OR Today - October 2017

CE ARTICLE A POSITIVE IMAGE PAGE 36

SPOTLIGHT ON

SALLY BROWN PROFORMANCE PAGE 54

NUTRITION

™

ADVICE FOR KIDS CLEANING VERIFICAT PAGE 58

CLEARLY VISIBLE, EASY TO INTERPRET, OBJECTIVE TESTS OF CLEANING METH

LUMCHECK™

The LumCheck™ is designed as an independent check on the cle performance of pulse-flow lumen washers. Embedded on the stainles plate is a specially formulated blood soil which includes the tou components of blood to clean.

TAKE GOOD CARE NURSES • SURGICAL TECHS • NURSE MANAGERS

OCTOBER 2017

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FLEXICHECK™

IMPROVE PATIENT

This three part kit simulates a flexible endoscope channel and is desig challenge the cleaning efficiency of endoscope washers with ch irriga�on apparatus. The kit includes a clear flexible tube, a�ache stainless steel lumen device. The test coupon is placed in the lumen a en�re device is hooked up to the irriga�on port of the endoscope wa

SAFETY

HEMOCHECK™/PROCHEK-II™

Take the guess work out of evalua�ng the cleanliness of instrument the HemoCheck™ blood residue test kit and the Prochek-II protein test. HemoCheck™ is simple to interpret and indicates blood residue to 0.1μg. The ProChek-II™ measures for residual protein on surfaces to 0.1μg.

SONOCHECK™

When the ultrasonic cleaner is supplying sufficient energy and cond are correct, SonoCheck™ will change color. Problems such as insuffi energy, overloading, water level, improper temperature and degassi increase the �me needed for the color change. In the case of problems the SonoCheck™ will not change color at all.

TOSI™

Reveal the hidden areas of instruments with the TOSI™ washer tes easy to use blood soil device that directly correlates to the cle challenge of surgical instruments. TOSI™ is the first device to pro consistent, repeatable, and reliable method for evalua�ng the cle effec�veness of the automated instrument washer.

HEALTHMARK INDUSTRIES CO. | WWW.HMARK.COM | 800.521.6224 | HEALTHMARK@HMARK.COM

READ OUR CORPORATE PROFILE ON PAGES 46-49 Address Service Requested MD Publishing 18 Eastbrook Bend Peachtree City, GA 30269

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Copyright ©2013 Ruhof Corporation 061015 AD-008 Rev. 1

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A SUPERIOR SYSTEM

PROCEDURE ROOM

REPROCESSING AREA

Endo SafeStackTM System

for the Safe Storage and Transport of Endoscopes

• Addresses all recent U.S., World and European guidelines • Molded tray protects endoscope; Stacks easily to save space • Transparent liners indicate clean or contaminated scopes • Both carts and trays are washer safe • Secure carts featuring locking bars For More Information Contact Ruhof at 1-800- 537-8463 www.ruhof.com

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AD-28 9/25/17 8:43 AM

5 NURSES 5 NIGHTS IN NEW ORLEANS We’re giving away five sets of 5-night hotel stays in New Orleans to celebrate the grand opening of Global Surgical Conference & Expo Never before has AORN offered such a dynamic range of speakers, topics, activities, and innovations. Stay in style in a city known for its unique culture, cuisine, and festivities.

Register in October for Chance to Win More Info & Register www.aorn.org/surgicalexpo

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OSHA Compliant for Every User Sinks are the primary tool for pre-cleaning, and many sinks in use in today’s reprocessing departments were not designed for optimal worker ergonomics or processes. These sinks don't meet OSHA guidelines and create risk of injuries for workers. The good news: PureSteel™ Healthcare Reprocessing Sinks can help departments achieve compliance, safety and efficiency to meet OSHA guidelines.

Height-adjustability lets sinks fit individual user’s needs and meet OSHA guidelines Adjustable back wall pegboard organizes tools and minimizes reaching Three FlexiPump™ Independent Flushing Systems allow users to flush up to nine lumens PureStation™ Sink Inserts raise the work level and help meet OSHA guidelines The Brush Bath & Shelf allow instruments to properly soak and makes draining easy For tube set organization, the AER Rack facilitates proper drying and storage Enzyme Rinse and Solution Tanks available Gallon and 32oz Bottle Holders makes storage simple and convenient

The XI Height-Adjustable Reprocessing Sink is perfect for departments looking for a smaller footprint sink or dedicated area for pre-cleaning minimally invasive instruments

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CONTENTS

features

OR TODAY | October 2017

46

CORPORATE PROFILE: HEALTHMARK Healthmark Industries’ mission is to continue to innovate, continue to support and continue to serve the health care provider industry and support services that make it possible to deliver quality health care.

y

50

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IMPROVE PATIENT SAFETY Surgery is still a dangerous undertaking despite the incredible advances that have been made in surgical technology and techniques. Every year, thousands of mistakes and complications occur that result in extended and costlier hospital stays for patients – and sometimes result in a patient’s death. It is critical for all OR personnel to remain continually focused on what they can do to improve patient safety.

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SPOTLIGHT ON: SALLY BROWN Sally Brown worked as an aide at a nursing home as a teen and her experience inspired her to pursue an associate’s degree. After receiving a cancer diagnosis, she said she was able to battle her illness while completing her degree, thanks to the support of friends, family, coworkers, and her professors at American Sentinel University.

OR Today (Vol. 17, Issue #9) October 2017 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530.

For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2017

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October 2017 | OR TODAY

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CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

11

19

EDITOR

John Wallace | jwallace@mdpublishing.com

ART DEPARTMENT Jonathan Riley Sarah Sutherland Kathryn Keur

ACCOUNT EXECUTIVES Lisa Gosser | lgosser@mdpublishing.com Jayme McKelvey | jayme@mdpublishing.com

ACCOUNTING

32

36

INDUSTRY INSIGHTS 11 18 20 22

News & Notes Company Showcase: Image Stream Medical AAAHC Update Webinar Update

Kim Callahan

DIGITAL SERVICES Travis Saylor Cindy Galindo Jena Mattison

CIRCULATION Lisa Cover

IN THE OR 25 27 28 36

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 56 Fitness 58 Health 60 Nutrition 62 Recipe 64 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

66 Index

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OR TODAY | October 2017

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Advancing Care

Through Practical Innovation

Introducing the new...

STERISŽ 5085 Harmony™ Surgical Table Optimal Patient Access

Easy to Clean

Shortened base for optimal access to patient

Unique table pad attachment and flush side rails with no exposed screws, promotes easier cleaning

Delivering industry-leading innovations specifically designed for the OR of today and tomorrow

Contact your STERIS representative or or visit www.steris.com/products/surgical-tables

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INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORT

IMP’s Expand-A-Peg Locking Peg addresses peg ‘wobble’ Innovative Medical Products’ Expand-A-Peg Locking Peg eliminates intra-operative peg motion and disengagement, keeping patients securely in place for the entire surgical procedure.

IMP’s Expand-A-Peg Locking Peg expands the base of the peg while it is set in the pegboard hole with just a twist of the locking mechanism’s cap. The result is a positively secure peg that will not move or dislodge during surgery. The ExpandA-Peg Locking Peg is designed for IMP’s modular MorphBoard Positioning System but is also compatible with most other

pegboard systems.

“With traditional pegs, the tendency is for them to move or wobble in the pegboard hole or even come out of the hole entirely during surgery because they have not been seated properly,” said Earl Cole, IMP vice president. “Our locking mechanism completely and securely seats the peg in the hole so that the patient will never lose positioning. This assurance is a huge benefit for the surgeon who doesn’t have to worry about a peg’s dislodging.”

IMP’s gold-colored, aluminum peg locking system comes in four lengths: 8, 9, 12 and 14 inches. •

3M Unveils Fast Biological Indicator Test Health care facilities can obtain faster sterility assurance results for surgical instruments following the Food & Drug Administration’s 510(k) clearance of the 3M Attest Rapid Readout Biological Indicator (BI) System for vaporized hydrogen peroxide sterilization (VH202). BI results for VH202 sterilization cycles with the 3M Attest system can now be read in 24 minutes – the fastest readout compared to any other FDA cleared product on the market – making the practice of every load monitoring increasingly feasible.

“We’ve seen overwhelming market excitement about this system since we announced 510(k) submission in May,” said Ericka Lutz, 3M Global Marketing Manager for Sterilization. “The common reaction we’re hearing is, ‘If our hospital is able to improve efficiencies and enhance patient safety, it’s a clear win-win decision.’ ” The 24-minute time to result is 10 times faster than 3M’s previous market-leading time of four hours, achieved with the 2016 release of the 3M Attest Rapid BI System for VH202. 3M scientists were able to increase system capabilities to achieve a faster readout time following the initial launch.

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Programming developments to the Attest Autoreader 490H make it possible for existing users of the four-hour system to upgrade to the 24-minute version. Customers will not be charged for this upgrade. Prior to 3M’s development of four-hour BI test results, VH202 BI readouts typically took 24 hours. •

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INDUSTRY INSIGHTS NEWS & NOTES

DePuy Synthes Launches Single Use Kits For Wrist Fracture Surgery DePuy Synthes has introduced the Distal Radius Sterile Kit, a pre-sterilized, single-use kit of instruments and implants to treat wrist fractures. The streamlined kits provide customers with the company’s plate and screw implants with instrumentation designed to help optimize operating room efficiency and eliminate procedural sterilization costs.

The Distal Radius Sterile Kit consists of one Variable

Angle LCP Two-Column Volar Distal Radius Plate, a distribution of screws, and the required fixation instrumentation – commonly what is needed for up to 80 percent of distal radius fracture cases currently treated with plates and screws. The simplified composition of the kit is designed to drive repeatable, more consistent procedures.

“It’s important in trauma cases for the instrumentation to be arranged in a way that the surgeon can focus on the patient without distraction from the back table,” said Marc Richard, M.D., Duke University Medical Center. “In my experience with these sterile kits, they have helped assure availability of the distal radius plates during unscheduled trauma cases. Additionally, I have found that the simplified set and instrumentation can help the scrub team preserve operating room efficiency.” •

Fortimedix Surgical Announces symphonX Instruments short Fortimedix Surgical has announced the official U.S. launch of its product line extension with symphonX Instruments short. The new product line offers shorter instruments that broaden surgical applicability of the symphonX Surgical Platform, further increasing the ease of use for surgeons during specific surgical procedures. symphonX is the world’s lowest profile singleport surgery solution for use in minimally invasive abdominal laparoscopic surgery. The symphonX Instruments portfolio includes various products for grasping, mobilizing, dissecting, retracting, cutting, cauterizing, ligating, and suction/irrigation of tissues and vessels. With this line extension, these different types of instruments are available in a short version. Choosing the appropriate symphonX Instruments for a specific surgical procedure, patient anatomy and/or operative site is at the physician’s discretion.

“This product line extension was developed in response to surgeon feedback,” said David Castiglioni, Vice President Sales of Fortimedix Surgical. “We have used these shorter instruments during cholecystectomy, inguinal hernia repair and several gynecologic procedures including tubal sterilization and ovarian cyst treatment with 12

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positive results, confirming the versatility of the platform across surgical specialties. The launch of symphonX Instruments short signifies a substantial milestone as we continue to execute on our strategy to establish broad based market adoption of symphonX and elevate the standard of care in laparoscopy.” •

For additional information or product specifications on symphonX nstruments short visit www.fortimedixsurgical.com.

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NEWS & NOTES

Children’s Hospital Introduces Technology to Combat HAIs There is a large variation in hospital infection rates across the UK, with the worst performers having more than 5 times the number of cases than the best performing hospitals.

As part of their ongoing effort to combat HCAIs, Royal Manchester Children’s Hospital (RMCH) recently added the Surfacide Helios Ultraviolet C (UV-C) Disinfection System to its cleaning protocol.

The Helios system is a triple-emitter UV-C hard surface disinfection system that eradicates multi-drug resistant organisms in the patient environment.

RMCH is the very first hospital within the NHS and the UK turning to UV-C technology as a complement to traditional cleaning methods. The hospital will be deploying four UV-C disinfection systems (12 emitters) throughout the hospital to protect patients and staff. This UV-C system uses three light emitting towers to safely and effectively disinfect all areas of a hospital room including tough to reach areas like bathrooms.

RMCH conducted an independent pilot study using the UV-C disinfection system in the hospital’s oncology/hematology unit. The eight-month independent study compared standard cleaning protocols alone to those including Surfacide Helios UV-C Disinfection. The result was an 83.7 percent decrease in contaminated sites and a 43 percent decrease in HAIs when the Helios system was introduced into the patient environment along with standard cleaning procedures. The Helios system was effective at reducing and eliminating a variety of drug-resistant microorganisms and has been shown to eradicate multi-drug resistant organisms, including C.Diff, MRSA, VRE, CRE and Acinetobacter. •

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INDUSTRY INSIGHTS NEWS & NOTES

Fujifilm Launches New Products for GI ESD Procedures FUJIFILM Medical Systems U.S.A. Inc. has announced the launch of two new additions to its advanced endoscopic platform including ClutchCutter and FlushKnife devices. Designed for use with compatible endoscopes, these devices aid clinicians in performing effective endoscopic submucosal dissection (ESD) interventions within the digestive tract.

“Gastrointestinal diseases – including cancers – affect some 60 to 70 million Americans annually,” said Keiichi Nagata, Division President, FUJIFILM Medical Systems U.S.A., Inc. “Fujifilm’s latest devices for ESD procedures are practical tools that allow gastroenterologists and surgeons to treat lesions with the goal of improving patient outcomes.”

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A three-in-one device, ClutchCutter is a rotatable forceps that supports clinicians in making incisions, dissections and coagulation. Built for the most rigorous procedures, ClutchCutter features jagged, serrated jaws for enhanced clutching ability and an insulated outer edge for maximum durability. The device offers a working length of 1800 mm and a 2.7 mm maximum diameter of insertion portion.

ClutchCutter is available in two jaw lengths – 3.5mm and 5.0mm.

The FlushKnife is a diathermic slitter that allows clinicians to carry out multiple applications including marking, flushing, incision, dissection and coagulation. Fujifilm’s FlushKnife features a working length of 1800 mm and 2300 mm. Product features include a

ball tip option with excellent traction, enabling dissection of the target tissue and effective coagulation. The unique tip flush function allows debris to be cleaned from the knife tip with saline or water delivered by a syringe for fluid pump. A variety of knife tip options and lengths that are suitable for different needs, are available.

ClutchCutter and FlushKnife are compatible with endoscopes that feature a working length of 1400 mm or less and a forceps channel size of 2.8 mm or greater. Additionally, select FlushKnife models are compatible with endoscopes featuring working lengths of 1700 mm or less. • For information, visit www.fujifilmendoscopy.com.

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NEWS & NOTES

St. Cloud VA Health System Studies Tru-D’s Efficacy St. Cloud VA Health Care System in St. Cloud, Minnesota, conducted a study on the effectiveness of Tru-D SmartUVC in operating rooms, endoscopy suites, urology procedure rooms and resident rooms of a community living center.

“The study demonstrated that after manual cleaning, more than half of environmental swabs grew colonies of organisms, which validates the incompleteness of manual cleaning,” said Alice Brewer, MPH, CIC, Director of Clinical Affairs for Tru-D SmartUVC. “This is consistent with other published research on the ineffectiveness of manual cleaning as a stand-

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alone process. Further, after using Tru-D, not a single environmental swab grew any colonies – proof that Tru-D is an exceptional adjunct to manual cleaning, and that it is capable of inactivating organisms throughout an entire room.”

Throughout the study, environmental swabs were done post-cleaning and prior to Tru-D, as well as after Tru-D was used in each room. A total of 40 environmental swabs were performed; 23 of the swabs grew organisms prior to Tru-D, and zero out of 40 swabs showed growth after the use of Tru-D. VA St. Cloud’s data confirms that Tru-D can eliminate colony growth of important pathogens in real-world settings and persuaded

the facility to purchase two of the germ-killing robots.

The study also assessed ease of use and cost per patient visit. Staff were able to perform other duties while the UV cycle was running and be alerted via cellphone when the cycle was complete. Over the course of seven years, purchase price and annual service contract cost for one Tru-D machine amounted to less than six cents per outpatient visit.

The combined results of the study concluded that, “Routine use of UV disinfection is a feasible addition to current infection control and environmental management service measures and may help reduce rates of health care-associated infections and ensure our Veterans a clean, safe environment for their health care.” •

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INDUSTRY INSIGHTS NEWS & NOTES

Prime Medical Outfits Florida Surgical Team in Chlorineshielded SAF-T Scrubs​ The medical staff at SurgCenter Pinellas wasn’t sure they heard it right – put your navy blue surgical scrubs into the laundry with regular bleach and “wash ‘em like they’re white.” The 25-person surgical team recently made the switch to SAF-T scrubs, a new line of health care apparel by Prime Medical that is made to be laundered and sanitized in good, old-fashioned, chlorine bleach without fading the color. But what was even more surprising is what happens to the scrubs after the wash.

“Each time SAF-T scrubs are washed with EPA-registered bleach, the patented fabric binds and retains a lasting shield of chlorine molecules,”

says Jim Sampey, Prime Medical CEO. “It’s an amazing breakthrough in fabric technology that is transforming scrubs into powerful tools to fight germs with every fiber. On the surface, SAF-T scrubs look like other surgical scrubs, but with the simple step of laundering with bleach, they’re powered with germ-killing protection that benefits staff and patients.”

Prime Medical launched in June 2016 with a line of privacy curtains, bed linens, patient gowns, lab coats and towels – and is bringing its products to health care facilities in Florida and across the country. •

Merivaara Q-Flow surgical light can reduce the risk of infection​ The Merivaara Q -Flow surgical light improves the working environment in operating rooms and offers a new way to reduce the risk of infections.​ Designed and manufactured in Finland, Q-Flow was developed to fulfill the needs of the modern surgical team. It offers improvements on many standard features in the industry as well as innovations.

“I believe this is one of the best operating theater lights in the world,” says CEO Markku Aherto. “We are very excited about this excellent product.”

The light achieves superb color rendering, particularly in red and skin shades, which makes the product perfect for a variety of surgical procedures such as internal or plastic surgery.

The Q-Flow gives a very deep column of light and dynamic obstacle compensation, so if the surgeon bends over his or her patient, sensors brighten other LEDs to reduce shadows.

Moreover, the light has sterile and intuitive controls. The Q-Flow displays simple user instructions on the operating table so the surgeon does not have to look up.

“We had surgeons, anesthesiologists and nurses give us their input as we developed the Q-Flow,” Aherto continues. “They are very enthusiastic about the final result.”

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One of the most popular features is the way it improves hygienic conditions. Standard operating room lights create turbulence intensity, acting like an aircraft wing to pull particulates in the air right over the patient. Merivaara’s designers shaped the Q-Flow as a series of concentric circles with open spaces in between. This improves laminar airflow so sterile conditions are maintained and the risk of infection is reduced. The standard turbulence intensity should be below 37.5 percent but the Q-Flow boasts 15.9 percent according to the DIN 1946-4:2008 standard. • WWW.ORTODAY.COM

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NEWS & NOTES

Eloquest Healthcare, Vancive Medical Technologies Launch Dressings Vancive Medical Technologies, an Avery Dennison business, and Eloquest Healthcare Inc. have partnered to develop an innovative post-operative dressing that contains an antimicrobial agent called chlorhexidine gluconate (CHG).

The antimicrobial properties of CHG inhibit microbial growth within the dressing.

CHG is extremely difficult to incorporate in an absorbent adhesive dressing, making the development of the BeneHold CHG platform a significant technical accomplishment for Vancive. The Eloquest Healthcare ReliaTect

Post-Op Dressings with CHG are the first to combine CHG in an absorbent, transparent and waterproof design.

“ReliaTect post-operative dressings are a natural fit for our BeneHold CHG platform, and the needs of patients and clinicians,” said Kirsten Newquist, general manager for Vancive Medical Technologies. “We look forward to further expanding our CHG technology to many more applications.”

ReliaTect is available in small and large sizes with a transparent window for surgical site visualiza-

tion, and a nonwoven border that facilitates dressing application and provides additional securement during wear. The dressings comfortably adhere to the skin, absorb fluids and protect the site from external contaminants.

ReliaTect Post-Op Dressings with CHG are now commercially available from Eloquest Healthcare in the United States. The device received 510(k) clearance from the FDA in March and is now available nationwide. Eloquest Healthcare is the exclusive distributor of the dressings in the United States and Canada. •

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INDUSTRY INSIGHTS COMPANY SHOWCASE

BY EDDIE MITCHELL

COMPANY SHOWCASE IMAGE STREAM MEDICAL

I

mage Stream Medical was founded in 1999 with the vision of solving the key clinical and business challenges for health care systems by facilitating collaboration across their enterprises. By connecting clinicians with the clear visual insights they need, and with each other no matter where they are, the company helps teams work more efficiently and effectively. The result is a clinical workflow experience that is more intuitive, natural and collaborative across the entire health enterprise.

OR Today recently interviewed Image Stream Medical CEO Eddie Mitchell to find out more about the company.

Q

AN YOU EXPLAIN C YOUR COMPANY’S CORE COMPETENCIES?

MITCHELL: We innovate to simplify connections. We have 3 cornerstones to our company’s foundation.

SIMPLICITY

We make sophisticated technology transparent. Our solutions simplify the complex, freeing care teams to focus on what matters most – caring for their patients.

Because technology should help clinicians, not frustrate them, we focus on not overwhelming our customers with long feature lists but provide an intuitive, clinical workflow-con18

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gruent, solution that is scalable and open in architecture, while calling for minimal infrastructure requirements (conduit, server, and data, etc.).

INNOVATION

Solving problems creatively is our passion. We listen to our customers and deliver practical solutions that improve the way they work. We adapt our solutions to their clinical workflows, not requiring users to change in any way how they provide the best patient care. And we consistently pave the way with new products that define the next generation of innovations.

Since our founding in 1999, we’ve established ourselves as market leaders in innovation with a long list of firstto-market technologies, including the first medical virtual presence solution for the hospital enterprise in 2017.

Eddie Mitchell, Image Stream Medical CEO

CONNECTION

Health care is a team sport. We facilitate collaboration by making it easy for clinicians to connect with each other and with clinically relevant information – at the moment of care, across the entire enterprise.

Traditionally, ORs have been one of the most isolated areas of the hospital – with good reason.

Its location must meet security, patient privacy and infection control requirements. However, today, we are making it possible to bring the OR to the rest of the hospital for remote consultations, telementoring, and surgical demonstrations for professional conferences, and focused student/ resident teaching sessions around the globe, all while protecting the patient care environment.

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IMAGE STREAM MEDICAL

Q

WHAT ARE SOME ADVANTAGES THAT YOUR COMPANY HAS OVER THE COMPETITION?

MITCHELL: Image Stream Medical (ISM) approaches integration/collaboration differently from all of the other vendors. With our solutions, there are three areas that differentiate Image Stream.

First, we are vendor neutral. ISM wants to stay true to each customer’s requirements both today and in the future. Our main priority is to work with all the vendors the customer selects such as lighting, booms, imaging, and endoscopes. Why is that important? As the facility’s requirements evolve across its procedure spaces, we can continue to provide the foundational technologies needed without holding the customer hostage as a vendor that only connects to our own equipment.

Second we believe that integration requires an enterprise-wide vision and approach. We focus on the capabilities to support connections across the enterprise, from ENT to ORs to a facility’s most advanced hybrid spaces. Organizations appreciate the time and money in providing a single solution that allows clinicians to have a consistant yet custom workflow that meets its enterprise standards.

Lastly, we understand the importance of workflows tailored to each individual customer’s procedure space and enterprise standards. Our technology integrates seamlessly with their existing workflows, freeing clinicians to focus on delivering the highestquality patient care. Supporting a hospital’s current workflows permits us to solve not just a customer’s WWW.ORTODAY.COM

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key clinical challenges, but also the business problems of other departments like biomed, IT, equipment planners and architects – all the members of the organization’s team.

Q

HAT PRODUCT OR SERVICE THAT YOUR W COMPANY OFFERS ARE YOU MOST EXCITED ABOUT RIGHT NOW?

MITCHELL: MedPresence™, it’s the next step in care team efficiency improvement, allowing hospitals to assemble teams of experts, no matter where they are located. Leveraging virtual experts elevates care team expertise, and protects the patient care environment by reducing room crowding, eliminating security and access concerns, and lowering a patient’s infection risk.

I am most proud of the care we’ve taken to ensure that all MedPresence™ participants can interact and communicate naturally with one another in the same kinds of ways that they would with an in-room colleague. We know that supporting natural ways of interacting and connecting is key to improving teamwork and efficiency.

Note: MedPresence™ and 4K applications for advanced integration in procedure room environments will be on display in the Image Stream Medical booth #415 at the OR Manager Conference on October 2-4 in Orlando, Florida.

Image Stream Medical, Inc. is a wholly owned subsidiary of Olympus Corporation of the Americas.

October 2017 | OR TODAY

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INDUSTRY INSIGHTS AAAHC UPDATE

AAAHC TOOLKIT ADDRESSES

FLEXIBLE ENDOSCOPE REPROCESSING

A

AAHC has released a new toolkit to help eliminate failures or lapses in flexible endoscope reprocessing through detailed guidelines and thorough checklists. The resource is designed to help health care organizations review and assess flexible endoscope reprocessing policies and procedures to mitigate risk of associated patient infection.

Flexible endoscopes are used in early detection of diseases such as colorectal cancer – which is the second leading cause of cancer death in men and third in women. Flexible endoscope interventions, such as colonoscopies, enable providers to remove adenomas, thus reducing morbidity and mortality, in a cost-effective way. In 2017, the ECRI Institute, an international nonprofit applied medical research organization, named inadequate cleaning of complex, reusable instruments – such as endoscopes – as one of the top 10 “technology hazards” in health care.

“Over the last several decades, we have seen an increase in the number of failures or lapses in flexible endoscope reprocessing as well as patient infections reported,” said Naomi Kuznets, PhD., vice president and senior director of the AAAHC Institute. “The costs of these failures include patient morbidity, mortality, pain and suffering, and decreased productivity, as well as legal, testing and treatment costs.”

To address this problem, national 20

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medical specialty societies and governmental agencies have developed and refined recommendations and clinical practice guidelines, including updates in 2016 and 2017.

GUIDELINES FOR REPROCESSING COMPLIANCE

In 2010, 4 million endoscopies of the large intestine and 2.2 million endoscopies of the small intestine were performed in an ambulatory setting.

Almost half of these were estimated to take place in ambulatory surgery centers, underscoring how critical this patient safety issue is to ambulatory providers.

The AAAHC toolkit outlines a flexible endoscope reprocessing program that helps organizations comply with AAAHC standards on infection control and prevention for ambulatory providers as well as recommendations from other national organizations such as the American Society of Gastrointestinal Endoscopy, American College of Gastroenterology and Centers for Disease

Control and Prevention. The toolkit guidelines are broken down into three steps: 1. Risk assess your existing flexible endoscope reprocessing program

• Use the provided checklist of elements required for a compliant reprocessing program, and alert a designated infection prevention and control staff member if any deficiencies are discovered so immediate action can be taken to eliminate the cause of the failure and prevent future occurrences.

• The reprocessing program should include policies on staffing training and competency training, requirements for physical environment, protocols for spill containment and breaches, and thorough and consistent documentation.

2. Develop a training plan to address deficiencies

• Follow the flowchart of reprocessing program components when training staff to ensure compliance.

• The training plan should include pre-cleaning, disassembling and leak testing, manual cleaning and visual inspection, disinfection, processing of accessories and proper storage.

3. Observe endoscope reprocessing routinely to ensure compliance

• Confirm all steps in the process are WWW.ORTODAY.COM

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being followed by regularly observing the cleaning and disinfecting of endoscopes, and communicating any changes to the process to all staff.

• Provide opportunities for staff to make suggestions for improvements in the processes that may reduce the risk of patient infection and increase staff satisfaction.

The AAAHC toolkit also provides a checklist for documentation of flexible endoscope reprocessing policy, outlining steps for high-level disinfection testing, disposal and replacement, as well as maintenance and repair of equipment.

The Flexible GI Endoscope Reprocessing Toolkit is available for purchase at http:// www.aaahc.org/en/institute for $10. For more information on flexible endoscope reprocessing, other AAAHC resources or ASC accreditation, visit www.aaahc.org.

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OCTOBER 2017 | OR TODAY

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INDUSTRY INSIGHTS OR TODAY WEBINAR

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WEBINAR SERIES

WEBINAR SERIES PROVIDES INSIGHT

he OR Today Webinar Series continues to grow as it provides insights regarding the challenges and decisions perioperative leaders must make in today’s health care environment.

Cheryl Nance, Ph.D., MN, BSN, RN, principal of Dean Associates, presented one of this summer’s webinars.

In her presentation “Harnessing Your Vision,” Nance brought clinical practice and research together to explore the creation of a service of excellence with engaged staff. She reviewed culture, competing values and change research. She addressed how to apply these principles to build a vision for organizational effectiveness and offered tools to support the creation of a strong and effective vision for your department.

Nance has 40-plus years of leadership experience for a variety of not-for-profit, single and multi-hospital and faith-based health care systems. She is recognized for her expertise in performance improvement, leadership development and coaching, culture transformation, and organizational effectiveness.

Attendees completed an online survey following the webinar and described the OR Today Webinar Series as “great resources/tools in advancing knowledge and skills as a nurse manager for my unit” and “always interesting and current.”

Another recent OR Today webinar, sponsored by the Competency & Credentialing Institute (CCI), provided tips regarding leadership.

“Lessons in Leadership” was presented by James Stobinski, Ph.D., RN, CNOR, CSSM. He is chief executive officer of CCI. Those attending the webinar were eligible for one continuing education (CE) hour by the State of California Board of Registered Nursing.

In the webinar, Stobinski explained how the lessons and challenges learned by the American auto industry can be applied to changes in American health care. He

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also identified three principles that perioperative nurse leaders can apply to their daily work.

More than 100 people attended the presentation and more have watched it online at ORToday.com and on YouTube.

Attendees were impressed by the presentation and shared what made it “excellent” in their post-webinar surveys.

“Very informative. Provided a new look at the changes occurring in nursing, the need for lifelong learning and other things to help nursing through the current changes,” wrote Alice S. “Excellent webinar! Very glad I took the time to attend,” Steve B. said.

“ Very informative. Provided a new look at the changes occurring in nursing, the need for lifelong learning and other things to help nursing through the current changes,” wrote Alice S. “James Stobinski provided a clear concept of how embracing continuous opportunities to expand one’s knowledge strengthens the leadership capabilities of not just the individual, but the department,” Robin C. shared.

“Motivational, simply put ... we need to all realize as a nurse it is an obligation to continue professional development to achieve the best outcome for our patients,” said Eva M. The series also received praise.

“The OR Webinar series provides a welcome opportunity to access quality education/information during busy schedules,” Jennie G. said.

“I enjoy the free webinars offered by OR Today. They are pertinent and to the point,” Cathy A. added.

For more information about the webinar series, including recordings of previous webinars and a schedule of future presentations, visit ORToday.com.

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Achieving Accreditation

2017

Building and using your accreditation toolkit.

DEC 1–2, LAS VEGAS, NV

Learn more at www.aaahc.org

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IN THE OR SUITE TALK

STAFF REPORT

SUITE TALK Conversations from the OR Nation’s Listserv

LEAD APRONS

Q

I s it acceptable to place lead aprons in each OR Suite? Currently the aprons are located on a cart in the hall. With the increase in equipment facilities are always looking for more space.

A: We have a coat rack in the OR suites and hang lead on that.

A: We have purchased a specific X-Ray Apron Rack/Hanger.

A: Aprons should not be kept in the OR.

A: The lead aprons are (from what I understand) a piece of equipment and should be stored as such. We store ours in the equipment room.

A: I am thinking the X-ray apron racks are outside of the actual OR suite and kept within the restricted area.

BEARDS IN THE OR

Q

Are beards allowed in the OR? Do they have to be covered?

A: All facial hair is to be covered. There are specialty masks for that. Look at you vendor catalog for masks and bouffants.

A: We have a hood that covers the side and neck.

A: Yes, beards should be covered. Medline makes a full head cover that covers the nape of the neck and side cheeks. They also make a beard mask. You would need to wear it along with a regular mask though.

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

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October 2017 | OR TODAY

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IN THE OR MARKET ANALYSIS

STAFF REPORT

ANESTHESIA MARKETS GROWING

T

here is more than one type of anesthesia and researchers are predicting growth for some of them. Mordor Intelligence forecasts growth in the global anesthesia drug market.

“The global anesthesia drugs market has been estimated at $11.54 billion in 2016 and is projected to reach $14.11 billion by 2021, at a CAGR of 3.4 percent during the forecast period from 2016 to 2021,” according to Mordor Intelligence. “Anesthetic is a drug which causes anesthesia, which is a reversible loss of sensation. The different types of anesthesia drugs are general anesthesia, spinal or epidural anesthesia, interscalene block, IV regional anesthesia, local anesthesia, peripheral nerve block, saddle block or caudal anesthesia, etc.”

“Increasing number of surgeries, development of new sedative and anesthetic drugs, reduction in the cost of newly invented drugs and decrease in the recovery time after surgery are some of the reasons driving the growth of the market,” adds Mordor Intelligence. “Risk of side effects of anesthesia drugs, lack of skilled anesthetists to administer the drugs and risk of adverse reactions of anesthesia drugs are some of the major constraints hindering the market growth.”

A report from PRNewswire predicts even more growth.

“United States anesthesia market is expected to be more than $4 billion by 2022. This growth is driven by increasing incidence of cardiovascular cases, growing old age population and rising number of urgent surgeries in United WWW.ORTODAY.COM

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States. Private as well as public health insurers also help to boost this market as they consider anesthetic products in their reimbursement policy,” according to the report.

General anesthesia is expected to grow and help power the overall anesthesia drug market.

“United States anesthesia market is expected to be more than $4 billion by 2022.”

“The U.S. general anesthesia drugs market is poised to reach $2.0 billion by 2020 from $ 1.6 billion in 2015, at a CAGR of 3.8 percent from 2015 to 2020,” MarketsandMarkets reports.

“Factors such as rapid rise in aging population, rising prevalence of cardiovascular and respiratory systemrelated diseases, and rising number of emergency surgeries are driving the growth of the U.S. general anesthesia drugs market. However, side effects associated with ketamine usage (such as elevation in blood pressure and heart rate, amnesia, respiratory depression, and hallucinations), regulatory issues, and lower compliance rates in comparison with other anesthetic drugs are likely to restrain the growth of this market.”

Mordor Intelligence also forecasts

that the global anesthesia devices market will reach $13.50 billion by 2021, at a CAGR of 11.64 percent during the forecast period from 2016 to 2021.

“This market has witnessed an excellent growth in the recent times.

This growth is expected to increase accordingly in the near future as well,” Mordor Intelligence reports.

“Continuous growth in this market can be attributed to the rapid adoption of anesthesia information management systems (AIMS), which have been implemented in an effort to move the industry away from the paper-based record keeping systems to more efficient electronic solutions,” the report adds. “The establishment of several government-supported national statistical databases is driving this market as well. The demand is also rapidly increasing with the growing safety awareness and technology enhancements in anesthesia machines.”

“However, the rapid advancements in the anesthesia industry make it increasingly difficult for the anesthesiologist to keep up with the various anesthesia machine technologies.

Additionally, the latest anesthesia technology does not come at a low price, and even the most basic configuration of the equipment can cost a fortune,” Mordor Intelligence states. “The decrease in reimbursements provided by governments for medical equipment, and increased availability of aftermarket service that prolongs the life of a facility’s existing equipment are also the challenges involved that this market may have to face with respect to its growth.”

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IN THE OR PRODUCT FOCUS

BAXTER SUPRANE (DESFLURANE, USP).

SUPRANE is sold in more than 60 countries and has been used to treat more than 290 million patients since its launch in 1992.

Baxter is the only supplier of all three modern inhaled anesthetics, demonstrating global market leadership in inhaled anesthesia since 2015. Baxter’s aluminum bottles are 100 percent recyclable. •

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PRODUCT FOCUS

DRAEGER PERSEUS A500 ANESTHESIA WORKSTATION A highly configurable anesthesia workstation, the Perseus A500 can be easily tailored to meet your needs. Its generous, well-lit workspace can be used to keep supplies organized and within reach. Its compact, heated breathing system is designed to reduce condensation build-up and facilitate fast gas exchange rates. And to support continuity of care between the ICU and OR, the Perseus A500 offers Airway Pressure Release Ventilation (APRV). •

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October 2017 | OR TODAY

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IN THE OR PRODUCT FOCUS

GE HEALTHCARE AISYS CS² Modular and upgradeable, with Aisys CS² you’re planning for the future while protecting your investment. Electronic agent control allows you to capture set agent concentrations and precisely measures agent usage. The 15-inch touchscreen ventilator display and ecoFLOW option displays oxygen flow alongside pre-set targets while calculating anesthetic agent cost and usage in real-time. Clinicians can use this to adjust oxygen flow to help avoid unnecessarily high fresh gas flow rates. •

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PRODUCT FOCUS

HALYARD ON-Q QUIKBLOC OVER-THE-NEEDLE CATHETER SET The ON-Q QuikBloc Over-the-Needle Catheter Set is a catheter assembled over an echogenic needle that enables placement in one simple step for continuous nerve block procedures. Its unique design both minimizes catheter dislodgement and saves time. Now clinicians can offer patients the benefit of longer term pain relief from a continuous nerve block while using a technique similar to a single-shot nerve block.

Additionally, the echogenic system delivers enhanced visualization under ultrasound – with a stimulation option for dual guidance. •

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October 2017 | OR TODAY

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IN THE OR PRODUCT FOCUS

INFINIUM ADS II ANESTHESIA SYSTEMS The Infinium ADS II anesthesia systems offer pure simplicity in patient ventilation and anesthetic delivery. The ADSII features highly accurate tidal volumes with 15 mL capability and a 12-inch touchscreen. It also features electronic flowmeters (Air, N20, O2). It is autoclavable and heated absorber. It has ventilation modes of VCV, PCV, SIMV+PS. It features highly mobile space saving design with a retractable writing table, battery backup and more. •

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PRODUCT FOCUS

MINDRAY A7 ANESTHESIA WORKSTATION WITH OPTIMIZER The new A7 Anesthesia Workstation takes the well-received A-Series to a higher level. The feature-rich A7 combines advanced ventilation with electronic fresh gas technology and Optimizer functionality to provide effective care across a wide range of patients. Electronic fresh gas control ensures precise, accurate and responsive flow dynamics while the Optimizer provides low flow and inhalation agent management tools to support hospital initiatives to improve clinical outcomes and reduce costs. Real time agent usage calculation, advanced ventilation modes, integrated suction, auxiliary common gas outlet, and a convenient pull out table provide the necessary tools for today’s clinical and cost-saving requirements. With built-in HL7 connectivity to AIMS and EMR systems and an industry-leading three-year warranty, the A7 functions as a truly comprehensive workstation that saves time, space and cost. •

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October 2017 | OR TODAY

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Designed for use in the clean core soiled utility/clean up area, the sink is designed to quickly and automatically remove gross soils and bioburden from instruments prior to being sent to the SPD

TBJ sinks are designed specifically for the pre-cleaning of surgical instruments and endoscopes. All of our sinks are custom made to order to enable you to design a system around your specific needs. A wide range of optional features and accessories enable you to tailor a design that puts the tools you for efficient, effective and ergonomic pre-cleaning right at your fingertips.

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away while the sink does the work. It makes transporting instruments safer and makes further pre-cleaning in the SPD easier and more effective.

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IN THE OR CONTINUING EDUCATION CE492E

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BY CYNTHIA SAVER, MS, RN, AND ROSALINDA ALFARO-LEFEVRE, MSN, RN, ANEF

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CONTINUING EDUCATION CE492E

DO YOU REFLECT A POSITIVE IMAGE OF NURSING?

E

very year, the Gallup Poll asks the public to rate the honesty and ethical standards of people in 23 professions. Nurses routinely come out on top, higher than physicians, dentists, and members of the clergy.1

OnCourse Learning guarantees this educational activity is free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See Page 43 to learn how to earn CE credit for this module.

Goal and objectives

The goal of this program is to provide nurses with information on nursing and its image so they can improve the image of the profession by taking action individually and as a group. After studying the information presented here, you will be able to: •D iscuss how self-image affects the image of nurses • Describe at least three ways to promote a positive nursing image in your workplace and to the public • State five actions nurses can take individually to improve the image of nursing

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Despite this favorable response, negative images of nursing still exist — on television (the demeaning way nurses are treated on “Grey’s Anatomy”), in movies ( most remember Nurse Ratched from “One Flew Over the Cuckoo’s Nest”), in books (novels with medical characters often ignore nurses or put them in bit roles), on greeting cards (check out the get-well section of your local card store), and in stock photographs (do an Internet search for images of nurses; you’ll be appalled at some of them). Negative stereotypes include nurses as “battle-axes,” physicians’ handmaidens, “airheads,” and sex objects.

We can explain this dichotomy of trustworthiness vs. negative stereotypes by understanding that trust is only one component of image. The public may trust nurses, but have little understanding of what they do and don’t think of them as key players in healthcare.

People are influenced by the negative images and unrealistic roles they see in the media. It’s up to us to promote ourselves as qualified professionals who have valuable knowledge that significantly

influences patient outcomes. To recruit and keep competent, caring nurses, we must get the message out that the nursing profession attracts talented, bright people.

This module discusses the interplay between public and personal image and gives strategies you can use to promote the image of nursing at work, at home, and in the community.

LINK BETWEEN PUBLIC AND PERSONAL IMAGE

The public image of nursing includes how the media portray us and how the public perceives us.

Public image matters because of the complex relationship between how we view ourselves as professionals and how the public views us. For example, public image affects how we feel about ourselves.

One study found that nurses’ perceptions of how others view them affected their self-concept; if the public image of nurses is negative, nurses’ self-concept is more likely to be negative.2 Another study concluded that the actual public image of nursing is “diverse and incongruous.”3 The authors of this study point out October 2017 | OR TODAY

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IN THE OR CONTINUING EDUCATION CE492E that image is partly self-created by nurses due to their invisibility and their lack of public dialogue. They also concluded that nurses derive their self-concept and professional identity from their public image, work environment, work values, education, and traditional social and cultural values.3 One nurse conducted a detailed literature review on the image of nurses, exploring why image is still an issue given the long history of discussion and proposed solutions to the problem.4 She concluded that public- and self-image are intertwined and that as a profession, nurses don’t have a very positive self-image. Because the self-image of nurses drives the social value of nurses, we need a better self-image to ensure a better public image.

In essence, changing how we feel about ourselves changes how others think about us.

Author Leann Strasen, RN, provides additional insight into the complexity of self-image and public image. She developed a model based on the linkage of thoughts and beliefs to action.4 Thoughts and beliefs — which are shaped by socialization factors, such as experiences, heredity, environment, gender socialization, and reference groups — influence self-image, action, and performance. Improving how nurses view themselves is likely to influence this cycle.4 For example, nurses who see themselves as professionals will be strong advocates for their patients.

Patients experience this advocacy and remember it when talking with others. This simple conversation contributes to the overall public image of nursing, which in turn, improves nurses’ self-image.

Developing nursing’s image begins with exploring how nursing students view themselves and the 38

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profession. An online article titled “Nursing at its Best: Competent and Caring” reports the results of a survey of nursing students.5 Based on analysis of the surveys and discussions with students, the authors conclude that at first, nursing students believe that the image of nurses as angelic caregivers is most important. After education and discussion, the students saw considerable value in promoting the image of nurses as competent and intelligent caregivers. They realized that competence and caring are interrelated. They acknowledged that the stereotypical “angel in white” isn’t realistic and doesn’t reflect the knowledge and skills needed to be a nurse today.

Clearly, we need to tackle the image conundrum from two angles: First, we need to improve our own self-image; second, we need to improve the public’s image of nurses.

WHO’S RESPONSIBLE?

It’s easy to sit back and complain.

Yet each of us is responsible for nursing’s image, from how we treat patients and colleagues to what we tell relatives, friends, neighbors, and community members about our profession.

We have an ethical duty to promote the image of nursing, dating back to the Nightingale Pledge, which states, “I will do all in my power to maintain and elevate the standard of my profession.”

The American Nurses Association’s Code of Ethics for Nurses makes a stronger statement: “The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice and for shaping social

policy.6 One way we can articulate nursing values is to speak to the public about what we do.

The authors of “From Silence to Voice: What Nurses Know and Must Communicate to the Public” recommend imparting knowledge via three tiers of public communication:7 • P rofessional self-presentation • A necdotal descriptions of nursing work • Mass media (television, newspapers, radio, and YouTube, blogs, Facebook, Twitter, and other social media).

This model enables all nurses to participate at least through tier 1 (professional self-presentation).

As you gain new skills through practice and modeling, you can move into the other two tiers.

One challenge involves the differing perceptions about what constitutes a “good” image. For example, is the image of nurses as “angels” helpful or hurtful? It may be a little of both. Angels have a positive image, but as one author states, “If virtue is its own reward, nurses cannot claim the importance and value of what it is they do.”4 We want to embrace the fact that people view us as caring. But, do we really want people to see us as angels? Perhaps we can all agree to promote nursing as a profession that uses evidence-based practice to improve the care of people who need help. Wear your brains, as well as your heart, on your sleeves.

10 ACTIONS TO TAKE TODAY

How can we take on the image of nursing, given our already busy professional and personal lives?

Here are 10 actions you can start to take today.

1. Identify yourself as a nurse.

Introduce yourself as a registered nurse or a licensed practical nurse.

Consider whether the uniform WWW.ORTODAY.COM

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CONTINUING EDUCATION CE492E

nurses wear in your organization is consistent for all nurses, thus differentiating them from other caregivers. Be sure these uniforms promote a professional image.

(We’ll discuss the research on dress codes later.)

2. Join professional nursing associations. It can be the American Nurses Association, your specialty association or The Truth About Nursing, a nonprofit association dedicated to improving the image of nursing in the media.

Ideally, join more than one association.

3. Give nurse-related books as gifts to non-nurses. Choose books that will inspire and inform.

Check out some of the resources in the sidebar “Resources for Talking About Nursing.”

4. Get the word out about the work nurses do and the contributions they make. Talk about what you do with friends and family. Make presentations to children and community groups. Here are some age-specific strategies: • Younger than age 9: Use coloring sheets or books, tell stories • Ages 9 to 11: Play interactive games • Ages 12 to 14: Focus on nursing as a “cool” profession • Ages 15 to 24: Point out the many different jobs nurses can do throughout the country, the work flexibility, the good salaries, the job security, and the rewards of making a difference in people’s lives 5. Get involved in a political campaign and legislative efforts related to healthcare. At the very least, find out the names of your elected officials and email them, being sure to identify yourself as a nurse. You can easily send an email by going to http://www.usa.gov/ Contact/Elected.shtml.

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Resources for Talking About Nursing INTERNET

•d iscovernursing.com. This site includes free brochures and videos from the Johnson & Johnson Campaign for Nursing’s Future, profiles of nurses in different roles, descriptions of nursing roles, and a free newsletter.

• The American Nurse: Healing America, a documentary. You can get free continuing education credit for watching this documentary at http://www.theamericannurse.org/index. php/2015/05/01/new-screenings-digital-download-availablefor-the-american-nurse-movie.

• 50 Top Nursing Blogs for 2015: Top RN to BSN (http://www. toprntobsn.com/top-nursing-blogs/) • Youtube.com. Put “nursing image” or “nursing careers” in the search field and you get many excellent videos on promoting nursing’s image.

BOOKS

For history buffs: • “ American Nightingale: The Story of Frances Slanger, Forgotten Heroine of Normandy,” by Bob Welch • “ Nightingales: The Extraordinary Upbringing and Curious Life of Miss Florence Nightingale,” by Gillian Gill • “ We Band of Angels: The Untold Story of American Nurses Trapped on Bataan by the Japanese,” by Elizabeth M. Norman, RN For those interested in U.S. healthcare: • “ Nursing America: One Year Behind the Nursing Stations of an Inner-City Hospital,” by Sandy Balfour • “ Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes and Medical Hubris Undermine Nurses and Patient Care,” by Suzanne Gordon • “ Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk,” by Sandy Summers and Harry Jacobs Summers For mystery lovers, collectors, and short story lovers: • “ Twice Dead,” by Eleanor Sullivan, RN, PhD • “ Postcards of Nursing: A World Wide Tribute,” by Michael Zwerdling, RN • “ When Chicken Soup Isn’t Enough: Stories of Nurses Standing Up for Themselves, Their Patients and Their Profession,” by Suzanne Gordon

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IN THE OR CONTINUING EDUCATION CE492E 6. Seek donations for scholarship funds. Even small donations add up and remind people about the importance of nursing.

7. Serve on community and organization boards. This gives people the opportunity to see nurses in action. One success story is the tenure of Jennie Chin Hansen, RN, as president of AARP. You don’t have to start at the top; the school board or the board of directors of a community association would do the trick.

8. Write a letter to the editor. Make the letter brief and send it promptly. Use only RN, APRN, or LPN after your name. A string of credentials may confuse the public.

9. Use your talent. Combine your nursing and writing (or speaking) expertise to write articles (or give presentations) for consumer publications. If you’re a photographer or an illustrator, have a local show of works depicting nurses in action. The talents of nurses are endless; so are the possibilities.

10. Be a role model everywhere you go. If nurses want to be treated as professionals, they must act like professionals.

PROMOTING NURSING’S IMAGE IN ORGANIZATIONS

The single most important action nurses can take to improve the image of nursing is to “walk the talk”: model how you want to be perceived. For example, consider the following questions: Do you gossip and put down coworkers, or are you the one who works with others to find solutions? Do you treat everyone with respect, from the housekeeping staff to the chief surgeon? Be sure you have a professional code of conduct that guides your interactions. (See your 40 OR TODAY | October 2017

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organizational code of conduct or download the Health Team Code of Conduct handout from http:// www.alfaroteachsmart.com/handouts.html.)

Meetings provide ideal settings to model professional behavior.

The next time you are in a multidisciplinary meeting defending your point of view, pause and consciously listen to the others in the room. Keep an open mind and consider how to collaborate. Remember that everyone from physician to nurse assistant takes away an impression of nursing from the interaction.

OTHER STRATEGIES CAN ALSO IMPROVE NURSING’S IMAGE:

Pay attention to how you introduce yourself to patients. How you approach patients leaves a lasting mark. When you introduce yourself, do you say, “Hi, I’m Cindy. I’m your nurse today”? Are you rushing about as you say this, looking at everything in the room except the patient? Instead, look the patient in the eye (if culturally appropriate) and say something like, “Hi, I’m Cindy Saver. I’m the registered nurse (or licensed practical nurse) taking care of you until 7 this evening.” Go one step further by pointing to your ID badge and saying something like, “You can tell who’s a registered nurse and who isn’t here because it’s on our badges.” Or if RNs wear specific colored uniforms, you can point to your uniform and say something like, “Navy blue uniforms here signify registered nurses.” This teaches patients how to know when a caregiver is an RN. Use gratitude to reinforce what nurses do. When patients thank you, don’t say, “No problem” or “It was just my job.” Instead, use it as a chance to educate them.

Say something like, “I’m glad I could help you understand the importance of how to take your asthma medicine correctly.”

Follow the dress code and dress for respect. What we wear says a lot about who we are. An image consultant once said of nurses’ uniforms: “You’re the only thing between the patient and death, and you’re covered in cartoons. No wonder you have no authority.”8 One organization has addressed the complex issue of dress codes by researching how to develop an evidence-based dress code within a healthcare organization.9 Nurses formed an “Image of Nursing” committee as part the recruitment and retention committee. The committee stated that “as promoters of shared governance, all nursing personnel are responsible for presenting and upholding a professional image … Each nurse is empowered to hold each other accountable to the dress code recommendations that exemplify pride, dignity, and professionalism in appearance.”9 The nurses on the committee reviewed more than 63 sources of evidence, patient perception surveys, and expert and staff nurse opinions to develop an evidence-based dress code to enhance professional image. They concluded that a dress code must consider the following:9 Identification: The public must be able to identify nurses. While traditional white uniforms help them do this, patient preference and the perception of nurse approachability favor bright colors.

Professionalism: Professionalism can be defined by attire and by how nurses interact with patients and families. The literature shows that patients believe they are receiving better care if their nurses look professional.

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CONTINUING EDUCATION CE492E

Functionality and practicality: Nursing attire must be functional and practical.

Hair hygiene: Patients prefer that if nurses have shoulder length or longer hair, they pull it up or back.

Pediatrics: Children and their parents prefer printed tops or bright colors.

Based on the themes of professionalism, identification, functionality, and practicality, the research group gave detailed recommendations that included discipline-specific standardized colors for professional attire of various healthcare team members.

The recommendations from this group are lengthy and detailed. If you’re working to implement an evidence-based dress code, you can access this well-written study by visiting goo.gl/6HSUXz. Don’t take dress code requirements personally. For example, those of you who are fond of piercings and tattoos must keep in mind that dress codes are developed to convey professionalism to consumers (no one is discriminating against you). Also remember the importance of easy-to-read name tags, not only for security but to help others identify you and your role on the healthcare team.

Wear them so your name is facing outward even if you don’t care for your ID photo. Name tags should clearly state that the wearer is a registered nurse or a licensed practical nurse by including RN or LPN after the name. Some nurses advocate wearing a red RN patch or LPN emblem to enhance identification. To avoid sending a negative image when off duty in public, avoid clothing that doesn’t support the professional image of nursing, such as T-shirts with the slogan “Nurses do it better.”

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the self-image of nurses, support each other and celebrate successes. Make recognition meaningful to each person. One nurse might prefer a public pat on the back while another may appreciate a handwritten note. Avoid contributing to the perception that “nurses eat their young” by supporting new nurses and nursing students.

Understand the business of healthcare. If we want to be heard by the “bean counters,” we must speak the language of business.

For example, nurses may complain that it doesn’t make sense that they can’t obtain a certain piece of equipment when their hospital is spending so much money on building a new wing. They fail to understand that equipment costs come out of the operations budget and construction costs come out of the capital budget; the money cannot be shifted between the two.

Use evidence-based practice. Professionals have data and research that support what they do. Evidence-based practice encourages clinicians to use the best evidence, in combination with the clinician’s expertise and the patient’s preferences, as the basis for decisions about care. By incorporating evidence-based practice into all levels of nursing practice, nurses align the profession of nursing with other professions and experts who advocate evidencebased practice as a vital method for improving healthcare.

Talk about what you do with family members, friends, and members of the community.

Practice a brief explanation of what you do and use it when you introduce yourself in public. For example, “I’m a registered nurse, and I manage the care of critically ill patients in the ICU.”

Make friends with your organization’s media relations person. Get that person excited about nursing by providing tours and opportunities to see nurses in action.

Offer to provide your contact with news about unique contributions of nurses in your organization.

Build a directory of nurse experts for the media relations department. Media professionals in your organization need to respond quickly to reporters and will appreciate having such a resource.

Most local television, radio, and newspaper outlets have reporters who cover healthcare. Learn who they are and offer your services.

Remember to respond promptly to any media requests.

Advocate for a link for nursing on your organization’s home page. This sends the message that nursing is important, attracts job seekers, and educates the public about what nurses do. One researcher evaluated 72 hospital websites on how they represented nurses, based on specific criteria.10 She found that 44% of Magnet hospitals’ home pages linked to nursing while only 8% of nonMagnet hospitals’ home pages did.

You can use this researcher’s criteria to evaluate your own organization’s website and suggest changes.

Don’t forget students and novices. Teach them the importance of educating the community to dispel misconceptions the public may have of nurses and the profession. Discuss how to project a positive nursing image and be sure they understand the meaning of professionalism.11 Encourage nurses to further their education.

Offer to mentor new nurses.

Write a letter. A letter to the editor can point out an error in an article, add new information, or present a point of view. Mention October 2017 | OR TODAY

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IN THE OR CONTINUING EDUCATION CE492E your expertise. Include a positive comment even if you are challenging something in the original article. (“I was happy to see your article on snowboarding. But the accompanying photo of adults and children snowboarding without helmets was disturbing. I work in the ICU of a trauma hospital, and every day we treat snowboarding and skiing head injuries, most of which could have been prevented by wearing a helmet.”) Keep the letter brief. Send it promptly, before the article or news item becomes dated; you can usually send an email by going to the publication’s website. If you see an offending portrayal on television, write the commercial sponsor, too. Tap into the power of numbers by linking up with media campaigns organized by The Truth About Nursing. When signing your letter, use RN or spell out registered nurse (or use “advanced practice nurse,” or “licensed practical nurse” if applicable). Include only the credentials that are relevant to the topic (e.g., if you’re making a comment on wound care, it may be appropriate to add “certified wound specialist” as long as you spell it out).

Too many letters after a name may confuse the public.

Participate in career days and shadowing experiences.

Volunteer to speak about the nursing profession at elementary, middle, and high school career days to students who are considering different careers.

Encourage the public to use advanced practice nurses.

Educate the public about nurses in different roles, such as nurse practitioners, certified nursemidwives, and certified registered nurse anesthetists.

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SUGGESTIONS FOR NURSE LEADERS

For those of you who are leaders, the following are strategies to promote nurses’ self-image.

• Recognize achievements, offer encouragement, and be willing to listen and coach your nurses • Make sure nursing is represented on key committees • Make sure articles on nurses appear in general hospital newsletters • Provide continuing education programs on how to work effectively on a team. (Work through your staff development department) • Review recruitment material to ensure it is professional in tone • Implement shared governance.

See the Forum for Shared Governance for more information • Help your organization obtain Magnet status, market it to the community, and live up to its criteria • Provide media training for key nurses • Promote ways for the community to interact with nurses, including participating in national job shadow days and offering summer camps to kids.

• Implement evidence-based practice in your organization • Make sure your nurses know that you have zero tolerance for bullying and lateral (peer to peer) and vertical (leader to subordinate) abuse12 • Encourage nurses at all levels to increase their education and achieve advanced practice degrees

before others do it for you.13 As Harvard Business School professor Laura Roberts says, “People are constantly observing your behavior and forming theories about your competence, character, and commitment, which are rapidly disseminated throughout your workplace … It’s only wise to add your voice in framing others’ theories about who you are and what you can accomplish.”13 To promote nurses’ image, you must be able to communicate effectively, negotiate, project a positive attitude, and be receptive to others’ ideas. Work to gain these skills — you are the one who holds the power to create a positive image.

Cynthia Saver, MS, RN, is president of CLS Development Inc. in Columbia, Maryland.

Rosalinda Alfaro-LeFevre, MSN, RN, ANEF, is the author of several books and president of Teaching Smart/Learning Easy in Stuart, Florida.

REFERENCES 1. Honesty/ethics in professions.

Gallup News Service Web site. www. gallup.com/poll/1654/Honesty-EthicsProfessions.aspx. Published December 6, 2015. Accessed June 28, 2016.

2. Takase M, Kershaw E, Burt L. Does public image of nurses matter? J Prof Nurs. 2002;18(4):196-205.

3. Hoeve Y, Jansen G, Roodbol P. The nursing profession: public image, selfconcept, and professional identity: a discussion paper. J Adv Nurs. 2014 ;70(2):295-309. doi: 10.1111/jan.12177.

IT’S UP TO YOU

In today’s diverse workplace, your actions and motives are constantly under scrutiny; manage your own professional image

4. Strasen L. The Image of Professional Nursing: Strategies for Action. Philadelphia, PA: Lippincott, Williams, & Wilkins; 1992.

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5. Rhodes M, Morris A, Lazenby R. Nursing at its best: competent and caring. OJIN: The Online Journal of Issues in Nursing Web site. http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/ No2-May-2011/Articles-Previous-Topics/Nursing-atits-Best.html. Published February 25, 2011. Accessed June 28, 2016.

6. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. Washington DC: Nursesbooks.org. 2015.

7. Buresh B, Gordon S. From Silence to Voice: What Nurses Know and Must Communicate to the Public.

2nd ed. Ithaca, NY: Cornell University Press; 2006.

8. Cohen S. The image of nursing. American Nurse Today Web site. http://www.americannursetoday.com/ the-image-of-nursing. Published May 2007. Accessed June 28, 2016.

9. Sulanke J, Shimp K. What works: implementing an evidence-based nursing dress code to enhance professional image. Am Nurs Today. http://www. americannursetoday.com/works-implementing-evidence-based-nursing-dress-code-enhance-professionalimage. Published October 2015. Accessed June 28, 2016.

10. Kasoff J. How do hospitals represent the image of nursing on their web sites? J Nurs Admin.

2006;36(2):73-78.

11. National Student Nurses’ Association Guidelines for Planning. 2012-2013 Image of Nursing Projects.

NSNA Web site. http://www.nsna.org/Portals/0/Skins/ NSNA/pdf/Image%20of%20Nursing%202012_2013. pdf. Published 2012. Accessed June 28, 2016.

12. South Carolina Nurses Association. The Free Library Web site. Lateral and vertical violence in nursing. http://www.thefreelibrary.com/Lateral+and+v ertical+violence+in+nursing.-a0241626830. Published October 1, 2010. Accessed June 28, 2016.

13. Stark M. Creating a positive professional image.

Harvard Business School Web site. http://hbswk.hbs. edu/item/creating-a-positive-professional-image. Published June 20, 2005. Accessed June 28, 2016.

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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 8/15/2018 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 an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider #50-1489). OnCourse Learning’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.

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

Prices subject to change.

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

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effec�veness of the automated instrument washer.

RK INDUSTRIES CO. | WWW.HMARK.COM | 800.521.6224 | HEALTHMARK@H

innovative solutions FOR INFECTION CONTROL

Since 1969, Healthmark Industries Company Inc. has developed and marketed innovative solutions to aid health care facilities in their delivery of surgical instruments and other lifesaving medical devices to patients. Healthmark Industries’ mission is to continue to innovate, continue to support and continue to serve the health care provider industry and support services that make it possible to deliver quality health care. OR Today recently interviewed Healthmark Industries Vice President Ralph Basile to find out more about this innovative company.

Q: What are some advantages that your company has over the competition?

Basile: Not only does Healthmark provide innovative solutions to health care facilities, but also educational opportunities. One of the ways we have done this is to offer free CEUs on our educational game website “Crazy4Clean.com.”

We try to offer two new games every year. We just wrapped up the second EndoGal game this past spring and are currently working to offer a new game this December.

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Visit the link www. crazy4clean.com to go play, learn and earn.

Q: What are some challenges that your company faced last year? How were you able to overcome them?

Basile: Flexible endoscopes have been a challenge to properly reprocess and news reports around the country have focused on how dirty scopes have led to outbreaks of CRE and other drug resistant bacterial infections.

Healthmark launched

two new products in order to test for potentially dangerous bacteria and have partnered with Nelson Labs in order to test on identifying the type of bacteria.

Flexible endoscopes are a challenge to clean and disinfect/sterilize.

Modern machines such as AERs are effective tools for rendering scopes safe for use on the next patient, but how do you determine if the process was effective? By using the new NOW! Test. This simple and rapid test (<12 hours) checks for Gram

negative bacteria, helping to ensure that it is safe to use on the next patient. Utilizing a unique enzyme detection method, the easy to read fluorometer checks for the Gram negative bacterial growth (<10 cfu) by reading telltale fluorescence in the recaptured water. If the fluorometer reading is positive for Gram negative bacteria, reprocess the endoscope following manufacturer guidelines prior to use.

Endoscope manufacturers, regulatory bodies and health care facilities WWW.ORTODAY.COM

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RESEARCH DEVELOPMENT LEAD, STEPHEN CLARK COLLECTING A SAMPLE FOR THE FLEXIBLE ENDOSCOPE SAMPLING KIT TEST.

are increasingly concerned about the spread of communicable diseases, including clinically relevant microorganisms, on reprocessed medical devices. Healthmark Industries and Nelson Laboratories have joined forces to create an endoscope sampling kit for the purpose of monitoring and reporting objective results from clinical scopes. Everything necessary to collect and send a sample from a reprocessed endoscope for testing to determine the presence of objectionable microorganisms will be provided in the kit offered by Healthmark. The sample will be sent by the health care facility to Nelson Labs WWW.ORTODAY.COM

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for independent testing of the sample for the presence of any microorganisms. If present, the organisms will be identified and quantified. The endoscope sampling kit is intended to be used as a proficiency assessment for health care practices and not as a safety assessment for the reprocessed scope (not a “fitness for use” test).

This surveillance assessment is important to help the clinical user determine if their scope is safe for use, requires additional reprocessing, requires additional testing or should be quarantined.

The kit and related tests are intended as another help to assess the adequacy of health care facility scope reprocessing.

Q: Can you explain your company’s core competencies and unique selling points?

Basile: Cleaning verification continues to be an important issue in health care across the country.

News headlines often consist of articles about complications from surgeries caused by instruments and equipment that have not been properly cleaned. It has affected the health care field in recent years.

Healthmark added products to its ProFormanceTM monitoring tools over the past 15 years to help ensure surgical instruments and other equipment are reprocessed correctly. AAMI and AORN recommend at

least weekly testing of the cleaning process. These products are designed to help facilities comply with standards and ensure they are reprocessing equipment and cleaning surgical instruments properly.

The company’s newest version of ProFormanceTMQA is one example. ProFormanceTMQA 2.1 is a single database that allows health care facilities to record key statistics for the performance of its decontamination procedures, including the test results from Healthmark’s ProFormanceTM line of monitoring products.

With this Microsoft Access database individuals can record data, use the information to generate impactful October 2017 | OR TODAY

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consistent, repeatable, and reliable method for evalua�ng the cleaning effec�veness of the automated instrument washer.

SPECIAL ADVERTISING SECTION

ARK INDUSTRIES CO. | WWW.HMARK.COM | 800.521.6224 | HEALTHMARK@HMARK.COM

ABOVE: HEALTHMARK WILL BE DONATING A PORTION OF PINK APPAREL SALES DURING OCTOBER TO GILDA’S CLUB. RIGHT: NOW TEST BEING PERFORMED ADDING WATER TO STERILE CUVETTE TO PROVIDE A GROWTH MEDIUM.

reports and track the performance of cleaning equipment over a period of time. With the latest version of the database, users will receive a USB stick with the software installed. Once the setup process is complete, begin using the database to its highest capabilities and see dramatic improvements in how recordkeeping is done.

For a more detailed description of the database watch the ProFormanceTMQA 2.1 video or read the Instructions for Use under the Cleaning Verification section at www.hmark.com.

Q: What product/ promotion or service that your company offers are you most excited about right now?

Basile: We are currently 48

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rolling out our Pink Promotion, partnering with Gilda’s Club of Detroit to raise awareness about breast cancer. A portion of our proceeds on our pink apparel products will be donated to Gilda’s Club.

Q: What is on the horizon for your company?

Basile: We will continue to anticipate our customers needs in the marketplace as the health care industry continues to evolve.

Q: Can you tell us about the company’s facility?

Basile: We are in the process of completing the construction of our new 100,000 square foot headquarters in Fraser,

Michigan. We now have a company of over 160 employees.

Q: Have their been any recent changes to the company, inventory or services?

Basile: We offer PPE and other personal attire products on StyleYourPPE.com for individuals who would like to purchase their own attire and apparel. We offer arm sleeves, back braces, compression socks, cool aids, PPE decals, scrub caps and vests.

successful career with Deknatel, he founded Healthmark Industries Company Inc. The mission he established for us then, is the mission we live by today: To provide innovative and cost-effective products that aid our health care industry customers in meeting their sterilization, decontamination, storage, distribution and security needs.

Ralph A. Basile passed away in 2001. He left behind a great legacy in Healthmark and his three sons manage the company that was his life’s work.

Q: Is there anything else you want readers to know about your company?

Basile: Healthmark was founded by Ralph A. Basile. In 1969, after a

FOR MORE INFORMATION For more information about Healthmark Industries, visit www.hmark.com or call 800521-6224.

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PROFORMANCE™ CLEANING VERIFICATION CLEARLY VISIBLE, EASY TO INTERPRET, OBJECTIVE TESTS OF CLEANING METHODS

LUMCHECK™ The LumCheck™ is designed as an independent check on the cleaning performance of pulse-flow lumen washers. Embedded on the stainless steel plate is a specially formulated blood soil which includes the toughest components of blood to clean.

FLEXICHECK™ This three part kit simulates a flexible endoscope channel and is designed to challenge the cleaning efficiency of endoscope washers with channel irriga�on apparatus. The kit includes a clear flexible tube, a�ached to a stainless steel lumen device. The test coupon is placed in the lumen and the en�re device is hooked up to the irriga�on port of the endoscope washer.

HEMOCHECK™/PROCHEK-II™ Take the guess work out of evalua�ng the cleanliness of instruments with the HemoCheck™ blood residue test kit and the Prochek-II protein swab test. HemoCheck™ is simple to interpret and indicates blood residue down to 0.1μg. The ProChek-II™ measures for residual protein on surfaces down to 0.1μg.

SONOCHECK™ When the ultrasonic cleaner is supplying sufficient energy and condi�ons are correct, SonoCheck™ will change color. Problems such as insufficient energy, overloading, water level, improper temperature and degassing will increase the �me needed for the color change. In the case of major problems the SonoCheck™ will not change color at all.

TOSI™ Reveal the hidden areas of instruments with the TOSI™ washer test, the easy to use blood soil device that directly correlates to the cleaning challenge of surgical instruments. TOSI™ is the first device to provide a consistent, repeatable, and reliable method for evalua�ng the cleaning effec�veness of the automated instrument washer.

HEALTHMARK INDUSTRIES CO. | WWW.HMARK.COM | 800.521.6224 | HEALTHMARK@HMARK.COM

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BY DON SADLER

50 OR TODAY | October 2017

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S

urgery is an inherently dangerous undertaking. This is easy to forget sometimes when you consider the incredible advances that have been made recently in surgical technology and techniques.

But each year, thousands of mistakes and complications occur in the OR that result in longer and costlier hospital stays for patients – and in worst-case scenarios, end up costing patients their lives.

Therefore, it’s critical for all OR personnel to remain continually focused on what they can do to improve patient safety.

A RISKY ENDEAVOR

“By its very nature, surgery is a risky endeavor,” says Alex Haynes, MD, MPH, Associate Director for the Safe Surgery Program at Ariadne Labs and Assistant Professor of Surgery at Harvard Medical School.

Haynes points out that extensive research has demonstrated that the lifesaving and transformative potential of surgery significantly improves when the surgical team focuses on communication, teamwork, OR preparation and safety procedures.

“Many surgical risks revolve around communication and teamwork among OR personnel,” he says.

“Everyone in the OR needs to be on the same page regarding the patient’s condition, medications and the intent of the surgical procedure.”

“Historically, the surgeon has been viewed as the most important person in the OR, but the reality is that surgery is the ultimate team undertaking,” Haynes adds. “Everyone on the team — including surgeons, anesthesiologists, perioperative nurses and surgical techs — is vital to ensuring a safe surgical outcome.”

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“A standardized surgical procedure list enhances communication and helps ensure that procedure-specific resources are available in the OR, including staff and equipment, so patient care is not impacted”

Janice Kelly, MS, RN-BC, president of AORN Syntegrity Inc.

that created the Safe Surgery Checklist that was adopted by the World Health Organization in 2008 as the global standard of care. Adoption of this checklist, which is used in an estimated 50 million operations performed annually worldwide, has been shown to reduce surgical complications and mortality by up to 47 percent.

In 2015, Ariadne Labs launched a national effort to bring the Safe Surgery Checklist to every hospital in the U.S. Ariadne Labs is also developing specialized safety checklists for ambulatory surgery centers, emergency rooms and OR crises. “These build on the Safe Surgery Checklist,” says Haynes.

SSI, RSI AND OTHER RISKS

There is a wide range of patient safety risks in the OR. These include surgical site infections (SSIs), retained surgical items (RSIs), wrong-site surgeries, improper medication labeling and administration, and improper patient positioning and lifting.

Research has shown that SSIs

are by far the most common OR safety risk, with an occurrence rate of between one percent and three percent per procedure, according to the Centers for Disease Control and Prevention (CDC). Among patients with SSIs who die after surgery, the death is directly related to the SSI in three out of four cases.

Almost all experts agree that SSI prevention starts with following basic hand washing practices and implementing strict aseptic procedures.

“Maintaining the sterile field and wearing sterilized gloves and gowns are other well-established practices for enhancing patient safety in the OR,” says Haynes.

Janice Kelly, MS, RN-BC, president of AORN Syntegrity Inc., a subsidiary of the Association of periOperative Registered Nurses (AORN), lists several other steps for improving patient safety in the OR. One of these is standardizing surgical scheduling to reduce the number of duplicate procedures in the surgical library.

“A standardized surgical procedure list enhances communication and helps ensure that procedurespecific resources are available in the OR, including staff and equipment, so patient care is not impacted,” says Kelly.

“ Everyone in the OR needs to be on the same page regarding the patient’s condition, medications and the intent of the surgical procedure.”

Alex Haynes, MD, MPH, Associate Director for the Safe Surgery Program at Ariadne Labs

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IMPROVE PATIENT SAFETY

Another is improving data collection and getting what you need from your electronic health records (EHRs).

“The collection and analysis of clinical data is how quality improvements for patient care are implemented and monitored,” says Kelly.

To accomplish this, documentation needs to be evidence-based and standardized from one patient to the next, Kelly adds.

“Data must be relevant, accurate, timely and consistent among staff, departments and health systems in order for quality and patient outcomes to be measured,” she says.

Kelly says there is no one-sizefits-all solution to nursing documentation across hospital departments.

“EHRs can give clinicians on-thespot information about a patient’s medical history; pre-, intra-, and post-operative needs; test results; and other critical information,” says Kelly.

“The documentation in a hospital’s EHR system improves communication of the patient’s current condition, needs and potential risks,” Kelly adds.

PATIENT POSTURING AND POSITIONING

R. Dan Allen, the president of D.A. Surgical, which designs patient positioning devices, has spent 40 years studying anatomy and physiology related to surgical patient posturing and positioning. He says studies have indicated that up to 60 percent of surgical patients suffer some type of physical injury due to positioning issues.

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“ If the patient is positioned incorrectly, every step of the patient’s care and the procedure can be compromised.”

R. Dan Allen, president of D.A. Surgical

like shoulder braces and candy cane stirrups, “ says Allen. “These were introduced before the Civil War and their continuing use is a cause of irreparable harm and suffering from stretched nerves and muscles.”

Allen recommends that hospitals perform an audit of all their positioners and replace obsolete positioners with new, modern equipment.

“OR personnel should also keep up to date on new positioning techniques and technologies and perform continuing improvement exercises on a regular basis,” he says.

PATIENT SAFETY GOALS

“Patient positioning is a vital first step in having everything right for the entire surgical procedure,” says Allen. “If the patient is positioned incorrectly, every step of the patient’s care and the procedure can be compromised.”

“Positioning is recognized as being every bit as important to patient outcomes as sterile technique, anesthesia, the surgical procedure itself and proper post-op patient management,” Allen adds.

According to Allen, budgetary constraints keep many hospitals from using the most technologically advanced positioning equipment that has been proven to eliminate patient positioning risks during surgery.

“Due to a lack of funding, obsolete positioning equipment is still being employed in some facilities even though the literature is clear in recommending against devices

The Joint Commission recently published its 2017 National Patient Safety Goals, which focus on problems in health care safety and how to solve them. The goals are divided into seven main categories: • Identify patients correctly – At least two different patient identification methods should be used.

• Improve staff communication – Important test results should be delivered to the right staff person on time.

• Use medicines safely – All medicines should be labeled before procedures begin, and extra care should be taken with blood thinners.

• Use alarms safely – Ensure that alarms on medical equipment will be heard and responded to on time.

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• Prevent infection – Hand cleaning guidelines from the CDC and the WHO should be followed.

• Identify patient safety risks – This includes suicide, in addition to other risks.

• Prevent mistakes in surgery – The surgical team must ensure that the correct surgery is performed on the correct patient, in the correct place.

To download the complete list of the Joint Commission’s 2017 National Patient Safety Goals, visit https:// www.jointcommission.org/assets/1/6/2017_NPSG_HAP_ER.pdf.

AORN’s comprehensive surgical checklist is another critical tool to help ensure patient safety. It includes specific steps to be followed at four key surgical phases: pre-procedure check-in, sign-in, timeout, and sign-out. The comprehensive surgical checklist is available at www. aorn.org/AORNSurgicalChecklist.

PROOF SHEE PROOF APPROVED

CHANGES NEEDED

CLIENT SIGN–OFF: PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT LOGO PHONE NUMBER WEBSITE ADDRESS

SPELLING

GRAMMAR

TRIM 3.25”

SAFETY IS TOP PRIORITY

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TRIM 4.5”

Haynes also stresses the importance of making sure that everyone who is present in the OR is comfortable saying something if they see anything that might compromise patient safety.

“OR personnel, including perioperative nurses, shouldn’t feel intimidated or afraid to speak up,” he says.

“Patient safety should be the number one priority for everyone, with no exceptions.”

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SPOTLIGHT ON

Sally Brown

BY M AT T S KO U FA LO S

M

edical surgical nurse Sally Brown got her start in the field as a teen, working as an aide at the Beacon Light nursing home in Marne, Michigan. Although she later held office and factory jobs, a love of caring for those in need returned her to Beacon Light as an adult. When her supervisor there inspired her to pursue her associate’s degree, Brown attended Grand Rapids Community College en route to becoming an RN. She had married and welcomed her first daughter, Tricia, by then, and ended up having her second, Kelly, while still in school.

S A L LY B R O W N

“It was an eye-opener, but it was enjoyable,” Brown said. “My first chemistry [class] was [in] college; my first biology [class] was anatomy. I had some very good teachers and some interesting courses.

I had lots of support from family and friends. That’s what got me through those years.”

Brown graduated in 1992. After a year at a Muskegon hospital, she caught on with the Zeeland Community Hospital in Zeeland, Michigan, now Spectrum Health Zeeland Community Hospital, where she has worked since 1993. Just as more education changed her outlook on the profession, so did milestone technologies like computerized charting and strategic deployments such as the RN-LPM teams in which Brown and her coworkers 54

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were typically arranged. What has neither changed nor diminished in her time in the field is Brown’s love of being a med/surg nurse in a community hospital.

“There’s so much patient care and patient interaction involved,” she said. “You get the full gamut, from pediatrics to surgery. It’s not like the big hospitals where you work a cardiac floor, a neuro floor, and ortho floor. That’s always kept me interested.”

Just as in her first assignment, Brown has been encouraged to continue her education throughout her tenure at Spectrum Health.

Five years ago, she began working on her BSN as part of an institutional initiative to drive better health outcomes for patients.

Although she has enjoyed school

and improving her professional skillset, the process has been fraught with personal challenges.

In 2012, the year she started her BSN track, Brown’s husband, Greg, was diagnosed with multiple myeloma. Their daughter, Kelly, who herself had survived a bout of childhood cancer, came home from her residency in Boston, Massachusetts to help her mother acclimate to the online coursework.

Meanwhile, Greg underwent two failed stem-cell treatments, and four years later, Sally Brown was diagnosed with triple-negative, stage 3, grade 3 breast cancer. She said the experiences shifted the intimacy of her understanding about just how much a diagnosis like cancer changes everything in a WWW.ORTODAY.COM

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patient’s life.

“I think about it all the time, especially when you take care of patients, because you know what it’s like to be on the other side,” Brown said. “I think I understand the worry behind it all. A lot of times you see the patient when they get the biopsy, the diagnosis, the mastectomy, but you don’t realize what happens after that.”

For Brown, the solution was to keep going ahead – with her schooling, with her treatments, and with her resolve to set an example of perseverance for her children.

She regards the challenges she’s been dealt “as just that: challenges.”

“You do what you have to do and get through it,” Brown said. “I always say that cancer wasn’t my choice, but my choice was to get the bachelor’s degree, and I just didn’t stop, I went through treatment. It helped me to have something else to focus on.”

Nursing has also offered Brown career flexibility that allowed her to incorporate family obligations and continuing education, but she felt like she was in especially the right profession during her battle with cancer. Along the way, she credits American Sentinel University with being “wonderful to work with” throughout the course of her diagnosis, treatment and recovery. Whether being granted flexibility with the timelines for her assignments, feeling a wellspring of support from her professors, or relying on a network of resources, Brown said the experience helped motivate her to get healthy and get her degree.

“They wanted me to succeed,” Brown said. “I can’t tell you how much support I have – my employer, my coworkers, school, friends, family. They’re what gets you through it.”

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her dosage. She underwent a left radical mastectomy, the removal of 21 lymph nodes, and another seven five-day weeks of radiation therapy before finally returning to work July 3. Her husband “has hit an even-keeled health,” she said, and she feels “wonderful” to return to her job.

Nonetheless, Brown said she doesn’t feel particularly special or different from any other cancer patient – just very well cared for.

“I think people would be amazed at what they can do when they are faced with these kinds of challenges.

I just did what I had to do, and had the support of a lot of wonderful people,” she said.

“You just have to live your life and keep moving forward,” she added.

“The cancer’s the one that comes out on top if you give up and curl up and do nothing.”

Things in her household are starting to settle into normalcy.

Kelly Brown is working in the cardiothoracic

surgical department at Yale University Hospital; her sister, Tricia Stokes, is an adjunct professor of education at Vermont University; like her mom, Tricia is married with a daughter while she puts herself through a Ph.D. program. Thinking of those things helped Sally Brown get through her illness and her degree program at the same time.

“You want your children to be proud of you,” she said. “I told them they could be whatever they wanted to be and do whatever they wanted to do; they just had to work hard.”

Brown is planning one more destination that she hopes will be the final stop in her cancer journey: reconstructive surgery and a rightbreast mastectomy in November 2017. No outcome is guaranteed, but she knows that with the love of her family and friends, the support of her employer, and the opportunity to continue working as she recovers, her individual resolve will spur her forward.

S A L LY B R O W N FIGHTS LIKE A GIRL!

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OUT OF THE OR FITNESS

BY MARILYNN PRESTON

WEIGHT LOSS 101 PLATEAUS HAPPEN. BE PATIENT AND REBOOT

I

’m going to skip over the obesity statistics for the moment. Let’s just sum it up by saying that every third person in the country is trying to lose weight.

It’s not on everyone’s mind – some folks are joyfully roasting chocolate-covered marshmallows over campfires – but with so many millions of American’s dieting, you get tons of people who lose ... lose ... and then they plateau. The needle gets stuck.

In spite of your best behavior – eating real food and smaller portions, exercising more – suddenly, your body simply stops losing weight. It’s a very common problem. Also very frustrating.

The first thing to know is that plateauing is normal, not personal. You might as well accept it and stick with the program. Attitude matters. You need patience and understanding.

Your body is a complicated organism. It can resist change and hold onto additional weight you’re trying to lose. Best spin to put on it? Your body is temporarily at rest, getting ready and stronger for the next set of challenges.

Meanwhile, your most personal trainer is offering a few strategies to 56

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help get you over the hump, past the slump, beyond the plateau.

TRAIN HARDER, NOT LONGER

Don’t let this one scare you. Interval training – also known as HIIT, for high-intensityinterval-training – isn’t just for bigtime competitive athletes who want to knock it out of the park. It’s for all mortals who want to see that needle on the scale slide south to a lower, lighter number.

To encourage that miracle, do something bold: Pick up the pace of your workout. Make it more intense, for short periods of time. You can do it in a general way: e.g., hike up hills instead of walking on the flats. Or

you can do it in a specific way: e.g., pedal a stationary bike at a casual pace for several minutes and then go as fast as you can – harder! harder!

– for 30 seconds. Then back off to an easy pace for 90 seconds ... and then max out again for 30 seconds ... and repeat for six or eight cycles. There are many formulas out there, waiting to be discovered.

Interval training is one of the hottest trends in fitness and an excellent way to reboot your weight-loss program. It’s also a great way to make your workouts much more efficient in a lot less time. (Another miracle.

You’re welcome.)

LIFT WEIGHTS AND LOVE IT

Another way to power through a weight-loss plateau is to start lifting weights and building muscle. The more muscles you have, the more calories you’ll burn.

But you can’t simply walk, run or bike more to build muscle. You need to get involved in a smart, targeted strengthtraining program, using weights, machines, resistance bands or your own body weight. (Hello, yoga.) >> Continued on page 61 WWW.ORTODAY.COM

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OUT OF THE OR HEALTH

BY ESC PRESS OFFICE

NUTRITION ADVICE AIMED AT CHILDREN

ALSO IMPROVES PARENTS’ DIETS

N

utrition advice aimed at children also improves parents’ diets, according to research published in the European Journal of Preventive Cardiology.

“Diets high in unsaturated fat and low in saturated fat have been associated with a reduced risk of cardiovascular events and death in adults,” said lead author Dr. Johanna Jaakkola, a postdoctoral researcher at the University of Turku, Finland. “Very little is known about the long-term effects of nutrition

health of children by recommending foods rich in unsaturated, instead of saturated, fat.

The current study examined whether the long-term dietary intervention focused on children was also associated with parental dietary intake and cardiometabolic risk factors over two decades of

“Our study emphasizes that long-term dietary counseling directed at children may be an efficient way to also improve the diets of parents...” advice for children on the diets and health of parents.”

The longitudinal randomised Special Turku Coronary Risk Factor Intervention Project (STRIP) decreased the saturated fat intake and improved the cardiovascular 58

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follow-up.

The primary results of the STRIP study have been previously reported. Briefly, the study included 1,107 infants and their parents who were recruited from well baby clinics in Turku, Finland, between 1989

and 1992. Families were randomly assigned to the dietary intervention (562) or control (545) groups.

The intervention group received dietary counseling at least once a year by a nutritionist from the child’s age of eight months to the age of 20 years. Counseling was first given only to the parents, and from the age of seven years, the children were also met alone. The main focus of the dietary intervention was to reduce the child’s intake of saturated fat and concomitantly increase the child’s unsaturated fat intake.

As previously reported, the repeated dietary counseling led to decreased saturated fat intake in the intervention children, and lower serum low-density lipoprotein (LDL) cholesterol concentration from infancy until 19 years of age.

For the current study, parental dietary intake was assessed by a one-day food record biennially from the child’s age of nine to 19 years.

Weight, height, blood pressure, serum lipids, glucose and insulin >> Continued on page 61 WWW.ORTODAY.COM

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OUT OF THE OR NUTRITION

BY LORI ZANTESON

ENVIRONMENTAL NUTRITION

ALL ABOUT BLUEBERRIES

T

oday, blueberries enjoy true star status as a favorite berry in the U.S., second only to strawberries.

THE FOLKLORE

One of the few fruits native to North America, blueberries have been coveted by Native Americans for hundreds of years. Native tribes called them “star berries” for the five-point “star” at the blossom end of the berry. The berries were believed to protect children from famine, ease the pain of childbirth, and treat coughs and digestive issues. They were also a food staple, made into a jerky with meat, called sautauthig.

THE FACTS

Blueberries are part of the genus Vaccinium, along with cranberries and lingonberries. There are more than 450 species of blueberries, which are categorized into three varieties: high bush (the most commonly cultivated), rabbiteye, and lowbush (also called wild blueberries). Colored deep blue to purple-black, blueberries range in 60 OR TODAY | October 2017

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girth from a tiny quarter inch to one inch in diameter. Wild berries tend to be more tart, while cultivated are sweeter. All blueberries are bursting with nutrition. Just one cup is packed with 36 percent DV (Daily Value, based on 2,000 calories/day) of vitamin K, 24 percent DV of the antioxidant vitamin C, and a punch of health-protecting phytochemicals, such as anthocyanins, which give blueberries their beautiful color and antioxidant activity.

THE FINDINGS

Blueberry anthocyanins benefit the brain, especially in older adults. One study showed cognitive improvement in adults who consumed the dried equivalent of one cup of fresh blueberries daily for three months (European Journal of Nutrition, 2017). Another study showed cognitive benefits in older adults at risk for dementia who supplemented with daily blueberries for 16 weeks (Nutritional Neuroscience, 2017).

Eating blueberries may also lower the risk of type 2 diabetes by improving insulin resistance in obese adults (Antioxidants, 2016).

THE FINER POINTS

Fresh blueberries are at their best

from May through October. Avoid those with signs of shrivel or dampness, refrigerate immediately, and eat them within 10 days. Research shows that organically grown blueberries have higher levels of phytochemicals than conventionally grown blueberries. Blueberries are also available frozen, dried, pureed, and canned.

Give these tasty tots a try in salads, cereals, yogurts, or smoothies; bake them into flaky scones or quick breads; or mix them into a turkey burger adorned with blueberry ketchup!

BLUEBERRY SALAD FLATBREADS RECIPE

Makes 16 servings (1 slice each) Ingredients:

• • • • • • • • • • •

2 (14.1-ounce) packages pizza dough 1 cup shredded mozzarella cheese 1 tablespoon sliced red onion 1 tablespoon olive oil 1 tablespoon lemon juice 1 teaspoon honey 1/8 teaspoon kosher salt Pinch black pepper 2 cups mixed baby greens 1/2 cup frozen blueberries 1/2 teaspoon lemon zest WWW.ORTODAY.COM

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Directions

1. Preheat oven to 425 F. 2. On floured surface, roll each piece of dough into an oblong shape, about 11-inches long.

Arrange on baking sheet, poke with a fork, and bake 8 minutes.

3. Remove from oven and top each piece with 1/2 cup cheese. Place directly on oven rack and cook until crispy and melted (8-10 minutes).

4. In bowl, combine olive oil, lemon juice, honey, salt and black pepper. Add mixed baby greens, blueberries and red onion and toss together.

5. Arrange salad on flatbreads, sprinkle with lemon zest, and slice.

Recipe adapted courtesy U.S. – Highbush Blueberry Council.

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

WEIGHT LOSS 101 (CONTINUED FROM PAGE 56) Find a way to make it fun, or at least tolerable. That’s the key to sticking with it. Routines that feel like a grind rarely last. Focus on proper technique. Learn to lift with awareness, in alignment, without stressing your joints or screwing up your back.

Join a class; buy some time with a trainer; read a book. And breathe!

That’s crucial. So is getting involved in a safe routine that delivers a strong flexible body that’s in balance front to back, top to bottom and side to side.

ADD SOMETHING NEW

A body that isn’t losing fat anymore – even though you’re eating well and exercising regularly – is a body that will benefit from a wake-up call, a surprise, a shock with benefits. Why? Because when you call on your body and mind to do something new, to move in different ways, it burns more calories than it’s used to burning. That’s why cross-training – doing a mix of sports instead of focusing on just one – is a well-known way to jumpstart continuing weight loss.

So add something that is challenging and new. Zumba? Soul Cycle?

Aerial dancing? That will fire up the engines that move us over obstacles, into action and back for another round of weight loss, if that’s your goal.

And don’t forget to spend some quality time with friends and family around the campfire, chocolate-covered marshmallows and all.

Marilynn Preston is the author of Energy Express, America’s longest-running healthy lifestyle column. Her new book “All Is Well: The Art {and Science} of Personal Well-Being” is available now on Amazon and elsewhere. Visit Creators Publishing at creators.com/books/all-is-well to learn more. For more on personal well-being, visit www.MarilynnPreston.com.

NUTRITION ADVICE AIMED AT CHILDREN (CONTINUED FROM PAGE 58) of the parents were measured repeatedly from the child’s age of seven months until 20 years.

The investigators found that the child-oriented dietary counseling increased the intake of polyunsaturated and monounsaturated fats and decreased the saturated fat intake of intervention mothers and fathers compared to control parents between the child’s ages of nine and 19 years.

In addition, the child-oriented dietary counseling tended to decrease serum total and LDL concentrations in intervention mothWWW.ORTODAY.COM

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ers compared to control mothers. There was a similar trend in fathers but it was not statistically significant.

“The child-oriented dietary intervention contributed advantageously to the parental diet in the long-term and tended to reflect lipid concentrations, particularly in mothers. Presumably all family members eat the same foods and thus child-oriented dietary counseling also affects parents’ diets,” Jaakkola said.

“Dietary intake may have been more strongly associated with ma-

ternal than paternal serum lipids because mothers might have more actively participated in the study and complied better with the diet,” she continued. “There is also the possibility that the improvement in the fathers’ diets was not strong enough to cause a statistically significant difference in serum lipids.”

“Our study emphasizes that longterm dietary counseling directed at children may be an efficient way to also improve the diets of parents.

These findings could be used to plan public health counseling programs,” Jaakkola concluded.

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OUT OF THE OR RECIPE

BY CHRISTINE GALLARY

RECIPE NOTES: You can use fresh dumplings in this recipe, but keep a close eye while they are cooking; they might brown more quickly than frozen dumplings.

Leftovers can be stored in an airtight container in the refrigerator for up to four days.

MAKE THE SAUCE: Whisk all the ingredients together in a small bowl until the cornstarch is dissolved; set aside.

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DUMPLINGS ARE THE PERFECT STARCH

RECIPE

FOR A SIMPLE STIR-FRY

S

tir-fries are in my regular dinner rotation because they’re fast and I can cook veggies and proteins together all in one pan. One day, I spotted the bag of frozen Asian dumplings that I always stock for quick lunches and an idea percolated in my head: What about using dumplings instead of meat or tofu in a stir-fry? And then a one-pan meal was born.

Crunchy on the outside, juicy on the inside, panfried dumplings are tossed with crisp-tender veggies and a savory, vinegary sauce that coats everything to glossy perfection.

No need to make rice or noodles to go with this stir-fry; with the dumpling wrappers, there’s already a starch included!

Frozen Asian dumplings are the heart and soul of this stir-fry. You can use Chinese potstick-

ers or smaller Japanese gyoza – both work beautifully. As for the filling, it’s really up to you. Go with chicken, pork or shrimp, or try vegetarian versions filled with mushrooms or tofu. This stir-fry cooks the dumplings straight from the freezer so no need to thaw; although you can definitely use homemade dumplings too.

After the dumplings are steam-fried, they are put aside and the same pan is

used to stir-fry mushrooms, asparagus and carrots.

Everything gets tossed together with a sauce inspired by my favorite dumpling dipping sauce: a mixture of vinegar (I love Chinese black vinegar, but unseasoned rice vinegar works well here too), soy sauce, a touch of sugar and a dash of sesame oil. This easy weeknight meal serves two as a main dish but can stretch to serve more if it’s part of a multi-course meal.

MAKE THE STIR-FRY: Heat 2 tablespoons of the oil in a large nonstick frying pan over medium-high heat until shimmering. Place the potstickers or gyoza pleat-side up in a single layer. Fry undisturbed until the bottoms are light golden-brown, about 3 minutes.

Carefully add the water (be careful because the oil may spatter). Cover and cook for 3 minutes. Uncover and, using tongs, turn the dumplings onto their unpleated sides. Continue cooking uncovered until all the water has evaporated, the filling is cooked through, and the unpleated sides are golden-brown, about 3 minutes more.

Transfer to a large plate.

Drizzle 1 teaspoon of oil into the pan; add the mushrooms and season with salt.

Stir-fry until the mushrooms are browned and softened, 2 to 3 minutes, then transfer to the plate with the dumplings.

Drizzle 1 teaspoon of oil into the pan, add the asparagus and carrot, and season with salt. Stir-fry until crisp-tender, about 2 minutes. Add the ginger and stir-fry for 30 seconds.

Retuen the reserved potstickers, mushrooms and any juices back to the pan and toss gently to combine. Whisk the sauce again to recombine, then add to the pan.

Stir-fry until the sauce thickens and coats everything in the pan, about 30 seconds.

Transfer to a serving dish and sprinkle with the scallions. Serve immediately.

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INGREDIENTS Potsticker Stir-Fry Serves 2 as a main dish

FOR THE SAUCE: 2 tablespoons rice vinegar or 3 tablespoons Chinese black vinegar 2 tablespoons soy sauce 2 tablespoons water 1 teaspoon cornstarch 1 teaspoon granulated sugar 1/2 teaspoon Asian sesame

seed oil FOR THE STIR-FRY: 12 frozen pot stickers or 16 frozen gyoza (do not thaw,

about 12 ounces total) 2 tablespoons plus 2 teaspoons

vegetable oil, divided 1/4 cup water 8 ounces cremini mushrooms,

sliced 1/4-inch thick

Kosher salt 8 ounces asparagus (about 1/2

bunch), cut into 1-inch pieces 1 medium carrot, peeled and cut

on the diagonal into 1/4-inch thick ovals 1 tablespoon finely chopped

peeled fresh ginger 2 medium scallions, thinly sliced

– Christine Gallary is food editor-atlarge for TheKitchn.com, a nationally known blog for people who love food and home cooking. Submit any comments or questions to editorial@thekitchn.com.

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OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • OCTOBER • ARE YOU IN THE KNOW?

FDA APPROVES NUT HEALTH CLAIM The FDA has approved the Royal Hawaiian Macadamia Nut Incorporated’s petition to claim that consuming macadamia nuts can help reduce the risk of coronary heart disease under certain circumstances. The decision follows nearly two years of FDA review, and marks a significant evolution in the recognition of macadamia nuts as a potentially healthful food, which will benefit the macadamia nut industry.

Coronary heart disease is the leading cause of death in men and women in the United States. While the FDA previously approved a qualified health claim for the consumption of other tree nuts, this announcement is the first time the agency has extended a qualified health claim to macadamia nuts specifically. An apprived statement may now be applied in connection to the con64

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{

nch!

Win Lu THE WINNER GETS A $50 SUBWAY GIFT CARD

sumption of whole or chopped macadamia nuts, including raw, blanched, roasted, salted or unsalted, and/or lightly coated and/or flavored macadamia nuts.

“This is a truly a historic day for everyone in the macadamia nut industry,” said Scott Wallace of Royal Hawaiian Macadamia Nut. “Research about the benefits macadamia nuts have for heart health has existed for decades, and we’ve worked tirelessly to secure the legal right to share this with the masses.

Many people associate almonds, pistachios and walnuts with better health, but this momentous decision from the FDA now puts macadamia nuts in a similar category.”

{

Email us a photo of yourself or a colleague reading a copy of OR Today magazine to be entered to win a $50 Subway gift card!

Snap a photo with your phone and email it to Editor@MDPublishing.com to enter. It’s that easy! Good luck!

Macadamia nuts have no cholesterol and are high in monounsaturated fats – the same healthy fats found in olive oil and avocados, which are known to help reduce bad cholesterol levels and can lower risk of heart disease and stroke.

Scientists first discovered that adding macadamia nuts to the diet appeared to lower the amount of LDL cholesterol in the blood during the 1990s and 2000s.

Since then, researchers have been exploring the connection, resulting in a growing body of scientific evidence supporting that a diet including macadamia nuts can help lower LDL cholesterol levels. One ounce of macadamia nuts (about 15 nuts) is also an excellent source of thiamin and manganese, a good source of dietary fiber and copper, and contains protein, magnesium, iron and phytosterols.y. •

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PINBOARD

OR TODAY OCTOBER

CONTEST WINNER

“THE LEHIGH VALLEY HEALTH NETWORK PERIOPERATIVE ADMINISTRATION TEAM IS EXCITED ABOUT WEBINARS ON LEADERSHIP!” - TARA BURKUS

Tara A. Burkus BSN, RN-BC

TURE: “ADOPT THE PACE OF NA .”

HER SECRET IS PATIENCE – RALPH WALDO EMERSON

YOU CAN’T BEET THIS DRINK Every year, consumers are getting more and more picky about what’s on (or not on) their food labels. “Clean” foods with added health benefits are a top priority.

And the food world is excited about one of nature’s untapped nutritional powerhouses: beets. In her article for WebMD about the benefits of beet juice, leading nutritionist Kathleen M. Zelman, MPH, RD, LD wrote, “Most lists of ‘super foods’ don’t include beetroot juice, but maybe they should.”

Kayco is proud to introduce Beetology, a new line of craft beverages made from one of nature’s untapped nutritional powerhouses, beets. These sweet, organic, cold-pressed juices are a delicious choice for today’s

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health-minded consumer, and they’re leading the pack of good-for-you products that offer all the “clean” attributes shoppers are demanding today.

“The movement toward simple, easy-to-understand, healthy ingredients is now in the mainstream. Beetology beverages contain no more than five ingredients – nothing but organic, natural, cold-pressed juice – perfectly blended for a crisp and unique flavor in every sip. The pure farm-to-table pedigree means you can taste the difference,” according to Charles Herzog, chief beetologist and vice president of new business development at Kayco.

Varieties include Beet + Lemon + Ginger, Beet + Veggie, Beet + Tropical Fruit, Beet + Berry, and Beet + Cherry.

Launched in April, 2017, each 8.45 ounce bottle of Beetology is fresh,

refrigerated, and ready to grab and go.

Find it at health food, specialty, grocery, and kosher food markets.

For additional information, visit www.kayco.com.

Kayco’s Beet ology in 5 va rieties: Beet Ginger, Beet + Lemon + + Veggie, Be et + Tropic al Fruit, Beet Berry, and Be + et + Cherry .

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INDEX ALPHABETICAL AAAHC………………………………………………………… 23

Encompass Group……………………………………… 53

Palmero Health Care………………………………… 45

AIV Inc.……………………………………………………………17

Flagship Surgical, LLC……………………………… 45

Paragon Services………………………………………… 26

AORN……………………………………………………………… 4

Healthmark Industries, Inc.………… 46-49, 59

Pure Processing……………………………………………… 5

Belimed………………………………………………………… 53

Image Stream Medical…………………… 18-19, 44

Ruhof Corporation………………………………………2-3

C Change Surgical……………………………………… 13

Innovative Medical Products…………………… BC

STERIS…………………………………………………………… 10

Cincinnati Sub-Zero…………………………………… 35

Jet Medical Electronics Inc…………………………21

TBJ Incorporated………………………………………… 34

Cygnus Medical…………………………………………… 24

MD Technologies inc.………………………………… 57

TIDI C-Armor ………………………………………………… 14,15

Diversey ………………………………………………………… 9

Pacific Medical……………………………………………… 6

TIDIShield Transport…………………………………………IBC

Palmero Health Care………………………………… 45 Pure Processing……………………………………………… 5 Ruhof Corporation………………………………………2-3 TBJ Incorporated………………………………………… 34

SAFETY Flagship Surgical, LLC……………………………… 45 Healthmark Industries, Inc.………… 46-49, 59

INDEX CATEGORICAL ANESTHESIA Paragon Services………………………………………… 26 ASSOCIATIONS AAAHC………………………………………………………… 23 AORN……………………………………………………………… 4 CARDIAC PRODUCTS C Change Surgical……………………………………… 13 Jet Medical Electronics Inc…………………………21 CARTS/CABINETS Cincinnati Sub-Zero…………………………………… 35 Cygnus Medical…………………………………………… 24 Flagship Surgical, LLC……………………………… 45 Healthmark Industries, Inc.………… 46-49, 59 STERIS…………………………………………………………… 10 TBJ Incorporated………………………………………… 34 DISINFECTANTS Cygnus Medical…………………………………………… 24 Diversey ………………………………………………………… 9 Palmero Health Care………………………………… 45 Ruhof Corporation………………………………………2-3 ENDOSCOPY Cygnus Medical…………………………………………… 24 Healthmark Industries, Inc.………… 46-49, 59 Image Stream Medical…………………… 18-19, 44 Ruhof Corporation………………………………………2-3 STERIS…………………………………………………………… 10

TIDI C-Armor ………………………………………………… 14,15 TIDIShield Transport…………………………………………IBC

INSTRUMENT STORAGE/TRANSPORT Belimed………………………………………………………… 53 Cygnus Medical…………………………………………… 24 TIDIShield Transport…………………………………………IBC

LIGHTING/VIDEO PRODUCTION STERIS…………………………………………………………… 10 MONITORS Pacific Medical……………………………………………… 6 OR INTEGRATION Image Stream Medical…………………… 18-19, 44 OR TABLES/BOOMS/ACCESSORIES Innovative Medical Products…………………… BC STERIS…………………………………………………………… 10 OTHER AIV Inc.……………………………………………………………17 Image Stream Medical…………………… 18-19, 44 TIDI Products…………………………………… 14,15,IBC

ERGONOMIC SOLUTIONS Diversey ………………………………………………………… 9 Pure Processing……………………………………………… 5

PATIENT MONITORING AIV Inc.……………………………………………………………17 Jet Medical Electronics Inc…………………………21 Pacific Medical……………………………………………… 6

FALL PREVENTION Encompass Group……………………………………… 53

PATIENT WARMING Encompass Group……………………………………… 53

FLUID MANAGEMENT SOLUTION Flagship Surgical, LLC……………………………… 45

POSITIONING PRODUCTS Cygnus Medical…………………………………………… 24 Innovative Medical Products…………………… BC

GENERAL AIV Inc.……………………………………………………………17 INFECTION CONTROL Belimed………………………………………………………… 53 Cygnus Medical…………………………………………… 24 Diversey ………………………………………………………… 9 Encompass Group……………………………………… 53 Healthmark Industries, Inc.………… 46-49, 59 66

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REPAIR SERVICES Cygnus Medical…………………………………………… 24 Jet Medical Electronics Inc…………………………21 Pacific Medical……………………………………………… 6 REPROCESSING STATIONS Pure Processing……………………………………………… 5 TBJ Incorporated………………………………………… 34

TIDI C-Armor ………………………………………………… 14,15 TIDIShield Transport…………………………………………IBC

SINKS Pure Processing……………………………………………… 5 TBJ Incorporated………………………………………… 34 STERILIZATION Belimed………………………………………………………… 53 Cygnus Medical…………………………………………… 24 Healthmark Industries, Inc.………… 46-49, 59 TBJ Incorporated………………………………………… 34 SURGICAL Image Stream Medical…………………… 18-19, 44 STERIS…………………………………………………………… 10 TIDI C-Armor ………………………………………………… 14,15

SURGICAL INSTRUMENT/ACCESSORIES C Change Surgical……………………………………… 13 Cygnus Medical…………………………………………… 24 Healthmark Industries, Inc.………… 46-49, 59 SURGICAL MAT SOLUTIONS Flagship Surgical, LLC……………………………… 45 TELEMETRY AIV Inc.……………………………………………………………17 Pacific Medical……………………………………………… 6 TEMPERATURE MANAGEMENT C Change Surgical……………………………………… 13 Cincinnati Sub-Zero…………………………………… 35 Encompass Group……………………………………… 53 WARMERS Belimed………………………………………………………… 53 Cincinnati Sub-Zero…………………………………… 35 STERIS…………………………………………………………… 10 WASTE MANAGEMENT Flagship Surgical, LLC……………………………… 45 MD Technologies inc.………………………………… 57 TBJ Incorporated………………………………………… 34

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Identification for transportation of biohazards TIDIShieldÂŽ Transportâ&#x201E;˘ is a single-use back-table contamination cover specifically designed to help identify and cover surgical instruments during transportation from surgical site to decontamination. TIDIShield Transport can help you prepare for upcoming audits with a post-case cover solution that is in compliance with OSHA, AORN, and AST guidelines.

For more information visit tidiproducts.com/tidishield-transport

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570 Enterprise Drive | Neenah, WI USA 54956 TIDIShield is a registered trademark of TIDI Products, LLC. For U.S. and foreign patent information, see go.tidiproducts.com/patents.

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