambulatory Care Accreditation Program at The Joint Commission, says their surveyors are amazed to occasionally find initial applicant organizations with the standards manual still shrink-wrapped. “To be successful you need to read and become familiar with the standards manual,” he says. The electronic edition of the manual is provided complimentary as part of accreditation, says Kulczycki, while hard copies are available for purchase. Grundman also emphasizes staying up to date on state regulations and licensing requirements, as well as CMS Conditions for Coverage. “Also conduct a full mock survey annually,” he adds. “And perform quarterly self-assessment audits of credential files, personnel files and medical record files. Keep credentialing and peer review files current with date-sensitive documents.” Kulczycki stresses the importance 48

OR TODAY | May 2017

Doug Rabkin, the president of AccreditSoft! Inc., a Pasadena, California company that provides software that helps health care organizations pass accreditation surveys, stresses the importance of getting all of your daily logbooks in order. “This means collecting three years worth of paper forms,” says Rabkin. “Surveyors look for compliance with these forms. More specifically, are the nurses filling them out on the days that surgeries are scheduled?” According to Rabkin, logbook fraud is currently a hot-button issue with the accrediting organizations. “It’s easy to tell if multiple days are filled out in one sitting, and surveyors are on the lookout for this,” he says. For example, many nurses will use Friday afternoon to backfill the week’s logbooks, Rabkin says. Accreditsoft!’s software automates logbooks to prevent such backfilling and also provides a report of improper logbook entries. Rabkin tells of a plastic surgeon who discovered that his techs had not

filled out logs for three years. “He hired a tech who tried to create three years of logs before his accreditation survey,” says Rabkin. “But the surveyor caught him and he lost his accreditation.” Both Davidson and Grundman concur with Rabkin’s emphasis on maintaining accurate logbooks. Davidson points specifically to books logging preventive maintenance of your equipment, patient and staff radiation exposure, employee dosimetry badge readings, and sterilization. “Keep meticulous records and logbooks on Inspection, Testing and Maintenance (ITM) on all equipment and devices following the manufacturer’s Directions For Use (DFU),” Grundman adds. Grundman also recommends documenting ongoing surveillance of infection prevention/control practices including hand hygiene, instrument/ equipment processing and staff education and training. “Also focus on safe medication practices,” he says. Safe medication practices include: • Medication reconciliation at each visit, • Lookalike and soundalike medications, • CDC guidelines for safe injection practices, • Proper use of multi-dose vials, • Proper disposal of unused/outdated meds, and • Prevention of drug diversion. “And don’t neglect to participate in continuing education programs from your accreditation organization and state and national professional associations,” Grundman adds. “Network with your peers and ask them for help, too.” INVOLVE YOUR KEY STAKEHOLDERS

Davidson recommends starting the survey process with a power point presentation of your facility. “Make sure your key stakeholdWWW.ORTODAY.COM

THE MAGNET RECOGNITION PROGRAM

While much attention is paid to accreditation surveys performed by The Joint Commission and the AAAHC, the American Nurses WWW.ORTODAY.COM

Credentialing Center’s (ANCC) Magnet Recognition Program is also important to many health care organizations. “The Magnet Recognition Program is a nursing designation of excellence for achievement of exemplary outcomes while working with inter-professional teams,” says Julia Aucoin, DNS, RN-BC, CNE, who has worked as an American Nurses Association nursing knowledge center consultant in Silver Spring, Maryland. “Attaining and sustaining a Magnet environment requires constant attention to opportunities for improvement while engaging colleagues in generating new ideas and applying evidence to nursing practice,” says Aucoin. She recommends creating a fouryear calendar to alert everyone to the milestones and flow of information necessary for ongoing documentation to the Magnet Program office. “Introducing the Magnet concepts to new staff and reminding existing staff that stakes are higher with every designation will help keep the teams engaged in the process,” says Aucoin. A LEARNING OPPORTUNITY

Davidson also stresses the importance of using the survey accreditation process as an opportunity to learn. “If the surveyor is critical of something at your facility, ask him or her to help you understand how to do things differently,” Davidson says. “Surveyors want you to succeed and they love to teach,” she adds. “Contrary to what you may believe, they are not there to find fault or be critical of your facility. They are there to make sure you have a facility and staff that will keep your patients safe and well cared for.”

ers are present at the introductory meeting,” she says. This includes your medical director, administrator, nursing director and the person who oversees your infection prevention program. This meeting is a great opportunity to showcase what you do best every day, says Davidson. “Be proud of your facility, your work, your staff and your patient outcomes,” she says. “And remember: Nothing frustrates a surveyor more than having to ask for everything,” Davidson adds. “Provide the surveyor with a private work area and have all the material available that will be needed to review. Be available if the surveyor needs anything, but otherwise give the surveyor the time and space needed to do the work.” “Remember that surveyors are evaluating processes, not people,” says Kulczycki. “So it’s OK for a staff member to not know the answer to a surveyor query as long as he or she knows which colleague does. Therefore, make sure you know who the experts are within your organization.” In preparation for your survey, Davidson also recommends reviewing your past survey report with the key stakeholders in your facility – such as the medical director, chairperson of the quality improvement committee, and persons who oversee infection prevention. “Identify any gaps since the last survey,” Davidson says. “Are there any new standards or changes to existing standards since your last survey? If so, how do they impact your facility?”

“ Preparation for your accreditation survey isn’t something you can do alone... Ideally, you should start preparing three months before the survey. Preparation should be something you work on every day and keep updating as needed.” –Jan Davidson May 2017 | OR TODAY

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SPOTLIGHT ON:

SPOTLIGHT ON

By Matt Skoufalos

AFRICA MERCY

OR TODAY | May 2017

Photo Credit: Debra Bell & Ruben Plomp Â©Mercy Ships

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n eight years touring the world with the non-governmental Mercy Ships, OR nurse Missy Brown has been to countries as far-flung as Togo, Benin, Sierra Leone, Congo and Madagascar.

AFRICA MERCY

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May 2017 | OR TODAY

SPOTLIGHT ON

“ There are so many opportunities. I love being able to directly help the surgeons; correcting a problem, helping people. I like hands-on nursing.” Brown traces her interest in medical mission work to a childhood during which she accompanied her physician father and nurse mother on several trips to Haiti. The climate was far different from that of her home in a small suburb of Fort Wayne, Indiana, but it left a lasting impression. Whether looking through the windows of a local household or sitting in while her father consulted on a medical procedure there, being immersed in a foreign culture from a very young age seemed natural, and each trip became more personally significant, Brown said. By the time of her final trip to Haiti, Brown was 16, and knew that she wanted to pursue a career in nursing. On that last visit, she left with more of an understanding about the broader local impact her family was having in the community, and it all fell together in her mind. Nursing is purposeful in and of itself, but nursing that elevates the standard of care in areas of the world where it is needed the most is an entirely different thing. Brown took that impulse with her into her senior year of high school, where a health occupations education program also afforded her a glimpse into life in the operating room. From the time she saw her first surgery, Brown said she knew she’d found her niché. In the scant months between finishing high school and starting nursing school, she volunteered in the OR as often as possible, and was able to put enough experience under her belt in a summer to land work as an OR

OR TODAY | May 2017

technician. It was a job Brown worked throughout the two-and-a-half years she spent earning her degree. Within three years, she’d passed her boards, launching a career that has spanned 22 years to date. Five years into it, Brown learned about Mercy Ships, which she said offered the opportunity to reconcile her

Missy Brown OR Manager, Mercy Ships

interest in helping communities of need while continuing in the OR. “I thought, ‘Oh, someday, I’m going to serve with them,’ ” she said. “And it wasn’t until 2009 that it was my first time to serve short-term. I didn’t know anyone, but I knew how to be an OR nurse.” Mercy Ships targets six different

surgical specialties, all of which are focused on restoring function or dignity to patients in the developing world. Pediatric plastic surgery patients are commonly recipients of burn contraction releases or skin grafts, she said. In places where families cook over an open fire or on a charcoal stove, young children can stumble into a bad burn that can lead to a lifetime of debilitation. When health care isn’t readily accessible, or is too expensive to obtain, families suffer for years from a lack of quality treatment. Corrective procedures can enable a child to develop the ability to provide for his or her family, or to go to school for the first time without social consequences, Brown said. The same work has comparable meaning for ophthalmological patients; typically, seniors who may be dependent on children to navigate through the world. “That child is not able to go to school because they’re needed at home,” Brown said. “Removing cataracts restores sight. That person can now provide for themselves, and they’re not dependent on their family to care for them. It changes the whole family.” The Mercy Ships maxillofacial program helps patients overcome facial tumors that they may have carried for years. Obstetric patients whose fistulae are corrected also go through a dress ceremony, in which each patient is given a new dress to celebrate their chance at a new life free of discomfort. “It’s such a huge realm,” Brown said. “There are so many oppor-

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tunities. I love being able to directly help the surgeons; correcting a problem, helping people. I like hands-on nursing.” The crew on Mercy Ships is multinational; although English is the common language, its 400-member crew hails from 35-plus different nations. It’s a seafaring organization, traveling from country to country on a converted Danish rail ferry, The Africa Mercy. Mercy Ships is also a faith-based organization, which Brown said allows her to live in a community that brings first-world medical care to third-world environments. The mix of factors gives her a sense of purpose and common cause at the same time. “I feel like we uphold our standards of practice from AORN, and we are able to do just as good of surgeries here at the highest standard of care,” Brown said. “I could be challenged and even learn and grow more here and learn from others. Everyone’s coming with the same purpose: I want to serve God with my professional abilities.” Brown said that her experiences have taught her that serving with Mercy Ships is “the most rewarding thing that you could do in your career.” Surgeons who check their egos – and their paychecks – at the door allow the crew to “fully focus on others, whether it’s your own team members or the local people you’re working with,” she said. “It’s so much more about relationships, or working with each other for the good of someone else who doesn’t have access to care,” Brown said. “I love the different specialties. I love having a smaller team where you become a family.”

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Top: The Africa Mercy is the world’s largest private hospital ship staffed by 400 volunteers from 40 nations. Middle: Missy Brown (right) assists Dr. Gary Parker in surgery on the Mercy Ships floating hospital in 2011. Right: Missy Brown oversees five state-of-the-art operating rooms onboard Mercy Ships.

May 2017 | OR TODAY

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OUT OF THE OR FITNESS

BY MARILYNN PRESTON

EXERCISE-DEPRIVED?

THE FEARLESS PATH TO FITNESS

have a personal question. It’s not intended to make you feel guilty (which is the mother of all useless emotions). It’s meant to tickle your neurons and invite thought.

What keeps you from exercising more? You know you should. Exercise is the miracle cure for whatever ails you. Feeling tired? Depressed? Get your body in motion. Regular, rhythmical exercise – over time – also helps prevent heart disease, diabetes and high blood pressure and is your truest and best friend when it comes to living a healthier, happier lifestyle. But you know all that. Shoulda, woulda, coulda ... So what’s the answer? What keeps you from exercising more? Let me guess: You’re too busy. It’s the No. 1 excuse in America: too much to do; too little time; people to see; places to go; family members – includ58

OR TODAY | May 2017

ing dogs, cats and parakeets – who need to be fed on a regular basis. As your most personal trainer, I need to spread a little tough love. Not having enough time to work some amount of physical activity into your day is a lame and self-destructive excuse. And you’re better than that. Make exercise your priority – something you value because you know it brings relief and adds joy – and you’ll make the time. You’ll write it down in your calendar and not feel guilty when you follow through. You’ll walk at dawn, replace happy hour with restorative yoga, spend more time on your bike and less time on the giant time-suck known as social media.

It’s up to you. But what else might be holding you back? That’s it: Dig a little deeper. Maybe it’s fear. Over 50 percent of people drop out of fitness programs within the first six months. Sports psychologists who have interviewed the dropouts have uncovered the fear factor as something that undermines people without their realizing it. Could your fears be getting in the way of your best intentions? Let’s explore. FEAR OF DOING IT WRONG

This is a reasonable fear, because it’s painfully true that if you don’t learn the correct way to hit a ball, lift a weight or do warrior pose, you can hurt yourself. So learn! Read a book. Study with good teachers. Learning to strength train safely isn’t like learning to speak Chinese. You can master it WWW.ORTODAY.COM

FITNESS

without great effort if you’re mindful and patient. Approach it with a beginner’s mind. Ask questions; understand the basics of injury prevention. When confidence replaces fear, the ease of exercise increases mightily. FEAR OF LOOKING STUPID

Chances are this fear began when you were a kid and grew up thinking you were klutzy and uncoordinated. Too bad someone kind and loving didn’t get to you and help you discover that there are no stupid moves when it comes to being active. Every move is bringing you further down the road to better health, greater energy and more mobility. You may not be the slimmest, fastest or most graceful person in your class or on your team, but

so what? As we say in yoga, keep your eyes on your own mat. Enjoy the athlete you are; appreciate that you’re doing the best you can; and keep moving. When you stop knocking yourself as too fat, too slow or too stiff, fears about looking stupid in front of other people will disappear. FEAR THAT PEOPLE ARE JUDGING YOU

This is an ego thing, so let it go. Simple truth: Other people are absorbed with themselves. When you start imagining that others are watching you critically, simply come back to the sound of your own breathing. Focus on your performance, the sensations in your own body. Fitness isn’t ice hockey: It’s not a competitive sport. It’s a personal journey. Turn your attention inward, and

find joy in the moment. Allow that useless fear of being judged to melt away, like that extra flesh that keeps your jeans from feeling really comfy. If you feel that personal anxiety is behind your failure to exercise more, get some help. Talk to a qualified listener. Join a support group. Start a journal. Acknowledging fear is the first step toward overcoming it. Good! Class dismissed. Thanks for playing along. Marilynn Preston is a healthy lifestyle expert, well being coach and Emmywinning producer. She is the creator of Energy Express, the longest-running syndicated fitness column in the country. She has a website, marilynnpreston.com, and welcomes reader questions, which can be sent to MyEnergyExpress@aol.com.

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OUT OF THE OR HEALTH

BY HARVARD HEALTH LETTERS

5 WAYS

TO HOLD ON TO OPTIMISM

n these turbulent times, it may be a struggle to maintain a glass half full view of life. A poll released by the Associated Press on Jan. 1 indicated that most Americans came out of 2016 feeling pretty discouraged. Only 18 percent feel things for the country got better, 33 percent said things got worse, and 47 percent believe things were unchanged from 2015.

However, 55 percent of those surveyed said they expect their own lives to improve in 2017. If you are among this majority, it may serve you well. A growing body of research indicates that optimism – a sense everything will be OK – is linked to a reduced risk of developing mental or physical health issues as well as to an increased chance of a longer life. One of the largest such studies was led by researchers Dr. Kaitlin Hagan and Dr. Eric Kim at the Harvard T.H. Chan School of Public Health. Their team analyzed data from 70,000 women in the 60 OR TODAY | May 2017

Nurses’ Health Study, and found that women who were optimistic had a significantly reduced risk of dying from several major causes of death over an eight-year period, compared with women who were less optimistic. The most optimistic women had a 16 percent lower risk of dying from cancer; 38 percent lower risk of dying from heart disease; 39 percent lower risk of dying from stroke; 38 percent lower risk of dying from respiratory disease; and 52 percent lower risk of dying from infection. Yes, you can acquire optimism. Even if you consider yourself

a pessimist, there’s hope. Hagan notes that a few simple changes can help people improve their outlook on life. Previous studies have shown that optimism can be instilled by something as simple as having people think about the best possible outcomes in various areas of their lives, she says. The following may help you see the world through rosier glasses: ACCENTUATE THE POSITIVE

Keep a journal. In each entry, underline the good things that have happened, as well as things you’ve enjoyed and concentrate on them. Consider how they came about and what you can do to keep them coming. ELIMINATE THE NEGATIVE

If you find yourself ruminating on negative situations, do something to short-circuit that train of thought. Turn on your favorite music, reread a novel you love, or get in touch with a good friend. WWW.ORTODAY.COM

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acteristic shared by most MONTH optimists. You can be kind to yourself by taking good care of your body, eating J well, F Mex-A M ercising, and getting enough sleep. Take stockDESIGNER: of your as-JL sets and concentrate on them. Finally, try to forgive yourself for past transgressions (real or imagined) and move on.

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OUT OF THE OR NUTRITION

BY LORI ZANTESON, ENVIRONMENTAL NUTRITION NEWSLETTER

BLACK-EYED PEAS, PLEASE!

lack-eyed peas practically define soul food, tantalizing Southern taste buds for more than a century in dishes like slow-cooked Hoppin’ John and, partnered with collard or mustard greens, a New Year’s Day tradition thought to bring good luck.

THE FOLKLORE

Resembling an eye, these creamcolored legumes with the prominent black “pupil,” are not peas at all, but beans that originated in Africa thousands of years ago. Black-eyed peas have an eye for good health too. This anti-inflammatory food delivers more health-promoting nutrients than would seem possible for such a tiny package. THE FACTS

Also called cowpea, southern pea or black-eyed bean, the black-eyed pea (Vigna unguiculata) is part of the family of peas and beans (Fabaceae or Leguminosae). Black-eyed peas grow in long green pods, which are shelled fresh or dried on the vine. Legumes nourish the earth – taking 64

OR TODAY | May 2017

nitrogen from the air and converting it into nutrients that improve soil quality – as well as our bodies. A cooked, half-cup serving packs almost half the day’s recommended amount of folate, for healthy immune function and digestion, and, together with a healthy 12 percent DV of iron, protects against anemia. High in dietary fiber (23 percent DV), protein (14 percent DV), and manganese (21 percent DV), black-eyed peas also satisfy the appetite and help maintain a healthy weight. THE FINDINGS

Eating legumes, such as black-eyed peas, along with fruits, vegetables, whole grains, nuts and seeds, is part of the Mediterranean diet, recommended in the 2015-2020 Dietary

Guidelines as an eating plan that promotes good health and disease prevention (Nutrients, 2016). Evidence shows that eating legumes is strongly associated with a reduced risk of colorectal cancer, and that replacing several meat-based meals a week with legumes can have long term benefits on longevity, diabetes, cardiovascular disease and weight management, which may be due to the positive effects of legumes on the gut microbiome (Asia Pacific Journal of Clinical Nutrition, 2016). THE FINER POINTS

A warm weather crop, black-eyed peas may be enjoyed fresh before the first frost, or, more commonly, dried or canned. Dried black-eyed peas store best in a sealed container in a cool, dry place. Before use, soak them in water overnight, or cover with water and boil for two minutes, and soak for one hour. Try replacing your usual beans with black-eyed peas as a side dish on their own or mixed with brown rice, or make them into a salad with tomatoes, red onion and vinaigrette. WWW.ORTODAY.COM

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OUT OF THE OR RECIPE

OR TODAY | May 2017

BY SHEELA PRAKASH ENTREE

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RECIPE

PASTA DISH

IS ALL FRILLS, NO FUSS

emember those sun-dried tomatoes lurking in the back of your pantry? Isn’t there a hunk of goat cheese somewhere in the fridge? Now’s the time to grab both of those ingredients, because together they make this creamy, dreamy weeknight pasta that’s proudly all frills and no fuss.

The highlight of this recipe is the creamy sauce that comes together almost instantly, thanks to soft goat cheese. Instead of simmering cream and butter together to make a sauce, pasta water and crumbled goat cheese are quickly stirred together in the same skillet used to sauté the pasta’s aromatics to make a cream sauce. Yep, it’s actually that easy! It’s as rich as

a classic cream sauce, but easier to assemble and arguably more interesting, thanks to the cheese’s bright, tangy flavor. You can go a step further with a seared chicken breast, crumbled bacon or a handful of spinach, but sometimes your night calls for a bowl of hot, creamy pasta you can whip up in 20 minutes, and this is exactly that.

DIRECTIONS

1. Bring a large pot of salted water to a boil over medium-high heat. Add the fettuccine and set a timer for 3 minutes less than al dente, about 7 minutes or according to package instructions. Add the sun-dried tomatoes and continue to cook until the pasta is al dente, about 3 minutes more. Reserve 1/2 cup of the pasta water, then drain the pasta and sun-dried tomatoes.

INGREDIENTS Sun-Dried Tomato Fettuccine Serves 4 to 6 1 pound dried fettuccine 1 cup thinly sliced dry sun-dried tomatoes (not oil-packed) 2 tablespoons olive oil 4 cloves garlic, minced 1 tablespoon fresh thyme leaves 1/4 teaspoon red pepper flakes 4 ounces soft, fresh goat cheese, crumbled (about 1 cup) Kosher salt Freshly ground black pepper

2. Meanwhile, heat the oil over medium heat in a large skillet until shimmering. Add the garlic, thyme and red pepper flakes, and sauté until fragrant, about 30 seconds. Remove from heat. 3 Add the 1/2 cup of pasta water and goat cheese, and stir until melted. Add the pasta and sun-dried tomatoes. Toss to combine and evenly coat the pasta in the sauce. 4. Taste and season with salt and pepper as needed. 5. Leftovers can be stored in an airtight container in the refrigerator for up to three days. WWW.ORTODAY.COM

Sheela Prakash is an assistant food editor for TheKitchn. com, a nationally known blog for people who love food and home cooking. Submit any comments or questions to editorial@thekitchn.com. May 2017 | OR TODAY

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FOODS TO HELP RELIEVE ALLERGIES Achoo! Gesundheit! When you suffer from allergies, your body launches an Bless You! immune response against an irritant – pollen, grass, mold – triggering itchy, watery eyes, congestion, a runny nose and general misery. Here are three foods to help keep the wheezing and sneezing under control, plus your allergy questions answered.

BROCCOLI These little green trees are rich in sulforaphane, an antioxidant that’s been found to fight airway inflammation, helping allergy and asthma suffers stay wheeze-free, research shows. SALMON Serve up this sneeze-fighting fish tonight. The omega-3 fats EPA and DHA in salmon act as antioxidants and prevent your body from releasing histamines, chemicals that cells pump out during an immune response causing allergic reactions,

notes a study in the British Journal of Nutrition. Other omega-3-rich fish to try: mackerel, sardines and tuna. CITRUS The flavonoid quercetin, found in citrus like oranges and lemons, may help thwart symptoms like sneezing, runny nose and congestion, reports a Japanese study. Quercetin seems to help blunt the expression of the genes that control the histamine response. Apples and red wine are two other quercetin-rich foods. – EatingWell.com

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YOGA PANTS AND MORE Yoga Design Lab recently launched its first ever yoga pants collection. After nearly two years of development, the company, known for their uber colorful yoga mats, entered the crowded apparel market with something different – Peek-a-Boo Leggings. “The goal was to design premium quality leggings so lovable (and attention-grabbing) you might question ever taking them off. Active luxury made for every movement and moment,” said Chad Turner, Yoga Design Lab founder. See-through laser-cut patterns with luxurious, extra-soft interior finish and compression form-fitting technology deliver yoga pants, redefined. The young brand has been shaking up the industry with its eye-catching

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yoga mats described by Vogue and Refinery29 as “stunning works of art.” With a growing U.S. celebrity following, the company is excited to launch the leggings that blend cutting edge functionality and aesthetic beauty. Yoga Design Lab produces visually stunning, fashionforward and ecofriendly yoga products designed to inspire. The Peek-a-Boo leggings collection features see-through patterns that are available in three eye-catching, breathable, laser-cut patterns blending premium quality and style. The pants offer a unique extra-soft-to-touch interior finish and premium functionality that provides unforgettable performance for any activity. The compression technology accentuates all the right

Peek-a-Boo Le ggings. places while hugging tight for a sleek form-fitting effect. Moisture wicking keeps sweat away from skin and keeps the garment odor free. For more information, visit yogadesignlab.com

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SAFETY GEAR Flagship Surgical, LLC……………………………… GelPro…………………………………………………………… Healthmark Industries Company, Inc.…… Key Surgical…………………………………………………

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