OR Today - June 2018 by MD Publishing

COMPANY SHOWCASE RUHOF

PRODUCT FOCUS INFECTION CONTROL

COMPANY SHOWCASE

FITNESS WORKOUT ROUTINE

STAFFING SHORTAGE

SOLUTIONS how education and training help

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

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

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OR TODAY | June 2018

contents features

STAFFING SHORTAGE SOLUTIONS how education and training help

48 STAFFING SHORTAGE SOLUTIONS: HOW EDUCATION AND TRAINING HELP A lot has been written about the nursing shortage in the U.S. and that includes the OR where half of all OR leaders say they’re having problems recruiting perioperative nurses. One solution to this crisis is providing OR nurses with ongoing training and educational opportunities.

For over 30 years, Ruhof has dedicated itself to the research, development and manufacturing of state-of-the-art products to ensure the complete cleaning

Medication reconciliation is a comprehensive review of a patient’s active medications during care transitions. It is a strategy that enables healthcare providers to make better

Palmero Healthcare has been committed to bringing a wide range of infection prevention products such as hospital-level disinfectants, barrier products and safety products to the

and reprocessing of all surgical instruments and scopes.

prescribing decisions for patients.

health care community since 1957.

COMPANY SHOWCASE

CE ARTICLE

CORPORATE PROFILE

OR Today (Vol. 18, Issue #06) June 2018 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 302691530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2018

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JUNE 2018 | OR TODAY |

contents features

PUBLISHER John M. Krieg

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VICE PRESIDENT Kristin Leavoy

OR TODAY CONTEST

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Find out last month's winner and how you could win!

EDITOR John Wallace

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ART DEPARTMENT Jonathan Riley Karlee Gower Kathryn Keur

ACCOUNT EXECUTIVES Lisa Gosser

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ACCOUNTING

Ed Friloux

Chocolate Cookies

SPOTLIGHT ON

Kim Callahan

RECIPE OF THE MONTH

DIGITAL SERVICES Travis Saylor Cindy Galindo Jena Mattison

CIRCULATION Lisa Cover Melissa Brand

INDUSTRY INSIGHTS

10 News & Notes 18 Update: Clorox Healthcare 20 ASCA 22 Webinar Recap

IN THE OR

26 Suite Talk 29 Market Analysis 30 Product Focus 34 CE Article

OUT OF THE OR 56 Fitness 58 Health 60 Nutrition 62 Recipe 64 Pinboard 66 Index

8 | OR TODAY | JUNE 2018

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INDUSTRY INSIGHTS

news & notes

Buffalo Filter Launches “End Surgical Smoke” Campaign

OR Today Live Rooftop Party Will Rock Music City! After enjoying a day of learning from top-notch presenters and networking with industry leaders in the exhibit hall, OR Today Live Surgical Conference attendees will have a chance to unwind and let loose in Nashville! On Monday, August 27 the Rooftop Party at Rock Bottom Brewery will feature Australian musician Carl Wockner. After achieving major success in the United States, Wockner moved his family and acoustic guitar from Australia to Nashville. OR Today Live is thrilled to share his talents and provide an atmosphere where guests can have fun, take in a live concert in the heart of Nashville and connect with peers from around the country. Entry into the event, food and beverages are complimentary with registration to OR Today Live, register online at www.ortodaylive.com. •

Sponsored by Clorox Healthcare

update

Ensuring Patient Safety

Through Advancement in Infection Prevention Protocols with UV Technology Healthcare facilities face numerous challenges when it comes to maintaining the safety of the patient environment. From common infection-causing bacteria and viruses to multi-drug resistant pathogens that cause healthcare-associated infections (HAIs), there are countless opportunities for patients’ health to be jeopardized, and despite vast progress, HAIs continue to claim the lives of thousands each year. As a result, healthcare facilities need a comprehensive approach to infection control to maintain the safety of the patient environment. This is why one such facility – Newton Medical Center (NMC), a hospital in Newton, KS – advanced its infection prevention protocols by investing in UV technology and the Clorox Healthcare® OptimumUV® System.

The Challenge: Safeguarding the Patient Environment Against Infections Multi-drug resistant pathogens that put patients’ health at risk such as Clostridium difficile (C. difficile), carbapenem-resistant Enterobacteriaceae (CRE) and methicillin-resistant Staphylococcus aureus (MRSA) can survive on surfaces from days to months making comprehensive, daily cleaning and disinfection critical in preventing infections. However, completing daily and discharge cleaning effectively is time-consuming and no matter how meticulous Clinical and Environmen-

18 | OR TODAY | JUNE 2018

tal Services teams are, some pathogens can still resist or hide out in hard-toreach places.

The Solution: Adding an Extra Layer of Protection with UV Technology NMC implemented four Clorox Healthcare® Optimum-UV® Systems to supplement their manual cleaning and disinfection efforts and enable comprehensive surface coverage. “The addition of the Clorox Healthcare® Optimum-UV® devices provides an extra layer of protection against HAIs and ensures we have the safest environment possible for our patients,” said John Spielman, EVS Manager, NMC. “We specifically chose the Clorox Healthcare® Optimum-UV® Systems because we knew we would be investing not only in a top technology but in a longstanding partner who will be there down the road to help us continue to provide our patients with the highest level of safety and protection.” The Clorox Healthcare® OptimumUV® System works by emitting UV-C light and killing microorganisms by inactivating their DNA, rendering them harmless and unable to multiply or spread.

Going the Extra Mile: Implementing UV Technology By supplementing manual cleaning practices with UV-C technology, NMC offers an extra layer of protection by killing microorganisms in areas that may otherwise be missed or insufficiently cleaned through manual

John Spielman EVS Manager Newton Medical Center

cleaning practices. The device can kill more than 30 HAI-causing pathogens in five minutes at a distance of eight feet, ensuring that healthcare facilities like NMC leave no crevice untreated. NMC uses their four devices throughout the hospital to clean operating rooms, patient and isolation rooms, critical care unit (CCU) rooms, the catheterization laboratory, and even emergency rooms during highrisk time periods such as flu season. The hospital has one device designated for operating rooms, while the others are used throughout the hospital. “With the Clorox Healthcare® Optimum-UV® System we have found an easy, effective and highquality solution that helps to ensure our patients’ safety and health and reflects our hospital’s standards of care and commitment towards safety,” said Spielman. “In the last five years, we have only seen three cases of MRSA, making us entirely confident in its ability to help reduce infection rates and all the prouder of our investment.”

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INDUSTRY INSIGHTS asca

New CAIP Credential Continues Tradition of Excellence for ASCs By William Prentice, ASCA CEO ith the introduction of a Certified Ambulatory Infection Preventionist (CAIP) certification program in January 2018 (see www. aboutcaip.org for more information), the Board of Ambulatory Surgery Certification (BASC) has given ASCs another opportunity to make sure they are doing everything they can to keep their patients safe and provide gold-standard care. With this new credential, ASC infection preventionists (IP) can now demonstrate their commitment to best practices in infection prevention and control within the ASC setting and tap into a network of support for continuing education that will keep them current on new developments in this field.

While the Certification in Infection Prevention and Control (CIC) credential awarded by the Certification Board of Infection Control and Epidemiology Inc. (CBIC) speaks to the responsibilities of a hospital IP, CAIP specifically targets the ASC IP’s needs. Those who earn the credential distinguish themselves from other IPs by demonstrating a more comprehensive understanding

20 | OR TODAY | JUNE 2018

of the ASC setting and the infection prevention and control issues ASCs manage daily. The BASC Board of Directors began working on the CAIP program in 2015. It assembled a group of ASC IPs to perform a job analysis to determine the body of knowledge a CAIP credential holder would be expected to understand. This analysis served as the basis for the exam questions that CAIP candidates must answer correctly to earn the credential. To be eligible to take the CAIP exam, an applicant must be a licensed health care professional responsible for an ASC’s infection prevention program; have at least two years of cumulative experience in infection prevention or hold the CIC credential; and have 10 contact hours in infection prevention education over the last two years. Credential holders will need to complete additional continuing education (CE) requirements to retain the credential over time. The CAIP exam covers five ASC infection prevention and control content areas: 1 program development, implementation and maintenance 2 education and training 3 s urveillance, data collection and analysis

4 s trategies 5 instrument/equipment cleaning, disinfection and sterilization The first exam, an online test, is scheduled for October. Individuals interested in taking this exam must register in August. CAIP is BASC’s second certification program for the ASC industry. It introduced the Certified Administrator Surgery Center (CASC) credential, its first certification program, in 2002. The CASC credential is a distinction earned by those in the ASC industry with a comprehensive understanding of the knowledge and skills that the role of an ASC administrator requires. CASC candidates report many different reasons for pursuing and maintaining the CASC credential. ASC employers, however, say that to them the credential validates that the credential-holder has mastered the skills that an ASC administrator needs. Like CAIP, the CASC exam tests knowledge in five categories. For CASC, those include delivery of patient care, quality management, human resources, financial, and regulatory and legal issues. CASC credential holders say that to pass the CASC exam, a candidate needs more than book knowledge. Many of the CASC questions are complex WWW.ORTODAY.COM

and situational, and those seeking CASC certification must have real-life experience to answer those correctly. The CASC certificate is valid for three years. To maintain certification, credential holders need to participate in continuing education that helps them keep their skills and knowledge up to date. For more information go to https://aboutcasc.org/recertification/annual-requirements. In recent years, health care professionals in every setting have expressed growing concern about the need for more comprehensive infection prevention and control standards and assurances of the skills and abilities of the health care professionals who provide patient care. Thanks to BASC, the ASC community is at the forefront in both of those areas. I congratulate BASC for its vision and leadership and encourage all ASC professionals to look inside your own facility and consider how these certification programs could help you improve.

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INDUSTRY INSIGHTS

news & notes webinar

Encompass Shares Knowledge via Free Webinar Staff report he OR Today webinar program continues to provide free educational material to nurses. The webinar “Back to the Future: New Innovations in Reusable OR Textiles” by Angie O’Connor, RN, BS, Director of Clinical Resources at the Encompass Group, shed light on an important topic.

The OR is the biggest user of medical supplies in the entire institution. AORN has been calling for the “greening” of the OR, and how the decision to use disposable or reusable gowns, drapes, and mayo covers can impact cost and provider comfort. There are also environmental considerations with either application. In the webinar, O’Connor provided an overview to the above issues and provided steps to consider within an institution when evaluating reusable gowns and drapes. The webinar sponsor Encompass, Group is a manufacturer and marketer of reusable textiles, professional apparel, disposable and single-use

22 | OR TODAY | JUNE 2018

medical products. The webinar had 228 people register and the session received a positive rating from attendees. Postwebinar surveys also included praise for the session. “Excellent material, very useful, excellent and very knowledgeable speaker,” Ellis Medical Consulting President S. Ellis shared. “Very informative webinar and timely because our reusable linen company just went out of business and we're switching back to disposables,” Staff Nurse M. Ritchie said. “What an informative and relevant presentation,” Learning Resource Manager J. Pirie said. “I found this webinar very insightful, especially comparing the cost of disposable to reusable items, and the reusable items number of uses,” said R. Hance, RN, Quality and Safety. “I appreciate the opportunity to attend these webinars. Very interesting and useful information,” said Retired OR Unit Coordinator G. Lowrance. “The OR Today’s webinar series offer a wonderful variety of topics with engaging speakers,” said J. Mattern,

“What an informative and relevant presentation.” – J. Pirie

Clinical Nurse Educator, OR. “The OR Today’s webinar series is truly job related and informative for daily practice of my profession,” shared Y. Sather, Retired Nursing OR Coordinator. “I attempt to participate in OR Today webinars whenever possible as they are relevant to current practices, issues and concerns we face daily,” said Periop Manager M. Tyson. For information about future OR Today webinars, visit ortoday.com/upcoming-webinars.

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COMPANY SHOWCASE Ruhof

SHOWCASE

company

his month, OR Today sat down with Ruhof Healthcare to find out the latest developments at the cleaning solutions company responsible for creating the very ﬁrst enzymatic detergent for cleaning surgical instruments. Read on to find out more about the company, including what makes their products unique and what you can expect from them in 2018.

Q: Can you share a little bit about Ruhof’s history and how you achieve success? The Ruhof Corporation was established in 1976 when Frank Bass and Bernard Esquenet became a team. Frank Bass’s role in the company is one of sales, marketing and research while Bernard Esquenet is the chemist behind Ruhof’s success. Prior to the launch of Ruhof, Frank recognized the need for hospitals to use more than simple dishwashing detergent in cleaning surgical instruments. Bernard had created cleaning solutions for the Navy, which were used to clean barnacles and other crustaceous marine residues from the heat ex-changers and water evaporators of submarines and other naval vessels. When Frank approached him to develop cleaning solutions for hospital instruments, Bernard realized that the enzymes

24 | OR TODAY | JUNE 2018

he was using to eat away at the marine organism residues would also dissolve proteins off of surgical instruments. Thus, Protozyme, the very first enzymatic cleaner for surgical instrumentation was born along with Surgi-Stain, a product for refurbishing corroded stainless steel instruments. Since then Ruhof has dedicated itself to the research, development and manufacturing of state-of-the-art products to ensure the complete cleaning and reprocessing of all surgical instruments and scopes. Addressing the ever-increasing concern of cross contamination in hospitals, Ruhof’s research and development department revolutionized the cleaning industry with our enzymatic detergents, cleaning brushes and foam sprays. Additionally, the comprehensive ScopeValet™ line of endoscopy products supports the steps of the scope reprocessing cycle from bedside cleaning through to transport and storage. These GI offerings help endoscopy suites improve operating efficiencies while adhering to guidelines and protecting patients and staff alike.

ScopeValet TipGuard

Q: What are some advantages Ruhof has over the competition? Ruhof Healthcare sells the only enzymatic detergent on the market (ENDOZIME® BIO-CLEAN) clinically tested to pass the difficult ISO standard 15883 Annex F by dissolving bioﬁlm and exposing underlying bacteria to high-level disinfectants or liquid chemical sterilants. Our products are of the highest quality available and we offer the most complete line of surgical instrument cleaning, scope cleaning, and reprocessing supplies in the marketplace. In addition, the company is innovative, continually developing new products and technologies that clean, protect, comply, and verify to meet the needs of our customers.

Q: What are some health care challenges Ruhof has been able to address? Recent reports to the U.S. Food & Drug Administration (FDA) of processing errors with flexible endoscopes have brought much attention to the importance of this issue. In general, while flexible endoscopes are inherently difficult to clean effectively due to their long narrow lumens and because they are used in highly contaminated areas of the body, the manual component of endoscope reprocessing appears to be the area most prone to error. As a result, newly WWW.ORTODAY.COM

SPECIAL ADVERTISING SECTION

revised guidelines from both the CDC and the AORN recommend the used of cleaning verification tests such as ATP bioluminescence, which has been shown to be both a rapid and effective method for assessing the efficacy of the cleaning process. The Ruhof ATP Complete® is a quick, simple, and reliable method for verifying the effectiveness of the cleaning and decontamination process for the outer surfaces and internal channels of scopes and cannulated instruments along with all non-critical facility surfaces. The ATP Complete® System consists of a lightweight hand-held device, sampling tools – Ruhof Test® Swab and Ruhof Test® InstruSponge™ — and easy to use software for tracking results. The system can also be used to test the efficacy of the cleaning process for the especially complex duodenoscope, an endoscope associated with recent outbreaks of Carbapenem-resistant Enterobacteriaceae (CRE) infections.

Q: What Ruhof product or service are you most excited about right now? New from Ruhof is the endoscopic distal tip protector, TipGuard, which provides a simple, safe, and highly effective method of protecting the delicate optics of an endoscope, while allowing the tip to aerate, decreasing the likelihood of microbiological growth. Furthermore, TipGuard will help to prevent the costly repair of endoscopes. Ruhof has also recently launched the DoseValet™ Autofill, which makes the task of manually cleaning surgical instruments easier and more complete. With the push of a button, the DoseValet™ AutoFill will fill your sink, dose your detergent, monitor temperature and detergent usage, all while freeing up technicians to do other important tasks. This helps sterile processors increase workﬂow while achieving high marks for instrument cleanliness.

Q: Can you explain Ruhof’s core competencies and unique selling points? We are the only supplier of enzymatic detergents that manufactures its own product, guaranteeing consistency and quality. Ruhof is a registered ISO 14001 manufacturer and we pride ourselves on the superior products we manufacture.

Q: How does Ruhof support customers? Ruhof has a most knowledgeable and responsive customer service department and sales team ready to help our customers with questions, orders, troubleshooting, etc. Our user-friendly website and informative technical data sheets/IFUs also provide support. We offer a program of free accredited continuing education for nurses and CS/SPD techs, as we understand that ongoing education, training and mentoring are critical to the success of any clinical department. These CE opportunities are offered at both national and local trade shows, as well as right on our website www.ruhof. com/pages/education.

Q: What is most important to you about the way you do business? At Ruhof we understand the importance of cleanliness in the health care field and are guided by our commitment to excellence. We demonstrate this by offering reliable solutions and individualized service to help health care facilities meet and exceed their decontamination and infection prevention challenges. We are always finding new solutions and new ways to help fight HAIs and to provide a safe work environment for patient and staff. We value our customers as much as the patients that they care for.

DoseValet™ Autofill WWW.ORTODAY.COM

JUNE 2018 | OR TODAY |

IN THE OR suite talk

Suite Talk

Conversations from 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 Q

26 | OR TODAY | JUNE 2018

GEL NAILS

Gel nails are fairly new. Is it acceptable to wear gel nails in the operating room?

A: No. A: There is a difference between gel nails and gel polish. Gel polish is OK, gel nails are not. A: We do not allow anything that cannot be removed immediately with regular nail polish remover. No gel, no, acrylic, no SNS, etc.

NEW HIRE

When a new hire calls in on their first day without a reason what is one to think?

A: That is their last day! A: First day without a reason, I have a conversation followed by an email and notify the human resources department.

SPD AND CERTIFIED SURGICAL TECHNOLOGISTS

Is it beneficial to staff sterile processing department with surgical technologists? Will this increase patient safety and decrease case delays? Can you tell me if certified surgical technologists have a role in your sterile departments? (Continued from last month)

A: I will say there is a benefit to having some of the SPD positions staffed with certified surgical

technologists. We have both in our department and find great value in the mix. We greatly value the certified sterile processing tech role and would add that the surgical techs add another dimension to the department as they often are aware of the unique perspective that scrubbing the cases in OR gives.

A: Surgical technicians definitely have a place in a surgical service and having knowledge of the WWW.ORTODAY.COM

When Quality Matters

numerous instruments found in every service of the operating room. However sterile processing technicians must also know all the instruments for every service along with all the processes that are involved with providing the operating room with sterile instrument trays. Many processes include cleaning, decontamination, packaging, sterilization and distribution of those trays also require in-depth knowledge. Along with these processes, sterile processing techs must also know the quality control of each process and the equipment requirements for each process. Sterile processing is a profession as is surgical technology. Each profession has its own standards and requirements. Most often resources are available for surgical techs but not sterile processing techs. Today more than ever before there must be resources given to SPD for certification and education of techs. With the difficult issues with devices now being used in surgery and following all the IFUs these resources must start being allocated in SPD. Certification of all SPD techs needs to become the standard in every department that uses sterile instruments. Patients should not have to be concerned that the instruments used in their surgery are clean, functional and sterile. Long story short, allocate resources for SPD and make certification mandatory in every health care facility including doctors offices, dentists offices and health care facilities offering surgical procedures. Keep surgical techs in the OR and processing techs in SPD. They each have a very important job function.

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market analysis

Infection Control Market Growth Continues Staff report nfection prevention and control will always be a concern for hospitals and health care facilities. Recent market analyses prove that point with predictions of continued growth coming from several organizations.

MarketsandMarkets is among those groups predicting continued growth in the global infection control market. “The global infection control market is expected to reach $21.06 billion by 2022 from $15.35 billion in 2017, at a compound annual growth rate (CAGR) of 6.5 percent,” according to MarketsandMarkets. “Factors driving market growth include the increasing incidence of HAIs, rising number of surgical procedures owing to the rapidly growing geriatric population and increasing incidence of chronic disorders across the globe. In addition, the emerging market in China, India, Russia, and countries in Latin America; increasing use of e-beam sterilization; and rising importance of single-use medical nonwovens and medical devices are further increasing the demand for disinfection and sterilization products and services.” “On the basis of products and services, the infection control market is segmented into disinfection products and sterilization products and services. In 2016, the disinfection products segment accounted for the largest share of the infection control market,” according to MarketWWW.ORTODAY.COM

sandMarkets. “The disinfection products segment will continue to dominate the infection control market, mainly due to the high prevalence of HAIs, rising number of surgeries, and increasing initiatives and regulatory actions taken by governments in various countries to fortify essential infection control standards.” Hospitals and clinics are expected to register the highest CAGR during the forecast period. “Based on end user, the global infection control market is segmented into hospitals and clinics, medical devices companies, food industry, life sciences industry, pharmaceutical companies and other end users,” according to MarketsandMarkets. “Hospitals and clinics are expected to register the highest CAGR during the forecast period. The growth in this end-user segment can be attributed to the factors such as the rising incidence of HAIs, growing volume of surgical procedures, increasing cost burden due to the rising geriatric population and incidence of chronic diseases, and increasing number of hospitals across the globe.” The global infection control market is expected to reach $258.3 billion by 2025, according to a new report by Grand View Research Inc. “The market is driven by rising concerns with respect to a significant upsurge in hospital acquired infections globally,” according to a Grand View Research news release. “This is believed to facilitate greater penetration of infection control

products. An influx in development of new biologics and subsequent demand for sterilized formulations serve as key growth factors for the overall infection control market. The health care organizations are focused on implementing strategies for early recognition, reporting, isolation and surveillance of disease episodes of potential public health concern.” In addition, an increasing number of intensive training modules, for nurses and other medical staff, on infection prevention and control is presumed to provide high potential for extensive usage of infection control products over the coming years, the news release reports. “For instance, College of Nurses of Ontario released guidelines concerning standard practices, that is focused on maintaining hand hygiene to reduce contamination and spread of infection. Furthermore, Centers for Disease Control and Prevention (CDC) has released guidelines for disinfection and sterilization for efficient usage of infection control products by health care personnel in wide array of health care settings such as ambulatory care, home care, hospitals and others. As a consequence of the aforementioned factors, it is presumed that there will be significant improvement in the overall penetration rate of infection prevention and control products, which is also anticipated to fuel the market demand as well as the revenue to unprecedented heights,” according to Grand View Research. JUNE 2018 | OR TODAY |

IN THE OR

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30 | OR TODAY | JUNE 2018

Medline

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IN THE OR

product focus

Surgical site infections are a leading hospitalacquired condition and cause for readmission. New evidence, focused on C-sections, was presented at this year’s AORN Global Surgical Conference. These two studies support a reduction in SSIs through utilization of Mepilex Border Post-Op antimicrobial dressings from Mölnlycke Health Care as part of the surgical protocol. Available as a standard or antimicrobial dressing, Mepilex Border Post-Op dressings were specifically designed for incisions, including: hip, knee, C-section and sternum. They have five-layer and safetac soft silicone technology, ultra-absorbent material, a unique flex-cut pad, transparent border with showerproof seal and up to a seven-day wear time. •

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UMF Corporation’s Operating Room Processing Training Program includes its PerfectCLEAN® green color-coded system, a series of processing checklists and a “ONEperROOM™” methodology. Capable of removing everything that can be physically removed from an environmental surface, including bacteria and virus particles, PerfectCLEAN adapts to every challenge, including absorbing and removing endotoxins released by bacteria when killed by disinfectants. Participants in on-site training learn how to process surgical suites to ensure readiness for pre-first procedure, between procedure and terminal processing. Upon completion, hygiene specialists are awarded a certificate and a environmental hygiene specialist pin recognizing their achievement. •

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IN THE OR

continuing education

IN THE OR

CE718

Medication Reconciliation: Avoiding Dangerous Errors

continuing education

Jennifer L. Gibson, PharmD s a patient was admitted to the hospital, no one would have predicted that he soon would be the subject of a common hospital error. In the hospital, the patient’s home medications were recorded in his medical chart. Throughout his hospital stay, his home medications were not reviewed or compared with his current admission medications. The patient never received his warfarin (Coumadin), an anticoagulant for preventing blood clots, which he had been taking for several years because of his clotting disorder and history of thrombosis. The omission of warfarin contributed to the development of a deep vein thromboembolism during his admission. This unfortunate event required further treatment and a longer hospital stay. Reconciling this patient’s home medications with the therapies given during his hospital stay could have prevented this type of medication error.

The Medications at Transitions and Clinical Handoffs study evaluated medication reconciliation at care transitions. The evaluators found that more than onethird (35.9%) of patients experienced an error in their medication orders at the time of hospital admission. Nearly all errors (85%) resulted from an incomplete or inaccurate medication history, and roughly half of the errors were omissions. Most errors were considered potentially harmful or required increased monitoring or intervention. Patients were more likely to experience an error if they were older than age 65, and the risk of an error increased with the number of prescription medications a patient was taking.1 WWW.ORTODAY.COM

The Centers for Disease Control and Prevention estimates that about 82% of Americans take at least one medication, and 29% take five medications or more.2 That means more than 80% of transitioning patients are at risk for a medication discrepancy. Therefore, accurate medication histories and thorough medication reconciliation processes may help prevent adverse outcomes and improve each patient’s quality of care. Every year, at least 700,000 patients visit the ED because of an adverse drug event.3 These adverse drug events can be caused by unintentional overuse or underuse of a prescribed medication, taking a medication that results in intolerable adverse effects or allergic reactions, major disease states that are untreated, running out of medication due to patientspecific barriers, or an interaction between prescribed medications or a prescribed medication and an over-the-counter agent. When patients are admitted to an acute care facility or evaluated at a healthcare provider’s office, a medication history and thorough reconciliation can identify potential medication-related adverse events that may contribute to the patient’s presentation. Primary care providers, nurse practitioners, nurses, and pharmacists play an essential role in conducting a thorough, effective medication reconciliation process, whether in the acute care or outpatient setting. Interprofessional communication and collaboration are key in preventing medication-related adverse events.

OnCourse Learning guarantees this educational activity is free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See Page 40 to learn how to earn CE credit for this module.

Goal and objectives The goal of this program is to deepen nurses’, advance practiced nurses’, physicians’, and pharmacists’ understandings of the medication reconciliation process and requirements, and to emphasize the importance of medication reconciliation in improving patient safety. After studying the information presented here, you will be able to: • Explain the impact of medication discrepancies on patients and the healthcare system • Describe the differences between medication history and medication reconciliation • Discuss the healthcare providers’ roles in providing both medication history and medication reconciliation services to patients and to the rest of the healthcare team

The What and How Medication reconciliation is a comprehensive review of a patient’s active medications during care transitions to enable healthcare providers to make better prescribing decisions for patients. JUNE 2018 | OR TODAY |

IN THE OR

continuing education “Reconciling Medication Information” was added as a Joint Commission National Patient Safety Goal in 2005 with the intent to “accurately and completely reconcile medications across the continuum of care.”4 The addition of medication reconciliation as an NPSG created awareness of the benefits of the service and formalized the process to bridge the gap between a patient’s medication history and acute treatments. The goal of improving medication safety continued to be emphasized in the 2016 NPSGs, which addressed medication reconciliation across multiple care settings, including ambulatory care, behavioral health, hospital care, home care, and office-based care.5 Medication reconciliation comprises five general steps:6 • Collect a list of the patient’s current medications • Review the list of medications that the patient is to be prescribed (or has already begun since the transition of care) with the patient or a patient representative (whenever possible) • Compare these lists and look for omissions, duplications, interactions, or gaps in therapy • Make corrections or recommend interventions to the prescriber regarding the review of the two lists • Communicate the new list to the patient or patient caregiver The purpose of medication reconciliation has evolved over the past few years; now there is a greater emphasis on providing the patient with a new list of medications at a transition of care and on empowering the patient to manage his or her medication list at home. The Centers for Medicare & Medicaid Services examined the potential benefit of medication reconciliation on improving the quality of patient care during the transition from the

36 | OR TODAY | JUNE 2018

inpatient to the outpatient setting. In 2011, CMS worked under the Patient Protection and Affordable Care Act to promote a culture of better care coordination through the creation of accountable care organizations.7,8 ACOs have an incentive to encourage providers to work together to improve the quality of care across the healthcare spectrum, from hospitals to physicians’ offices.7,8 Organizations that meet the CMS standards by providing high-quality care while reducing healthcare costs will be financially rewarded by the Medicare Shared Savings Program.7,8 One of the measures included in the patient safety and care coordination domain is medication reconciliation. The rationale for its inclusion in the ACO standards was that patients often require changes in medications or doses during an inpatient stay and that these adjustments should be relayed to the outpatient provider to ensure there is continuity between the inpatient care setting and ongoing medical care providers.8 Although the terms “medication history” and “medication reconciliation” are often used interchangeably, they have different meanings. A medication history is a list of medications that the patient was taking before the current phase of care and is an essential first step in the medication reconciliation process. Such lists may also be referred to as prior-toadmission medication lists, preadmission medication lists, or home medication lists.9 The medication history should include key information, such as the prescribed medication, dose, route, frequency, purpose, and the date and time the last dose was taken.10 A medication history should be taken whenever a transition in care occurs, such as at admission or discharge from an acute care facility, a visit to a primary care provider, or transference into a long-term care facility. While conducting a medication history, an ideal opportunity exists to

identify other drug-related issues that may affect the patient’s plan of care, which include an allergy assessment. Confirming or clarifying a patient’s allergies may potentially avoid the use of inappropriate agents, or conversely, allow the patient to receive medications that may otherwise have been avoided unnecessarily. An error in compiling the initial medication history list is one of the strongest predictors of future errors related to admission orders, as well as errors in orders upon discharge.11,12 However, gathering an accurate medication history does not come without challenges. Patients may not recall their medication list completely, or they may simply be unable to relay information because of mental or physical health status or language or health literacy limitations. In other cases, the medication regimen may be too complex for patients to remember. Home medication lists can be particularly helpful in these situations. A recent study demonstrated that conducting medication histories for patients who present a medication list decreases the risk of medication errors.13 Unfortunately, even with lists or the availability of patient prescription bottles, a risk exists that a history can be wrong if the information in the list is not discussed with and verified by the patient or patient’s caregiver. Without discussing home medications directly with the patient or his or her caretaker, nuances of medication habits and medications that the patient no longer takes can be inaccurately documented. Direct patient participation allows the opportunity to identify the patient’s use of herbal products and over-thecounter medications — products that are often overlooked and omitted. A comprehensive and accurate pretransition history of medications is critical to the medication reconciliation process and sets the stage for effective medication reconciliation across the continuum of care.13 WWW.ORTODAY.COM

IN THE OR

continuing education

Medication reconciliation, on the other hand, involves a review and comparison of the medication history with currently ordered treatment to identify discrepancies. During the medication reconciliation process, the practitioner must compare the medication history with the medications to be started or taken during and after the care transition. This is an opportunity for providers to identify medications that are no longer active and to discontinue these orders. The reconciliation process also provides an opportunity to restart previously omitted home medications. Further, duplications can be identified and the patient’s regimen can be simplified by discontinuing the duplicate therapy. In addition, medication reconciliation provides an opportunity to identify and fill, if clinically appropriate, gaps in a patient’s therapy to improve the level of care. When evaluating the patient’s home medication list, one also must consider whether anything on the medication list could be contributing to the patient’s presentation. Primary care providers should consult with pharmacists if there is any question about potential adverse effects of a medication that may be affecting a patient’s health or placing the patient at risk for an adverse drug event. During this comparison, the patient’s records, current health status, previous diagnoses, and complicating factors should be taken into account to make an accurate assessment about whether the patient’s home regimen should be restarted, continued, discontinued, modified, or temporarily held.13,14 Medication reconciliation should take place on admission to any healthcare facility, during transfer between phases of care, and again upon discharge. Primary care practitioners should make an effort to reconcile the patient’s medications at each visit to ensure their records are up-to-date and that there are no duplications or omissions in the WWW.ORTODAY.COM

medication regimen.13,14 Community pharmacists should also engage in the medication reconciliation process, as they are the point-of-care providers for medications most utilized during transition periods. In addition, high accessibility for any other member of the interprofessional team means these pharmacists are positioned uniquely to help improve this specific measure of quality. The CMS ACO medication reconciliation measure outlines a similar process of medication reconciliation, except with a focus on the transition once a patient is out of the acute care setting. The measure indicates that the first step is to collect a medication list any time the patient is transitioning from an inpatient stay (e.g., hospital, skilled nursing facility, or rehabilitation center) to a provider in an outpatient setting who will be providing ongoing care.8 The ACO measure emphasizes that all the patient’s medications — not only prescription medications, but also over-the-counter products, and herbal and other supplements — should be recorded, and the route of administration, frequency of use, dose, indication, and the patient’s adherence to the regimen should be documented.8

The Who According to The Joint Commission, “in medication reconciliation, a clinician compares the medications a patient should be using (and is actually using) to the new medications that are ordered for the patient and resolves any discrepancies.”10 The Joint Commission is purposefully vague about the identity of the “clinician,” as the responsibility for taking accurate medication histories and conducting thorough medication reconciliations belongs to all healthcare providers. Healthcare providers who work directly with patients typically perform a medication history and reconciliation; generally, these first patient

contacts include nurses, nurse practitioners, physicians, and physician assistants.15 As front-line workers, nurses are most often the first to interview patients and gather information about home medication regimens. During this time, the nurse may need to rely on the patient, family, medication lists, or prescription bottles to obtain a medication history. The reconciliation process ideally involves providers making clinical decisions on the basis of a nurse’s documentation of the patient’s medication history. Similar to The Joint Commission standards, the ACO medication reconciliation measure, as defined by CMS, does not indicate who should be responsible for the collection of a medication history. This measure says that, at the end of any medical visit, a clinician should review the patient’s medication list to identify medications that are to be discontinued, altered, held, or started after the visit.8 Again, the definition of “clinician” is not specific and does not necessarily designate a physician. The measure goes on to say that once the clinician makes these identifications, the physician should review the changes; the only specific mention of the physician is in reviewing the patient’s potential medicationrelated changes. Nurses and pharmacists should support providers during the reconciliation process by reviewing the medication history to ensure accuracy and identify medication-related issues. Any medication-related issues should be communicated to the prescriber. Nurses are well positioned to identify medication-related issues — such as medication discrepancies, missing diagnoses, holes in therapy, and inappropriate dosing or frequencies — because of their direct patient care roles and interactions. Pharmacists undoubtedly play an important role in the reconciliation process and can help nurses and physicians identify medication-related JUNE 2018 | OR TODAY |

IN THE OR

continuing education

issues. They also may provide benefits at the time of discharge when medication changes are being discussed with the patient or when medication-specific education is needed. In fact, studies have shown that when pharmacists take a lead role in the medication reconciliation process during hospitalization, the identification of discrepancies increases. An important opportunity exists to reduce medication-related errors during transitions of care by having nurses and pharmacists work as advocates alongside physicians during the medication reconciliation process. While meeting with the patient to conduct the medication history and reconciliation, there is also an opportunity to clarify medication allergies and identify possible adherence issues. The physician or other providers can use this information to make adjustments in the patient’s medication regimen to customize the medication regimen and improve patient adherence.15,16

The Barriers The medication history and reconciliation processes are not without barriers. Many patients have mental illness or acute changes in mental status, or lack family presence to help outline the home regimen. In 2006, The Joint Commission released a sentinel event alert acknowledging that some patients are “too ill, injured, young, or disabled” to help with medication reconciliation.4 Other obstacles to conducting a thorough medication history include language, cultural, and socioeconomic barriers.12 In such cases, the clinician should make every effort to contact a patient-approved resource to gather the patient’s medication information. An easily accessible and generally reliable resource is the patient’s pharmacy. Outpatient pharmacies can relay information about specific medications, doses, routes of administration,

38 | OR TODAY | JUNE 2018

frequencies, last date filled, providers, patient adherence, disease states, and drug allergies or intolerance.17 Occasionally, the patient may not recall what pharmacy he or she uses or may use multiple pharmacies; in these cases, other options should be explored to ascertain an accurate medication history; family members, assisted living facilities, hospitals, and provider clinics may help piece together a patient’s home regimen. When using any resource other than the patient, review the medication list with the patient or caretaker to establish the validity of the list whenever possible. In all of these situations, the clinician conducting the history or reconciliation should take every step possible to gather the patient’s home medication regimen. However, The Joint Commission acknowledges that circumstances exist in which a medication history cannot be gathered and states that a “good faith” attempt to collect this information meets the intent of the NPSG.10 Resources needed to conduct thorough medication histories and retrospective reconciliations, such as nurses or ancillary staff, can be limited, and this poses a challenge to successful medication reconciliation. Although most patients will meet medication reconciliation requirements, one possible strategy is targeting subgroups that have an elevated risk of medication-related errors for retrospective review by pharmacy staff. Examples of high-risk subgroups include older patients; patients with polypharmacy regimens (i.e., patients taking between four and 13 medications); and patients with three or more comorbid conditions.14 Other examples include patients who are on complex medication regimens or who have high-risk disease states, such as patients with solid organ transplants, HIV, or heart failure. The complex regimens for such disease states have among the highest

risk potentials for medication-related problems. When inaccurate histories are taken or reconciliation is bypassed, these patients are at risk for developing transplant organ rejection, drug resistance, or acute heart failure, respectively. A strategy consideration in a setting where resources are limited is prioritizing patients with the highest risk of harm from medication-related problems.

The Transition Home When patients make the transition out of a hospital or to a new phase of care, The Joint Commission requires they receive a written report of their most up-to-date medication list. Often, patients will have their medication regimen altered during hospitalization and may be required to stop or modify previously used therapies. The patient can use a printed handout, such as a discharge summary, as a reference and an updated medication history as he or she continues to go through care transitions, such as following up with the primary care physician. Patients should be instructed to take any printed discharge or transitional information with them to their next primary care visit appointment and to their pharmacy. Patients also should be instructed and encouraged to maintain a list of their medications for reference whenever they are transitioning into the hospital or visiting a provider for an appointment. As previously discussed, medication lists are especially helpful when a patient cannot recall medications due to an acute illness or injury, or the medication regimen is too complex to remember, and such lists greatly reduce the risk of medication-related errors during admission. Patients also should be encouraged to carry the medication list with them at all times in case of an emergency so their medication history is easily accessible. The medication list should be reviewed again with patients before discharge WWW.ORTODAY.COM

IN THE OR

continuing education

to ensure their medication regimen is up-to-date; they can update a pill box or hand off the list to a caretaker to handle such adjustments.10 The CMS ACO medication reconciliation measure also focuses on the patient’s transition home after the visit with the ongoing care provider. The measure states the patient must receive clear instructions about how to make any medication-related changes, about follow-up that may be required after the changes are implemented, and about clear time frames of when to make the follow-up.8 The medication list and changes should then be documented in the outpatient medical record. Nurses typically provide discharge education or discharge instructions when a patient is leaving a hospital or clinic. In this role, nurses have the opportunity to review the patient’s medication list before arrival and compare that to the medication list for the patient as he or she is going home. This task can help identify errors that were missed during the physician’s discharge reconciliation and serves as a double check in favor of the patient’s safety.18 Nurses have an excellent opportunity to address the patient’s understanding of new medications and provide additional education materials or referral to a pharmacist for medication-specific education. Adherence can be discussed and potential barriers to a patient’s adherence can be identified and addressed by discussing the patient’s comfort with a difficult medication regimen. All education provided should be documented in the patient’s record, and a copy of the medication list should be retained.19

The Take-Home The goal of conducting a thorough medication history and reconciliation is to reduce medication-related errors by optimizing the patient’s therapy WWW.ORTODAY.COM

and avoiding interruptions in care. This can be done by conducting a detailed medication history that can be compared to current therapy to screen for therapeutic duplications, holes in therapy, and drug interactions, thus protecting the patient from unforeseen medication-related errors and adverse events. During a patient’s transition through healthcare settings, a medication history should be obtained with as much detail as possible; the medication history should then be compared to the patient’s current treatment and treatment goals to reconcile any treatment- or medication-related issues. Typically, nursing and ancillary staff perform medication histories with a provider completing the reconciliation. Medication reconciliation offers an important opportunity for the healthcare team to work together to improve patient outcomes during patient care transitions. As there are no standardized guidelines specifying which roles each team member must perform, the healthcare team may use interprofessional collaboration, with each clinician contributing, verifying, and communicating with each other to ensure reconciliation is complete, accurate, and safe. As an example, pharmacy and nursing staff should work together to help primary care providers identify medication-related errors during transitions of patient care. Looking more closely at the patient’s history, verifying the information, and recognizing duplications, omissions, and gaps in therapy help nurses and other care providers advocate for patients by identifying pharmacotherapy optimization opportunities and by helping patients navigate the ever-changing landscape of healthcare.

not had an opportunity to influence the content of this version. OnCourse Learning guarantees this educational activity is free from bias. Jennifer L. Gibson, PharmD, is a pharmacist and medical communicator. She is the owner and principal of Excalibur Scientific, LLC.

References 1. Gleason KM, McDaniel MR, Feinglass J, et al. Results of the Medications at Transitions and Clinical Handoffs (MATCH) Study: an analysis of medication reconciliation errors and risk factors at hospital admission. J Gen Intern Med. 2012;25(5):441-447. doi: 10.1007/s11606010-1256-6. 2. Medication safety basics. Centers for Disease Control and Prevention Web site. http:// www.cdc.gov/medicationsafety/basics.html. Updated August 14, 2012. Accessed January 19, 2017. 3. Adult and older adult adverse drug events. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/medicationsafety/adult_adversedrugevents.html. Updated October 2, 2012. Accessed January 19, 2017. 4. Sentinel event alert. The Joint Commission Web site. http://www.jointcommission.org/ assets/1/18/SEA_35.pdf. Published January 25, 2006. Accessed January 19, 2017. 5. National Patient Safety Goals. The Joint Commission Web site. https://www.jointcommission.org/standards_information/npsgs.aspx. Published 2016. Accessed January 19, 2017. 6. Barnsteiner JH. Medication reconciliation. In Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008:38. 7. Summary of the June 2015 final rule provisions for accountable care organizations (ACOs) under the Medicare Shared Savings Program. Centers for Medicare & Medicaid Services Web

EDITOR’S NOTE: Kimberly Cohen-Pelosi, PharmD, BCPS; Emily Dutton, PharmD; and Maja Gift, MHA, BS Pharm, past authors of this educational activity, have

Site. http://www.cms.gov/Medicare/MedicareFee-for-Service-Payment/sharedsavingsprogram/Downloads/ACO_Summary_Factsheet_ ICN907404.pdf. Accessed January 19, 2017. JUNE 2018 | OR TODAY |

IN THE OR

continuing education 8. Accountable care organization 2015 program analysis quality performance standards narrative measure specifications. Centers for Medicare & Medicaid Services Web site. http://www.cms.gov/ Medicare/Medicare-Fee-for-Service-Payment/sharedsavingspro-

CE718

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

gram/Downloads/ACO-NarrativeMeasures-Specs.pdf. Published January 9, 2015. Accessed January 19, 2017. 9. Gardella JE, Cardwell TB, Nnadi M. Improving medication safety with accurate preadmission medication lists and postdischarge education. J Comm J Qual Patient Saf. 2012;38:452-458. 10. National Patient Safety Goals effective January 1, 2016: hospital accreditation program. Joint Commission Web site. https://www. jointcommission.org/assets/1/6/2016_NPSG_HAP.pdf. Accessed January 19, 2017. 11. Salanitro AH, Osborn CY, Schnipper JL, et al. Effect of patientand medication-related factors on inpatient medication reconciliation errors. J Gen Intern Med. 2012;27(8):924-932. doi: 10.1007/ s11606-012-2003-y. 12. Cornu P, Steurbaut S, Leysen T, et al. Effect of medication reconciliation at hospital admission on medication discrepancies during hospitalization and at discharge for geriatric patients. Ann Pharmacother. 2012;46:484-494. doi: 10.1345/aph.1Q594. 13. Kaboli PJ, Fernandes O. Medication reconciliation: moving for-

Deadline Courses must be completed by 2/15/2019 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.

ward. Arch Intern Med. 2012;172(14):1069-1070. doi: 10.1001/archinternmed.2012.2667. 14. Mueller SK, Sponsler KC, Kripalani D, Schnipper JL. Hospitalbased medication reconciliation practices: a systemic review. Arch Intern Med. 2012;172(14):1057-1069. doi: 10.1001/archinternmed.2012.2246. 15. Lee KP, Hartridge C, Corbett K, et al. “Whose job is it, really?” Physicians’, nurses’, and pharmacists’ perspectives on completing inpatient medication reconciliation. J Hosp Med. 2015;10(3):184-186. doi: 10.1002/jhm.2289. 16. Vogelsmeier A, Pepper GA, Oderda L, Weir C. Medication reconciliation: a qualitative analysis of clinicians’ perceptions. Res Social Adm Pharm. 2013;9(4):419-430. doi: 10.1016/j.sapharm.2012.08.002. 17. Andrus M. Student pharmacist initiated medication reconciliation in the outpatient setting. Pharm Pract (Granada). 2012;10(2):78-82. 18. Bradley EH, Sipsma H, Curry L, et al. Quality collaboratives and campaigns to reduce readmissions: what strategies are hospitals using? J Hosp Med. 2013;8(11):601-608. doi: 10.1002/jhm.2076. 19. Ruggiero J, Smith J, Copeland J, Boxer B. Discharge time out:

Accredited In support of improving patient care, OnCourse Learning is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. OnCourse Learning is also an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider #50-1489). OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. OnCourse Learning is approved by the California Board of Registered Nursing, provider #CEP16588.

an innovative nurse-driven protocol for medication reconciliation. Medsurg Nurs. 2015;24(3):165-172.

40 | OR TODAY | JUNE 2018

ONLINE

Questions

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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IN THE OR

continuing education

Clinical VignettE For CE718 Mary is a nurse on a general medicine floor in a large hospital. She has recently finished nursing school and has little experience with processing newly admitted patients. She is assigned to a patient with a complicated medical history who is presenting with altered mental status.

1 What should Mary try to collect

at admission to ensure her patient’s medications are reconciled with his current inpatient medications?

a. A vaccination history b. A medication history c. An allergy history d. A past medical history

he patient’s altered mental 2 T

status makes him unable to clearly communicate his medication list to Mary. All of the following are most likely to provide a source of accurate medication history for the patient EXCEPT:

a. The patient’s current pharmacy b. The patient’s home medication list found in his wallet c. The patient’s wife and caretaker d. The patient’s previous discharge summary from five years ago

ary calls the patient’s pharmacy 3 M

and wife, but cannot reach anyone. This attempt to gather complete and accurate information is known as:

a. A grand gesture attempt b. A good faith attempt c. A good try d. A sincere endeavor

ary is finally able to confirm the 4 M

patient’s home medication list and compare it with the patient’s inpatient medication list. Mary notices clinically significant differences between the patient’s home and current therapy. What should Mary do with this information?

a. Discuss the differences with the patient’s pharmacy b. Do not discuss the differences with anyone; simply note the completed history in the patient’s medical record c. Discuss the differences with the physician d. Mentally note the differences and alert a physician if needed

1. Answer: B, A medication history should be taken at all transitions of care, including hospital admission. 2. Answer: D, A discharge summary that is 5 years old is the least likely source of an accurate medication history. The other options are much more likely to provide up-to-date information about the patient’s home medication regimen. 3. Answer: B, A good faith attempt is made whenever all options are used to attempt to gather a patient’s home medication list. 4. Answer: C, Mary should discuss the differences found with the primary physcian, as they are clinically significant and may affect the patient’s care. WWW.ORTODAY.COM

JUNE 2018 | OR TODAY |

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CORPORATE profile

profile Palmero Healthcare

In January 2017, Palmero Healthcare was acquired by Hu-Friedy, a global leader in the manufacturing of healthcare instruments and products. Palmero Healthcare has been committed to bringing a wide range of infection prevention products such as hospital-level disinfectants, barrier products, and safety products to the healthcare community since 1957. With quality and reliable products, Palmero’s goal is to become the recognized leader in infection prevention and safety products. “We take pride in knowing that our legacy will continue to expand and flourish as a Hu-Friedy subsidiary where our mission is to provide infection prevention and safety products that protect clinicians, patients, and the practice,” said Palmero President Karen Neiner, RDH, BSDH, MBA. The Palmero Healthcare product portfolio consists of five key categories: CLEAN: Features E-Vac System for economical vacuum line maintenance DISINFECT: Hospital-level DisCide® Ultra’s 1 minute kill claims (TB included) provide an intermediate level surface disinfectant that accelerates operatory turnover

44 | OR TODAY | JUNE 2018

CO R P O R AT E

PROTECT: A market leader in safety eyewear; protective category also includes consumable barriers and x-ray aprons ORGANIZE: Office support holders SUPPORT: Restorative, mixing bowls, pads, and spatula products

PALMERO’S LATEST INFECTION PREVENTION AND SAFETY PRODUCTS

our one-step intermediate hospital grade disinfectant, cleaner and decontaminant. It is non-corrosive, and non-staining. With its recently expanded list of kill claims, DisCide Ultra is proven to kill 27 deadly pathogens including tuberculous in 1 minute or less accelerating your operatory turnover. EPA registered, DisCide Ultra is ready to use (no mixing or measuring is required). It is available in towelettes, spray, and bulk gallon refills.

DISCIDE® ULTRA SURFACE DISINFECTANT Many disinfectants need up to 10 minutes to take effect – crucial time when it comes to keeping your surfaces clean and safe for patients, clinicians, and staff. DisCide Ultra is

DISCIDE® EFFECT HAND ASEPSIS SOAP A professional hand asepsis soap with aloe vera, vitamin E, and WWW.ORTODAY.COM

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fresh almond scent to promote healthy skin and staff compliance. Contains PCMX, a broad-spectrum antimicrobial agent effective against germs, bacteria, yeast and fungal microorganisms. Viscous formula removes stubborn dirt, grease, and transient bacteria without irritating sensitive skin.

TABLET BARRIER SLEEVES 100-PACK Don’t risk contamination or damage to your devices. Palmero’s Tablet Barrier Sleeve protects your portable, sensitive touch screen tablet devices. The single-use disposable sleeve provides infection prevention by mitigating crosscontamination of harmful pathogens. The easy-to-use Palmero Tablet Barrier

CLEAN

Sleeve protects equipment from harmful chemicals by minimizing disinfection requirements. The sleeve fits comfortably over a tablet with or without a case and is compatible with full or mini iPads and tablets.

DYNAMIC DISPOSABLES PINK SAFETY EYEWEAR

PROVISION™ ANTI-FOG SOLUTION Fogging can limit visibility during crucial procedures. Provision™ Anti-Fog Solution is an alcohol-free optical foaming cleaning solution that resists scratches, static, and stains. It is easy to use and cost effective. Simply apply the foaming solution to the surface of your eyewear or face shield and wipe clean with a soft cloth. Provision Anti-Fog Solution is compatible with all eyewear, face shields,

DISINFECT

PROTECT

mirrors, loupes, and scopes. The foam formula yields five times the applications compared to a traditional pump or squeeze bottle. It doesn’t drip or run and is non-toxic and non-flammable.

Our new pink safety eyewear is an exciting addition to our Dynamic Disposables Safety Eyewear line. A cost-effective alternative to traditional protective glasses, Dynamic Disposables can be worn comfortably with a clinician’s own prescription glasses. The lenses on our entire disposable line feature self-closing holes to prevent gaps and meet the OSHA and Center for Disease Control’s Guidelines for protective eyewear. We’re also extremely proud to announce that

ORGANIZE

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• MIXING BOWLS, PADS, SPATULAS & STICKS

• EVACUATION

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• ANTI-FOG SOLUTION

• MATRIX STRIPS

• MOUTH PROPS • NAPKIN BIB HOLDERS • PATIENT THROW • WASTE BAGS/LINERS

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JUNE 2018 | OR TODAY |

CORPORATE profile

SPECIAL ADVERTISING SECTION

Palmero Healthcare

our pink safety eyewear is an important part of our commitment to breast cancer awareness. When you purchase our new pink safety eyewear, 5% of the proceeds will be donated to the National Breast Cancer Foundation Inc. – an organization providing help and inspiring hope to those affected by breast cancer through early detection, education, and support services. Purchase any of the items above to increase the safety of your practice and at the same time, help support those affected by breast cancer.

and meet OSHA bloodborne pathogens PPE guidelines. Our Dynamic Disposables are extremely easy to use and remove and fit comfortably over prescription glasses or goggles. Unlike some systems that use an “eyeglass style” frame to support the shield, our lightweight frame does not require a nose bridge delivering a more comfortable, more-secure fit. The full and half shields both offer our Ultra-Clear™ Technology to prevent fogging, glare, and static electric buildup. The crystal-clear plastic allows for excellent front and peripheral vision with protection you can trust. Because they are disposable, your shield is guaranteed to be scratch free for optimal visibility.

DYNAMIC DISPOSABLES NEW SNAPEEZ FACE SHIELDS

of our mission to protect patients, clinicians, and the practice to include the environment as well. Our new eco-friendly and environmentally responsible program rewards participants for supporting greener initiative! We know that lead aprons have a useful life as their shielding properties wear down gradually. Proper maintenance includes either checking via fluoroscopy or replacing if they show any signs of damage. According to the EPA, recycling lead aprons is the preferred method since it keeps lead out of landfills. Now you can go green with our environmentally friendly X-Ray Apron Recycle/Trade-in Program. All materials will be responsibly disposed of and all lead liners will be properly distributed for processing back to base material. If you are only looking for a method of responsible disposal we are happy to accommodate, however we hope you will take part in our Trade-In Program and benefit from a complementary apron hanger that will help protect your investment in safety through proper storage. From eyesight safety to radiation mitigation wear, the Palmero Healthcare portfolio of products delivers infection prevention and safety products for clinicians, patients and your practice.

The next generation of disposable face shields is here! Known for our safety and infection prevention compliance products, we understand the imPALMERO X-RAY APRON REportance of face shields when additional CYCLE/TRADE-IN protection is needed to safeguard the PROGRAM entire face from infectious agents. Our We are committed to environmental new Dynamic Disposables Snapeez is an responsibility. It’s a key component of For more information, visit palmaddition to our traditional face field line our core values and an extension erohealth.com, email customerserwith an easy-to-use snap-on disposable vice@palmerohealth.com or call lens feature. It is lightweight, dispos800.344.6424. able, and cost effective. The self-sealing face shields prevent We take pride in knowing that our splatter exposure legacy will continue to expand and flourish as a

“

Hu-Friedy subsidiary where our mission is to provide

”

infection prevention and safety products that protect clinicians, patients, and the practice. - Palmero President Karen Neiner, RDH, BSDH, MBA

46 | OR TODAY | JUNE 2018

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Zero to Gone In Sixty

Accelerate Operatory Turnover with DisCide Ultra Disinfectant With intermediate level DisCide Ultra, surface disinfectant and decontaminant cleaner, you can accelerate the way you disinfect clinical settings. In just 60 seconds, DisCide Ultra is effective against TB, viruses (HBV, HCV, RSV, HIV-1), bacteria (MRSA, VRE, E. coli), and fungi (C. albicans). Specifically formulated to resist evaporation, it’s non-corrosive, non-staining, and leaves no residue. Plus, it meets OSHA’s blood-borne pathogen standard. Ready-to-use for the ultimate in convenience, DisCide Ultra is available in identical formulations in both spray and towelette formats to ensure efficacy when liquid and towelettes are used in tandem. DisCide to be sure with fast acting DisCide Ultra.

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Visit discide.com for a disinfectant efficacy chart.

* To receive your no charge item(s), please email a copy of your dealer invoice dated 06/01/18-07/31/18 to: customerservice@palmerohealth.com, fax to (203) 377-8988, or mail to: 120 Goodwin Place, Stratford, CT 06615. Must receive invoice by 08/31/18. Please allow 4–6 weeks for no charge goods.

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STAFFING SHORTAGE

SOLUTIONS BY DON SADLER

48 | OR TODAY | JUNE 2018

how education and training help

WWW.ORTODAY.COM

lot has been written about the nursing shortage in the U.S., with a projected shortage of more than one million nurses by 2022. The nurse staffing challenge extends to the OR where half of all OR leaders say they’re having problems recruiting

solution: aa solution: training and and training education education O n e s o lu ti o n to thi s c ri s i s i s p rov i din g O R nur s e s wi th o n g o ing trainin g an d e du c ati o nal o p p o r tuni ti e s .

perioperative nurses.

“ H i gh - qu ali t y an d

“ T h e qu e s t to f in d

c o ntinu al tr ainin g

qu ali f i e d , we ll -train e d

i s a mu s t in h e al th

nur s e s , c o up l e d wi th th e

c are to d ay,” s ay s

growin g b aby b o o m e r nur s in g

M aria M o ral e s , M S N ,

d e m o grap hi c , has e l evate d

R N , C PA N , E xe c u ti ve

th e O R s t af f in g s ho r t ag e to

wi th O n C o ur s e L e arnin g .

s ay s M D Pub li s hin g

“ Edu c ati o n an d trainin g are o f

V i c e Pre s i d e nt

u tm o s t imp o r t an c e in lay in g a

K ri s tin L e avoy.

s o li d f o un d ati o n f o r p rac ti c e .”

“A s a re sul t ,

A p ar ti c ular c hall e n g e wh e n

c urre nt O R s t af f are

i t c o m e s to O R nur s e s t af f in g

s tre tc h e d thin as th ey in c re as e d re s p o ns ib ili ti e s an d th e b urd e n to hire th e ir re p l ac e m e nt s a s re tire m e nt ap p ro ac h e s ,” L e avoy ad d s .

i s th e f ac t that th e p rin c ip l e s K R I S T I N L E AV O Y

are t as ke d wi th l o n g e r s hi f t s ,

MARIA MOR ALES, MSN, RN

D ire c to r, H e al th c are Pro gram s

unp re c e d e nte d h e i ght s ,”

o f p e ri o p e rati ve p rac ti c e are no t in c lu d e d in un d e rgraduate nur s in g p ro gram s . “ T hi s m ake s i t di f f i c ul t to hire n ew nur s in g s c h o o l graduate s s e t tin g ,” s ay s S u s an B akewe ll , M S , R N - B C , th e D ire c to r o f Pe ri o p e rati ve Edu c ati o n & Pro f e s s i o nal D eve l o p m e nt f o r th e A s s o c iati o n o f p e ri O p e rati ve R e gi s te re d

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N ur s e s (AO R N) .

JUNE 2018 | OR TODAY |

SUSAN BAKEWELL, MS, RN-BC

into th e p e ri o p e rati ve

there are more opportunities for ongoing perioperative training and education today than ever before The good news is that there are more opportunities for ongoing perioperative training and education today than ever before. These include industry conferences and workshops, online webinars, preceptorships, residencies and continuing education programs. “When hospital administration encourages and supports staff to participate in continuing education opportunities like these, they are paving the way for better facility management, higher employee satisfaction and improved best practices,” says Leavoy. “In addition, participating in industry conferences and taking advantage of educational resources gives nurses the opportunity to earn or maintain their certifications and learn best practices from their peers,” Leavoy adds. “It also allows nurses to share the struggles they face on a day-to-day basis with each other and steps to overcome them.”

preceptorship and residency programs Morales is a strong proponent of preceptorship and residency programs for new nursing school graduates who want to enter perioperative nursing.

“A high-quality preceptorship or residency program helps nurses learn the technical, communication, critical-thinking and practical skills needed in today’s health care environment,” she says. According to Morales, there is a gamut of research-based information to support how preceptorships and residency programs should be administered. She points specifically to the Nursing Preceptor Specialty Practice Focused CE Series offered by OnCourse Learning. “It’s not enough to just pair a nurse or physician with a trainee and hope for a good educational experience,” says Morales. “We need prepared and trained preceptors to deliver researchbased educational programs of a sufficient duration to help yield prepared, astute health care professionals who are ready to provide clinical care.” Bakewell says that AORN has developed a standardized, evidence-based program to help close the education gap for new perioperative nurses. “The use of this program – which is titled Periop 101: A Core Curriculum – eliminates the need for the perioperative educator and staff to develop a home-grown course,” says Bakewell. “This saves time and money for the staff and hospital and focuses the efforts on the development of the students.” According to Bakewell, new nursing school graduates and registered nurses moving into the perioperative specialty can learn the foundation of perioperative practice in a supportive environment by completing this six-month, blended online program. “A critical element of the clinical practicum is the assignment of an experienced preceptor,” says

Bakewell. “He or she works side by side with the novice nurse to ensure safe implementation of perioperative practice, culture and patient advocacy during a time when the patient is most vulnerable.” The Periop 101 course is continually updated when new or revised guidelines are released and other evidence-based clinical practices are adopted, Bakewell adds. “And all Periop 101 students receive a free one-year membership to AORN,” she says.

or today live! Another terrific training and education opportunity for perioperative nurses is the OR Today Live! Surgical Conference. This year’s conference will be held August 26-28 in Nashville, Tennessee. “OR Today Live! hits the trifecta of conference must-haves,” says Leavoy. “There’s a top-notch educational line-up and an exhibit hall offering the latest technologies in the marketplace,” says Leavoy. “Also, the conference takes place in an intimate setting that allows attendees to network not only with their fellow nurses, but also with presenters and vendors.” “Perhaps best of all, the organizers at OR Today Live! strive to make the conference affordable and value-packed by keeping admission prices low,” Leavoy adds. For more information or to sign up for this year’s OR Today Live! Surgical Conference, visit www.ortodaylive.com. Leavoy points out that preconference workshops like the CSSM Exam Prep Course at OR Today Live! often provide opportunities for nurses to earn certifications in specialty areas of expertise. Morales also encourages nurses to

pursue specialty certifications. “If you have worked in a certain area of health care, don’t be afraid to pursue certification,” she says. “Begin earning continuing education credits. Attend conferences and participate on a practice council committee.” “The more you can hear good teaching, watch good practice and demonstrate proper skills yourself, the more you will grow in your specialty,” Morales adds. Bakewell says that simulation labs are being used more and more to assist perioperative staff in learning new specialty techniques and procedures in a safe, supportive environment. “There are online education activities that can help perioperative nurses prepare to go into a specialty area by learning about highly specialized equipment, such as lasers and robotics,” she says. “Once the theory behind the equipment has been mastered, the nurse is

the more you can hear good teaching, watch good practice and demonstrate proper skills yourself, the more you will grow in your specialty

ready to go into a room with a preceptor to use the equipment,” Bakewell adds. “An online activity can provide the content nurses need to practice safely, such as learning about the growth and development of the pediatric patient.”

STAFFING SHORTAGE SOLUTIONS how education and training help

sources of training and education Bakewell encourages hospitals and nurses to seek out training and education opportunities available through continuing education medical groups, hospital education departments and publishing companies. Meanwhile, Morales lists a number of training and education programs offered by OnCourse Learning, including the following: • The Focused CE Series offers a blended learning format where nurses can study on their own, watch or participate in customized webinars, and interact with a subject matter expert and peers. • The Charge Nurse Focused CE Series is designed for nurses who want to pursue a charge nurse or manager role. • The Adult CCRN/PCCN Certification Review Focused CE Series is designed for nurses who want to strengthen their critical care knowledge. “If you would rather pursue a shorter, self-study option that you can complete on your own schedule, a PearlsReview course might be right for you,” says Morales. These are offered in the areas of operating room nursing (CNOR), Hemodynamics Review, Nurse Manager and Leader (CNML) and Preceptor Specialty. To learn more, visit www.pearlsreview.com.

Finally, don’t forget about CE Direct. “This is a great website and continuing education solution that offers a massive inventory of quality nursing articles, recorded webinars, self-study slide presentations and more,” says Morales. To learn more about CE Direct, visit lms.nurse.com. Of course, AORN is also a goldmine of training and education resources for perioperative nurses. “AORN members have free access to numerous tools and education resources that are evidence-based and present current practice standards,” says Bakewell. “Members can also access the peer-reviewed AORN Journal with up to 200 free CHs in its 12 monthly issues,” she adds. “And throughout the year, AORN presents workshops in cities across the country supporting management growth and providing hands-on and didactic clinical practice support along specialty areas such as infection prevention.” To learn more about AORN training and education resources, visit www.aorn.org.

SPEAKER SPOTLIGHT As a nurse, you have many opportunities to share your skills. On the street, as a bystander to a heart attack victim, as a helping hand to someone who has fallen, the possibilities are endless. I chose to take my skills to Third World countries, including Cuba, the Democratic Republic of the Congo and Guatemala. Since 2002, I have been working with Faith In Practice and in 2016 joined WOGO – Operation Walk: Women Orthopedist Global Outreach to bring healing and care to those who would not otherwise be given this gift. It is truly an honor and a privilege to share my skills on these trips. It has made a lasting impression on me. “To whom much is given; much is expected.” •

Constance “Connie” B. Squib

Constance “Connie” B. Squib BSN, MPA, RN Strategic Program Manager Medtronic Transformative Solutions

SURGICAL CONFERENCE

Find out more about Connie and her experience in new program development and blood management as she presents, “Every Drop Counts: A comprehensive approach to blood management” at the 2018 OR Today Live conference being held August 26-28 in Nashville, TN.

www.ortodaylive.com

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FRILOUX,RN BY M ATT S KO U FA LOS

For Ed Friloux, emergency medical service (EMS) is a family business. A second-generation EMT and the son of a retired New Orleans firefighter, Friloux joined the fire service after the conclusion of his naval career, and became a paramedic in Gulfport, Mississippi. Among the many incidents through which he provided care, Friloux was on duty during Hurricane Katrina, and recalled taking a swim when his ambulance hit some eight feet of water during that storm. All along, Friloux kept his eyes on his dream of becoming a flight nurse. To bolster his resume, he completed certificate programs at Mississippi Gulf Coast Community College, then returned home

54 | OR TODAY | JUNE 2018

to Lafayette, Louisiana to finish nursing school when his father fell ill. There, he worked in a cardiac care unit at Lafayette General, then continued on to Our Lady of Lourdes Regional Medical Center for four years while he built the skills that would qualify him for his career of choice. He kept up his paramedic certifications until the right opportunity finally opened up, and today, Friloux is a boardcertified emergency nurse, a registered paramedic, a registered nurse, and the Base Clinical Lead Flight Nurse for Air Evac Lifeteam Base 124 of Opelousas, Louisiana. Air nursing is an extension of EMS,

and Friloux’s task is to rapidly transport critical-care patients from rural areas to health care facilities in which they can receive the best care for their condition. His caseload typically includes advanced cardiac transports, stroke patients; incidents that require urgent medical evacuation and which extend hospital resources into areas of the country too far removed from them. “If you have a traumatic patient, they really need to get to a Level I trauma center,” Friloux said. “We’re out in the boondocks; we have a lot of farmers here. It’ll take an hour for the ambulance to get to the closest trauma center in New Orleans, Shreveport; Jackson, Mississippi. WWW.ORTODAY.COM

We can get there in 30 minutes.” That timeframe, which professionals refer to as “the golden hour” to transport a patient from the scene of an incident to a place of medical care or surgery, greatly improves the chances of survival. Flight nurses operate in an even smaller window that EMTs call “the platinum 10 minutes,” which is the ideal amount of time to get a patient off the scene, Friloux said. The crew – which includes a nurse, a pilot and a paramedic – travels in a Bell 206, single-engine, long-range helicopter. Top speed is about 110 miles per hour, and Friloux describes the conditions as cramped but the ride as smooth. “You get real personal with your partner or any patient, but you just do what you’ve got to do,” he said. “It’s loud, but it’s fun. You’re looking out the window and you see this picture of the countryside, which is breathtaking sometimes.” On the chopper, pilot, nurse and medic all work together like a firehouse crew, working back-to-back 12-hour shifts. In their down time, they complete online training, hang out, cook – and then check the weather when the tones drop: the cue that they’re going to be dispatched to a rescue scene. The destination comes in over the radio once they’re airborne. From any preliminary information they have, the crew must come prepared “to try to make that scene time as short as possible,” Friloux said. Flight crews are deployed with the help of status management software; posted throughout a region based on

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predictive data software. When one unit gets a call, the others shift to better cover the area. Air Evac Lifeteam operates bases throughout the country, with each situated about 70 nautical miles apart from one another. Across such a wide geographic theater of operations, Friloux must keep up his licensure in Mississippi, Louisiana, Texas and Arkansas. He also has to keep a thick skin when the joking gets edgy. In the high-pressure environment of flight nursing, “you’ve got to have the kind of personality that things bounce off of you,” Friloux said. “If we don’t pick on you, we don’t like you,” he said. “You’ve got to be able to handle the stress and the pressure [because] families, when they see us, it’s the worst day of their lives.” “Everybody’s put on this earth to do special things,” Friloux said. “For me, [flight nursing is] home, but I’m more relaxed there than with other things.” After 25 years, the most rewarding aspect of his job is still the chance to save a life, Friloux said. Once, over lunch, dispatch radioed in to check his location, and not long after, a man approached and asked for his name. “He said, ‘I want to extend my gratitude to you,’ ” Friloux recalled. “‘You saved my life a few months ago.’” “You don’t get true saves that often, but when you do, it’s worth the training and everything else,” he said. “You see a lot of the bad side of society, unfortunately, but when you get those occasional saves,

it really makes your day.” Nursing is a broad profession, but specialties like flight nursing allow it to touch a variety of lives and people. For those interested in the job, Friloux recommends learning event management and laboratory specialties; and getting paramedic, emergency, and critical care or flight nurse certification. Temperamentally, he said emotional resilience is key, since flight nursing can be a tough field to crack. “If you have a chance to work in an ICU, you learn a lot about lab levels,” Friloux said. “In an emergency room, you get different types of prioritizing. Some companies require five years [EMS service] in a high-volume 9-1-1 area to get your hands-on experience.” “It’s not an easy field to get into, to get your foot in the door,” he said. “Don’t get discouraged by your first turn-down. Keep chiseling away at it; someone will pick you up. You might not be the right fit for one base, but you might be the right fit for another base.”

JUNE 2018 | OR TODAY |

OUT OF THE OR fitness

Returning to an Old Exercise Routine? Here’s what you need to know BY Heidi Godman, Harvard Health Letters

y ancient workout clothes are folded neatly (and squished) beneath a pile of sweaters on a shelf in my closet. They were cute – from the 1990s – when I cared very much about how I looked at the gym. Decades later, I skip the gym and instead walk most days and do body weight exercises, all while clad in a sweatshirt and yoga pants. But whenever I see my old gym outfit (blue leotard “overalls” with a cropped tee shirt built in), I wonder if maybe I’d get more from a gym workout. It wouldn’t be hard to jump back in, would it?

Just a second It turns out, it’s smarter to ease back into a gym workout when we’re older, even if we’ve been active. And if you’ve been sedentary for a long time, it’s even more important. Why? Because our bodies change as we age. “We lose muscle mass and strength as we get older, and the muscles become less flexible and less hydrated,” says Clare Safran-Norton, P.T., Ph.D., M.S., O.C.S., clinical supervisor of rehabilitation services at Harvardaffiliated Brigham and Women’s Hospital. There can be other changes, too:

56 | OR TODAY | JUNE 2018

arthritis that weakens joints, and vision changes, neurological disease, joint pain, or inner ear problems that can throw off balance. There may also be underlying conditions we aren’t aware of, such as high blood pressure or heart disease, that can increase the risk for severe health consequences if we try to exercise today with the vigor of our youth.

cising again, you should stop if you experience any symptoms that could indicate heart disease.

A new routine

Before beginning any kind of exercise program after being sedentary, get the all-clear from your doctor, especially if you have heart disease, risk factors for heart disease, or lung problems. Ask if you need to monitor your heart The downside of jumping right back in rate during exercise. If you’ve been sedentary for a long Once you have the green light, time, jumping back into a workout think about what type of exercise sets you up for injury. routine appeals to you, such as taking “Lifting weights that are too heavy a tai chi or yoga class, doing a gym or or taking an exercise class that’s too home workout, or going for a brisk strenuous often causes trouble, and daily walk. Make it something you’ll it’s usually a muscle tear or a strain,” want to do, so you’ll stick with the says Safran-Norton. program. Other risks include: Think of your current abilities as • rotator cuff tears, from arthritic you consider your options. shoulders with bone spurs that “If it’s a yoga, cycling, or tai chi can rub on a tendon class, you’ll need adequate strength • falls that result from poor and flexibility. You need to be able balance, and broken bones from to do the basics, like raise your arms the falls over your head and lift your legs eas• heart attack or stroke from an ily,” Safran-Norton says. intense workout, particularly if Then, ease into exercise. you have undiagnosed high blood “Start with a low-intensity workpressure or heart problems. out for 20 or 30 minutes. Increase You might also fail to recognize the intensity and length over time,” symptoms of heart disease if you are suggests Safran-Norton. “It’s the same taking medications that mask them, for working with weights. Try a slight such as beta blockers. If you are resistance at first, and then moderate.” taking beta blockers and start exerWWW.ORTODAY.COM

NO MORE

WHEEL obstructions

The wiser workout To avoid injury, warm up your muscles before exercising, particularly if you are out of shape. Safran-Norton recommends five minutes of brisk walking or time on an elliptical machine to get blood flowing to the muscles to make them pliable. You’ll need to stretch afterward and repeat the whole process two or three times a week. Don’t feel self-conscious if you’re not the fittest person in the room, if you need to modify a particular exercise, or if you need to take breaks. And don’t feel funny about your gym attire. We’re all older and wiser about health. And we know now that it’s more important to feel good than to look good.

– Heidi Godman is executive editor of Harvard Health Letters.

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JUNE 2018 | OR TODAY |

OUT OF THE OR health

Exercise Your Brain

to Improve Memory in Retirement BY Mary Kane, Kiplinger’s Retirement Report hen retired professor Darlene Howard taught in the psychology department of Georgetown University, she often had to remember the names of as many as 50 students a semester. So Howard used a memory trick: She created an association with a student’s name or face. A student with the last name of Brady might make her think of New England Patriots quarterback Tom Brady. The next time she saw the student, she would tap that image to remember his name.

If you struggle to recall a word that’s on the tip of your tongue, or have trouble putting names to faces, you may think memory decline is a normal part of aging you have to accept. But you can strengthen certain memory skills, and improve your overall brain health and cognitive function. “There are a lot of ways you can facilitate the health of your brain,” says Howard, now age 70. “What we need to do is not get worried so much about the fact we’re not remembering something, and instead think of ways we can remember it.” Start with techniques to help you improve specific skills. When meeting someone for the first time, repeat the name when introduced, to make sure you’ve got it, Howard says. Then create an association to help you remember and

58 | OR TODAY | JUNE 2018

practice it. “Even something ridiculous is good, and it will work,” Howard says. Take notes on your phone after the introduction to refer to later. If you can’t recall a word, that’s generally because it’s a word you don’t use that often, says Lise Abrams, a University of Florida psychology professor who has studied word-finding problems for 20 years. But consciously using other words that start with the same syllable as the word you forgot may be helpful in the future. For example, if you intended to use the word, "denote" but couldn’t remember it, try frequently using words such as, "decide" or "debate", and it may help you recall the missing word the next time around.

Boost brain health Brain training games are widely advertised, but the benefits are limited. Memory games may improve your memory slightly, and language games may boost your language ability a bit, but there’s no proof yet of any major changes beyond that, says D.P. Devanand, director of geriatric psychiatry at Columbia University Medical Center in New York. “There simply isn’t enough evidence to recommend this strategy as a means to reverse memory impairment and decline,” he says. But research does prove that taking care of your overall brain health helps improve your brain function and

memory. A healthy brain actually begins with your heart, Devanand says. Older people sometimes suffer small strokes without realizing it, so stopping smoking, lowering your cholesterol and getting hypertension treated can reduce that risk. “What’s good for the heart is good for the brain,” he says. Add in exercise, but an occasional stroll isn’t enough. You need to combine aerobic and resistance exercises, such as using weights, Devanand says. Or walk for 45 minutes at least three days a week, and push yourself to go faster. If that’s too much, “any exercise or activity is better than none,” Howard says. Being social helps, because social interaction stimulates the brain. Ask a friend to join you on a walk or at the gym. Or consider volunteering for a cause you care about. A recent Johns Hopkins University study showed that seniors who tutored in Baltimore schools had improved brain performance. Keep your brain active by taking classes to learn new skills or teach yourself to use new technology. Or consider meditating, which can help you focus, a skill that declines with age. And don’t panic: You may forget words more often as you age, but it’s not a sign your memory is gone. Seek a medical evaluation, including a cognitive performance test, to rule out any major issues. Then practice memory techniques and healthy habits. That name is likely to come back to you eventually. WWW.ORTODAY.COM

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OUT OF THE OR nutrition

3 Breakfast Boosters to Keep You Going All Day By Jessica Migala tarting the day with breakfast gets the entire day off on the right foot – but many of us skip it on a regular basis, or eat foods that leave our stomachs grumbling by 10 a.m. These tips will help you combine foods to keep you going strong all day long.

Breakfast booster: avocado Tame hunger by adding an avocado to your A.M. routine. People in a recent study who did that as part of their breakfast reported feeling fuller for the next six hours, according to research in the FASEB Journal. Healthy fat helps quash hunger, but avocado packs fiber as well. Together, the two nutrients send stronger signals to your brain that you’re satisfied for longer, says one of the researchers. • Avocado-topped omelet: Beat 2 large eggs with 1 teaspoon milk and a pinch of salt. Cook in 1 teaspoon olive oil in a small nonstick skillet over medium heat until the bottom is set and the center is still a bit runny, 1 to 2 minutes. Flip the omelet over and cook until set, about 30 seconds more. Top with one of the variations below. 1. Avocado and smoked salmon: 1/4 sliced avocado, 1 ounce smoked salmon, 1 tablespoon fresh basil and 1/2 teaspoon olive oil. 2. Avocado and arugula:

60 | OR TODAY | JUNE 2018

1/4 diced avocado, 1/2 cup arugula tossed with 1 teaspoon each olive oil and lemon juice plus 2 tablespoons plain whole-milk Greek yogurt and a pinch of salt.

Breakfast booster: rye bread Go for rye toast or rye crisps to curb your appetite. According to research published in Nutrition Journal, study participants who ate breakfasts built around 230 calories of rye crisps reported less hunger after breakfast versus those who ate white bread – and they consumed 56 fewer calories at lunch. The fiber in the rye may help keep blood sugar levels steady and trigger the body to release appetite-suppressing hormones. Try rye bread, too: the researchers noted that rye may have a unique structure that lets it outperform other whole grains. • Ham and jam smorrebrod: Divide 2 teaspoons each cultured butter and lingonberry (or raspberry) jam, 2 ounces thin-sliced ham and chives to taste between 2 rye crispbreads. • Cream cheese and cucumber smorrebrod: Divide 2 tablespoons each cream cheese and walnuts, 8 slices cucumber, 1 teaspoon honey and a pinch of salt between 2 rye crispbreads.

Breakfast booster: almonds

protein, healthful fats, fiber and crunchy texture may encourage people to naturally eat less. • Mango-almond smoothie bowl: Blend 1/2 cup each frozen chopped mango and nonfat plain Greek yogurt, 1/4 cup each frozen sliced banana and plain unsweetened almond milk, 3 tablespoons unsalted almonds and 1/8 teaspoon ground allspice. Top with 1/4 cup raspberries, 2 tablespoons unsalted almonds and 1/2 teaspoon honey. • Berry-almond smoothie bowl: Blend 2/3 cup frozen raspberries, 1/2 cup each frozen sliced banana and plain unsweetened almond milk, 3 tablespoons sliced almonds, 1/4 teaspoon ground cinnamon, 1/8 teaspoon each ground cardamom and vanilla extract. Top with 1/4 cup blueberries, 2 tablespoons sliced almonds and 1 tablespoon coconut flakes.

– EatingWell is a magazine and website devoted to healthy eating as a way of life. Online at www.eatingwell.com.

Make almonds part of your morning routine to keep your blood sugar levels on an even keel, particularly if you’re at risk for Type 2 diabetes. Almonds’ mix of

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OUT OF THE OR

Recipe

recipe

the

62 | OR TODAY | JUNE 2018

My Favorite Chocolate Chip Cookies

INGREDIENTS:

• 1 3/4 cups all-purpose flour • 1/2 cup old-fashioned rolled oats • 1 teaspoon baking soda • 1 teaspoon salt • 2 sticks unsalted butter, room temperature • 1 cup firmly packed golden brown sugar • 1/2 cup sugar • 1 teaspoon vanilla extract • 2 large eggs • 1 1/2 cups semi-sweet chocolate chips (If you prefer less sweet use 60 percent bittersweet) • 1/2 cup toffee bits • 3/4 cup chopped walnuts, pecans or almonds

Brownie Toffee Cookies

INGREDIENTS:

• • • • • • • • • •

1 cup all-purpose flour 1/4 teaspoon salt 1/4 teaspoon baking powder 4 tablespoons unsalted butter 1/2 pound bittersweet chocolate chips (11/4 cups) 1/4 pound semisweet chocolate chips (2/3 cup) 3 large eggs 3/4 cup sugar 1 teaspoon vanilla extract 1/2 cup toffee bits

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.

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These Chocolate Cookies

OUT OF THE OR recipe

are Worth Every Bite If I had to pick my favorite cookie either one of these would be the one. The following recipes for chocolate chip cookies and brownie toffee cookies rely on excellent quality chocolate, like Ghirardelli or Guittard, and both contain toffee. The first one is a classic chocolate chip, while the other one is a crossover of a brownie converted into a chewy, fudgy cookie. I love the Tate chocolate chip cookie that I first tasted at Tateâ&#x20AC;&#x2122;s Bake Shop in Southampton, New York. I returned home to my kitchen and began trying

to duplicate the texture and flavor. I substituted some oatmeal for part of the flour, used lots of brown sugar and toffee bits to give these cookies a crisp, crunchy texture. Rounds of cookie dough will produce thicker and chewier cookies, while flattened rounds of dough will spread into thin flat crisps of buttery dough studded with chocolate chips and toffee. If you prefer larger cookies, drop golf-ball sized cookies onto baking sheets, and bake the cookies a few minutes longer.

The brownie toffee cookies are easy to make and include a combination of bittersweet chocolate batter and toffee bits. One of the secrets to making exceptional cookies is to make up the dough a day ahead, cover and refrigerate. This gives either baked cookie a richer, fuller flavor with notes of toffee and caramel. So go ahead and enjoy a platter of both or just one of these chocolate cookie gems. Watch how fast they disappear.

My Favorite Chocolate Chip Cookies Makes about 5 dozen 2 1/2-inch cookies or 28 4-inch thin cookies 1. Preheat the oven to 375 F. In a small bowl, combine the flour, oats, baking soda and salt. Reserve. 2. In a large mixing bowl, beat the butter, brown sugar, sugar and vanilla until creamy. Add the eggs one at a time, beating well after each addition. Add the flour mixture a little at a time and beat until incorporated. Stir in chocolate chips, toffee and nuts. Cover the dough and refrigerate overnight. 3. Line baking sheets with parchment paper. For cakier cookies: Using a teaspoon, drop cookies onto ungreased baking sheets, leaving 2-inches between each cookie. For crispier cookies: Using a 1-inch ice cream scoop, drop 4 scoops of cookie dough onto each baking sheet. Then press them into very thin rounds using the heel of your hand, leaving 2 inches between the cookies, until they are approximately 4 inches across. 4. Bake for 9 to 11 minutes, or until golden. If using two racks, swap the baking sheets halfway through baking (these may need a minute or two longer to brown). Cookies will cook faster if using a dark non-stick cooking pan. 5. Remove baking sheets from oven and let cookies cool on sheets for 2 minutes. Transfer cookies to wire racks to cool completely. Advance preparation: The cookies can be made up to one day ahead, covered and refrigerated through Step 2. Store the cookies in airtight containers for up to 1 week, or freeze for another time.

Brownie Toffee Cookie Makes about 30 cookies 1. 2. 3. 4.

Preheat the oven to 350 F. Grease and flour two baking sheets, or line the baking sheets with parchment paper. Place the flour, salt and baking powder in a strainer over wax paper and sift. Reserve. Melt the butter and chocolate in a double boiler over boiling water. Whisk the butter and chocolate until blended. Cool. In a medium bowl with an electric mixer on medium-high, beat the eggs and sugar until lemon colored, about 1 minute. Add the chocolate mixture and the vanilla, and beat until combined. 5. Stir the flour mixture into the batter slowly so it has no lumps. Stir in the toffee bits. Cover the dough and refrigerate overnight. 6. Use a small ice cream scooper to scoop out cookies about 1 1/2 inches in size. Place the cookies about 3 inches apart. Dip the ice cream scoop in hot water between cookies to prevent sticking. 7. Bake the cookies for about 10 to 12 minutes or until the tops barely spring back and are slightly puffed. Cool and serve. Advance preparation: The cookies can be made one day ahead, covered and refrigerated through Step 4. Keep the cookies in an airtight container for up to three days or freeze for another time.

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JUNE 2018 | OR TODAY |

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The News and Photos that Caught Our Eye This Month

OUT OF THE OR pinboard

8 Ways to Get the Most Out of a Gym Membership

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JUNE 2018 | OR TODAY |

PROOF S

TRIM 4.5”

For health and fitness success, Fitness Premier 24/7 Clubs recommend 8 steps to find the perfect gym: Location: When looking for a buddy helps both people workproper nutrition. Eating right can gym membership, make sure out harder, have more fun and make all the difference in a fitness to always go close to home. A maybe even get a friendly comjourney. APPROVED CHANGES NEEDED gym should be in PROOF a location that petition going. Keep it up: To get the most out makes it convenient. If the locaNutrition: Getting into the gym of a membership – use it! A good CLIENT SIGN–OFF: tion of the gym is close to home, for a hour is the easy part comway to get the most out of it is by PLEASEnot CONFIRMpared THAT THE FOLLOWING CORRECT it’s harder to make excuses to the other 23ARE hours of staying consistent in how many LOGO PHONE NUMBER WEBSITE ADDRESSdaysSPELLING to go. the day. While hitting the gym a week one GRAMMAR goes to the gym. Amenities: Take advantage of the can be a great boost to health Stick to a plan, get that coach, amenities the gym has, such as and body image, it does little to take those classes, stay on top of the locker rooms with showers nothing without a good diet and TRIM 4.5” nutrition and achieve success! and 24/7 access. Keep a gym bag packed and ready to go at all. Fitness Assessment: All gym goers should remember it’s always important to assess personal health and fitness levels. A sitdown with a personal trainer is the perfect place to get an awareness for one’s physical health, discuss health risks based on personal habits, begin to establish attainable goals and increase confidence in any fitness environment. Get a coach: Everyone needs a coach. A coach acts as a guide, a motivator and a mentor. They can help new fitness members maximize their gym time and steadily reach their goals. Take a class: Working out with a group of people has been proven to keep people more motivated and comfortable, as well as ensure a fun workout. Bring a buddy: If a class doesn’t work in the schedule, grab a friend and go push through a workout together! Having a gym

INDEX

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Alphabetical AIV Inc.………………………………………………………… 27 Alco Sales Service, Co.…………………………………21 Arthroplastics, Inc.…………………………………………21 ASCA…………………………………………………………… 42 Avante Health Solutions…………………………… 23 C Change Surgical……………………………………… 13 Clorox…………………………………………………………… 19 CSZ, A Gentherm Company……………………… 59 Cygnus Medical……………………………………………… 9 D. A. Surgical……………………………………………… 67

Doctors Depot…………………………………………… 32 Healthmark Industries Company, Inc.……… 4 Innovative Medical Products…………………… 68 Innovative Research Labs………………………… 57 Jet Medical Electronics Inc……………………… 65 Key Surgical……………………………………………………17 MD Technologies inc.………………………………… 53 MedWrench………………………………………………… 61 Microsystems……………………………………………… 33 Pacific Medical…………………………………………… 42

Palmero Health Care…………………………… 44-47 Paragon Services………………………………………… 43 Ruhof Corporation…………………………2, 3, 24, 25 SIPS Consults……………………………………………… 52 TBJ Incorporated…………………………………………… 5 Tetra……………………………………………………………… 15 TIDI C-Armor………………………………………………… 6 TRU-D…………………………………………………………… 28

Clorox…………………………………………………………… 19 Cygnus Medical……………………………………………… 9 Healthmark Industries Company, Inc.……… 4 Palmero Health Care…………………………… 44-47 Ruhof Corporation…………………………2, 3, 24, 25 SIPS Consults……………………………………………… 52 TBJ Incorporated…………………………………………… 5 TIDI C-Armor………………………………………………… 6 TRU-D…………………………………………………………… 28

Doctors Depot…………………………………………… 32 Jet Medical Electronics Inc……………………… 65 Pacific Medical…………………………………………… 42

categorical ANESTHESIA

Doctors Depot…………………………………………… 32 Innovative Research Labs………………………… 57 Paragon Services………………………………………… 43

ASSET MANAGEMENT

Microsystems……………………………………………… 33

ASSOCIATION

ASCA…………………………………………………………… 42

CARDIAC PRODUCTS

C Change Surgical……………………………………… 13 Jet Medical Electronics Inc……………………… 65

CARTS/CABINETS

Alco Sales Service, Co.…………………………………21 Cygnus Medical……………………………………………… 9 Healthmark Industries Company, Inc.……… 4 Innovative Research Labs………………………… 57 TBJ Incorporated…………………………………………… 5

CRITICAL CARE

Innovative Research Labs………………………… 57

INSTRUMENT STORAGE/TRANSPORT

Cygnus Medical……………………………………………… 9 Key Surgical……………………………………………………17

INSTRUMENT TRACKING

Microsystems……………………………………………… 33

REPROCESSING STATIONS

TBJ Incorporated…………………………………………… 5

RESPIRATORY

Innovative Research Labs………………………… 57

SAFETY

D. A. Surgical……………………………………………… 67 Healthmark Industries Company, Inc.……… 4 Key Surgical……………………………………………………17 TIDI C-Armor………………………………………………… 6

SINKS

TBJ Incorporated…………………………………………… 5

INVENTORY CONTROL

Key Surgical……………………………………………………17

STERILIZATION

MONITORS

Doctors Depot…………………………………………… 32 Pacific Medical…………………………………………… 42

Cygnus Medical……………………………………………… 9 Healthmark Industries Company, Inc.……… 4 TBJ Incorporated…………………………………………… 5

ONCOLOGY SERVICES

SURGICAL

ONLINE RESOURCE

MedWrench………………………………………………… 61

Avante Health Solutions…………………………… 23 MD Technologies inc.………………………………… 53 SIPS Consults……………………………………………… 52 TIDI C-Armor………………………………………………… 6

Clorox…………………………………………………………… 19 Cygnus Medical……………………………………………… 9 Palmero Health Care…………………………… 44-47 Ruhof Corporation…………………………2, 3, 24, 25

OR TABLES/BOOMS/ACCESSORIES

SURGICAL INSTRUMENT/ACCESSORIES

DISPOSABLES

Alco Sales Service, Co.…………………………………21

AIV Inc.………………………………………………………… 27 TRU-D…………………………………………………………… 28

ENDOSCOPY

PATIENT MONITORING

CS/SPD

MD Technologies inc.………………………………… 53 Microsystems……………………………………………… 33

DISINFECTIONS

Avante Health Solutions…………………………… 23

D. A. Surgical……………………………………………… 67 Innovative Medical Products…………………… 68

OTHER

Clorox…………………………………………………………… 19 Cygnus Medical……………………………………………… 9 Healthmark Industries Company, Inc.……… 4 MD Technologies inc.………………………………… 53 Ruhof Corporation…………………………2, 3, 24, 25

AIV Inc.………………………………………………………… Avante Health Solutions…………………………… Jet Medical Electronics Inc……………………… Pacific Medical……………………………………………

FALL PREVENTION

CSZ, A Gentherm Company……………………… 59

Alco Sales Service, Co.…………………………………21

GENERAL

AIV Inc.………………………………………………………… 27

HOSPITAL BEDS/PARTS

Alco Sales Service, Co.…………………………………21

INFECTION CONTROL

Alco Sales Service, Co.…………………………………21

66 | OR TODAY | JUNE 2018

27 23 65 42

C Change Surgical……………………………………… 13 Cygnus Medical……………………………………………… 9 Healthmark Industries Company, Inc.……… 4 Key Surgical……………………………………………………17

TELEMETRY

AIV Inc.………………………………………………………… 27 Pacific Medical…………………………………………… 42

TEMPERATURE MANAGEMENT

C Change Surgical……………………………………… 13 CSZ, A Gentherm Company……………………… 59

PATIENT WARMING

WARMERS

POSITIONING PRODUCTS

WASTE MANAGEMENT

Cygnus Medical……………………………………………… 9 D. A. Surgical……………………………………………… 67 Innovative Medical Products…………………… 68

RENTAL/LEASING

Avante Health Solutions…………………………… 23

CSZ, A Gentherm Company……………………… 59 MD Technologies inc.………………………………… 53 TBJ Incorporated…………………………………………… 5

WOUND MANAGEMENT

Tetra……………………………………………………………… 15 Arthroplastics, Inc.…………………………………………21

REPAIR SERVICES

Cygnus Medical……………………………………………… 9

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