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contents features

42 MINIMIZING OR NOISE & DISTRACTIONS Noise and distractions in the OR increase the possibility of adverse patient outcomes during critical phases like time-out periods, critical dissections, surgical counts, confirming and opening of implants, induction and emergence from anesthesia, and care and handling of specimens. OR Today shares tips on how to improve the environment and minimize mistakes.

Join in on the conversation from the OR Nation Listserv. This month we talk about smoke evacuator filters and age limits on observers.

“Learning new things and developing skills as part of lifelong learning gives a fresh perspective on your work; a new lens on the work setting.”

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OR Today (Vol. 18, Issue #01) January 2018 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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contents features

PUBLISHER John M. Krieg

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Each month we post the news and photos that caught our eye. Be sure to enter the photo contest this month!

EDITOR John Wallace

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ART DEPARTMENT Jonathan Riley Sarah Sutherland Karlee Gower

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DIGITAL SERVICES

Learn about Melissa Mordecai’s career path as a nurse!

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Travis Saylor Cindy Galindo Jena Mattison Kathryn Keur

CIRCULATION Lisa Cover Melissa Brand

INDUSTRY INSIGHTS 10 News & Notes 16 AAAHC Update 18 CCI: Lifelong Learning 20 OR Today Webinars

IN THE OR

22 Suite Talk 25 Market Analysis 26 Product Focus 32 CE Article

OUT OF THE OR 48 Fitness 50 Health 52 Nutrition 54 Recipe 56 Pinboard

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INDUSTRY INSIGHTS

news & notes

Olympus Announces Continued Expansion of EndoTherapy Line Olympus has expanded its EndoTherapy product line. The 3-in-1 SB Knives enable mucosal incision, submucosal dissection and hemostasis, for controlled, precision cutting. The SB Knives are a line of scissor-type ESD knives available in the U.S. through an exclusive distribution agreement between Olympus and Sumitomo Bakelite Co., Ltd. SB Knives are used in ESD to remove early gastrointestinal cancers that have not entered the muscle layer. Minimally invasive ESD procedures can sometimes help patients avoid open surgery. Olympus also announced its co-promotion agreement of Eleview in the U.S. with Aries Pharmaceuticals. Eleview, designed for easy and safe resection, increases visibility of target lesion margins and is designed to lower the risk of perforation. Eleview improves margin visualization to help decrease the risk of gastrointestinal perforation and damage to the external muscular layer, which can lead to gastrointestinal perforation and may decrease the time needed to resect a lesion while reducing both reinjections required and piecemeal excisions, as compared to saline. Eleview was developed by Cosmo Pharmaceuticals N.V. Olympus and Aries, the U.S. distribution arm of Aries Ltd. and a wholly owned subsidiary of Cosmo, will work together to promote Eleview to end-user customers and will each sell the product through their existing distribution networks. Additionally, Olympus announced its exclusive distribution agreement with Ruhof Healhcare for Guardian Endo-

10 | OR TODAY | JANUARY 2018

scope Single-Use Valve Set, a sterile, disposable valve that eliminates the need for manual cleaning. Manufactured by Ruhof, Guardian Endoscope Single-Use Valve Set will be distributed in the U.S. by the Olympus Endoscopy Sales team. Designed for use in Olympus 140/160/180/190 Series Endoscopes, Guardian Endoscope Single-Use Valve Set is color coded for easy identification and differentiation. Each set contains one air/water, suction and biopsy valve and helps to prevent cross contamination. Through this partnership, Ruhof and Olympus are helping to create consistent practices and reduce the potential for error and healthcareassociated infections. “With each device we unveil to the GI community, Olympus gains strength as being more than an excellent imaging partner; we evolve into a complete solutions provider to our customers,” Olympus America’s Kurt Heine said. “Strategic partnerships, a commitment to innovation and a drive to provide methods to raise quality and satisfaction while lowering costs – these are ways we build trust with our customers every day.” •

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INDUSTRY INSIGHTS

news & notes

Key Surgical Introduces New Brushes Key Surgical recently introduced new Lumen Guard Cleaning Brushes. This new line of channel cleaning brushes features a smooth, protective tip (traditional exposed wire at the end of the brush is transformed through Z-Tip technology) and rigid, antimicrobial nylon bristles help with effective removal of debris during decontamination. The brushes are available in diameters of .05-inch to 1-inch and lengths of 6 inches to 24 inches. •

Study Finds Compliance Concerns Remain with Safe Injection Practices (SIP)

Healthmark has announced the addition of the Foam Protectors to its ProSys Instrument Care product line. Manufactured from open cell, polyurethane foam, the blue latex-free Foam Protectors are designed to help prevent costly damage to instruments caused by shifting during transport, handling and sterilization. The Foam Protectors are available in the following styles: pouch, tip protector, pinhole holder, corner protectors, and a 12-instrument foam protector. •

The AAAHC found that the level of deficiencies associated with the accreditor’s SIP Standard was significant (greater than 10 percent) in several of the health care settings which the AAAHC accredits. Last year, the AAAHC Institute released a patient safety toolkit to help organizations comply with the AAAHC Standard and national guidelines. This year, the AAAHC launched a voluntary benchmarking study to measure compliance with specific aspects of national SIP guidelines. The AAAHC Institute Safe Injection Practices (SIP) Study for January-June 2017 revealed a significant proportion of ambulatory health care organizations do not always meet national SIP guidelines. In response, the AAAHC is continuing to provide member organizations with educational resources to improve safe injection practices and compliance with national guidelines. Despite guidelines from national and international organizations, safe injection practices remain a challenge for a number of health care providers. For the study, the AAAHC Institute collected self-reported responses from 110 AAAHC-accredited ambulatory organizations on a cross-section of their standard SIP activities to identify areas for quality improvement. The study results were broken down by type – ambulatory surgery center (ASC) and primary care – and shared with participants. Safe injection practices (SIP) are the processes health care providers use to prevent the transmission of bloodborne viruses and other microbial pathogens to patients or the providers themselves when preparing and administering injectable medications. According to the World Health Organization (WHO), a safe injection does not harm the recipient, does not expose the provider to any avoidable risks and does not result in any waste that is dangerous for other people. •

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INDUSTRY INSIGHTS

news & notes

ISE Launches New Initiative The Institute for Surgical Excellence (ISE) has launched an international initiative to develop the first standardized curriculum for robotic surgical trainers. The Train-the-Trainer initiative is a direct response to rapidly changing surgical robotic technology and expanded surgeon use worldwide that is outpacing education and training needs, hindering health care providers and patients. “Right now when patients enter the operating room, they have no way of knowing if their surgeon has been trained by an instructor using the best education and training practices,” said ISE Interim Executive Director Dr. Jeffrey Levy. “Patients need to feel confident that their surgeon has been trained properly and has the experience needed to perform safe and effective robotic surgery.” The Train-the-Trainer consensus conference brought together 36 master trainers and education experts from across the United States and Europe to develop a curriculum that includes components from the best training programs and facilities around the world. The curriculum is centered around robotic surgery, and is especially important since robotic surgery allows for patients to have faster and less complicated recovery times with less infection or error, lowering overall costs in certain procedures. The first conference to develop Train-the-Trainer standards was held in Philadelphia in late June 2017. Representatives joined from the United States, France, Germany, Sweden, England, Italy and Spain. The representatives brought a variety of backgrounds with them, including gynecology, urology, colorectal surgery, thoracic surgery, psychology, education, federal aviation and the military. The Train-the-Trainer curriculum development process will continue under the guidance of the ISE leadership. The next steps are to determine the key elements of a core curriculum through a validated expert-driven consensus process. • For more information, visit surgicalexcellence.org.

12 | OR TODAY | JANUARY 2018

BD Celebrates Anesthesia Milestone Becton, Dickinson and Company (BD) recently celebrated the 20th anniversary of its Pyxis Anesthesia ES system. Designed for the unique needs of the operating room (OR) and procedural care areas, the Pyxis Anesthesia ES system maximizes medication safety and workflow efficiency while helping to minimize drug diversion. The combined incidence of medication errors in anesthesia is approximately 1 in 211 anesthetics, with anesthesia errors carrying an annual cost between $3.1 billion and $4.6 billion in the U.S. The Pyxis Anesthesia ES system may help hospital pharmacists and anesthesia care providers avoid errors such as administering expired medications and dispensing the wrong medication or dosage. “Patient safety increased with immediate unplanned, but likely, drug availability in a secure source,” said Bruce Latimer, director of Pharmacy at Kingman Regional Medical Center during a recent TechValidate survey where customers said the Pyxis Anesthesia ES system helps their anesthesia providers and pharmacists improve workflow efficiency and safely manage medication in the OR. In the mid-1990s, BD began developing the initial Pyxis Anesthesia system by consulting anesthesiologists to understand how medications were managed in the OR. These discussions identified the types, sizes and daily volumes of medications that were typically used, as well as workspace requirements. Since then, BD has continually used customer input to refine the Pyxis Anesthesia ES system. One example is the addition of a controlled-access pop-matrix drawer to provide secure storage space for bulkier, high-risk medication. Other enhancements include reporting tools, a patient-centric workflow and My Kits integration. Another key challenge in the perioperative environment is the labeling of medication containers especially in connection with the anesthesia care provider prescribing, administering and charting medications in real time. The Pyxis Anesthesia ES system supports label printing solutions that follow the ISMP and ASA recommendations and ensures that labels are readily available, a standardized policy is in place to support appropriate use and frequency, etc. The Pyxis Anesthesia system also helps hospitals and other procedural care facilities address drug diversion. With tracking, reconciliation, documentation and other management tools, the Pyxis Anesthesia system helps protect patients from medication errors due to diversion. It also helps protect anesthesiologists from diversion suspicion by providing clear traceability. •

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Ambulatory Surgery Center Completes $12 Million Remodel In October, Kelsey-Seybold Clinic unveiled a newly remodeled and expanded ambulatory surgery center (ASC) at the Spencer R. Berthelsen, M.D., Main Campus. The ASC renovation project lasted over 20 months, completely reconfiguring the space to improve patient flow from the lobby to pre-op and recovery, as well as adding two operating rooms, and replacing and expanding the endoscopy suites and the pain management suite. This $12 million capital project has added more than 10,000 square feet of usable space to the Kelsey-Seybold ASC, bringing the total square footage to over 38,000. With 15 procedure rooms, including seven endoscopy suites, seven operating suites and one pain management suite, KelseySeybold Clinic now has the largest freestanding non-hospital based ASC in Texas. “When it comes to the surgical care of conditions, the ambulatory surgery center has always been the most efficient way to safely provide affordable, outpatient care. It connects the right patient, in the right setting, with the right provider using the right tools,” said Jose Nolla, M.D., chief of staff of the ASC and an orthopedic surgeon at Kelsey-Seybold Clinic. “The completely remodeled ASC at Main Campus enhances our capabilities and capacity to safely perform procedures here that were previously done in a hospital-based setting.” Over the past three years, the Spencer R. Berthelsen Main Campus Clinic has undergone a $50-million transformation that brought more specialties under one roof by remodeling the existing space, adding nuclear medicine, expanding the cancer center, adding radiation oncology and PET/ CT to the list of services offered to cancer patients and increasing the size of the main campus pharmacy and clinical laboratory to improve patient service. The ASC is the final key area to undergo a transformation. The Kelsey-Seybold ASC is accredited by the Accreditation Association for Ambulatory Health Care (AAAHC). Kirksey Architecture designed the ASC, and Gamma Construction was the general contractor for the project. •

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INDUSTRY INSIGHTS

news & notes

Universal SteriBump Guarantees Sterility As every OR staff member knows, any material entering the sterile field during surgery needs to be as free from contaminates as possible in order to prevent surgical site infection. Because IMP’s lint-free Universal SteriBump positioner is designed for single use, there is no possibility of cross contamination. Its guaranteed sterility frees up operating room personnel from having to bundle together sterile towels and other cloths to create a makeshift limb support, saving valuable OR and sterile processing departments’ time. Safer for the patient than cloth bundling, the Universal SteriBump is a contoured, polyurethane foam block that is latex-free with a closed cell geometry that doesn’t have the particulate breakdown of cloth. Protected by guaranteed sterile packaging, and ready to use for multiple applications, the SteriBump is cost effective, guaranteeing product sterility, while providing the patient and the surgical team a

physical platform that can securely elevate a patient’s limb in the sterile field when required. Also, the SuperBump is a guaranteed, sterile, weighted bump, employed when simplicity is all a surgical team needs for a knee procedure. The SuperBump can be positioned on top of the OR table’s drapes, at any location, eliminating the need for OR personnel to go under the table drapes to reposition makeshift bumps or barriers. •

RTI Surgical Introduces TETRAfuse 3D Technology RTI Surgical Inc. has announced the introduction of TETRAfuse 3D Technology. TETRAfuse 3D Technology is the first 3D printed polymer implant material that has demonstrated trabecular bone ingrowth while maintaining radiolucency and bone-like mechanical properties. “The 3D printing process creates a nano-rough surface on every aspect of the implant, not just the endplates,” said Robert Watkins IV, M.D. of Marina Spine Center. “This nano-rough surface facilitates bony

14 | OR TODAY | JANUARY 2018

ingrowth throughout the disc space from endplate to endplate, allowing deeper implant osseointegration.” TETRAfuse 3D Technology was developed to offer surgeons an interbody material that participates in the fusion process while maintaining bone-like mechanical properties and radiolucent imaging. Bringing these features together combines the osseointegrative advantages of titanium and allograft bone with the benefits surgeons experience with PEEK. RTI will soon announce the release of a family of products manufactured

with TETRAfuse 3D Technology, providing a platform that will have many derivative products. “We are excited about the promise this cutting-edge technology holds for our surgeon customers and their patients,” said Camille Farhat, RTI chief executive officer. “Being the first to offer surgeons a 3D printed interbody polymer optimized to participate in fusion marks another significant milestone for RTI in our quest to continuously deliver relevant and innovative products without compromise.” •

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INDUSTRY INSIGHTS

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news & notes

FDA Clears New Robotically Assisted Surgical Device The U.S. Food and Drug Administration has cleared the Senhance System, a robotically assisted surgical device (RASD) that can help facilitate minimally invasive surgery. RASD enables a surgeon to use computer and software technology to control and move surgical instruments through one or more tiny incisions in the patient’s body (laparoscopic surgery) in a variety of surgical procedures or operations. The benefits of RASD technology may include its ability to facilitate minimally invasive surgery and assist with complex tasks in confined areas of the body. The design of the Senhance System allows surgeons to sit at a console unit or cockpit that provides a 3-D high-definition view of the surgical field and allows them to control three separate robotic arms remotely. The end of each arm is equipped with surgical instruments that are based on traditional laparoscopic instrument designs. The system also includes unique technological characteristics: force feedback, which helps the surgeon “feel” the

stiffness of tissue being grasped by the robotic arm; eye-tracking, which helps control movement of the surgical tools and laparoscopic-type controls similar to traditional surgical equipment. The Senhance System is intended to assist in the accurate control of laparoscopic instruments for visualization and endoscopic manipulation of tissue including grasping, cutting, blunt and sharp dissection, approximation, ligation, electrocautery, suturing, mobilization and retraction in laparoscopic colorectal surgery and laparoscopic gynecological surgery. The system is for use on adult patients by trained physicians in an operating room environment. The FDA concluded that study data, supported by real-world evidence, along with performance testing under simulated use and worst-case scenario conditions, demonstrated the substantial equivalence of the Senhance System to the da Vinci Si IS3000 device for gynecological and colorectal procedures. The FDA granted clearance of the Senhance System to TransEnterix Surgical Inc. •

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INDUSTRY INSIGHTS aaahc

AAAHC Creates Orthopaedic Certification for ASCs he Accreditation Association for Ambulatory Health Care (AAAHC) has developed a orthopaedic certification program for ambulatory surgery centers (ASC) looking to demonstrate a high quality of care and compliance with industry requirements.

According to the Agency for Healthcare Research and Quality (AHRQ), the demand for joint replacement procedures is expected to grow at an unprecedented rate and become one of the nation’s most common elective procedures. While the majority of these are performed in hospital settings, the American Academy of Orthopaedic Surgeons cites more procedures are taking place in the ASC setting in an effort to reduce costs and increase efficiency. In 2010, researchers estimated 7 million Americans had a total hip or knee replacement, and of those, 620,000 individuals underwent both procedures. Experts expect knee replacements alone could reach 3.5 million per year by 2030. Researchers attribute the increase in these procedures to the rising incidences of patients with conditions that lead to orthopaedic problems such as obesity and arthritis. Further, the aging population of Baby Boomers looking to maintain active lifestyles is also driving demand.

16 | OR TODAY | JANUARY 2018

“Advancements in surgical procedures and prosthetics, coupled with reduced length of stay in hospitals, are leading to more orthopaedic procedures being performed in the outpatient setting,” said Tess Poland, RN, BSN, MSN, senior vice president, accreditation services for AAAHC. “ASCs embody the principles of value-based care by delivering highquality services at a fraction of the cost of a hospital visit.” The orthopaedic certification program builds off the AAAHC ASC Accreditation offering or accreditation from another organization. After an ASC has achieved overall accreditation, it can acquire the certification to demonstrate excellence in the orthopaedic specialty by meeting specific industry standards. The requirements touch on several aspects of the ASC orthopaedic specialty including: Credentialing and privileging of providers Rigorous prescreening criteria to ensure optimal patient outcomes Clinical care based on current evidence-based guidelines AAAHC-accredited ASCs requested an orthopaedic certification be developed to create an organized structure toward ensuring high-quality delivery of care and strong patient outcomes in orthopaedic procedures. The certification demonstrates a center’s

“The goal of the certification program is to provide a highly clinical-relevant resource that recognizes centers of specialty excellence.” high-reliability and culture driven to excellence, creating a competitive advantage over other ASCs and providing assurance to patients, referrers and the industry. “The goal of the certification program is to provide a highly clinical-relevant resource that recognizes centers of specialty excellence,” said Poland. “We plan to extend our certification programs to include more specialties in the future.” The orthopaedic certification program standards can be found in the 2018 Accreditation Handbook for Ambulatory Health Care, which includes updated Standards for 2018 and the Centers for Medicare and Medicaid Services (CMS) Emergency Preparedness requirements. For more information, visit www.aaahc. org/publications.com. WWW.ORTODAY.COM

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INDUSTRY INSIGHTS

cci news & notes

Lifelong Learning in the OR Setting by Jim Stobinski erioperative Nurse Leaders, a group of which I am a member, is a mature cohort with long careers in the OR. As our careers wind down, we must confirm that future perioperative nurse leaders have the education and training to carry out their complex duties. While working on this article I came across two other articles that gave me pause.

I will confess that I am a news junkie with a preference for current events, business and finance topics. I recently came across two articles in Forbes, a business news and financial information magazine. The first article, “Bono and Thomas Friedman Reveal Three Skills American Workers Need Today,” related the thoughts of Bono (a rock musician and entrepreneur) and the author Thomas Friedman on the changing nature of workplace skills. The second article, written by Gary Burnison, spoke to burnout in the workplace and how to deal with that unfortunate occurrence. Burnout is a legitimate concern for nurse leaders in the high stress OR work setting. It struck me that there was pertinent information for perioperative nurse leaders in each article and both

18 | OR TODAY | JANUARY 2018

complemented my thoughts well. Baldelomar, writing about the views of Bono and Friedman, speaks to the accelerating pace of change in the business world and the need for workers to adjust and stay current with that pace. She stressed that the education which brought you into the profession, even combined with years of productive experience, may not keep your skill set from becoming obsolete. Bono and Friedman spoke to the need for lifelong learning and for enhancing soft skills like collaboration, communication and relationship building. The pace of change in the OR is rapid and as technology advances and payment mechanisms change we must develop new skills sets. We must also impress on aspiring perioperative nurse leaders this need for lifelong learning and the importance of these new soft skills, some of which were not common place for us in our careers. Burnison, in the second article on workplace burnout, states that one way to combat burnout is to find the passion and purpose in your work. I believe one way to re-energize your work performance is to learn new skills. Learning new things and developing skills as part of lifelong learning gives a fresh perspective on

“Learning new things and developing skills as a part of lifelong learning gives a fresh perspective on your work; a new lens on the work setting.” your work; a new lens on the work setting. In example, honing communication skills may allow you to see the perspective of other stakeholders in the OR such as the surgeons and anesthesia providers. Baldelomar stresses that by, “ … embracing these three traits, you will be equipped to help lead your company into the future.” I maintain that you could also utilize these strategies to prevent obsolescence in your current work and to maintain your engagement. Your life circumstances may not grant unlimited choices and opportunities but there are things which are within our control. Among the things we can control is how we choose to respond to how the work of surgery and nursing is evolving.

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The Competency and Credentialing Institute, my employer of the last six years, is acutely aware of the pace of change in the operating room. That knowledge provided us with the impetus to develop the CSSM (Certified Surgical Services Manager) certification for perioperative nurse leaders. This credential, for which CCI recently received accreditation, endeavors to facilitate the ongoing professional development of these nurse certificants through an innovative recertification mechanism. Through the required learning activities in that recertification process we hope to partner with perioperative nurse leaders to help them stay current in this challenging profession. Our ongoing work with OR Today Live, and our other partners, is another way in which we strive to be attuned to your learning needs. We look forward to future work with perioperative nurses as we support lifelong learning through webinars, articles and continuing education activities.

References Baldelomar, R. (Oct. 22, 2017). Bono and Thomas Friedman Reveal Three Skills American Workers Need Today. Forbes. Retrieved from: https://flipboard.com/@ flipboard/-bono-and-thomas-friedman-reveal-three-s/f7c063dcb34%2Fforbes.com Burnison, G. (Oct 22, 2017). Four Symptoms That You’re Stuck In Your Career: The Real Reasons You’re Staying Put in Your Job. Forbes. Retrieved from: https://flipboard. com/@flipboard/-four-symptoms-that-youre-stuck-inyour-/f-30c3dbc9d5%2Fforbes.com

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INDUSTRY INSIGHTS

news & notes webinar

Nurses Applaud OR Today Webinar Series Staff report urses and health care professionals continue to praise the OR Today webinar series.

The recent OR Today webinar “Continuous Professional Development for Perioperative Nurse Leaders” presented by Jim Stobinski, PhD, RN, CNOR, CSSM, Chief Executive Officer of the Competency & Credentialing Institute (CCI), drew positive reviews. In the webinar, Stobinski reviewed the known demographics of current perioperative nurse leaders, detailed a trend impacting recruitment into the perioperative nurse leader role and discussed a potential scenario affecting the continuous professional development choices of leaders/managers in the OR. More than 100 people attended the live webinar and many more have viewed a recording of the webinar online. The positive reviews came from a wide range of health care professionals, including nurse managers, directors of perioperative services and more. “The webinar presentation today was very valuable in describing the ongoing needs and areas of needed improvement for the perioperative nurse leaders and those that aspire to be,” said D. Huckfeldt, Nurse Manager. “I am a perioperative nurse leader and struggle with areas for self assessment to improve from a high-volume model to a value-based care model. This webinar has shed light on a direction on how to perform a self-assessment with peer review to document a

20 | OR TODAY | JANUARY 2018

path for success. Leaders still need to be led by other professionals,” shared K. Gonzales, Clinical Supervisor. “This was a very informative and educational webinar, I will be looking forward to what future topics will be. Loved having the leading leaders providing such indepth and current education,” said T. Goodall, Unit-based Educator.

resources to create zero tolerance for incivility/bullying; and an approach to managing incivility and bullying based in the principles of emotional intelligence. “This was one of the best webinars I’ve attended. It gave an excellent overview of bully behaviors and provided down-to-earth, workable suggestions for dealing with these staff members. I know a “This was a very informative and few people who would benefit greatly from this educational webinar, I will be webinar,” Administrator and Clinical Director D. looking forward to what future Zimdahl shared. “This was a great wetopics will be. Loved having the binar, as most are offered through OR Today. Releading leaders providing such ally appreciate the CEs offered to complete our in-depth and current education.” requirements for CNOR and others,” Regional – T. Goodall Patient Safety Officer T. Ralls wrote. “Excellent webinar for The OR Today webinar “Bringing everyone to hear, gives you insight into Shadow Behavior into the Light bettering your performance as well as of Day” presented by MFW how to manage others’ behaviors,” CoConsultants President Phyllis Administrator V. Lococo said. Quinlan was also well received with “Phyllis Quinlan presented a topic tons of positive comments. that is current and relevant in periQuinlan, PhD, RN-BC, is a successoperative nursing. Her presentation ful nurse entrepreneur and is a certiincluded practical information and fied transformational personal/career suggestions that can easily be put into coach. She specializes in the unique practice,” Perioperative Education needs of nurses and other professional/ Nurse Manager V. Pokorny wrote. family caregivers. In her insightful pre“Unfortunately, bullying is presentation, Quinlan discussed awaredominant in our society and in ness and insight into the personality medicine. Great information in this of a bully; the collaboration needed webinar for you to deal with it,” said between leadership, labor and human M. Kuznitz, CRNFA. WWW.ORTODAY.COM

TRIM 4.5”

“I appreciate the topics provided through the OR Today’s webinars. They are current and pertinent to the issues we are facing today,” said J. Bollig, Director of Perioperative Services. “These webinars are a great way for perioperative professionals to come together for one hour and get education and updates related specifically to our specialty … it was a great way to utilize one hour of my very busy day,” shared R. Martini, Perioperative Manager. “I find OR Today’s webinars on trend for current topics of concern. With all things changing on an almost daily basis, this is not an easy task. Great Job, OR Today,” said T. Stanford, OR Analyst. For more information about the OR Today webinar series, including a calendar of upcoming webinars and recordings of previous webinars, visit ORToday.com and click on the “Webinars” tab.

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IN THE OR suite talk

Suite Talk

Conversations from the OR Nationâ&#x20AC;&#x2122;s Listserv THESE POSTS ARE FROM OR NATIONâ&#x20AC;&#x2122;S LISTSERV JOIN THE CONVERSATION, VISIT WWW.THEORNATION.COM.

Q Q

SMOKE EVACUATOR FILTERS

Recently the filters in the Neptune suctions that are used when a smoke evacuator bovie pencil is used, have been getting contaminated with blood. It was suggested to have the surgeons not use this for suction of blood, but only for smoke. It is difficult to achieve this when doing a high fluid/blood loss case. Is this common? Each filter is approx. $500. Should this cost go to the patient? Each filter has an 80-hour lifespan, however once it is contaminated with blood, it needs to be tossed.

A: Stryker offers a fluid trap that costs about $10 to prevent fluid going into the filter.

A: Why would your surgeons/staff be us-

blood? We use regular suction tubing on the field to suction blood and then have the smoke evacuation tubing for removing smoke.

ing the smoke evacuator pencil to suction

OBSERVERS

Is there an age limit on observers to the operating room. Oftentimes children from public/private schools, community colleges and home-schooled children inquire about observing in the operating room. One hates to deny a child who is dreaming of being a doctor or nurse, but there must be some guidelines on who can observe.

A: We have a job shadowing program through our human resources department. High school

students, 16 years old or older may participate. They are given education about HIPPA, attire, etc. We only allow them in the OR after the patient is draped. We feel anyone younger than high school is not appropriate. There is always YouTube!

A: Here is our policy:

Non-medical student observers must: 1. 2. 3. 4. 5.

22 | OR TODAY | JANUARY 2018

provide reasons for his/her request, be sponsored by a physician in good standing, be approved by the chief of staff wear a hospital-issued identification badge only observe Monday through Friday from 06:30-15:00

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TRIM 3.25”

6. observe only with the sponsoring physician (may not provide any clinical care, write in the chart, etc) OBSERVATION ONLY 7. be at least 16 years of age – (18 years of age if observing in the OR, ER, trauma, labor and delivery, cath lab, special procedures, and pediatric departments) 8. Provide Medical Staff with evidence of: TRIM 4.5”

Two-step Tb test/CXR Confidentiality agreement Attend hospital associate training (orientation online) Proof of immunization record Sign an Observer Agreement Provide a government-issued ID Attend HIPAA awareness training Notify the department they wish to observe in within 24 hours of approval **Provide Surgery with 72 hours’ notice to prepare for OR Orientation (Covers observation in Surgery, L&D, Cath Lab, Special Procedures) Provide a current resume

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IN THE OR

market analysis

Protective Textiles Market Continues to Grow Staff report he PPE/Protective Textiles market is large and spans several industries, including health care.

Global Industry Analysts (GIA) explains the growth of the overall PPE market in a recent industry report. “The global market for Personal Protective Equipment (PPE) is projected to reach $45 billion by 2022, driven by the rise in the number of companies investing time and resources into building a robust workplace safety culture,” according to the GIA report. Scrubs, caps and drapes play an important role in preventing infections and promoting positive outcomes in health care facilities. “The global protective textiles market is expected to reach $7.78 billion by 2025,” according to a Research and Markets report. “The market is expected to witness growth at 3.4 percent CAGR owing to increasing industrial fatalities in developing economies owing to the lack of protective gear coupled with growing awareness of worker’s health and safety are expected to drive the market growth,” according to the report. In a separate Research and MarWWW.ORTODAY.COM

kets’ offering, the global surgical drapes market is expected to grow at a CAGR of 3.81 percent during the period 2017-2021. “One trend in the market is paradigm shift toward disposable surgical drapes,” according to the report. “The use of disposable surgical drapes is gaining popularity due to their several

scopically. The availability of robotic platforms for complex surgeries such as hysterectomy, hernia repair, and lumpectomy has increased the number of surgeries in the Americas and Europe. To increase patient comfort and reduce the prevalence of HAIs, hospitals and ASCs use surgical drapes, which is driving the growth of the market. According to Eurostat, in 2017, the adoption “The global protective textiles of MI surgeries increased the demand of surgical drapes in market is expected to reach Europe, due to the increase of laparoscopic procedures. $7.78 billion by 2025.” Further, the report states that one challenge in the market is lower profit margins and benefits. Disposable surgical drapes increasing pricing pressure. The global offer consistent product quality and surgical drapes market is highly fragreduce the need for sterilization in mented due to the presence of several central sterile processing (CSP). This vendors that have significant market enables CSP staff to focus on the pro- shares. The leading vendors have broad cessing and sterilization of surgical in- product portfolios of advanced highstruments and other supplies. Singleend surgical drapes, which are disposuse linens provide a better barrier to able and reusable. Small and mediumlimit the transfer of microorganisms.” sized companies focus on a single According to the report, one driver product line in a specific geographic in the market is the growing number region. Hence, the leading vendors of surgical procedures in developed are facing lower profit margins due countries. Endoscopic surgeries such to competition. The vendors are also as colectomies and appendectoexperiencing severe pricing pressure, mies are usually performed laparowhich has resulted in price wars. JANUARY 2018 | OR TODAY |

IN THE OR

product focus

ANSELL

GAMMEX PI Glove-in-Glove System GAMMEX PI Glove-in-Glove System allows for double gloving in just one don. Featuring Ansellâ&#x20AC;&#x2122;s exclusive Glove-in-Glove Technology, the system offers pre-donned outer and inner gloves packed in one poly-pouch and one inner-wrap, making double gloving easier and faster. The semi-transparent GAMMEX PI Hybrid serves as the outer glove, delivering the comfort of polyisoprene and the strength of neoprene. Combined with the green-colored GAMMEX Non-Latex PI Underglove as the inner glove, this system allows for quick and easy glove breach detection. In addition, the GAMMEX PI Glove-inGlove System uses 50 percent less inner packaging materials, reducing environmental impact. â&#x20AC;˘

26 | OR TODAY | JANUARY 2018

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IN THE OR

product focus

Encompass Group LLC Reusable OR Textiles

Through a partnership with Canadian based Lac-Mac, Encompass Group LLC is offering reusable OR gowns and drapes in the U.S. Paragon Reusable Surgical Gowns and Patient Drapes are made with R-MOR-Tex tri-laminate fabrics, available in both AAMI Levels 3 and 4. R-MOR-Tex fabric is high performing and breathable, especially compared to disposable gowns. These reusable surgical textile products can be re-processed and re-used 75-125 times making them cost-effective. They are validated to meet or exceed industry standards providing the highest level of protection from blood, body fluids and microscopic pathogens while maintaining superior comfort for the wearer.Â â&#x20AC;˘ For information, visit www.encompassgroup.net.

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IN THE OR

product focus

Halyard Health

AERO SERIES Gowns Managing many different gowns takes time and effort. With Halyard Health’s AERO SERIES Gowns, hospitals can reduce codes in inventory up to 40 percent while improving staff satisfaction and cost in use. AERO CHROME Gowns give surgical staff cool comfort and AAMI Level-4 protection. Its patented gray color and design make it easy for the surgical team to choose the protection they need for long, fluid-intensive procedures. Light, cool comfort and AAMI Level-3 fluid protection make AERO BLUE the go-to-gown for a wide range of procedures. The combination of these two advanced gowns means less to order, stock, pull, and waste – with more protection, comfort and staff satisfaction. •

28 | OR TODAY | JANUARY 2018

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IN THE OR

product focus

Healthmark Headwear

Healthmarkâ&#x20AC;&#x2122;s custom headwear allows health care professionals the opportunity to custom design the print of their scrub hats (single-use and re-useable) and bouffants. This one-size-fits-most headwear is intended to provide health care professionals style and comfort while they perform their important duties. The custom printed headwear offers true personalization for the individual staff member. It provides health care professionals style and comfort while delivering patient care. By providing truly custom imprinted, single-use scrub hats that cover the head, ears and the nape of the neck and bouffants, we are helping to promote team unity and employee satisfaction within procedure departments. â&#x20AC;˘ For information, visit hmark.com

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JANUARY 2018 | OR TODAY |

IN THE OR

product focus

MEDLINE Surgical Headwear

Reduce risks associated with surgical site infections. Medline’s new line of surgical headwear drives compliance with its patent-pending design to protect critical sites known to harbor bacteria. Developed with the new AORN Guidelines in mind, this line promotes full coverage of the ears, sideburns and nape of the neck. The breathable design minimizes irritation and provides all day lasting comfort. Ensure your team has the tools they need to focus on their patient – not their headwear. •

30 | OR TODAY | JANUARY 2018

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IN THE OR

product focus

PRIME MEDICAL

Chlorine-shielded Textiles

Prime Medical’s unique line of cubicle curtains, bed linens, patient gowns, scrubs and lab coats are made with a patented fabric technology that binds chlorine with each laundering in EPA-registered bleach. Ideal for PACUs, isolation and treatment rooms, the cubicle curtains are designed with removable privacy panels that can be unsnapped and replaced in less than one minute without a ladder. Fade-resistant, durable and safe, Prime Medical’s chlorine-shielded textiles are changing the fabric of health care for life. •

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IN THE OR

continuing education

IN THE OR

continuing education

CE711

No Way Around It: Rounding Means Satisfied Patients and Nurses by Lynn Deitrick, PhD, RN lice is a new nurse employee on a busy medical/surgical unit at General Hospital. During her first week, she noticed how often she heard call lights beeping. The unit was noisy from all the call lights, and the nurses seemed to be constantly scurrying around in and out of patient rooms. She asked Anne, her preceptor, why they weren’t doing hourly rounds. Anne said she was unfamiliar with hourly rounding. Alice explained that where she had worked before, nurses had rounded hourly on their patients. Because the unit was quiet, patients weren’t ringing their call lights, the number of patient falls had been reduced by half, and nurses had more time to get their work done because they weren’t constantly interrupted to go in and out of patient rooms. Anne was intrigued by what Alice was telling her and wanted to learn more about rounding and whether it would work on their unit at General Hospital.

Hourly rounding is a systematic, proactive, nurse-driven evidence-based process designed to anticipate and address needs of hospital patients.1-9 Rounding has been shown to increase patient satisfaction with the hospital experience because of regular attention from nurses. In addition, research indicates that on inpatient units where rounding has been “hardwired,” patient falls WWW.ORTODAY.COM

have decreased by 50%, skin breakdown has been reduced by 14%, and the number of patient calls via call lights has dropped by 38%. The concept of hourly rounding was developed in the late 1980s at a medical center in Birmingham, Ala. That hospital introduced the role of a unit “hostess,” who rounded on every patient four times each shift. The hostess answered call lights within five minutes and addressed all patient requests that did not require a licensed staff member. Tasks that the hostess took care of included adjusting room temperatures and providing patients with juice, water, or pillows. The change brought about by the hostess was dramatic: Within two weeks, there was a noticeable decline in patient and physician complaints together with many positive comments about the hostess from nurses. Nurses appreciated having someone available to answer call bells quickly, and patients felt that their needs were being met promptly.10 Hourly rounding developed from these roots.

Patient Satisfaction One of the key drivers of hourly rounding is patient satisfaction. The unit hostess role described above indicates that patient satisfaction can be affected by things such as prompt response to call lights and attention to other patient needs and concerns. Patient satisfaction can be defined as “the consumer’s fulfillment response; the degree to which the level of fulfillment is pleasant or unpleasant.”11 One author suggests that “sat-

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 39 to learn how to earn CE credit for this module.

Goal and objectives The goal of this continuing education program is to provide nurses and nurse leaders with an understanding of hourly rounding’s purpose and process and offer tips for implementation success. After studying the information presented here, you will be able to: • Define purposeful hourly rounding • Discuss the different types of rounding: introductory rounds, initial rounds, and hourly rounds, and the key behaviors in each • Explain how to measure the success of hourly rounding in the clinical setting

JANUARY 2018 | OR TODAY |

IN THE OR

continuing education

isfaction is a short-term attitude that is encounter specific.” He adds that “service quality is often judged by patients based on their perceptions of performance relative to expectations.”12 These perceptions about a patient’s hospital experience are measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey. The HCAHPS survey measures experiences of patients during their hospital stays and is used by hospitals throughout the United States.13 Hospital patients often need help with basic tasks, such as using the restroom, eating, bathing, and ambulating. Nurses’ responsiveness to their needs is a key factor that patients often consider when making judgments about the quality of their care. Other factors that can influence opinions about satisfaction can include patient and family perceptions of things such as prompt response to call lights, timely assistance to the restroom, timeliness and appropriateness of pain control, the friendliness of the nurses, and an effective exchange of information with nurses. When a patient’s need for assistance isn’t met promptly, it can result in patient falls and increased pain, as well as complaints from patients and families.1-3,4,13-15 It should be noted that the HCAHPS survey includes questions about pain control and assistance to the restroom.13 As noted, patients often measure their satisfaction with hospital care based on factors such as staff responsiveness to their needs and prompt answering of the call bell. The call bell is a “lifeline” for a hospital patient.15 It is how the patient summons the nurse for assistance or information. Patients expect that when they push the call bell, the nurse will come promptly. But busy caregivers may find it time-consuming to answer call bells. Also, every time a nurse tells a patient, “Call me if you need anything,” she or he seems to be giving up control of her time to the patient.15 Because of the expectations of patients for assistance and attention as well as the need for nurses to

34 | OR TODAY | JANUARY 2018

The P’s of Rounding1,8,17-21 Basic P’s of rounding: PAIN: Address patient’s pain at every round; use scale of 1-10; document medication given and when next dose is due on the room communication board. Explain pain medication, adverse effects, dose. Tell patient, “I will round on you every hour to make sure your pain is under control.” POTTY: Offer patient assistance with restroom needs. Caution not to get out of bed alone. Ask, “Do you need to use the restroom now? May I help you to the restroom?” POSITION: Assess patient position and reposition as needed for comfort. Help patient into or out of bed, into or out of chair, and turn. Ask, “Is there anything I can do to make you more comfortable?”

Other P’s that can be used: PUMP: Check IV and other pumps to ensure that everything is working correctly so alarms do not go off. PERIPHERY: Assess patient room: tidy up, clear clutter, straighten bed, fluff pillows, remove used linen. Ensure that telephone, call light, TV control, and wastebasket are within reach. PLAN: Review patient agenda or plan of care with patient. Update on tests and treatments; discuss needs at home; plan for discharge. Ask patient, “What is the most important thing I can do for you today?” and update the communication board. POSSESSIONS: Make sure the patient’s belongings are within reach. Make sure that items, such as dentures and hearing aids, have labeled containers for safekeeping when patient isn’t using these items. Secure patient valuables. PARTING: Before leaving room ask the patient, “Is there anything else I can do for you before I leave? I have the time.” Explain that you will be back again in an hour and that during the night you will round on them every two hours, even if they are sleeping. Document the round on the rounding log in the room.

have some control over their activities, it became important to find a way to satisfy both patients and nurses while meeting the legitimate needs of both. Rounding fills this need in the inpatient setting. Rounding allows the nurse to focus on the needs of each patient so he or she gets the full attention of the nurse. During the round, the nurse will address all patient needs, including pain, restroom, comfort and position, information, treatments, and medications so that when the round is complete, all the patient’s needs have been met.1

Purposeful Hourly Rounding Hourly rounding means visiting patients every hour to proactively take care of their needs, with rounding modified to every two hours overnight.1 Often the word “purposeful” is used along with hourly rounding to indicate that rounding requires specific actions and words, or scripting, on the part of the nurse who is rounding. Rounding is different from just checking to see if a patient needs anything. Instead, rounding is purposeful. By asking the patient about specific things during each round, nurses can antici-

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IN THE OR

continuing education

pate patient needs instead of reacting to patient needs by waiting for the patient to use the call bell.1-4,14-18 The tasks of rounding are organized using the letter P. The three basic P’s of rounding are pain, potty, and position, which are the three basic needs common to most patients. These three P’s are universal and used in most hospitals that use hourly rounding as their patient care model. Other P’s can be added, based on the preferences of each hospital.11,13,16

medication passes and treatments, into those P’s.8,16-21

Types of Rounding Three types of rounds occur during each shift: introductory (which can include bedside shift report), initial, and hourly. Let’s examine each type. The introductory round is just what it says, a round to introduce the oncoming nurse by the outgoing nurse. The process allows the oncoming nurse to be “man-

an excellent nurse, one of our best. She will take very good care of you today.” A statement like this from the outgoing nurse sets up the oncoming nurse as competent and lets patients feel they are in good hands.13,18,19 The introductory round can be included as part of the bedside shift report or can take the form of the outgoing and incoming nurse’s visiting each patient together at change of shift for introductions and a quick check of the patient’s

Types of Rounding1,13,16-19 Type of Round

Different Behaviors

Commonalities

INTRODUCTORY ROUND

•

Off-going and on-coming nurse go to each patient room together. Off-going nurse introduces on-coming nurse and “manages up.” Nurses conduct shift report at bedside. On-coming nurse closes round by saying, “I’ll be back to round on you as soon as I’ve met all of my other patients.”

Ask about P’s Conduct environmental scan

• • •

INITIAL ROUND

• • •

Washes/foams hands on entry to room Introduction: explains hourly rounding to patient Asks patient, “What’s the most important thing I can do for you today?

Ask about P’s Environmental scan Parting Mark off round on in-room rounding log

HOURLY ROUND

•

Night-shift rounds (2300) explain to patients that you will round every two hours through the night You will come into to room to check that they are safe but will not wake them.

Same until 10 p.m., then modified for overnight hours (2300 to 0600). Resume regular hourly rounding schedule at 0600.

•

Other P’s for rounding include “pump, periphery, plan of the day, possessions.” Using words beginning with P makes the tasks of rounding easy to remember. When rounding, it is best to limit the number of P’s so it is easier for staff to remember the tasks associated with rounding. Most hospitals choose four or five P’s as their focus for rounds and incorporate all patient care tasks, including WWW.ORTODAY.COM

aged up” by her colleague who is leaving and increases the patient’s confidence in the oncoming nurse. Managing up means that the outgoing nurse introduces the oncoming nurse by highlighting the nurse’s strengths. An example of this is: “Hello, Mrs. Jones, I’m going home now, but I wanted to introduce Kelly, who will be taking care of you today. She has worked here for three years and is

well-being. As part of the introductory round, the outgoing and oncoming nurse visit all their patients together at shift change and give shift change report. The outgoing nurse can then leave, and the oncoming nurse can begin his or her initial rounds.13,16,18,19 The initial round is the first hourly round of each shift, and it is done after the outgoing and oncoming nurses JANUARY 2018 | OR TODAY |

IN THE OR

continuing education

complete the introductory rounds. The initial round includes all the dialogue and actions that are part of a regular hourly round with the addition of two important elements. First, the initial round should include an explanation to the patient of what hourly rounding is. This way, the patient understands rounding and knows that it is purposeful. Second, during this initial round that the nurse should ask each patient, “What is the most important thing that I can do for you today?” The MIT may be something as simple as making a phone call to check on the status of a patient’s pet or checking with the physician to see if the patient can have regular instead of decaf coffee. Asking for the MIT shows patients that their priorities are important and will be addressed along with their medical treatment. The MIT is usually written on the patient’s communication board so the nurse can focus on ensuring the MIT is carried out. Each oncoming nurse should ask about the MIT as part of the initial round, as the patient’s MIT likely will change shift to shift.13,16-19 The regular hourly round is done every hour for the remainder of the shift. The hourly round is performed in the same way at most hospitals although the P’s used may vary. The hourly round is performed every hour addressing the P’s from 0600 to 2200. At night, the nurse can set up the overnight expectation for rounding by telling the patient that he or she will round every two hours from 2200 until 0600. The nurse will come into rooms quietly and check that patients are safe, but will not waken them if they are sleeping. The nurse will sign the rounding log at each round so the patient can see that the round happened during the night. Rounds return to every hour beginning at 0600.13,16-21

Communication An important part of every round is nurse-patient communication. One way to encourage this is with a communication board. At many hospitals where

36 | OR TODAY | JANUARY 2018

rounding is practiced, a glass dry-erase communication board is installed in patient rooms to help with communication. Typically, these wall-mounted boards, often called white boards, contain basic information for the patient, including date, room number, room telephone number, and names and phone numbers of nurse, nurse tech, and nurse manager. A possible discharge date is often included. Other information on white boards can include pain level, meds for pain and the schedule of the next dose, the MIT, and information about the plan for the day, including tests and treatments. Information on these boards is updated at the start of each shift and communicated by the nurse to the patient so the patient understands what is going to happen each day, who his or her care team is, and what the goals for pain control are.17 Another communication tool often used with rounding is the in-room rounding log. This log is often paper and is posted on the wall inside the room. The log has spaces for each hour where the nurse can write his or her initials to note that the round was completed. These in-room rounding logs let patients know that rounding has occurred even if they were asleep.2,13-18

the round. Patients know that the nurse is there to do an hourly round and can expect that the nurse will address the P’s. By telling the patient what the P’s are, the nurse is letting them know that their basic needs are important and will be addressed every hour.9,16-19 Nurses also should round using the concept of “nursing out loud.” NOL means talking as you perform the round. For example, “I’m pulling the curtain for your privacy.” Or “Let me check your pitcher to be sure you have enough water and ice.” By talking through what they are doing, nurses let the patient know what they are doing and why, which allows for better communication between patient and nurse.19 Rounding helps nurses organize patient care so that all patient needs in areas of pain, restroom, position, information, room orderliness, and patient requests can be addressed during the round. Once all these things are done for the patient during the round, the nurse can move on to round on the next patient and know that the patient is comfortable. Patients also know that the nurse will be in to round on them on a regular schedule, so they are less likely to use the call light.1-3,4,15-19

Rounding Process and Scripting

Into Action

Hourly rounding is a formal process that requires key actions and words during each round. It is important to use key words at key times. For example, when entering a room for a round, the nurse should say, “I am here to do my hourly round” and explain hourly rounding and the P’s to the patient. When finishing the round, the nurse should say, “Is there anything else I can do for you before I leave? I have the time.” Then, when the nurse is ready to leave the room, he or she should say, “I’ll be back in an hour to round on you.” During the initial round, a key phrase the nurse should use is “What’s the most important thing I can do for you today?” These key words at key times help set up expectations for

Implementation of purposeful hourly rounding can be difficult. You must have the nursing leadership team’s support because you will need its help in getting rounding started on inpatient units. Research indicates that nurses need to be involved in the implementation of rounding and have ownership of it. Management needs to communicate clearly about rounding and its benefits.9,19-21 At the beginning of implementation, nurses may view hourly rounding as more work for them instead of as a way of reorganizing their work and making their time in a patient’s room more purposeful. Also, nurses often don’t understand that regular tasks, such as medication passing, can be integrated into the hourly WWW.ORTODAY.COM

IN THE OR

continuing education

rounding process, not done outside the round. Careful communication about the benefits of rounding for both nurses and patients should take place to help nurses understand the why of rounding. Communicating the why is essential in getting hourly rounding established on a patient care unit. Nurses want to do what’s best for their patients, and when they understand the benefits, such as a reduction in falls and skin breakdown, as well as time savings for them, they are more likely to adopt the practice willingly.2,3-4,15-21 Communicating the why and benefits to the nurse, such as reducing the interruptions of call lights, answers the “what’s in it for me?” question. Nurse leaders should clearly explain to nurses that purposeful hourly rounding seeks to reduce patient calls, because nurses are anticipating patient needs and being proactive in addressing them.1-4,15-21 Staff training will be needed to demonstrate what rounding looks and sounds like. The training skills labs will need to be repeated quarterly until rounding is fully established on each unit. As noted above, part of rounding training includes scripting, or providing specific words that staff use when rounding. Rounding will need to be validated on each unit daily to ensure that staff are not only rounding, but doing it correctly.1,2,13-16

Rounding Verification As rounding is being implemented, it is essential to verify that hourly rounding is being done purposefully and correctly. Nurse leaders can validate that nurses are rounding effectively through nurse leader rounding. Nurse leader rounding is done on every patient every day by the nurse manager. One of the key purposes of nurse leader rounding is for the nurse leader to visit each patient daily and ask whether the nursing staff are effectively addressing the tasks of rounding (pain, potty, position). Nurse leaders round using a rounding log that lists patients’ names and room numbers. The log includes columns WWW.ORTODAY.COM

with questions nurse leader can ask patients about rounding behaviors, such as pain control, toileting, personal comfort, hygiene, and call bell use.18,19 Answers to these questions can provide the nurse leader with information about how each nurse is practicing rounding and where coaching may be needed to improve rounding practice. The nurse leader also assesses the appearance of the patient room during the round. After nurse leader rounding is completed, the nurse leader can follow up with nurses and coach them as needed on their rounding based on the feedback from patients. Nurses who are rounding well can be praised. Nurse leader rounding is not done to “catch” nurses not performing hourly rounding, but rather to affirm that hourly rounding is being done in a purposeful way and is addressing patient needs efffectively.2,18,19 Successful implementation of hourly rounding can be assessed by looking at scores on patient satisfaction surveys, such as HCAHPS.13 A nonstandard HCAHPS survey question, “Did the nurse visit you every hour?” is designed to provide information from a patient about whether rounding took place during his or her hospital stay. Some hospitals choose to add the above nonstandard question to their HCAHPS survey to directly measure rounding. When used on the survey, this question is worded as above. This question is noted as nonstandard because it is not part of the required HCAHPS survey but an option that can be added.10 Tracking the “yes” responses will provide information about the implementation of rounding on a hospital unit and in the hospital overall. As rounding becomes hardwired on a unit, the number of “yes” answers to this questions should increase. Scores of 90% or more on “yes” responses on this HCAHPS question indicate that hourly rounding is being performed effectively on a patient care unit.13,19

Rounding Outcomes Studies have shown that when purposeful hourly rounding is implemented effectively, the frequency of patient call lights should decrease by as much as 65%, patient falls by 65%, and pressure ulcers and skin breakdown to almost none.1-7,16-19 Similarly, patient satisfaction at hospitals and on units with hourly rounding usually improves dramatically. Hospitals where hourly rounding is implemented fully have reported that their patient satisfaction scores have increased as much as 30 to 40 points and that the increase has been maintained over time. Nurses also report satisfaction with rounding since they aren’t interrupted so often with call bells. Reduction in nurse fatigue has also been reported because nurses aren’t running around as much answering call bells. Staff overtime has also been reduced at some hospitals with rounding because nurses can organize their work and manage their time better.1-5,9,11-12,16 While the implementation of hourly rounding can be difficult at first, once it is fully hardwired, the benefits to both nurses and patients are well documented. Today’s nurses must be aware of the importance of hourly rounding given the proven impact of this nurse-driven intervention on patient satisfaction. OnCourse Learning guarantees this educational activity is free from bias. Lynn Deitrick, PhD, RN, is a nurse-anthropologist who has worked in the field of patient satisfaction and patient experience for more than 13 years. She has published more than 25 articles in peer-reviewed journals on topics, including call bells, patient satisfaction, and hourly rounding, and has presented on these topics at numerous professional conferences.

References 1.

Meade CM, Bursell AL, Ketelsen L. Effects of nursing rounds on patients’ call light use, satisfaction and safety. Am J Nurs. JANUARY 2018 | OR TODAY |

IN THE OR

continuing education

2006;106(9):58-70. Deitrick L, Baker K, Paxton H, Flores M, Swavely D. Hourly rounding: challenges with implementation of an evidence-based process. J Nurs Care Qual. 2012;27(1):13-19. doi:10.1097/ NCQ.0b013e318227d7dd. Rondinelli J, Ecker M, Crawford C, Seelinger A, Omery A. Hourly rounding: a multisite description of structures, processes, and outcomes. JONA. 2012;42(6):326-332. doi: 10.1097/

NNA.0b013e31824ccd43. Olrich T, Kalman M, Nigolian C. Hourly rounding: a replication study. MedSurg Nurs. 2012;21(1):23-36. Bourgault AM, King MM, Hart P, Campbell M, Swartz S, Lou M. Circle of excellence. Does regular rounding by nursing associates boost patient satisfaction? Nurs Manage. 2008;39(11):18-24. doi: 10.1097/01. NUMA.0000340814.83152.35. Torres SM. Rapid-cycle process reduces patient call bell use, improves patient

satisfaction, and anticipate patient’s needs. J Nurs Adm. 2007;37(11):480-482. doi: 10.1097/01.NNA.0000295609.94699.76. Tea C, Ellison M, Feghali F. Proactive patient rounding to increase customer service and satisfaction on an orthopedic unit. Orthop Nurs. 2008;27(4):233-240. doi: 10.1097/01.NOR.0000330305.45361.45. Nursing: quality and safety: purposeful rounding. Stanford Health Care Web site. https://stanfordhealthcare.org/healthcare-professionals/nursing/quality-safety/

Clinical Vignette for CE711 You have been hearing a lot about hourly rounding and the positive effect is has on clinical outcomes at other hospitals in the area. You are the nurse executive who has been assigned by the chief nursing officer the task of implementing hourly rounding at your hospital. You have been told that you need to have a plan for rounding implementation ready for approval in one month.

1 W hat is an important first step in planning for

hourly rounding? a. D ecide what rounding P’s you will use at your hospital b. Explain rounding to nurse managers and get their buy-in c. Tell everyone they must start rounding immediately d. G et the support of the nursing leadership team for the initiative

2 What is a documented outcome of rounding? a. A reduction in nurse paperwork b. A reduction in infiltrated IVs c. A more efficient unit discharge process d. A reduction in patient call lights

3 For nurses to understand the importance of rounding, it is important to: a. C learly communicate to nurses the benefits of rounding for nurses and patients

b. M andate from the top that this is what is going to be done c. Tell nurses that they MUST round, no excuses d. Threaten to take disciplinary action against nurses who don’t round

4 Scripting and the use of key words at key

times is an important aspect of successful rounding implementation. When discussing rounding with nursing leadership, you get objections to scripting and using key words at key times. You tell the team that: a. N urses can say what they want as long as they round every hour. b. I t’s important for nurses to adapt their rounds to their own personal style. c. I t doesn’t matter what the nurses say as long as they get the rounding done using the P’s. d. Scripting helps nurses make sure they don’t forget any of the steps of rounding.

1. Answer D. You must have the support of the nursing leadership team to get started since you will need its help in getting rounding started on inpatient units. 2. Answer D. A reduction in patient call lights has been documented in the literature. 3. A nswer A. Nurses need to understand the WHY for their patients as well as the “what’s in it for me.” Once nurses understand that rounding will have benefits for them during the workday, they are more likely to cooperate in the implementation process. 4. Answer: D. Key words at key times are essential to the success of rounding. Without scripting, rounding can become too casual, and some of the key components of the process, such as the most important thing (MIT), may be lost if said in a different way.

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CE711

How to Earn Continuing Education Credit

10. 11. 12.

13.

14.

15.

16.

17. 18.

19.

20.

21.

purposeful-rounding.html. Accessed December 21, 2016. Mitchell MD, Lavenberg JG, Trotta RL, Umsheid CA. Hourly rounding to improve nursing responsiveness: a systematic review. J Nurs Admin. 2014;44(9):462-472. doi: 10.1097/ NNA.0000000000000101. Sheedy S. Responding to patients: the unit hostess. J Nurs Admin. 1989;19(4):31-33. Oliver RL. Satisfaction: A Behavioral Perspective on the Consumer. New York, NY: McGraw-Hill; 1999:28 Taylor SA. Distinguishing service quality from patient satisfaction in developing healthcare marketing strategies. Hosp Health Services Admin. 1994;39(2):221-236. HCAHPS fact sheet. Hospital Consumer Assessment of Healthcare Providers and Systems Web site. http://www.hcahpsonline.org. Accessed December 21, 2016. Deitrick LM, Capuano TA, Paxton SS, Stern G, Dunleavy J, Miller WL. Becoming a leader in patient satisfaction: changing the culture of care in an academic community hospital. Health Mark Q. 2006;23(3):31-57. doi: 10.1300/J026v23n02_03. Deitrick L, Bokovoy J, Stern G, Panik A. Dance of the call bells: using ethnography to evaluate patient satisfaction with quality of care. J Nurs Care Qual. 2006;21(4):316-324. Proactive patient rounding reduces call light use and falls, eliminates pressure ulcers and enhances patient and staff satisfaction. Agency for Healthcare Research and Quality Web site. https://innovations. ahrq.gov/profiles/proactive-patient-rounding-reduces-call-light-useand-falls-eliminates-pressure-ulcers-and. Updated June 18, 2014. Accessed December 21, 2016. Ford B. Hourly rounding: a strategy to improve patient satisfaction scores. Medsurg Nurs. 2010;19(3):188-191. Hancock KK. From the bedside: purposeful rounding essential for patient experience. Association for Patient Experience Web site. http://www.patient-experience.org/Resources/Newsletter/ Newsletters/Articles/2014/From-the-Bedside-Purposeful-RoundingEssential-to.aspx. Published February 27, 2014. Accessed December 21, 2016. Ketelsen L, Cook K, Kennedy B. The HCAHPS Handbook. 2nd ed. Tactics to improve quality and the patient experience: Gulf Breeze, FL: FireStarter Publishing; 2014. Fabry D. Hourly rounding: perspectives and perceptions of the frontline nursing staff. J Nurs Manag. 2015;23:200-210. doi: 10.1111/jonm.12114. Brosey LA, March KS. Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. J Nurs Care Qual. 2015;30(2):153-

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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 https://www.nurse.com/ sign-up for $49.95 per year.

Deadline Courses must be completed by 1/31/2019 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).â&#x20AC;? OnCourse Learningâ&#x20AC;&#x2122;s continuing education courses are accepted by the Georgia Board of Nursing. OnCourse Learning is approved by the California Board of Registered Nursing, provider #CEP16588.

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

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

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minimizing

ORNOISE &DISTRACTIONS

By Don Sadler

If asked whether they would prefer to perform their jobs in a quiet, distraction-free environment or a loud, distracted environment, most people will probably choose the former. This includes the surgeons and perioperative nurses who perform incredibly complex and detailed tasks upon which lives are dependent. So, itâ&#x20AC;&#x2122;s somewhat surprising that noise levels in operating rooms frequently exceed the EPAâ&#x20AC;&#x2122;s recommended level for continuous background noise in hospitals.

Interrupting Patient Care

Excessive noise in the OR can be harmful to patients and OR personnel, says Mary J. Ogg, MSN, RN, CNOR, Senior Perioperative Practice Specialist with the Association of periOperative Registered Nurses (AORN). “Noise is a distraction that interrupts patient care and potentially increases the risk for error,” says Ogg. “It may minimize the ability of OR team members to communicate effectively, making it difficult to understand content and contributing to miscommunication.” Noise and distractions in the OR increase the possibility of adverse patient outcomes by “diverting attention from the current task of a team member, which could lead to omissions and mental lapses,” adds Ogg. “This is especially relevant during critical phases of the surgical procedure.” Such critical phases include timeout periods, critical dissections, surgical counts, confirming and opening of implants, induction and emergence from anesthesia, and care and handling of specimens. One study evaluating OR noise levels during hernia repairs found that noise levels were substantially higher during wound closure for patients who developed surgical site infections.

“ NOISE IS A DISTRACTION THAT INTERRUPTS PATIENT CARE AND POTENTIALLY INCREASES THE RISK FOR ERROR.” O G G

Another study found that when the average noise level during OR trauma surgeries is 85 decibels (dBs), distractions and interruptions occurred an average of 60.8 times during the procedure. And another study determined that the noisiest periods during surgery are associated with induction and emergence of anesthesia. Noise negatively impacts concentration and

tively,” says Erin Lawler, MS, CPPS, Human Factors Engineer with the Office of Quality and Patient Safety, Division of Healthcare Improvement, The Joint Commission. “This not only impacts productivity and efficiency, but it also contributes to adverse patient events,” adds Lawler.

Common Sources of OR Noise

Ogg lists a number of different sources of noise and distractions in the OR, including the following:

M a ry Og g

Senior Perioperative Practice work among anesthesiologists, the survey found, and hinders the ability to detect signals from monitors and other equipment. In a lab study simulating OR background noise, there was a 17 percent reduction in the accuracy of anesthesia residents in detecting changes in saturation on a pulse oximeter.

Noise Impacts on OR Staff

Excessive OR noise and distractions can also negatively impact OR staff. “Noise in the OR is associated with job dissatisfaction, irritability, tachycardia, anxiety, fatigue, illnesses, stress, emotional exhaustion, burnout and injury,” says Ogg. “High noise levels in the OR can interfere with concentration and make it difficult to hear and discern information and communicate effec-

Medical equipment devices such as radiology equipment, waste management systems, smoke evacuators, powered surgical instruments, monitors, clinical and alert alarms, and dropped metal instruments. Fixed communication devices such as overhead pages and announcements and landline telephones in the OR. Environmental devices such as HVAC systems and pneumatic tube systems. Personal communication and electronic music devices such as cellphones, pagers, personal digital assistants and digital audio players. Behavioral activities by OR personnel such as having non-case relevant conversations and walking in and out of the OR during procedures. Electronic activities by OR staff such as emailing, texting, posting on social media, surfing the Internet and playing games.

According to The Joint Commission, the EPA’s recommended level for continuous background noise in hospitals is 45 decibels (dB). However, one study measuring noise levels in OR trauma procedures found that average noise levels were 85 dB, or almost double this recommendation, and reached as high as 130 dB. The highest sustained background noise levels tend to occur during orthopedic surgery and neurosurgery

procedures. Intermittent peak noise levels exceed 100dB more than 40 percent of the time during these procedures, The Joint Commission notes.

Lawler and Ogg suggest the following steps for reducing OR noise and distractions:

Patient and Surgical Safety Risks A study published in the Journal of the American College of Surgeons in 2013 was the first to demonstrate the patient and surgical safety risks posed by ambient background noise in the OR.

“The operating room is a very fastpaced, high-demand, all senses running on all cylinders type of environment,” stated study coauthor Matthew Bush, MD, assistant professor of surgery at the University of Kentucky Medical Center, upon the study’s publication. “To minimize errors of communication, it is essential that we consider very carefully the listening environment we are promoting in the OR,” added Bush. In this study, researchers created a noise environment similar to that of an OR and tested surgeons with a wide range of surgical experience. It concluded that background noise – and music in particular – resulted

E rin Law le r

Human Factors Engineer mistakes,” added Bush.

How to Reduce Noise and Distractions

Given that miscommunication is one of the most common causes of preventable medical errors, there has been a concerted effort by some health care organizations to limit ambient

“ ALL TEAM MEMBERS SHOULD FEEL EMPOWERED TO SPEAK UP AND ASK FOR SILENCE IF THEY FEEL LIKE OR NOISE AND DISTRACTIONS ARE BECOMING EXCESSIVE.” L A W L E R in a significant decrease in speech comprehension when the words were unpredictable. “Our main goal is to increase awareness that operating room noise does affect communication,” said Bush. “The surgical team needs to work diligently to create the safest environment possible.” “That step may mean either turning the music off or down, or limiting background conversations or other things in the environment that could lead to communication errors and medical

background noise in the OR. “The first step is to determine if there is a noise problem in the OR,” says Lawler. She recommends using a sound level meter or a dosimeter to measure OR noise levels. “It’s important to identify and understand sources of noise within the environment, including any nuisance sources,” says Lawler. “Then, you can employ a systems-based program to address the sources of noise and foster a culture to decrease noise.”

Create a no-interruption zone where nonessential conversation and activities are prohibited during the critical phases of the surgical procedure. Insist that personal communication and electronic music devices like those listed above be placed on vibrate or silent mode during surgical procedures. Better yet, they should be turned off or left outside the OR if they aren’t needed for the procedure. Use fixed communication devices only for essential communication, and make sure they’re turned down to the lowest volume. Evaluate the level of noise generated by medical equipment devices during the purchase evaluation decision and consider equipment alternatives that produce less noise whenever possible. Provide simulation and training to enhance OR staff members’ focused attention skills in the presence of continuous and intermittent noise and distractions. Use care to quietly place metal instruments in trays, instead of loudly dropping instruments in trays. Limit the amount of foot traffic going in and out of the OR during surgical procedures.

“Small adjustments can make a big difference,” says Lawler. “OR staff should practice effective team training and communication to ensure that information has been effectively received. “And all team members should feel empowered to speak up and ask for silence if they feel like OR noise and distractions are becoming excessive,” Lawler adds.

SPOTLIGHT ON

MELISSA

MORDECAI

RN, MSN, APN, ACMP-BC Director of Post-Acute Care Integration, Jefferson Health

BY MATT SKOUFALOS

rom her public school nurses to her cheerleading coach to her pediatrician, Melissa Mordecai said she’s always had very positive interactions with health care professionals. When it was her time to choose a career, Mordecai, who started college as a business administration major, said the choice to pivot into nursing helped her find a vocation that’s given her room to grow.

“I wouldn’t change the past 16 years for anything,” she said. “I’ve been very proud of the teams that I’ve been on or the accomplishments that they have.” “I’m always asked what made me go to nursing school, and to be quite honest, it was more of a necessity than it was my calling,” Mordecai said. “In hindsight, all my role models in life were nurses; I didn’t realize until I went into nursing who those people were.” In 16 years as a nursing professional, Mordecai has gone from a college graduate finding her rhythm in a fledgling career into a master’s-degreed leadership role in a large, regional health system. She began as an ER nurse at St. Peter’s University Hospital in New Brunswick, New Jersey; a position into which she grew from being an ER technician there during nursing school. Mordecai said her fondest

46 | OR TODAY | JANUARY 2018

recollections of the job involved her responsibilities for “taking care of people when they really needed you the most,” but the emergency room also was a valuable vocational stepping stone. When the opportunity to grow into additional positions in the facility arose, Mordecai began working as a clinical analyst, helping her department make the transition to an electronic health record system. In almost no time, she’d parlayed a weekly, volunteer committee appointment into a full-time position. “I haven’t been in the ER in the last eight years, but I still relate to that as part of my identity,” Mordecai said. “Any opportunity I had to make a difference, I participated. I’m a lifelong learner; I’m always looking for opportunities to learn something new.” “I embrace change,” she said. “It’s my drive and my motivation. When I’m taking care of them, I want people to feel confident and trust that I’m helping do what’s best for them.” Eventually, Mordecai’s embracing attitude toward change led her to a position with a Staten Island hospital. More than an opportunity to grow her management experience, Mordecai saw it as a chance to learn how a different health system approached patient care. Unexpectedly, it proved to be the place where she met, Russell, an emergency orthopedist who would become her husband. The couple

relocated to southern New Jersey, and Melissa took a job at a private practice office in Philadelphia. While Russell studied to be an orthopedist, she took the opportunity to pursue her nurse practitioner’s certificate. Looking back on it, Melissa Mordecai remembered, “it was the right time to be busy.” “He was busy studying, I was studying; it complemented each other,” she said. Eventually, the couple had children, and Melissa decided she wanted to work closer to home. In 2012, she left the private practice office to join the Kennedy Health System in Cherry Hill, New Jersey, as the nurse practitioner for its Acute Care for Elders (ACE) unit, a geriatric floor of specialized care. Kennedy eventually merged with the Thomas Jefferson University Health System, and Mordecai was named Director of Post-Acute Care Integration at Jefferson Health. She’s spent the past year in the role. Administratively, she is called on to deal with the health system’s post-acute partners, including long-term and home care providers, to help patients after they’re discharged from the hospital. Her chief task is to help clinically integrate their care needs at home to make sure the patients don’t require re-admittance. Despite her oversight responsibilities, Mordecai makes it a point to see patients eight hours a week in a nursing home environment to maintain her clinical skills and focus on patient care. After nearly

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Melissa, her husband, and their two daughters.

17 years on the job, she’s seen those in her care present with ever more complex cases. “They have more resource needs,” she said; “things we take for granted. [For example], sometimes nurses go for home visits and the patients don’t have food in the fridge. As the population is aging, they’re getting more and more complex, and they have more social needs on top of their chronic medical conditions, which are also complex.” In dealing with a geriatric population, Mordecai has become comfortable brokering uncomfortable conversations around those complicated cases. Where some families may struggle with “having the goals-of-care conversation or the end-oflife conversation,” as she puts it, Mordecai has an ability to connect with her patients and their caregivers about developing the most comfortable course of care delivery for their needs. It’s an area of strength she’s had the opportunity to cultivate personally thanks to her advanced professional training, which is something she stresses with younger nurses. “I think personal development is important,” Mordecai said. “The hospital has me on a leadership course. I do pay attention and I do read, just to improve my skills as a leader, and building the right team. We have a good foundation but we need more people. Nursing may not be the calling for everybody, but it is still a great opportunity, and I wish young people could see that advantage.” WWW.ORTODAY.COM

JANUARY 2018 | OR TODAY |

OUT OF THE OR fitness

Take a hike

for better health

ou don’t need to summit Mount Everest to net the many benefits of hiking. Even a moderate one-hour hike can burn around 400 calories, all while sculpting your core and lower body. And as the elevation goes up, so do the benefits.

Find a trail near you at www.hikingproject.com, which features GPS and elevation data and user-generated tips for almost 14,000 beginner to advanced trails. (Just remember to download your route from the app in case you lose reception.) Grab a granola bar and set out to tap these powerful rewards.

Your legs will never look better. “Trekking up a mountain is a lot like climbing the stairclimber or doing lunges over and over, which strengthens your glutes, quads, hamstrings and calves,” says Joel Martin, Ph.D., an assistant professor of exercise, fitness and health promotion at George Mason University. But traveling downhill is what really leaves your legs sore, then sculpted. “To go downhill, your glutes and quads need to do a lot of slow, controlled work to stabilize your knees and hips so you don’t fall,” Martin says. “These types of contractions damage muscle fibers the most because you’re resisting the force of gravity against weight.” This means that while you probably won’t huff and puff on the descent, your muscles aren’t getting a second to slack off.

48 | OR TODAY | JANUARY 2018

Every step firms your core. Navigating tough terrain also requires your abs, obliques and lower back to work to keep your body stabilized and upright – even more so if you’re carrying a backpack. “A heavier bag – around eight to 10 pounds – makes you more unstable, so your core muscles need to work harder,” Martin says. You’ll burn calories regardless (anywhere from 400 to 800 an hour, depending on the trail, he says).

“People who spent 50 minutes walking through nature reported less anxiety and more happiness compared with those who walked near traffic.”

It’s killer cross-training. Whether you’re prepping for a race or not, scheduling some hikes can up your running and cycling game. “Cyclists tend to have strong quads but underdeveloped hamstrings, and runners tend to have weak hamstrings

and glutes,” Martin says. “Hiking helps strengthen these muscles to eliminate those types of imbalances.”

It gets you moving better. Hiking forces you to move every which way, as you climb over fallen trees and sidestep slippery rocks. “By doing things that require you to move in multiple directions, you strengthen the stabilizing muscles that fire to prevent common injuries,” Martin says. Think about it: Most everyday injuries occur when people quickly shift from one plane of motion to another, such as when they reach over to pick up a heavy object and pull a back muscle.

It’s a happy pill. Know that feeling you get when you see a beautiful waterfall or gaze out from atop a mountain? Research shows that such experiences benefit your state of mind: People who spent 50 minutes walking through nature reported less anxiety and more happiness compared with those who walked near traffic, according to a study in the journal Landscape and Urban Planning. And because exercise produces endorphins (known as the happiness hormone), actually moving through nature takes the feel-good benefits to a new level. Courtesy of shape.com

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OUT OF THE OR health

8 tips to master portion control Studies show that slicing

ENVIRONMENTAL NUTRITION rom restaurants to packaged foods to home cooking, portion sizes have ballooned in past decades. Many health experts link the rise in obesity rates with our tendency towards portion distortion – a mismatch between our portion sizes and energy needs. Research by the University of Cambridge found that less availability of super-sized portions alone could reduce Americans’ caloric intake by 29 percent.

“Instead of focusing on complicated diets and deprivation, simply eating less through better portion control is one of the best strategies people can take towards dropping pounds,” says Lisa R. Young, Ph.D., R.D., adjunct nutrition professor at New York University and author of “The Portion Teller Plan.” The portions we eat are strongly influenced by our environment. So, make these tweaks to your eating habits to reclaim portion control.

1.Pay attention.

Thumbing through your smartphone or watching your favorite TV show while noshing is not the innocent habit you think it is. A 2017 study in the Journal of the Academy of Nutrition and Dietetics found that adults who never watch TV or videos

50 | OR TODAY | JANUARY 2018

during meals were 37 percent less likely to be obese than their peers who always ate in front of a screen. “Anytime your eyes and brain are distracted when food is sitting in front of you, you’re more likely to munch mindlessly and eat more than you need,” says Young.

up items such as pizza and bagels into several smaller pieces decreases food consumption and calorie intake.

2.Keep your distance.

At your next meal, try this suggestion from Cornell University: Keep serving dishes away from the dining table. The scientists found that women and men ate on average 20 percent and 29 percent fewer calories, respectively, when food was served from the countertop rather than from their table. It’s a case of “out of sight, out of mind.”

3.Downsize your dinnerware.

The size of plates, bowls and glasses in American households has increased over the decades, which is a problem for waistlines, considering we eat 92 percent of the food we serve up. People served themselves 77 percent more pasta when provided larger bowls compared to using a medium-sized bowl, per a study in the Journal of Nutrition Education and Behavior. Outfit your kitchen with smaller plates (8- or 9-inch instead of the typical 10- to 12-inch size), bowls, and drinking vessels to make small portions seem more substantial.

4.Scale back.

You can’t trim your portions until you come to grips with how much you’re actually eating. Using a digital food scale can help you get a better sense of what the recommended 3 ounces of chicken or 1 ounce of cheese looks like. Measuring cups and spoons for items like granola and olive oil can also help keep portions in line.

5.Play with knives.

To cut calories from your diet cut up your food. Studies show that slicing up items such as pizza and bagels into several smaller pieces decreases food consumption and calorie intake. We tend to think of one piece of food, like a steak or muffin, as an appropriate serving size regardless of its size. “Slicing foods into several units can trick your brain into thinking you’re eating more than you actually are so you’re more likely to be satisfied with less,” Young adds. WWW.ORTODAY.COM

OUT OF THE OR health

6.Lighten up.

Save the mood lighting for date night. Research from Cornell University found that subjects who dined in a dark room consumed 36 percent more food and were less accurate in estimating how much they consumed than those who ate in a bright room. A bright space can boost alertness to encourage mindful eating, while dimmer lighting may loosen eating inhibitions and mess with satiety cues.

7.Slow down.

Eating at a snail’s pace could bring about better portion control. According to a Texas Christian University study, people who ate a meal in 22 minutes consumed 88 fewer calories and felt less hungry than those who cleaned their plates in nine minutes. “Pacing yourself allows time for your body to register satiety signals and prevents calories from adding up without realizing it,” says Young. Put utensils down between bites, chew food more thoroughly, engage in conversation, drink water with meals, and even try chopsticks to keep you at the table longer.

8.Watch out for “health halos.”

Don’t give foods like avocado, quinoa, granola and smoothies a “free pass.” Research shows that edibles portrayed as “healthy” can tempt you to let your guard down and overeat. It may be that people think of healthy foods as less filling or lower in calories, so decide more is needed to quell hunger.

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OUT OF THE OR nutrition

Eating for

kidney health

early one in seven American adults has chronic kidney disease (CKD), and millions more are at risk.

son for the Academy of Nutrition and Dietetics who works with kidney disease patients. “Getting those chronic diseases under control is an important step to avoiding kidney problems.” “The incidence of CKD in the U.S. And, since obesity is linked to both is definitely increasing,” says Michael diabetes and high blood pressure, Conrad, M.D., senior member of the excess body weight can be considered Center for Kidney Care in New Jersey, the number one preventable risk fac“and since the major risk factors for tor for developing kidney disease. CKD – diabetes, high blood pressure Since these major CKD risk factors and obesity – are on the rise, it looks are all greatly influenced by dietary like the CKD numbers are going to choices, researchers have begun to keep climbing.” take a closer look at diet as a means The kidneys have a lot of important of preventing kidney disease. jobs in the body. They remove waste “While in the past research was and extra fluid from the body, make an focused on how best to treat CKD, active form of vitamin D to support in recent years there has been greater bone health, regulate the production interest in preventing CKD in the first place, and in the role that diet and dietary The kidneys are responsible for pattern can play,” says Deidra C. Crews, M.D., maintaining acid-base balance in the Sc.M., F.A.S.N., F.A.C.P., associate professor of body. Too much acid in the blood makes medicine, Division of Nephrology at Johns the kidneys work harder, potentially Hopkins University School of Medicine. wearing them out over time. Here’s what the latest research says about diet and kidney disease of red blood cells, control pH levels, prevention: and release hormones that regulate blood pressure. The label “chronic DASH to Fight CKD. kidney disease” includes any condition The Dietary Approaches to Stop Hythat damages the kidneys and decreaspertension diet (DASH) was originally es their ability to perform these tasks. developed to lower high blood pres“Most of the people I see with sure. Recent research has shown that kidney disease have a history of people who eat a DASH-style diet are uncontrolled diabetes or high blood less likely to develop kidney disease. pressure,” says Kristen F. Gradney, DASH limits sodium to 1,500-2,300 M.H.A., R.D.N., L.D.N., a spokespermilligrams a day; emphasizes vegeta-

52 | OR TODAY | JANUARY 2018

bles, fruits and whole grains; includes fat-free or low-fat dairy products, fish, poultry, beans, nuts and vegetable oils; and limits saturated fats, sugar-sweetened beverages and sweets.

Mediterranean-style eating. A diet pattern based on foods common to the Mediterranean region, like vegetables, fruits, whole grains, nuts and seeds, seafood and extra-virgin olive oil, has been associated with lower blood pressure, improved lipid profile, and decreased inflammation – all of which are good for kidney health.

Lowering acid load. The kidneys are responsible for maintaining acid-base balance in the body. Too much acid in the blood makes the kidneys work harder, potentially wearing them out over time. While it seems logical that eating acidic foods would increase the acid load on the kidneys, the pH of a food actually has nothing to do with whether it makes your blood more acidic. For example, once they are digested, acidic citrus fruits like oranges and lemons actually decrease acid load in the bloodstream. In fact, plant foods tend to lower acid load, while animal proteins like meats and cheeses raise acid load. Both the DASH and Mediterranean dietary patterns have a lower dietary acid load then the traditional Western diet, which may be one of the reasons why they are associated with lower risk of CKD. Courtesy of Environmental Nutrition

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Recipe

recipe

Diane Rossen Worthington is an authority on new American cooking. She is the author of 18 cookbooks, including “Seriously Simple Parties,” and a James Beard Award-winning radio show host. You can contact her at www.seriouslysimple.com.

the

54 | OR TODAY | JANUARY 2018

For the sauce vierge:

For the salmon:

• 4 Roma tomatoes, seeded and diced (about 3 cups) • 1 large shallot, finely chopped • 1/2 cup chopped flat-leaf parsley • 1/2 cup chopped fresh chives • 3 tablespoons chopped fresh tarragon • 1/2 cup extra-virgin olive oil • Zest and juice of 1 large lemon • Sea salt • Coarsely ground black pepper

• 1 salmon fillet (2 to 3 pounds) • Olive oil, for brushing the salmon and for drizzling • Sea salt • Coarsely ground black pepper • 1/2 lemon Coarsely ground black pepper

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OUT OF THE OR recipe

Wild Salmon Bake with Sauce Vierge is Sustainable, light and refreshing Chef Ned Bell, of Vancouver, has penned a new book on seafood called “Lure: Sustainable Seafood Recipes from the West Coast” ($32.95, Figure 1 Publishing). Not just any seafood. Bell has made it his mission to cook only with sustainable seafood, and in his book he explains how to select and cook with sustainable seafood. He has cooked at many restaurants and now holds the title of Ocean Wise executive chef and ambassador. Ocean Wise is Vancouver’s sustainable seafood program that works with chefs to develop recipes. What is sustainable seafood? According to www. davidsuzuki.org, it is defined as “seafood fished or farmed in a manner that can maintain or increase production in the long term, without jeopardizing the health or function of the web of life in our oceans.” “Lure” gives the reader a thorough understanding of sustainable seafood guidelines with recommended apps

to download to always make sure you are buying sustainable. While the book features Pacific coast seafood, it is easy enough to find alternatives, no matter where you live. Bell’s simple recipes and techniques can be seen in this baked salmon recipe. Bell bakes the whole salmon filet with a simple glistening of olive oil brushed on top of the fish. I love the lemon, which is also baked to serve alongside the salmon. Sauce vierge is originally a recipe introduced in the 1980s by Michel Guerard, a French chef, author and one of the founders of nouvelle cuisine. Uncooked and loaded with herbs, this classic French sauce is lighter than the usual creamy French sauces. Look for bright red Roma tomatoes and the freshest herbs you can find. I like to present the salmon on a rectangular platter, garnished with the lemon and sauce. Serve remaining sauce on the side.

Wild Salmon Bake with Sauce Vierge Serves 8 1.

For the sauce: Combine all the ingredients in a large bowl. Season to taste. Set aside to marinate for 30 minutes.

2. Preheat the oven to 350 F. Line a baking sheet with parchment paper. Brush the skin of the salmon with olive oil, and season both sides with salt and pepper. 3. Place the salmon skin side down onto the prepared baking sheet. Add the lemon (cut side up) WWW.ORTODAY.COM

beside the salmon, and bake for about 20 minutes, depending on the thickness of fish. An instantread thermometer inserted in the thickest part should read 120 F to 125 F. Set aside to rest for 2 to 3 minutes. 4. Add a few generous spoonfuls of sauce vierge on top, drizzle with olive oil, and serve with the charred lemon. Serve remaining sauce on the side. JANUARY 2018 | OR TODAY |

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56 | OR TODAY | JANUARY 2018

Thank you so much, Karely Karely Deal, RN, Center Director

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The News and Photos that Caught Our Eye This Month

OUT OF THE OR pinboard

Clever mom keeps kids on track with ‘the Fear: The Hidden Killer placebo effect’ Alicae. Ximost apellen ditiam If you have never been to the ut voluptatur, tem apiti ditium eum Texas State Fair, you don’t know eosae inum, evelestibus. what you are missing. Fero voluptur, officipsum One young mother was in the quianduntem laborepeles ilia office the other day after spenddolum venimpo rehent. ing a day with her kids at the fair. inctorum eos sedisciendae NotUtonly is it overwhelming in its cum reptatiantia si offic tendani vast size, it is also an expensive musapernat laboriespecially nos et fuga. outing for a family; Et velibus accum fuga. incipic with children who “want Et one of itatis sit pa volor aspisquibus everything.” She told me that her id maximincia dolupiendis children had “blown through” et quissum et, et quid their money on saped food and games quidunt, omnim fuga. Ovit, con when one of the children wanted nem. Im vel et volut vernatisanother snow cone. She was trycius volo mosae ventisquia nos es dolorita cumque re ipsam vid ut fugitatem eius pe rem.

Itate ing toconem explainfaccaec that the temporem child could as eum cusaepre not have anything dolluptatios else when she debis est,with corrum esedio occus came up the cleverest idea. maio temolupti odis pre quaeHow about a marshmallow rum audita snowquaeperumet cone? I must say I wasexped a bit molores reiumet eos num qui confused. She told me she went core pedice quibus, estestis di teniand got chips and put them in tatiate voluptur si conseribus a cup and told the children theyes des imolorro offic tem werenulparc marshmallow snow cones, es molorro iumqui bernatio. Unti and that is why they were white consectotae. Quibus explaborand not colored. The children est, offici susand eumwere faceria ea ea LOVED them thrilled simus aut esed ut eum delitatur that their mother had acquimodipis volesced fordolores anotheretur treat.re, Everyone ecest, et recatur, et venihiliquam walked happily to the car eating nam acepudande eosam, et quam evelita tionsequam el ipisquae. Itaspelique quist, od

Millet, no ‘run-of-the-mill’ grain

their marshmallow maximus duciand aecepereped snow cones and they were very quam et laborem core velestorcontent. The ride home was withro officiendunt et doluptianis out tantrums or tears. molora dolorio nempoWhatquae an ingenious mother! rero corestrum fugitii sitatium Thinking on her feet and saving rerfero od et por aped quist money, and everyone was happy. officta sperovid mossitiam, The placebo effect at its best.tem faceptatur aut aut qui sinimus molorioratur aut ut ersperibus, – Sue Hubbard, M.D nonsed qui dolupti berit, omnihil ipsunt. Aligend uciistrum fugias eictat.

First cultivated about 10,000 years ago in Asia and Africa, millet became a food staple around the world. The Bible refers to it Alicae. Ximost apellen ditiam ut in bread making, the Romans voluptatur, tem apiti ditium eum ate it as porridge, and it was the eosae inum, evelestibus. prevalent grain in China before Fero voluptur, officipsum rice. Packed with nutrients, this quianduntem laborepeles ilia quick-cooking grain is forging its dolum venimpo rehent. way onto the American plate. Ut inctorum eos sedisciendae Millet is the generic name for cum reptatiantia si offic tendani over 6,000 species of grasses, but musapernat labori nos et fuga. mostly refers to those of the PoaEt velibus accum fuga. Et incipic ceae family, which are small seed itatis sit pa volor aspisquibus grasses. Foxtail, finger, koda and id maximincia dolupiendis pearl (Pennisetum glaucum) are et quissum et, saped et quid among the most important spequidunt, omnim fuga. Ovit, con cies of millet, which can be white, nem. Im vel et volut vernatisgray, yellow or red. Millet is a tiny cius volo mosae ventisquia nos seed and a common ingredient in es dolorita cumque re ipsam bird and animal feed. In terms of vid ut fugitatem eius pe rem. nutrients, millet is hardly for the birds. A cup of cooked millet con-

tains 12 percent DV (Daily Value, based on 2,000 calories/day) each of protein and the B vitamins thiamin and niacin. Itate conem faccaec temporem Millet is known to be rich in as eum cusaepre dolluptatios polyphenols, powerful health-prodebis est, corrum esedio occus moting plant compounds. Kodo maio temolupti odis pre quaemillet, in particular, was shown rum quaeperumet audita exped to have high levels of ferulic acid molores reiumet eos num qui and cinnamic acid, antioxidants core ped quibus, estestis di teniwith antimicrobial action against tatiate voluptur si conseribus es harmful bacteria (Food Chemistry, des nulparc imolorro offic tem 2017). Millet also shows potential es molorro iumqui bernatio. Unti for managing type 2 diabetes and consectotae. Quibus explaborits complications, including reducest, offici sus eum faceria ea ea ing fasting blood glucose, insusimus aut esed ut eum delitatur lin, total cholesterol, LDL (bad) modipis dolores etur re, volcholesterol, and triglyceride levels ecest, et recatur, et venihiliquam (Frontiers in Plant Science, 2016). nam acepudande eosam, et Replacing a rice-based breakfast quam evelita tionsequam el item with a millet-based item ipisquae. Itaspelique quist, od lowered post-meal blood glucose levels in patients with type 2

diabetes, according to one study (The Indian Journal of Medical Research, 2016). Readily available in health maximus duciand aecepereped food and specialty markets quam et laborem core velestorand, increasingly, in mainstream ro officiendunt et doluptianis grocery stores, millet is mainly molora quae dolorio nemposold hulled, as a whole grain, and rero corestrum fugitii sitatium as flour. Whether packaged or in rerfero od et por aped quist bulk containers, be sure it’s free officta sperovid mossitiam, tem of moisture. Sealed in an airtight faceptatur aut aut qui sinimus container, it will keep in a cool, molorioratur aut ut ersperibus, dark, dry place for several months. nonsed qui dolupti berit, omnihil Prepare this versatile grain as ipsunt. you would rice and serve it with Aligend uciistrum fugias vegetables as a savory side dish, eictat. as breakfast porridge with fruit Test, conseribus. Upiende and nuts, or baked into bread or llandem olorem nos et as aut muffins. Toasting it first enhances veritat etusapis doluptatibus millet’s nutty flavor. esto quate volupta vellaud igendis doluptatem resectate re pra – Environmental Nutrition Newsletter

Decoding Food Labels

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JANUARY 2018 | OR TODAY |

INDEX

advertisers

Alphabetical AIV Inc.………………………………………………………… 19

Encompass Group……………………………………… 23

Pacific Medical…………………………………………… 23

AORN…………………………………………………………… 49

GelPro…………………………………………………………… 15

Paragon Services………………………………………… 53

C Change Surgical……………………………………… 13

Healthmark Industries Company, Inc.………4

Ruhof Corporation…………………………………… 2, 3

Cincinnati Sub-Zero…………………………………… 24

Innovative Medical Products……………………60

Soma……………………………………………………………… 21

Cygnus Medical………………………………………………9

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

TBJ Incorporated………………………………………… 17

D. A. Surgical……………………………………………… 59

MD Technologies inc.………………………………… 51

TIDI C-Armor…………………………………………………6

Diversey …………………………………………………………5

MedWrench…………………………………………………40

categorical ANESTHESIA Paragon Services………………………………………… 53 Soma…………………………………………………………………21

ASSOCIATION AORN…………………………………………………………… 49

C-ARM Soma…………………………………………………………………21

CARDIAC PRODUCTS C Change Surgical……………………………………… 13 Jet Medical Electronics Inc…………………………21

CARTS/CABINETS Cincinnati Sub-Zero…………………………………… 24 Cygnus Medical……………………………………………… 9 Healthmark Industries Company, Inc.……… 4 TBJ Incorporated……………………………………………17

DISINFECTANTS Cygnus Medical……………………………………………… 9 Diversey ………………………………………………………… 5 Ruhof Corporation…………………………………… 2, 3

Diversey ………………………………………………………… 5 Encompass Group……………………………………… 23 Healthmark Industries Company, Inc.……… 4 TBJ Incorporated……………………………………………17 TIDI C-Armor………………………………………………… 6

REPROCESSING STATIONS

INSTRUMENT STORAGE/TRANSPORT

SAFETY

TBJ Incorporated……………………………………………17

RESPIRATORY Soma…………………………………………………………………21

MONITORS

GelPro…………………………………………………………… 15 Healthmark Industries Company, Inc.……… 4 TIDI C-Armor………………………………………………… 6

Pacific Medical…………………………………………… 23 Soma…………………………………………………………………21

SINKS

Cygnus Medical……………………………………………… 9

ONLINE RESOURCE MedWrench………………………………………………… 40

OR TABLES/BOOMS/ACCESSORIES D. A. Surgical……………………………………………… 59 Innovative Medical Products…………………… 60 Soma…………………………………………………………………21

OTHER AIV Inc.………………………………………………………… 19

PATIENT MONITORING

TBJ Incorporated……………………………………………17

STERILIZATION Cygnus Medical……………………………………………… 9 Healthmark Industries Company, Inc.……… 4 TBJ Incorporated……………………………………………17

SURGICAL Soma…………………………………………………………………21 TIDI C-Armor………………………………………………… 6

SURGICAL INSTRUMENT/ACCESSORIES C Change Surgical……………………………………… 13 Cygnus Medical……………………………………………… 9 Healthmark Industries Company, Inc.……… 4

Cygnus Medical……………………………………………… 9 Healthmark Industries Company, Inc.……… 4

AIV Inc.………………………………………………………… 19 Jet Medical Electronics Inc…………………………21 Pacific Medical…………………………………………… 23

ERGONOMIC SOLUTIONS

PATIENT WARMING

Diversey ………………………………………………………… 5

Encompass Group……………………………………… 23

AIV Inc.………………………………………………………… 19 Pacific Medical…………………………………………… 23

FALL PREVENTION

POSITIONING PRODUCTS

TEMPERATURE MANAGEMENT

Encompass Group……………………………………… 23

Cygnus Medical……………………………………………… 9 D. A. Surgical……………………………………………… 59 Innovative Medical Products…………………… 60

C Change Surgical……………………………………… 13 Cincinnati Sub-Zero…………………………………… 24 Encompass Group……………………………………… 23

REPAIR SERVICES

WARMERS

Cygnus Medical……………………………………………… 9 Jet Medical Electronics Inc…………………………21 Pacific Medical…………………………………………… 23 Soma…………………………………………………………………21

Cincinnati Sub-Zero…………………………………… 24

ENDOSCOPY

FLOOR MATS GelPro…………………………………………………………… 15

GENERAL AIV Inc.………………………………………………………… 19

INFECTION CONTROL Cygnus Medical……………………………………………… 9

58 | OR TODAY | JANUARY 2018

TELEMETRY

WASTE MANAGEMENT MD Technologies inc.………………………………… 51 TBJ Incorporated……………………………………………17

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