OR Today - October 2018

challenge of surgical instruments. TOSI™ is the first devic consistent, repeatable, and reliable method for evalua�n effec�veness of the automated instrument washer.

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PRODUCT FOCUS INSTRUMENT STORAGE

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CE ARTICLE EFFECTIVE LEADERSHIP

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CORPORATE PROFILE

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OR TODAY | October 2018

contents features

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DEALING WITH STAFF HEALTH, SAFETY & STRESS REDUCTION

The saying, “Physician, heal thyself,” could just as easily apply to perioperative nurses. Unfortunately, too many OR nurses fail to maintain good health. According to the American Nurses Association, the health of U.S. nurses is often worse than that of the average American.

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As more and more surgeries are performed each year it makes sense that the surgical instrument storage and transport market will grow. This month, OR Today looks at some of the storage and transport solutions.

Nurses may not be aware of the extent of ongoing changes in today’s health care environment, the opportunities available to them as a result, and the role they may play as a leader or follower to achieve optimal outcomes. After completing this course,

Healthmark Industries is looking forward to an exciting future with its continued expansion of staff and products. Soon to celebrate 50 years in business, Healthmark continues to adapt to the needs of its customers.

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nurses will better understand ways in which they can influence change.

OR Today (Vol. 18, Issue #10) October 2018 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530.

For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2018

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OCTOBER 2018 | OR TODAY |

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contents features

PUBLISHER John M. Krieg

john@mdpublishing.com

VICE PRESIDENT Kristin Leavoy

48

kristin@mdpublishing.com

SPOTLIGHT ON

EDITOR John Wallace

Rosanna Pollack, MSN, PNP

editor@mdpublishing.com

ART DEPARTMENT Jonathan Riley Karlee Gower Kathryn Keur

ACCOUNT EXECUTIVES Jayme McKelvey Megan Cabot Nick Whitehead Jeffrey Berman

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DIGITAL SERVICES

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win lunch for your department!

Korean Barbecued Beef

OR TODAY CONTEST

RECIPE OF THE MONTH

Travis Saylor Cindy Galindo Kennedy Krieg

CIRCULATION Lisa Cover Melissa Brand

WEBINARS

INDUSTRY INSIGHTS

Linda Hasluem webinar@mdpublishing.com

11 News & Notes 18 OR Today Live Recap 20 ASCA: Federal Policy Changes 23 Webinar Recap

IN THE OR

25 Market Analysis 26 Product Focus: Surgical Instrument Storage 30 CE Article: Effective Leadership

OUT OF THE OR 50 Fitness 53 Health 54 Nutrition 56 Recipe 60 Pinboard 62 Index

8 | OR TODAY | OCTOBER 2018

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

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INDUSTRY INSIGHTS

EchoNous Unveils AI Station for Emerging Nursing Tools EchoNous has released the AI Station, a new docking system especially designed for emerging nursing tools, aimed at raising convenience for nurses and lowering costs for health systems. With the goal of reinventing what has historically been an afterthought medical device element, EchoNous commissioned an industrial designer and listened to clinicians and biomedical leaders at one of the nation’s top health systems.

“Everything from colors, to selection of materials, to the most minute of daily functions were reconsidered from a blank sheet of paper and through a fresh set of eyes,” said Niko Pagoulatos, COO of EchoNous. “Quite importantly we have integrated a ‘flexible electronic hub’ into the AI Station, aimed at both current and newly emerging AI functionality tasks.”

The AI station is a uniquely expandable platform that integrates EchoNous’ current intelligent tools, the Uscan bladder scanner and recently released EchoNous Vein, as well as devices currently in development. Together, this family of

tools will powerfully utilize emerging artificial intelligence methods along with the company’s extremely miniaturized ultrasound platform to conquer everyday problems in health care.

Designed from the ground up, EchoNous reimagined every component of the nursing dock, based on first-hand direct input from nurses and biomedical engineers in the creation of this new AI Station.

Key design elements include a more narrow lateral design for better maneuvering in tight spaces, a lower base height to fit underneath a hospital bed – enabling the entire cart to be closer to the patient, probe cords docked in an “inner channel” to prevent snagging and tripping, and importantly, the use of the best materials available in consideration of aggressive infection control techniques used in hospitals.

EchoNous chose AI Station materials with the goal of optimizing durability and cleanability while maintaining a low weight for ease of maneuvering. Featured

news & notes

materials include chemically resistant anodized aluminum, Tritan plastic, specifically designed for durability and offering a much higher level of chemical resistance than previous generation polymers, and stainless steel, which is widely recognized for its high resistance to chemicals. • For more information, visit www. echonous.com.

ProFormance QA Updated and Available Online Healthmark has announced an updated version of ProFormace QA 2.1 software that is now available as a cloud-based application.

ProFormance QA 2.1 is a secure database that allows you to record key statistics for the performance of your decontamination procedures, including the test results from Healthmark’s ProFormance line of monitoring products. With this web-based application, health care professionals can record data, use the information to generate impactful reports and track the performance of cleaning equipment over a period of time.

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To begin the setup process go to https://www.proformanceqa.com. Then, call 800-521-6224 ext. 6657 or email proformanceqa@hmark.com to schedule a call with the ProFormanceQA Help Desk. • For more information, visit www.hmark.com.

OCTOBER 2018 | OR TODAY |

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INDUSTRY INSIGHTS

news & notes

Duke University Medical Center Acquires Synaptive Medical’s Modus V and BrightMatter Synaptive Medical Inc. has announced that Duke University Medical Center has acquired its connected neurosurgery system. Modus V, the cornerstone of the company’s automated robotic and imaging technology, sets a new standard for visual accuracy during surgery and advances minimally invasive cranial and spine procedures.

Modus V is an automated robotic arm with high-powered digital microscope that provides an unprecedented view of patient anatomy. Using the most powerful optics available on the market today and robotic technology originally developed for the International Space Station, Modus V allows surgeons to perform less invasive procedures with more precision. In some cranial cases, it may allow surgeries that were previously deemed inoperable.

Duke has also acquired Synaptive’s BrightMatter integrated surgical platform. BrightMatter Plan automates the generation of brain tractography imaging, which maps the sensitive white matter tracts that control sight, mobility and other functions in the body. This functionality gives surgeons a dynamic 3D visualization of the brain that may allow for less invasive surgery and potentially safer surgical routes. For patients, less invasive procedures may lead to reduced complications and faster recovery times.

The Preston Robert Tisch Brain Tumor Center at Duke is internationally known for its advancements in surgical care and research and treats approximately 700 patients per year. •

12 | OR TODAY | OCTOBER 2018

Total Scope Inc. Announces the Acquisition of EndoCart Total Scope Inc. (TSI), a medical device repair company, recently acquired EndoCart from EndoChoice, a Boston Scientific company. This purchase, along with Total Scope’s recent entry into the used endoscopy equipment, market further expands the company’s products and services.

Ann Glavin, CEO and founder of TSI, explains the acquisition.

“Total Scope Inc. has become a trusted source for hospitals and ambulatory care centers for over 25 years. Our customers asked us to get more involved in helping them solve the challenges they face every day in the procedure room, so when the opportunity presented itself to become involved in procedure carts we jumped at the chance because we knew it would help both our customers and our organization,” Galvin said.

EndoCart is one of only a few brands of endoscopy carts on the market. They are fully customizable and come with an 18-month warranty. There are three different models available: the Standard, the Deluxe and the Motorized Deluxe.

The EndoCart was designed by GI nurses, for GI nurses.

“The TSI EndoCart comes in a variety of models to maximize value and efficiency for procedure rooms worldwide.

Every aspect of the EndoCart is engineered to make it durable yet lightweight enough to move with almost a single touch. The one touch motorized cart allows the nurse or tech to travel from procedure room to procedure room on different floors and different departments. The simple but efficient design limits injuries and makes nurses happier,” TSI President Denis Kennedy said. • For more information, visit www.totalscopeinc.com/endocart.

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Used in conjunction with the De Mayo Knee Positioner, the De Mayo Universal Distractor is a sterile, external device that only works with the IMP boot and attaches to the back of the boot. It allows the surgeon to independently control the distracting of the knee joint by applying finite pressure to separate the joint space by means of a handle on the device that incrementally pumps the required tension.

During arthroscopic procedures, the IMP solution eliminates the need for the surgeon to achieve distraction by applying pressure to the joint with the aid of a stress post, which sometimes creates post-operative pain.

“Reducing procedure time for unicompartmental and TKA surgeries, the IMP distractor also eliminates the need for lamina spreaders, the use of a bone hook or having an assistant manually pull on the femur at the thigh throughout the surgical procedure. The IMP solution is like having an extra pair of hands in the OR,” according to a press release.

The De Mayo Universal Distractor comes with a sterile, single-use, latex-free Pressure Protector Pad set that protects the popliteal area of the knee from direct pressure to the popliteal nerve and soft tissue. Designed with an inner core of dense, non-collapsible plastic material covering the square tube portion of the distractor, the pad cannot roll or rotate, providing a wide distribution of forces protecting the delicate structures of the knee. • For more information, visit www.impmedical.com

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INDUSTRY INSIGHTS

news & notes

MediCapture Launches MVR Pro HD MediCapture announced that its new MVR Pro HD medical video recorder is commercially available with first shipments beginning in the third quarter of 2018.

The new recorder is part of a series of recorders that will launch throughout 2018, offering hospitals and surgery centers unique features that “will elevate how surgical procedures are recorded and stored for post review,” according to a press release.

A DICOM option will be available soon, and a 4K Ultra HD alternative will follow.

“This represents a major step forward in medical video technology,” said Mike Bishop, CEO of MediCapture. “Never before has there been a series of medical recorders that incorporates all the latest technological advancements, yet still has the flexibility and scalability to address the visualization needs of today’s modern operating rooms, all while maintaining the ease of use for which MediCapture products are known.”

Bishop said that each recorder in the series is powered by the exclusive iMave Pro Platform, an Integrated Medical Archiving Video Engine for nextgeneration OEM camera systems and medical devices.

Other MVR Pro recorders with 4K Ultra HD and DICOM will be launching throughout the year. •

14 | OR TODAY | OCTOBER 2018

US Endoscopy Releases Pre-Cleaning Kit US Endoscopy, a endoscopy device design and manufacturing company, has announced the release of the Revital-Ox Bedside Concentrate pre-cleaning kit – an all-in-one, enzymatic detergent and impregnated sponge designed for bedside pre-cleaning of flexible and rigid endoscopes, accessories and other medical devices.

The Revital-Ox Bedside Concentrate pre-cleaning kit is an add-water option kit supporting proper bedside pre-cleaning every time. The concentrated detergent is packaged in a lay-flat pouch that converts to a stand-up pouch when ready to mix. The kit includes a free-rinsing enzymatic detergent that is designed to wash away residue as well as a flat, krinkle sponge to accommodate the diameter of larger endoscopes.

“US Endoscopy is committed to offering a complete solution to support our customers through each step of the endoscope reprocessing cycle,” says Tony Siracusa, vice president and general manager of US Endoscopy. “The new Revital-Ox Bedside Concentrate pre-cleaning kit is another valuable product that allows for adherence to industry guidelines helping to provide peace of mind to hospitals, staff and patients.”•

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Digital Surgery Deploys Surgical AI System for the Operating Room Digital Surgery has developed and demonstrated a real-time, dynamic artificial intelligence (AI) system designed for the operating room (OR).

“The company is building the data to power the future of surgery through its world-class and proprietary surgical procedure road maps, which aim to aid the surgical team in the OR, reducing risk and making surgery safer. Digital Surgery is the first patented AI platform bringing this scale of knowledge to the surgical community,” according to a press release.

“This is a huge milestone for the future of surgery because it lays the foundation for how AI and computer vision will support surgical teams to deliver safer surgeries. It also enables the next generation of robotic surgery, giving these future systems the capability to function more intelligently and safely,” said Dr. Jean Ne-

hme MD, co-founder and CEO of Digital Surgery. “We have already developed AI algorithms for multiple procedures across bariatrics and other surgical specialties like orthopedics, and our library will continue to grow. With AI, we have the unique ability to scale global surgical best practices.”

The press release adds that Digital Surgery’s AI platform can provide road maps and act as a navigational system for every OR and surgery center, addressing the countless variables that surgical teams face – from staff turnover, language, culture, tools, resources, to the training and skill level of the surgical team.

“The AI recognizes what is happening during surgery through a camera view, and cross-checks and correlates the anatomy and actions against the largest library of surgical road maps. The OR team can then see in real time the platform analyz-

INDUSTRY INSIGHTS

news & notes

ing and predicting next steps,” according to the release.

“The impact of a technology leap like this is astounding. Digital Surgery is creating the technologies that will drive the ‘integrated ORs’ and robotic systems of the future,” said Dr. Daniel Buchbinder, Mount Sinai School of Medicine. •

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Fujifilm Launches 700 Series Endoscopes, Expands Eluxeo Platform Fujifilm Medical Systems U.S.A. Inc., has launched its 700 Series Endoscopes. This newest product line features several enhancements in comfort, efficiency, and visualization. As part of Fujifilm’s Eluxeo platform, the 700 Series Endoscopes are compatible with special light observation modes Blue Light Imaging (BLI) and Linked Color Imaging (LCI), expanding Fujifilm’s offerings in image enhanced endoscopy.

“At Fujifilm, we work closely with our provider partners to create new solutions and improve existing technologies to better suit their clinical needs. Our 700 Series Endoscopes feature several enhancements from the preceding line, in an effort to provide physicians with improved visualization and illumination during endoscopic procedures,” says Johann Fernando, Ph.D., Chief Operating Officer of Fujifilm Medical Systems U.S.A., Inc. Eluxeo is Fujifilm’s next-generation image enhanced endoscopy platform, comprised of the 7000 Video Imaging System and now, the 700 Series Endoscopes. This platform provides improved image quality in terms of sharpness and brightness. It also delivers optimal visual information for diagnostic and therapeutic procedures in daily clinical practice.

700 Series Endoscopes feature Fujifilm’s CMOS chip-inthe-tip technology for noiseless and brilliant image transmission, as well as other new enhancements.

The Eluxeo 7000 Video Imaging System is equipped with 4-LED Multi-Light technology featuring BLI and LCI special light observation modes. The system has an extended lamp life expectancy of six years and an intuitive user interface for an enhanced experience. The 700 Series Endoscopes and 7000 Video Imaging System are designed to be used together for optimal results. • For more information, visit fujifilmendoscopy.com.

or call us today at 800.826.4490 VISIT ORTODAY.COM FOR MORE INDUSTRY INSIGHTS.

16 | OR TODAY | OCTOBER 2018

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APRIL 6 – 10, 2019

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INDUSTRY INSIGHTS

ortl recap SURGICAL CONFERENCE

OR Today Live Rocks Nashville

By John Wallace, Editor usic City USA hosted the 2018 OR Today Live Surgical Conference with wild success. More than 100 people were on hand for the fifth annual OR Today Live Surgical Conference as its continues to grow each year.

M

The 2018 version welcomed perioperative professionals from around the nation including attendees from South Dakota, Nevada, Iowa and more! The exhibit hall included leading companies with perioperative solutions from near and far, including California, New York, Chicago, Florida, the the Washington, D.C. area to name just a few.

The Competency & Credentialing Institute (CCI) provided a reason to arrive early with a pre-conference prep course. The CSSM Exam Prep Course delivered educational sessions for those seeking the certification.

Top-notch education continued throughout the conference with an opportunity to earn up to 11 CEUs by attending sessions on Monday and Tuesday. An informative keynote address and luncheon as well as CE Super Sessions provided even more educational opportunities to those in attendance. The

18 | OR TODAY | OCTOBER 2018

keynote address by Ken Perez, vice president of healthcare policy for Omnicell, explored the nation’s health policy and what can be expected in the future.

Informal education was also available during the entire conference thanks to OR Today Live’s signature networking events, including a Welcome Reception that packed the exhibit hall on Sunday night. Attendees and exhibitors were able to share their insights in a relaxed atmosphere. OR Today magazine was excited to sponsor the welcome reception and provide complimentary gourmet food and beverages to all.

MD Publishing Vice President Kristin Leavoy explained how the 2018 conference offered attendees a unique experience.

“This year’s OR Today Live conference had an energy about it that was unlike any other in years past.

Attendees were abuzz about the incredible speaker line-up and the opportunity to be able to follow-up with the presenters after classes to get more information on the topics discussed – something they are rarely, if ever, able to do at other

conferences,” Leavoy said. “Not to mention the ability to network one-on-one with fellow colleagues and industry peers! OR Today Live sets a pace for the conference that allows for networking time so that it’s not constantly go, go, go for attendees.”

Bob Gaw from Physicians Resource Network Inc. (PRN) travelled from Boston, Massachusetts to exhibit at OR Today Live and was impressed from the very beginning.

“I thought the welcome reception was excellent,” Gaw said.

“Everybody stopped by our booth. I thought it was real good. (OR Today Live) is a smaller conference and you get a chance to meet everyone. You also have time to talk to everyone. I would definitely say it’s a good show.”

Jeff Taltavull from AIV also enjoyed being able to make a connecWWW.ORTODAY.COM

INDUSTRY INSIGHTS

ortl recap

tion with attendees in the exhibit hall.

“Intimacy” is the word Taltavull used to describe the atmosphere at OR Today Live.

“In this crowd and environment, I get more one-on-one time. It is easy to engage,” he added. “Everyone says it’s a great learning environment and very intimate. I’ve heard it referred to as a smaller AORN (conference).”

Following another day of topflight education, exhibit hall access and a fun door prize drawing, attendees were treated to another signature event thanks to another generous sponsor. AIV Inc. backed a rooftop party in the heart of music city with live music, delicious food, craft beer and signature cocktails at Rock Bottom Brewery on Broadway in downtown Nashville.

Jon Frey, who came all the WWW.ORTODAY.COM

way from Alaska, said he decided to attend OR Today Live for the CSSM Exam Prep Course and was impressed by the presenters at the conference. His colleague Kara Moore echoed his thoughts.

“I feel like I’m leaving well informed,” Moore said.

Tanya Joyce from Coteau des Prairies Health Care System said this was her first time to attend the OR Today Live Surgical Conference.

“I think it is really good. It is really informative,” Joyce said. “I think it’s the perfect size. The classrooms are small so you can ask questions and bounce ideas off each other.”

One of the benefits Joyce liked was being able to talk with perioperative professionals from much larger health care systems who are experiencing the same problems her staff is having to overcome and share ideas and approaches to find solutions.

For information about the 2019 OR Today Live Surgical Conference, in Las Vegas, including and special discounts, visit ORTodayLive.com and sign up for the e’newsletter at the bottom of the page.

OCTOBER 2018 | OR TODAY |

19

INDUSTRY INSIGHTS asca

Federal Policy Changes Support Patient Access to ASCs

By William Prentice hen it comes to federal health care policy, 2018 is shaping up to be an incredible year for ASCs. This summer, the U.S. Congress and the Centers for Medicare & Medicaid Services (CMS) advanced several significant policies that affect ASCs and respond to years of advocacy efforts involving ASC professionals from across the country.

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In May, Congress set in motion substantial reform of the Veterans Administration (VA) health care system when it passed the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018.

The VA MISSION Act will directly impact ASCs that offer care to veterans since a major provision in the legislation requires non-VA provider claims to be reimbursed in 30-45 days. ASCA worked hard to raise awareness on Capitol Hill regarding concerns over significant reimbursement delays after ASCA members reported reimbursement delays of 12 months or more for services provided through the Veterans Choice Program. In addition to the new claims reimbursement process, the VA MISSION Act authorizes local provider agreements with the VA that, according to a U.S. Senate bill summary, will “remove bureaucratic red tape and meet veterans’ needs for care in the community.” ASCA will work with the VA as it implements this new law to ensure veterans’ access to ASCs is improved.

20 | OR TODAY | OCTOBER 2018

Addressing other longstanding ASC concerns, the U.S. House of Representatives passed the ASC Payment Transparency Act of 2018, which comprises two provisions ASCA has promoted for years. First, the bill would add an ASC representative to CMS’ Advisory Panel on Hospital Outpatient Payment (HOP) – a 15-member panel that helps determine payment policies for hospital outpatient departments (HOPD) and ASCs. Current statute requires all HOP members be employed by a hospital or health system. Second, CMS would be required to disclose, for the first time, the specific criteria it uses to exclude procedures from its ASC covered procedures list.

If the ASC Payment Transparency Act of 2018 becomes law, it will help ASCs, specialty societies and other health care stakeholders engage CMS as it considers future changes to the ASC payment system.

On July 25, CMS published its 2019 Hospital Outpatient Prospective Payment System (OPPS)/ASC Payment System Proposed Rule. Although the final rule isn’t due out until early November, ASCA is pleased that the proposed rule addresses several longstanding priorities for ASCs. In the preliminary rule, CMS proposes to align update factors for ASCs and HOPDs by moving ASCs to the hospital market basket (HMB). The HMB is already used to update HOPD payments, and if this proposal is finalized, will be used to update ASC payments for at least the next five years.

ASCs use the same staff, services and supplies as HOPDs, so it only makes sense to apply the same inflation rate for our annual updates. ASCs have been asking for this for about a decade.

CMS also proposes to define ASC device-intensive procedures as those procedures with a device offset percentage greater than 30 percent based on the standard OPPS ambulatory payment classification rate-setting methodology. The current threshold is 40 percent. Adoption of this new threshold would allow more procedures to be performed in ASCs. In another proposal, CMS would revise its definition of “surgery” in the ASC payment system to account for certain “surgery-like” procedures that are assigned codes outside the Current Procedural Terminology (CPT) surgical range. Along with this change, CMS proposes to add 12 cardiac catheterization procedures to the ASC covered procedures list.

For 2019, CMS proposes separate payment for non-opioid pain management drugs that function as a supply during a surgical procedure and when the procedure is performed in an ASC. Currently, Exparel is the only therapy that meets the proposed criteria and will receive separate payment when used in an ASC surgical procedure.

Health professionals aware of other drugs that could qualify for these payments are encouraged to contact ASCA. Finally, there are sweeping changes proposed to the ASC Quality Report-

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TRIM 4.5”

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ing (ASCQR) Program. Most significantly, CMS proposes to remove a total of eight measures from the ASCQR Program over a two-year period. In most cases, the reason CMS cites for removing the measures is that the data collected to date indicate such high performance on those measures that there is little room for improvement.

ASCA is encouraging CMS to finalize the majority of these proposals as written. Our thanks go out to all the members of the ASC community who have worked for many years to support these policy changes that we are seeing proposed and enacted for the first time.

ASCA is optimistic these new and proposed policies signal a recognition of the value ASCs provide to the program and a desire to ensure ASCs have the support they need to continue to serve Medicare patients. ASCs welcome the opportunity these new policies could provide to contribute in new ways to containing the cost of outpatient surgical care, improving the patient experience and providing the high-quality care our aging population needs.

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OCTOBER 2018 | OR TODAY |

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INDUSTRY INSIGHTS

webinar

Webinar Sets New Records Staff report

he recent Healthmarksponsored webinar “Always Keep It Clean!” set new registration and attendance records for the OR Today program. More than 400 people registered for the webinar with a confirmed attendance of 187 for the live presentation.

T

Perioperative Consultant Sharon Van Wicklin, MSN, RN, CNOR, CRNFA(E), CPSN-R, PLNC, FAAN, was the presenter for the webinar “Always Keep It Clean!” As part of the popular webinar, she shared reasons and methods for cleaning verification of surgical instruments and medical devices.

Attendees gleaned several informative tips, including: • Why having oversight by an interdisciplinary team is important; • How to identify areas where cleaning verification is needed; • The evidence supporting enhanced visual inspection and cleaning verification; and • The types of rapid cleaning verification tests currently available.

Van Wicklin has more than 44 years experience as a perioperative WWW.ORTODAY.COM

RN and has worked in all facets of the OR environment from scrub person to director. For seven years, she worked as a senior perioperative practice specialist with AORN. She was the lead author for six of the AORN guidelines, including the “Guideline for Processing Flexible Endoscopes.” In 2005, she received the AORN award of excellence for Outstanding Achievement in the Application of Perioperative Clinical Research.

Her presentation was well received by the health care professionals who attended the live webinar.

“That was a great webinar! I have been in sterile processing for 35+ years and Sharon was very precise, informative and presented the information that would be applicable to all groups. Surgery, endoscopy, sterile processing and even brought in the fact the environmental services could benefit from her topic. She was easy to listen to and her slides showed valuable pictures for the attendees,” said P. Sabrosky, Educator/Sales. “I like how engaged the attendees were with the questions!

That was a very cool part with

surprising outcomes. Great to see that many more are getting engaged in the improving patient safety products that are on the market. I have known the Healthmark family for my whole career, and they have always done things first class. Please say thanks to them as well!”

“I am glad I participated in this great webinar,” she added. “Thanks for the offering!”

OR Today would like to thank Healthmark for serving as a sponsor of the webinar. Since 1969, Healthmark Industries Company Inc. has developed and marketed solutions to aid health care facilities in their delivery of surgical instruments and other lifesaving medical devices to patients.

For more information about OR Today webinars, visit ORToday.com.

Visit www.hmark.com for more information.

Sponsored by:

OCTOBER 2018 | OR TODAY |

23

IN THE OR

market analysis

Surgical Instrument Storage and Transport Market Expected to Grow Staff report s more and more surgeries are performed each year it makes sense that the surgical instrument storage and transport market will grow. The increase in surgeries can be attributed to increased education regarding health care, a growing global population and other factors.

Minimally invasive surgery is another of the reasons for growth.

A

“The global minimally invasive surgical instruments market is expected to exceed more than $21.23 billion by 2022 at a compound annual growth rate (CAGR) of 12.3 percent in the given forecast period,” according to a Market Watch report.

The global general surgery devices market is expected to reach $25 billion by 2025, according to a new report by Grand View Research Inc. Government initiative and an increasing volume of surgeries is anticipated to boost growth in the market.

Global health initiatives for advanced surgical procedures are expected to boost the general surgery market. Advancements in polymer WWW.ORTODAY.COM

science and technology are directly co-related to the evolution of minimally invasive methods and associated medical device design that is anticipated to increase the demand over the forecast period.

An increase in research and development investments pertaining to general surgery devices and the commercialization of new devices are among the factors responsible for propelling the growth of the market.

In October 2017, NIH provided funding of $169 million to Brain Research through Advancing Innovative Neurotechnologies Initiative for the introduction of innovative brain scanners to the market for better diagnosis and procedures.

Further key findings from the Grand View Research report suggest that the laparoscopes category dominated the minimally invasive surgery instruments segment, cosmetic benefits for patients and increase in insurance coverage for laparoscopic surgeries contribute to its growth.

Orthopedic surgery dominated the application category with around 16.4 percent share in 2016, according to Grand View Research.

North America captured a sig-

Orthopedic surgery dominated the application category with around 16.4 percent share in 2016, according to Grand View Research. nificant share in the global general surgery devices market. Favorable reimbursement policies, local presence of key market players and various initiatives undertaken by the government to provide access to advanced devices leads to a greater consumption of these devices, the report states.

Technavio’s latest market research report on the global surgical instruments market indicates that it is expected to grow at a CAGR of over 6 percent from 2018 to 2022.

The increase in the volume of surgeries coupled with chronic diseases and older population is a major factor driving the market’s growth.

OCTOBER 2018 | OR TODAY |

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IN THE OR

product focus

Healthmark

SST Tray Systems Healthmark’s SST Tray Systems are sized for complete surgical sets.

They are designed for the safe handling, retrieval, decontamination and sterilization of instruments and equipment. They are ideal for retrieval of OR and OB instruments.

Also, they are the right size for highvolume emergency rooms. The trays are available in 3 material configurations and the maximum temperature for all Steristrainers is 285° F. •

Cantel

ENDODRY Storage and Drying System Professional societies and key opinion leaders acknowledge inadequate drying of flexible endoscope channels as a possible cause of microbial growth during endoscope storage. Cantel’s ENDODRY™ Storage and Drying System forces HEPA-filtered air through the endoscope channels to eliminate all residual water droplets. Drying endoscopes within one hour, the ENDODRY Cabinet shortens the amount of time needed to fully dry internal channels and external surfaces of a flexible endoscope when compared to traditional hanging methods. In addition, its data management feature allows users to quickly identify endoscope storage time to help prevent expired endoscopes. •

26 | OR TODAY | OCTOBER 2018

WWW.ORTODAY.COM

IN THE OR

product focus

Summit Medical, an Innovia Medical Company

InstruSafe Instrument Protection Trays Take your organization and protection of instrument sets to the next level with InstruSafe Instrument Protection Trays. The customizable trays – made of durable, highly perforated aluminum and silicone instrument holders – lock down delicate instruments with 360 degrees of cushioned protection during sterilization, transportation, storage and in the OR. InstruSafe Trays are made with you in mind – constructed with strong, quality materials to reduce breakage and frequent replacement, as well as to meet unique instrument set needs.

With a variety of FDA 510(k) sterilization cycle clearances, these trays are a smart, easy upgrade for use with wrap and rigid containers. •

Key Surgical

Plastic Sterilization Trays Protect and organize delicate surgical instrumentation during the sterilization process with Key Surgical Plastic Sterilization Trays. Constructed of a durable polymer, the trays provide strength, durability and chemical resistance while remaining lightweight and easy to use. Available in various sizes, each Plastic Sterilization Tray includes a silicone finger mat that can be removed for easy washing. Perforations in lid and base of tray help with steam circulation and aid in the drying process. • Fore more information, visit www.keysurgical.com

WWW.ORTODAY.COM

OCTOBER 2018 | OR TODAY |

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IN THE OR

product focus

Medline

Surgical Instrument Consignment With operating rooms being one of the most costly areas of hospital operation, eliminating shortages and surplus of surgical instruments is essential for managing costs. Medline’s consignment program is a cost-effective method for managing OR instrument costs, and helps streamline ordering and billing, minimizes pegboard and instrument clutter and offers the ability to pay only for what is used. As part of the program, Medline analyzes the hospital’s annual instrument usage to determine its initial stock, and then sets everything up once instruments arrive. The stock is routinely inventoried and replenished so the OR always has what it needs. •

28 | OR TODAY | OCTOBER 2018

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IN THE OR

continuing education

IN THE OR

CE514

continuing education

Spread Your Wings: RNs Have What It Takes to Be Effective Leaders Maureen Habel, MA, RN

id you know that when geese fly in a “V” formation, their work is much more efficient than if they each flew separately? When the goose leading the flight tires, it moves back into formation, and another goose takes its place. If a goose falls out of formation, it quickly feels the drag of flying alone and rejoins the flock to take advantage of the power of the goose it follows. Not only do birds flying in formation greatly reduce their energy expenditure, evidence exists that this flight pattern also increases communication and group coordination.1 Learning how to be in the lead position, how to support and relieve the leader, and how to increase work efficiency as part of a team are “goose flight” skills that nurses can learn and use to their advantage. If nurses can learn some of the skills that geese use on their long migratory flights, they can individually and collectively influence future changes for the nursing profession and for patients.

D

From Stability to Chaos Only a few decades ago, our healthcare system was significantly less complicated.

Most patients received care at hospitals until they were well enough to function independently at home. The hospital bill was sent to a third-party payer, who reimbursed the hospital or individual care provider. An increasing number of hosWWW.ORTODAY.COM

pitals were constructed, each filled with costly technology and increasing numbers of healthcare staff. Expensive life-saving treatments, innovative surgical procedures, and noninvasive imaging techniques have resulted in the world’s most sophisticated — and expensive — healthcare system.

In fact, the U.S has the most expensive healthcare system in the world, spending about $3 trillion annually. However, our health outcomes are often worse than those in many other countries where care is less costly. In addition, some Americans experience unnecessary, ineffective, or even harmful treatments, decreasing quality of life.2 Some of the driving forces that stimulate improvement and innovation in other industries have not significantly affected healthcare. One problem is that healthcare consumers traditionally have not been cost sensitive, because their employers and health plans often cover a large share of costs, and they may lack the information required to evaluate quality and value. Another barrier is the fee-forservice system that provides compensation based on service volume rather than on quality, efficiency, and price sensitivity.

The result has been inadequate efforts in preventing costly chronic diseases and using early intervention as a way to improve health and reduce costs.2 In the current environment, exciting opportunities exist to transform American healthcare into a high-performing system that provides quality care at a lower cost. The Peterson Center on Healthcare projects that the U.S. would have one of

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

Goal and objectives The goal of this nursing leadership continuing education program is to educate nurses about trends in the healthcare industry, discuss skills nurses can learn to influence change, and challenge every nurse to become a strong leader and a supportive follower. After studying the information presented here, you will be able to: • Discuss how nurses can gain control of their destinies in response to trends affecting the healthcare industry • Identify five new skills that will help nurses positively influence change in healthcare organizations • Discuss three key characteristics of effective leaders and supportive followers

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continuing education the world’s best-performing healthcare systems if current and future best practices in healthcare delivery were adopted on a national scale.2 The nursing profession is increasingly involved in evaluating and implementing best practices and thus is well positioned to help lead changes that can significantly improve health outcomes.

The Impact on Nursing The American Nurses Association projects that four healthcare trends will have a major impact on nurses:3 • Nursing shortages will offer more opportunities for nurses.

• Job opportunities for nurses will expand outside the hospital.

• Technology will play a larger role in healthcare.

• Nurses will expect to collaborate more closely with other healthcare professionals.

As a result, there are tremendous opportunities for nurses to influence the healthcare system of the future.

There is an increasing realization that nurses have the significant potential to participate in restructuring healthcare delivery. Most nurses already have been involved in efforts to streamline care delivery, including work redesign, in which a job role is evaluated with the goal of increasing productivity.

Nurses also can have a major impact in educating patients about healthy lifestyles and preventing complications from chronic diseases. However, staff involvement in decision-making in many organizations may be limited.

As a result, healthcare executives may make important decisions about healthcare delivery with limited input from nurses.

In most healthcare organizations, particularly in acute care hospitals, nursing is the largest and most laborintensive component, representing about half the annual operating budget.4 In addition, much discretionary spending occurs at the unit level,

32 | OR TODAY | OCTOBER 2018

where nurses are the key decisionmakers about the use of equipment, linens, and supplies — items that also have a major budgetary impact.

Ironically, many nurses have no way of knowing what costs they generate as they provide care and often lack the economic awareness needed to make cost-conscious decisions. Those closest to the point of care bring a unique perspective to ways of trimming costs.

In many organizations, the voices of nurses who have practical and realistic suggestions for improving quality and reducing costs are not heard because they often lack critical leadership skills.

Learning New Skills To take advantage of these exciting opportunities, nurses can learn new leadership skills to influence positive change. As healthcare organizations undergo rapid change, nurses may feel busier than ever; yet, at the same time may feel frustrated and powerless or see themselves as victims of a huge impersonal system. Consumed by daily problems, they may not have time to talk about — let alone plan for — the future. Those who experience these stresses may question the value of what they do, fracture relationships with colleagues, choose to leave the profession, and discourage others from entering it — at the time when a nursing shortage threatens the health of all Americans. At times, nurses and other healthcare professionals have found it difficult to accept or resisted changes imposed from above. At the same time, managers bemoan the fact that staff doesn’t share their concern for the organization’s financial viability, and staff lament that management cares only about money.

Fortunately, the nursing profession is in a unique position to influence both healthcare delivery and policy. In addition to recruiting nurses to serve on hospital-wide committees, many organizations have established shared

governance, a model that places large numbers of staff nurses in pivotal leadership roles to make significant policy decisions affecting education, nursing practice, and quality of patient care.

Nurses must be prepared with a new set of leadership skills that includes analyzing problems, creating solutions, and initiating and supporting appropriate changes so healthcare organizations can take advantage of the knowledge and expertise staff nurses can bring to governance and healthcare restructuring.

Nurses can become future-oriented rather than speculating about the future or adopting a “wait-and-see” attitude. What the future will bring can be predicted by looking at demographics, technology, and other societal forces. Demographic trends in the U.S. clearly point to an increasing number of older people needing care and a decreasing number of nurses prepared in geriatrics to direct their care. Another major trend is the increasing pace of scientific knowledge and the use of technology in healthcare.

Trends that soon will affect nurses’ work include the replacement of traditional patient care “routines” by best practice processes that are outcomes-related and research-based, and an evolution of nursing practice from “fulfilling every patient need” to a model that is realistic and responsive to limited resources. Although every nurse may not end up being a “nurse futurist,” learning more about projected trends will equip nurses to deal more effectively with system changes.

Seeing the big picture is the ability to analyze how a situation is connected to other aspects of a broader situation. Because nurses have not always been included in decisions affecting patient care services, they tend to look for a quick fix without considering the larger picture. For example, having mandatory staffing ratios as a sole solution to meet patient care needs does not automatically ensure better WWW.ORTODAY.COM

IN THE OR

continuing education

Staff Nurse Leadership Skills5 •

Becoming future oriented

•

Being proactive rather than reactive

•

Communicating persuasively

•

Seeing the “big picture”

•

Viewing change as an opportunity

patient outcomes or increased nursing job satisfaction. “More” does not necessarily mean “better.” It is important to have a high percentage of RNs, but the skill mix and quality of staff nurses, their clinical competence, and their ability to analyze problems critically and make appropriate decisions have a significant impact on providing high-quality care.

A person looking at a bigger picture can look beyond the immediate problem. The shift length, staffing mix, reimbursement criteria, and type of delivery system all have a major impact on appropriate staffing.

Simply changing staff numbers or staff skill mix may not be the only or the best way to provide safe and effective patient care. Although improving nurse-patient ratios is important for nurses, many also report that their job satisfaction is related to issues such as compensation, information technology, the opportunity to use nursing knowledge to improve patient care, and the quality of nurse-physician relationships.6 Sometimes, an action taken without considering a bigger picture may fix the immediate concern, but in the WWW.ORTODAY.COM

long term will not solve the root issue — or may even create other problems. Leaders can see beyond quick fixes because they are system focused.

They’re able to think about the whole, knowing that everything affects something else, and they’ve learned how to ask the right questions. People who see the big picture don’t become bogged down in task-oriented practice; instead, they implement tasks and care interventions directed toward specific outcomes.

Communicating persuasively: Nurses are often excellent listeners; they listen effectively to patients and families. But when it comes to participating on a shared governance committee or a task force with other professionals or presenting ideas to management, many nurses need help.

To be effective patient advocates and change agents, nurses must be able to communicate assertively and confidently.6 In an interprofessional group, nurses may be the least verbal even though they may have the most relevant information. To act powerfully, nurses must improve their ability to communicate with administrators and colleagues. Using judgmental words, failing to reason out a position adequately, or speaking too fast or too slowly can all be barriers to effective communication.6 In addressing patient needs with others, nurses may spend considerable time providing anecdotal information and numerous details about problems affecting patient care while administrators are listening for a large picture to develop. The book “Becoming Influential: A Guide for Nurses” by Eleanor J. Sullivan has excellent suggestions on communication and other skills needed to use your influence in a proactive way.

Nurses also need to learn how to focus on major issues and give up “sweating the small stuff.” The goal of communication, whether oral or writ-

ten, is to create understanding, and the level of understanding increases directly in relationship to the clarity of the message and the way it’s delivered. Nurses need the skills to make clear, organized presentations that are delivered confidently and to write memos that get results because they communicate in a way that gains attention and support.

Viewing change as an opportunity: Times of great change are also times of great opportunity because organizational resistance to change temporarily lessens. We need to learn how to view the many “problems” of organizational restructuring as challenging opportunities to improve care for patients and nurses’ working conditions. The same emotional responses that patients and families go through during personal health crises apply to nurses when they face organizational change.

Fortunately, nurses can learn strategies to see the opportunities inherent in change. They can start by becoming involved with the change so they have some influence over what will change and how the change occurs. If a nurse has no ability to influence the change, he or she can resolve to focus less on grieving for what he or she is losing and instead start focusing on positives that will result from the change. If the change in question is particularly difficult, consider that no one can control changes that occur naturally in life, and it is not realistic to expect that there will be a return to a more stable healthcare environment.

Nurses often react rather than anticipating problems and taking a proactive stance. Instead of taking the initiative, nurses frequently blame those in executive leadership positions or “the system.” Nurses “eat their young,” often don’t collaborate with others, fail to capitalize on their knowledge and experience, and may describe themselves as “just a nurse.”

All nurses have a vision for a better world for their patients, and they OCTOBER 2018 | OR TODAY |

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continuing education cannot wait for someone else to make something happen. Each nurse must have passion for his or her little corner of the nursing world. You don’t have to be in a position of authority to advocate for needed change, raise issues, gain support for your ideas, and speak clearly and strongly about possible solutions. If you’re not satisfied with an issue at work, you can complain to your colleagues, blame administration or someone else — or create positive change. The professional nurse who is a leader will always do something more than just complain. Professional nurses all share accountability to create solutions for the problems they encounter.

Every Nurse as a Leader The most effective leaders know what they want to accomplish, care about the organization and the people in it, act with integrity, inspire others to share their goals, and are good communicators.7 Essentially, a good leader is someone others want to follow, whatever his or her formal position is within an organization. When facing major change or when dealing with a crisis, good leaders come to the fore because they bring clarity to a situation and inspire others to take appropriate action.

As new graduates, nurses begin their nursing careers in a “followership” position. With time and experience, this should change. However, many nurses depend on their nursing administrators to provide all the leadership for patient care services within an organization. Yet this practice does not always provide the most effective leadership. Some of the most powerful leaders have no position of authority in an organization but can point the way to both small and large improvements in patient service delivery.

Nursing is a people business, and effective leaders have learned how to influence people to work toward a shared goal. Leadership is related

34 | OR TODAY | OCTOBER 2018

directly to “real nursing” — staff nurses must exert leadership to fulfill their responsibility as patient advocates and to help design a more effective healthcare system that will benefit individuals, families, and communities.

Leadership is not about power, but about acting powerfully.

Leadership is not an inborn ability but a set of skills and qualities that can be learned and enhanced over the course of a career. Different types of leadership skills are needed in different situations. For example, some situations call for fast action while others require time to determine the best way to solve a complex problem.

Management training for nurses is important for organizations to be efficient and effective in today’s healthcare environment. To exert influence, nurses must be committed, innovative, and involved.8 Increasingly, a transformational leadership style is important to drive positive change. Unlike an autocratic manager who issues orders or a laissezfaire individual who fails to lead, transformational leaders are highly relational and engaged with followers. Transformational leaders are good at motivating people and can inspire by appealing to an individual staff member’s morals and values.8 One study found that a transformational leadership style was important in driving organization change because it provides vision and support for followers to achieve goals.9 Another study looked at the relationship between leadership style and patient safety. This study documented that a transformational leadership style had a positive impact on a climate of patient safety, as compared with a laissez-faire style, associated with a negative environment and a culture of blame.10 Evidence points to a positive relationship between relational leadership styles and higher patient satisfaction and lower patient mortality,

medication errors, restraint use, and hospital-acquired infections.11 Nurses can no longer see themselves as “just nurses.” Whether a staff nurse or a chief nursing officer, it’s vital to be self-confident, have high professional self-esteem, and be visionary. Individual nurses tend to focus on daily tasks within a designated shift.

Because of this focus, some nurses act as passive followers rather than as leaders and remain in positions in the organization that are less powerful.

One of the most influential people to take the lead was Florence Nightingale. She had a mission, her timing was right, change was desperately needed, and she had the skills to be a leader.

She was also intelligent, resourceful, strong-willed, and not willing to take no for an answer.

Just like the flying geese, nurses must learn to share leadership and take their turn doing the work that will help patients recover, the profession evolve, and organizations thrive.

Every member of a nursing team has the potential to fly the point position and serve as the leader.

The Power of Supportive Followers In today’s flatter, leaner organizations, leaders cannot survive without committed, engaged, contributing followers. Being a leader and being a follower are separate roles that complement each other. There can be no leaders without followers, and there can be no followers without leaders.10 Leaders can develop and communicate a vision, but followers contribute the energy needed to achieve change. Being a good follower takes special talents, just as being a good leader does. Leaders need to count on followers to provide input that focuses on finding solutions, not just identifying and complaining about problems. Followers can support leaders by asking questions, giving thoughtful feedback, working WWW.ORTODAY.COM

IN THE OR

continuing education

to achieve group goals, and providing encouragement when the leader takes a risk on behalf of the group.

Transformational leaders communicate a clear and compelling view of the future, intellectually inspire followers, and encourage followers to develop their strengths.12 When followers have input into the team’s vision, they feel valued, and the relationship between leader and follower is enhanced. Followers then begin to share in the leader’s vision and are more likely to use their leadership skills to motivate others.

Being an effective follower is not a passive position. The follower must think critically about the leader’s ideas and opinions, have the skills to advocate with others for those ideas, and take an active role in providing support to the leader. Exemplary followers are those who can function independently, think critically about ideas that are proposed or directions that are suggested, and become actively involved.13 Effective followers challenge the ideas and opinions of leaders, suggest alternative courses of action, and invest time and energy to arrive at the best possible solutions for the group.14 Active and engaged followers consider themselves the equals of leaders and are willing to support the leader to accomplish a common goal.6 Effective followers thoughtfully criticize the leader’s ideas, but they don’t just complain and withdraw.14,15 They also heed certain guidelines, such as discussing their disagreements with the leader privately and considering the leader’s point of view when exploring alternative solutions to a problem. The most valuable followers are selfdirected professionals who actively participate in determining the team’s goals, think critically, invest energy in achieving the goals, and advocate for new ideas.15

WWW.ORTODAY.COM

Alienated, Passive Followers Other types of followers are less supportive. Alienated followers may consider what the leader is proposing, but remain passive and withdrawn.

They may continue to complain about the ways things are done, but rarely invest the time or energy to suggest alternative approaches.14 Ineffective followers often have limited vision, are primarily concerned with their own needs, and rarely think about the stress that leaders experience. “Yes people” are those who are eager to take orders, defer to the leader, and thrive on a great deal of order, predictability, and structure. They are often uncomfortable with making decisions and rarely raise questions or challenge the group.

Passive people are dependent and go along with whatever they are told to do. Easily led and manipulated, they need a great deal of direction and never go beyond their own work assignment. They are unable or unwilling to commit themselves to the larger goals of the group.

What nursing needs now are more exemplary followers. Blindly following a leader without thinking or questioning, or taking a passive backseat role at work will do little to advance the nursing profession, promote individual growth, or enhance quality patient care. Nursing needs followers who have many of the same qualities leaders have: the ability to act as change agents, the ability to challenge ideas, assertiveness, courage, determination, openness to new ideas and perspectives, and a willingness to serve.14

Taking Action The nursing profession continues to need expert clinicians, but the greatest need is for leaders who can collaborate with leaders in other disciplines, with policymakers, and with community members to transform healthcare.

One of the recommendations of the report “The Future of Nursing: Lead-

ing Change, Advancing Health” was to prepare nurses at all levels for leadership positions.16 All nurses can have a profound influence on finding the best ways to deliver high-quality healthcare at an acceptable cost. To reach this goal, nurses must ask themselves what they are doing personally to improve themselves as individuals and to improve nursing.

Nurses can strengthen leadership skills in many ways. First, keep informed about current issues affecting healthcare. Second, dispel myths about healthcare and the direction it needs to take. Third, be aware of and get involved with the quality and safety initiatives in your workplace. Fourth, be aware of what your elected representatives are doing at the state and national level to improve the healthcare system. Lastly, talk about nursing and what you do as a nurse to provide patient care. Be enthusiastic and vocal about the role nurses have as valuable caring clinicians and as agents for healthcare reform.14 Remember that every nurse with a vision about how to improve care can be a leader.

To develop and exercise your leadership potential, convince your administration that you need a leadership course for staff nurses in your organization and volunteer to be on the committee that organizes it. As you improve your skills in problem solving, critical thinking, and communicating, seek out other nurses whom you can mentor. Learn how to lead, how to follow, and how to use your knowledge and experience to act powerfully.

And the next time you see a goose migration, think of the possibilities for nursing.

OnCourseLearning.com guarantees this educational activity is free from bias.

Maureen Habel, MA, RN, is an awardwinning nurse author living in Seal Beach, California.

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continuing education

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J, eds. Essentials of Nursing Leadership &

11. Wong CA, Cummings GG, Ducharme L.

Nursing-Leading-Change-Advancing-Health.

Management. 3rd ed. Clifton Park, NY: Delmar

The relationship between nursing leadership

aspx. Published October 5, 2010. Accessed

Cengage Learning; 2014:139-160.

and patient outcomes: a systematic review

March 13, 2017.

Clinical VignettE ANSWERS 1. Answer: B, Joan is obviously interested in change, and her experience in other organizations will benefit the hospitalwide committee. The other staff members lack experience, may be reluctant to speak up in the group, or may be a negative influence.

2. Answer: A, As an assertive person, George is likely to express his views on the practice council. As a new graduate, he will also bring new ideas to the council.

3. Answer: D, Preparing followers for a change such as self-governance is an important strategy for success. Talking to staff who will be involved will help enlist their support. Mistakes are actually opportunities for growth rather than failures. Being a leader involves taking risks and volunteering to try new ideas. Having a partial commitment or “wait-and-see� attitude are not characteristics of a leader.

4. Answer: B, Simply complaining about problems is not a characteristic of effective followers. Supportive followers propose solutions, analyze potential changes critically, and give objective and thoughtful feedback to the leader.

36 | OR TODAY | OCTOBER 2018

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CE514

Clinical VignettE For CE514 Shelly Green is a nurse manager in an organization that is involving more nurses in decision-making. Nursing shared governance and inclusion of staff nurses on more hospitalwide committees are among the strategies being considered. Four staff members Shelly might ask to serve are George, an assertive new graduate who has just completed orientation; Joan, a nurse with 12 years of experience who has worked in two other organizations and who often offers ideas about possible changes; Candice, who has 20 years of experience on Shelly’s unit and who often complains about minor issues; and Rachel, an experienced nurse who is shy in groups and rarely expresses her opinion. hich staff member should Shelly consider 1 W

appointing to an interdisciplinary committee whose goal is to look at organizational changes?

a. George b. Joan c. Candice d. Rachel

hich staff member might be most 2 W

appropriate to represent the unit on the nursing practice council?

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.

Deadline Courses must be completed by 4/15/2019 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.

a. George

Accredited

b. Joan

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.

c. Candice d. Rachel

helly is being encouraged by her supervisor to 3 S implement shared governance on the unit level.

Which strategy will be helpful in this situation?

a. Holding on to daily operations rather than delegating to qualified subordinates b. Seeing mistakes as failures to be avoided c. Adopting a “wait-and-see” attitude to see how shared governance works on other units d. Starting to talk to staff about the value of self- governance

o make changes on her unit, Shelly 4 T

must have the support of effective followers. Which attribute is associated with being an ineffective follower?

a. Giving input that focuses on solutions b. Identifying and complaining about problems c. Giving thoughtful feedback to the leader

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.

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

d. Thinking critically about proposed changes

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FUTURE

EALTHMARK INDUSTRIES CO. | WWW.HMARK.COM | 800.521.6224 | HEAL

LOOKING TO THE

H

ealthmark Industries is looking forward to an exciting future with its continued expansion of staff and products. Soon to celebrate 50 years in business, Healthmark continues to adapt to the needs of its customers.

Over the years, the company has experienced a great deal of growth with a variety of products and services. Known for providing innovative solutions for infection control to health care facilities, Healthmark is currently expanding its product line. The company has over 200 employees and is in the transition process of moving its headquarters that is an overall size of around 100,000 square feet in Fraser, Michigan.

The latest focus at Healthmark includes the introduction of custom imprinted headwear.

“We now offer our customers the ability to custom design their own disposable bouffants and scrub hats,” says Ralph Basile, Vice President.

There has been much controversy surrounding the use of reusable scrub hats in surgery. AORN Guidelines recommend that scrub hats cover the head, ears and the nape of the neck.

Further, all attire worn in the OR should be controlled by the health care facility, including laundering of reusable attire. This includes scrub hats, although many professionals enjoy their own customized version of their headwear. Therefore, owners of scrub hats (often surgeons) have fought this policy. They don’t want to

40 | OR TODAY | OCTOBER 2018

By switching to truly custom printed, single-use scrub hats that cover the head, ears and the nape of the neck, it helps to promote team unity and employee satisfaction within procedure departments. be limited to disposable bouffant hats, but no other option will allow for a customized style to their preference.

“We feel that the next growing trend will likely be moving to singleuse custom headwear in order to put an end to the controversy. By switching to truly custom printed, single-use scrub hats that cover the head, ears and the nape of the neck, it helps to

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guidelines. Even people that don’t like the feel of disposable bouffant hats are moving toward materials like spunlace non-woven rayon disposable scrub caps that are very comfortable to wear.” says Basile.

He added that reusable custom printed scrub caps are also available.

Another way the company is adapting to meet customers’ needs is by offering continuing education credits through online games.

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often consist of articles about complications from medical procedures caused by instruments and equipment that have not been properly cleaned.

Healthmark has added products to its ProFormanceTM cleaning monitoring tools over the past 15 years to help ensure health care products are reprocessed correctly. AAMI and AORN recommend at least daily testing of the cleaning process. These products are designed to help facilities comply with standards and ensure they are reprocessing equipment and cleaning surgical instruments properly.

“One of the ongoing challenges in the health care industry is to consistently reprocess health care products effectively and consistently,” Basile said.

Healthmark has products designed to help hospitals and health care facilities provide safe environments and reduce the incidence of infections.

Researchers have discovered that devices that haven’t been reprocessed correctly can emerge from the cleaning process with bits of bone, bodily fluids and tissue from the previous procedure, contaminants that can become reservoirs for some potentially lethal bacteria. Proper cleaning and sterilization are essential for ensuring that medical and surgical instruments do not transmit infectious pathogens to patients.

According to the Centers for Disease Control and Prevention (CDC), multiple studies in many countries have documented a lack of compliance with established guidelines for device OCTOBER 2018 | OR TODAY |

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reprocessing. Failure to comply with scientifically based guidelines has led to numerous outbreaks.

“Our ProFormanceTM products are designed to help hospitals and health care facilities meet the challenge to regularly test their cleaning process in order to ensure their medical devices are being reprocessed properly. Once reprocessed, inspection will need to take place to ensure the items are indeed clean,” Basile explained.

Healthmark continues to offer new innovative products that are designed to provide solutions for their customers. The new Transportation Identification Tag is produced precisely for transporting materials considered a biohazard, while acting as an essential communication tool in the process. By labeling a cart or container as “clean” when it goes out and a “biohazard” upon its return to the sterile processing department, the Transportation Identification Tag assists in supplying information to the OR/procedure room. Furthermore it has a checklist for the surgical/procedure room/sterile processing team to ensure adequate delivery of the case cart or container in question.

Another innovative product Healthmark recently launched is the newest Flexible Inspection Scope (FIS-005). It features a distal tip composed of a light source and camera lens at the end of a 110cm, flexible shaft. Designed for lumens 2.0mm in diameter or larger. The camera and light are powered by the USB connection on a PC. Compatible with computers running Windows 7 or later, the included software allows viewing and recording. Paired with the optional Flex Arm, the Flexible Inspection Scope

42 | OR TODAY | OCTOBER 2018

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Healthmark also has a website, www.healthmark.info/hmarkqa.html, that is a non-biased forum to encourage health care workers to ask questions and share solutions anonymously. It is easy to sign up and share experiences with other peers within the industry.

If you are looking for industry news, helpful hints and other information, Healthmark produces a weekly newsletter that is distributed to thousands of readers. Each Healthmarket Digest features a story written by a member of the Healthmark team or a guest writer, as well as a weekly coupon.

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S t a f f H e a l t h, DEALING WITH

Safety &Stress Reduction

BY DON SADLER

The saying, “Physician, heal thyself,” could just as easily apply to perioperative nurses. Unfortunately, too many OR nurses fail to maintain good health.

According to the American Nurses Association (ANA), the health of U.S. nurses is often worse than that of the average American. For example, nurses are often overweight, have higher levels of stress and get less sleep than the average American, states the ANA. “Because health care delivery requires 24/7 support, the demands of shift work exacerbate the health of nurses,” states the ANA on its website. “In addition, hazards such as workplace violence and musculoskeletal injuries are contributing factors to poorer health.”

Don’t Neglect Yourself

“As a nurse, you’re used to looking after the needs of others, but far too often nurses find that they are neglecting their own health and safety needs,” says David Taylor, MSN, RN, CNOR, president of Resolute Advisory Group LLC. “This is especially true when they are working long hours and have added responsibilities at home,” Taylor adds. “It’s important for nurses to make the time to take care of their own health. This includes getting enough rest, eating healthy foods and doing the things that bring them joy outside of the workplace.”

Linda Groah, MSN, RN CNOR NEA-BC, FAAN, the CEO and executive director of the Association of periOperative Registered Nurses (AORN), concurs.

“Many OR nurses do not take breaks or eat lunch, and when they do eat, it’s not consistent with current nutrition recommendations,” she says.

“For example, they’ll substitute processed foods for fruits and vegetables.”

“Also, many nurses consistently volunteer for hours above and beyond the standard 40-hour work week, or they work two jobs,” Groah adds. “And too few are committed to a consistent exercise routine, either before or after work.”

A Grand Challenge

To help nurses improve their personal health, the ANA has instituted the Healthy Nurse, Healthy Nation Grand Challenge. This is a social movement designed to transform the health of the nation by supporting nurses to take positive action to improve their own health.

The Grand Challenge is focused on helping nurses take actions to improve their health in five focus areas: physical activity, sleep, nutrition, quality of life and safety. It encourages nurses to: • Sleep for at least seven hours of restorative rest every day. According to the ANA, 12 percent of nurses have nodded off while

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“ A s a nurse, you’re used to looking after the needs of others, but far too often nurses find that they are neglecting their own health and safety needs,” David Taylor

driving. Healthy sleep leads not only to safer driving, but also to heightened alertness, increased energy, better concentration and judgment, more stamina and improved learning.

• Maintain the correct Body Mass Index (BMI). According the ANA, the average nurse’s BMI is 27.6, which is considered overweight.

In addition, only 16 percent of nurses eat the recommended daily amount of fruits and vegetables.

The Grand Challenges recommends that nurses eat a balanced diet with reasonable portion sizes; enjoy sweets, fats, and alcohol in moderation; drink more water and less sugary drinks; and move more and sit less.

• Quit smoking. “The literature is clear: Smoking is bad for you,” says Taylor. The ANA has compiled a self-help guide to help nurses with tobacco cessation, which can be accessed at www. nursingworld.org/practice-policy/ work-environment/health-safety/ healthy-nurse-healthy-nation/ tobacco-cessation/.

Taylor adds a few more health recommendations of his own, including getting regular exercise. “Granted, nurses are on their feet all day so it can be hard to find the motivation to exercise,” he says. “But exercise is critical to good health.”

Less than half of all nurses exercise

regularly, according to the ANA. Nurses also must guard against substance abuse, says Taylor.

Safety in the OR

Staying healthy also means practicing safety in the workplace. There is a wide range of potential safety risks within the OR itself, including sharps injuries, exposure to surgical smoke and the physical challenge of moving and handling obese patients.

According to the CDC, 385,000 needlestick and other sharps-related injuries are sustained by hospitalbased health care personnel each year.

“Nurses have the highest incidences of sharps injuries, so staff education is critical to reducing this risk,” says Groah.

AORN has produced a sharps safety toolkit that includes a video, PowerPoint presentations, guidance documents and more tools designed to help increase sharps safety in the OR. The toolkit is available to AORN members at www.aorn.org/guidelines/ clinical-resources/tool-kits.

Meanwhile, an estimated 500,000 health care workers are exposed to potentially dangerous surgical smoke each year. In fact, being in an operating room for a full day could expose OR nurses to the same amount of smoke plume as smoking more than a pack of cigarettes.

Eliminating the dangers of surgical smoke requires changes in OR prac-

OCTOBER 2018 | OR TODAY |

45

tices as well as the use of technology like smoke evacuators, disposable tubings, filters, ESU pencils with tubing and in-line filters.

Groah emphasizes that smoke evacuation must be used on every procedure that generates smoke, regardless of how much smoke is generated.

Safe patient handling and mobility (SPHM) has become more important due to the dangers inherent in transporting, lifting,

to Beth Genly, MSN, the co-author of "Save Yourself From Burnout: A System to Get Your Life Back", one-third of all nurses experience burnout at some point in their careers.

“It’s a vicious cycle,” says Genly. “Numerous safety issues have been linked to nurse stress and burnout, including medical and medication errors, substance abuse, injuries and illness, depression, and even suicidal ideation.”

Genly says there’s a common misperception that burnout is simply fatigue after a long day or a big case. “But it goes much deeper than this,” she says.

“Burnout is felt as ‘soul-deep’ exhaustion, withdrawal from work and life, and deep doubts about one’s ability to make a difference,” Genly adds. “It typically has three dimensions: emotional fatigue, cynicism and inefficacy.”

Genly believes that personal self-care among OR nurses is flawed in two main ways.

“First, many nurses live almost like they’re superheroes in a blockbuster movie,” she says. “They absorb immense punishment with no more recovery needed than a wisecrack and a wry grin.”

“And second, nurses tend to define selfcare within narrow physical boundaries, like ‘Did I eat?,’ Have I slept?,’ and maybe, ‘Did I exercise?,’” Genly adds.

“Expanding the commitment to selfcare to a wider framework is necessary to protect objectivity, empathy, reaction times, judgment, and the physical and mental capacity required to handle the demands of the work,” says Genly.

To reduce stress and combat burnout, Genly recommends that OR nurses focus on five specific areas: self-care, reflection and recognition, capacity, community and coping skills.

“ N umerous safety issues have been linked to nurse stress and burnout, including medical and medication errors, substance abuse, injuries and illness, depression, and even suicidal ideation.”

Beth Genly

positioning and holding patients in the OR. “Therefore, hospitals should take steps to reduce the risks involved when physically moving and handling patients,” says Groah.

These include using the right SPHM devices and technologies to move obese patients, like overhead tracks with slings, in order to reduce or eliminate manual patient handling.

The ANA has published the Safe Patient Handling and Mobility Interprofessional National Standards, which can be purchased at www.nursingworld.org/nurses-books/safepatient-handling-and-mobility-package/.

h

Avoiding Job Burnout

If health and safety are neglected by OR nurses for too long, this can lead to high stress and eventually job burnout. According

46 | OR TODAY | OCTOBER 2018

Taking a Toll

Whether it’s in the workplace or at home, Taylor says that poor health, unsafe practices and high stress can take a toll on OR nurses.

“They’re not good for nurses and they’re not good for patients, either,” he says. “OR nurses should prioritize good health, safety and stress reduction in order to serve patients better and lengthen their careers.”

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a n n a s o R SPOTLIGHT ON

ROSANNA POLLACK, MSN, PNP

BY MATT SKOUFALOS

From the time she was 16 years old, Rosanna Pollack knew she wanted to work in pediatric medicine. From the time she was 18, Pollack knew she’d be working in oncology. In December, she’ll enter her 21st year in the field, a pediatric nurse practitioner in neurooncology at the Children’s Hospital of Philadelphia (CHOP) in Pennsylvania.

Pollack traces her interest in caring for very ill children to the Erma Bombeck book, “I Want to Grow Hair, I Want to Grow up, I Want to Go to Boise: Children Surviving Cancer.” It relates the anecdotes of pediatric cancer survivors with a humorist’s insight.

Pollack, who read it as a teen, was smitten from the beginning. She said the book steeled her resolve to pursue nursing.

“I knew it was a calling,” she said.

“I knew that being a nurse, I could be able to navigate my own career. I felt like there was so much opportunity in nursing.”

After an undergraduate internship at CHOP, Pollack began an externship there while she finished school. When she graduated in

48 | OR TODAY | OCTOBER 2018

1994, Pollack was able to leverage that externship into a full-time position at the hospital. She began in the adolescent unit, working with patients battling a variety of diseases.

Pollack later transitioned to the ICU while working on her master’s degree, but still had her sights set on an oncological assignment. Yet, even with an advanced degree, hiring managers wanted candidates with oncology experience. Just 25, she entered the interview with a chip on her shoulder. She’d already demonstrated that she could handle the pace of the ICU, why couldn’t she do the same in oncology?

“I said, ‘Give me a year,’ ” Pollack said. “I was able to take my short experience as a nurse of two years, and also make the jump to work in a critical care environment. I said, ‘I learned that, what makes you think I can’t learn this too?’ ” Some of her supervisors were skeptical, and “a lot of them gave me a hard time,” Pollack recalled.

Her early years on the unit were fraught with challenges from some colleagues who felt it necessary to measure her resolve with constant testing. Pollack channeled that criticism into motivation, and kept her

nose to the grindstone. In reflection, she understands more than most the adage about nurses “eating their young,” but she’s also adapted her own approach in light of it.

“Here I am 21 years later,” Pollack said.

Pollack believes that nursing units work best when staffers support one another professionally, and she tries to live that mantra. In any hospital setting, busy days can be stressful for patients as well as for health care practitioners; in an acute pediatric environment, there’s such little room for error that every bit of professional support helps.

“Kids are very sick, and it’s a high-paced environment,” Pollack said. “I think nurses can be more supportive and compassionate toward one another, just like we are toward our patients.”

To support her fellow nurses, Pollack said her office “is Vegas — what they tell me about here stays in here; it does not leave these four walls.” By creating a place for consequence-free conversation, she’s made something of an emotional airlock upon which staff can rely to buffer their experiences.

“I try to make an impact on more nurses today by listening and by

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k c a l l o P a Pictured from left to right, Social worker Zoe Artz; Rosanna Pollack, MSN, PNP; and Jane Minturn, MD, work together in the pediatric oncology unit at the Children's Hospital of Philadelphia in Philadelphia, Pennsylvania.

“It’s so important to forge relationships with your work family. It feels incredibly good to be supported by the people who go through the same things every day.” giving them some solid, good advice without being biased, but also giving them the opportunity to express their feelings, whether I agree with them or not,” she said. “Honesty is key in mentoring people.”

Pollack said she survived the criticism of her early career by focusing on the things she could change in her daily experiences, and by finding opportunities to become a leader.

The ability to provide hands-on care, and to work as part of a team; that the doctors with whom she works view her as a critical piece of decision-making for vulnerable patients – all these aspects of her job are among the most valuable to her. Most of all, however, is the opportunity to communicate with WWW.ORTODAY.COM

patients and their families.

“When I talk to families, I try to remind them that even though I’m not going through [their circumstances] as a parent, I am trying my best,” Pollack said. “If they’re not getting the result, I want them to know that not only I, but that their whole team, is doing their very best to help them. There is so much emotion that goes into every single day, I want them to know that we’re right there with them.”

Pediatric cancer patients can face lives of difficulty, even when their disease is in remission. To many of them and their families, the care and attention of the nursing staff in the unit, and the ability for their caregivers to employ a human touch

in dire circumstances turns on the maintenance of clear communication.

“I think it’s families knowing we’re there and we’re listening” Pollack said. “They want the truth, and they want it raw. They don’t want false hope.”

After nearly 21 years, Pollack’s way of doing things has gained her “an incredible support system” in the workplace that she describes as a second family.

“Because of that, we’re all good friends outside of work” she said.

“It’s so important to forge relationships with your work family. It feels incredibly good to be supported by the people who go through the same things every day.”

OUT OF THE OR fitness

How to Get a Leg Up on Well-Being

By Marilynn preston efore I was a walker, I was a runner – a slow, lumbering, back-of-the-pack runner. When I discovered racewalking, I found my sport.

And since then, I’ve become a ferocious fan of every style of walking: all ages, speeds, styles and sexes. (If only walking were, somehow, a sexier sport.)

B

I could fill the rest of this column and several more spelling out all the wonderful things walking will do for your body and your mind. It’s great for your brain, your strength, for every cell in your body, for calming yourself mentally and boosting your energy physically.

It’s also the perfect antidote to the crazed, stepped-up pace of life today, when too much technology walks all over our human need to slow down and ... how can I put this? ... think.

“Thinking is generally thought of as doing nothing in a productionoriented society,” Rebecca Solnit writes in her smart and inspiring book called “Wanderlust: The History of Walking.” “And the something closest to doing nothing is walking.”

How fast should you walk to pro-

50 | OR TODAY | OCTOBER 2018

tect and maintain your health? That question has been around as long as I have, and now new research published in the June issue of the British Journal of Sports Medicine has provided a practical answer: 100 steps a minute seems to be an ideal pace. The researchers call it “brisk” walking – not too hard, not too easy, and probably easier than you think.

So start where you are. Walk for 10 seconds, count your steps, multiply by six and you’ll know how many steps you take in a minute.

Then, you can gradually speed up or slow down the pace, keeping in mind that according to federal exercise guidelines we can trust, we should plan on 30 minutes of brisk walking most days.

More vigorous walking – 130 steps a minute – is also an admirable goal, but if that’s too much for you, an easier 100 steps a minute will help you make big strides in your well-being.

POP QUIZ To go faster, should you take longer strides or shorter ones? Shorter, quicker steps is the way to go.

KEEP YOUR HEAD UP Walking with your head down – a la

the dreaded text neck – is a common mistake. It can strain your back and shoulder muscles and get in the way of efficient breathing. You are remembering to breathe, aren’t you?

MOVE YOUR ARMS Scan your body to make sure you’re not hunching your shoulders or tensing your arms. Let them swing in a natural way in opposition to your legs.

Keep your elbows tucked into your sides, arms bent at about a 90-degree angle, hands loose. The more you pump those arms, the better workout you’ll get.

WORK THOSE HIPS To stride with more power, imagine that your leg begins at your hip.

As your right leg comes forward, so should your right hipbone, in a natural rotation. Then do the same with your left. Racewalkers get a lot of speed, forward thrust and, yes, funny looks from this exaggerated hip wiggle. It takes practice and patience, but once you get it, it’s yours forever.

PULL IN YOUR TUMMY As you walk, be aware of engaging your abdominal muscles and your glutes, your butt muscles. Walking this way requires some attention at first,

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but eventually it becomes part of your routine and a fantastic way to help tighten those areas that tend to get loose and flabby as we age.

When Quality Matters

GO FOR THE ROLL There’s no wrong way to walk, but for maximum efficiency and power, focus on walking heel-ball-toe. Practice landing on your heel, your toes flexed to the sky, then roll through the foot, using the big toe to give your body a powerful push forward. That way all your leg muscles – from your calves to your glutes – will be awake and involved.

It can take a while to develop this kind of body awareness, but remember: The results are far from pedestrian!

Bottom line, you want to find a pace and style that spark joy, relax your brain and allow you to connect to the natural world around you. That way, the bliss chemicals flow. And when that happens, you’re hooked on walking, not because you should but because you really want to.

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OUT OF THE OR health

Yoga For People with Back Pain

By Matthew Solan

henever my lower back gets tight (which happens more often than not after being glued to my work chair for hours on end), I sit on the floor and slowly move into my favorite yoga pose: half lord of the fishes, also known as a seated spinal twist. Just a twist to the left and right never fails to restore my sore back.

W

Yoga is one of the more effective tools for helping soothe low back pain. The practice helps to stretch and strengthen muscles that support the back and spine, such as the paraspinal muscles that help you bend your spine, the multifidus muscles that stabilize your vertebrae, and the transverse abdominis in the abdomen, which also helps stabilize your spine.

But unfortunately, yoga is also the source of many back-related injuries, especially among older adults.

A study published in the November 2016 Orthopedic Journal of Sports Medicine found that between 2001 and 2014, injury rates increased eightfold among people ages 65 and older, with the most common injuries affecting the back, such as strains and sprains. So, the question is this: WWW.ORTODAY.COM

how can you protect an aching back from a therapy that has the power to soothe it?

Proper form is especially important for people with back pain.

The main issue with yoga-related back injuries is that people don’t follow proper form and speed, says Lauren Elson, M.D., instructor in medicine at Harvard Medical School.

“They quickly ‘drop’ into a yoga pose without gradually ‘lengthening’ into it,” she says.

This is similar to jerking your body while lifting a dumbbell and doing fast reps instead of making a slow, controlled movement, or running on a treadmill at top speed without steadily increasing the tempo. The result is a greater chance of injury.

In yoga, you should use your muscles to first create a solid foundation for movement, and then follow proper form that slowly lengthens and stretches your body. For example, when I perform my seated twist, I have to remember that the point of the pose is not to rotate as fast and far as possible. Instead, I need to activate my core muscles and feel as though my spine is lengthening.

Then, I can twist slowly until I feel resistance and hold for as long as it’s

comfortable and the tension melts away.

Talk to your doctor first about whether it’s OK to begin a yoga program if you suffer from low back pain. Elson suggests staying away from yoga if you have certain back problems, such as a spinal fracture or a herniated (slipped) disc.

Once you have the green light, you can protect your back by telling your yoga instructor beforehand about specific pain and limitations. He or she can give you protective modifications for certain poses, or help guide you through a pose to ensure you do it correctly without stressing your back. Another option is to look for yoga studios or community centers that offer classes specifically designed for back pain relief.

Remember that the stretching and lengthening yoga movements are often what your low back needs to feel better, so don’t be afraid to give it a try.

“By mindfully practicing yoga, people can safely improve their mobility and strength while stretching tight and aching back muscles,” says Elson.

SOURCE: Harvard Health Letters OCTOBER 2018 | OR TODAY |

53

OUT OF THE OR nutrition

8 Ways to Add Fiber

By Joyce Hendley ietary guidelines recommend that most adult Americans get 25 to 38 grams of fiber a day, depending on their age and sex, which is more fiber than many people get. The good news? Getting more whole grains and fiber in your life is easier and tastier than you think. The key is to work more fiber-rich plant foods into your meals and snacks, and to get at least half of your grain-based foods each day from whole-grain sources. Here are some tried-and-true tips.

low-sugar, high-fiber cereal into your (or your kids’) favorite cereal.

Gradually increase the proportions until your palate – and digestive tract – have adjusted.

Upgrade your favorites

Think outside the (cereal) box

D

Seek out whole-grain versions of your favorite foods, such as whole-wheat pasta, whole-wheat bread, brown rice and whole-grain crackers. If you don’t like one brand, experiment with another; there are so many choices nowadays, you’re sure to find one you love.

Go halfsies Phase in a whole grain by mixing it half-and-half with a refined one – for example, a blend of wholewheat and regular pasta, or half brown and half white rice. The same goes for cold cereals: try mixing a

54 | OR TODAY | OCTOBER 2018

Start smart Cross a serving or two of whole grains off your list before sunup: Have a bowl of old-fashioned or quick (not instant) oatmeal, or whole-grain breakfast cereal. Look for cold cereals with at least 5 grams of fiber per serving and/or those that carry a seal identifying them as an “excellent” or “good” source of whole grains.

Expand your whole-grain pantry: how about bulgur (cracked, steamed and dried wheat kernels), wholewheat couscous, quinoa or millet?

Try taking a trip to a natural-foods store for some inspiration. Finding new recipes can also help expand your comfort zone.

Read, read, read Become a label reader, zeroing in on the “dietary fiber” value.

Compare brands and choose those that offer the highest numbers. As a benchmark, you can consider any

food providing 5 or more grams of fiber per serving to be a “high fiber” food.

Eat your veggies Try to make vegetables – preferably nonstarchy types like greens and broccoli – a part of every meal and snack. Top your egg sandwich with spinach and tomatoes, add a side salad or vegetable soup to your lunch, snack on carrots and hummus, and double your usual portion of veggies at dinner.

Choose whole foods When fruits or vegetables are processed to make juice, most of the beneficial fiber is left behind.

Instead, try blending fruits and vegetables into smoothies and snacking on fruits and vegetables.

You’ll get more fiber and feel fuller.

Ditch the peeler Don’t peel edible skins from fruits and vegetables if you can help it.

To avoid pesticide residues, wash skins thoroughly before eating, and opt for organic varieties whenever possible.

SOURCE: EatingWell.com

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OUT OF THE OR

Recipe

recipe

the

56 | OR TODAY | OCTOBER 2018

Grilled Korean-Style Skirt Steak

INGREDIENTS: • For • • • • • • • •

4 pounds skirt steak the marinade: 1 cup low-sodium soy sauce 1/2 mirin (sweet Japanese rice wine) 1/2 cup plus 1 tablespoon brown sugar 1/4 cup dark sesame oil 1/4 cup unseasoned rice vinegar 16 medium cloves minced garlic (about 3 tablespoons) 2 scallions, white and light green part, thinly sliced 1/4 cup peeled and grated

ginger • 3 tablespoons hot sauce like Sriracha • 2 tablespoons toasted sesame seeds

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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OUT OF THE OR recipe

Korean Barbecued Beef will get your party started recently threw a California Korean barbecue party, aka my version of what I have enjoyed at many Korean barbecue restaurants in Los Angeles. I think it is the perfect way for people to share a meal in a casual and relaxed environment.

The barbecue must be superhot so that when the meat hits the heat it begins to caramelize.

While most Korean barbecue restaurants serve either boneless short ribs or thinly sliced flanken with the bone, I prefer to use skirt steak. Something about the texture of the meat

I

and the marinade comes together to produce a succulent, flavor-packed steak. I like to grill the pieces whole, and then thinly slice them and serve them on a cutting board or a platter.

Alongside the meat I offer fresh crisp romaine leaves, store-bought kimchi (fermented cabbage), shredded daikon radish and carrot salad, spinach with sesame oil and, of course, a big bowl of vegetable fried rice. And nothing goes better with this meal than ice-cold Korean beer.

Grilled Korean-Style Skirt Steak Serves 8 to 10 people 1. Combine all marinade ingredients in a bowl, and mix to combine.

2. Place the skirt steak in a large plastic lock-top bag. Reserve 3/4 cup marinade, and add the rest to the meat. Seal the bag, making sure to get all of the air out, and move the meat and marinade around to coat all of the meat. Marinate for at least 4 hours or overnight. Make sure to turn the bag a few times to evenly distribute the marinade.

3. Prepare the barbecue for high heat. When the barbecue is very hot, place the flat skirt steak on the barbecue and grill about 3 minutes or until the meat is dark and caramelized. Turn meat over and grill another 2 to 3 minutes or until the outside is slightly charred and caramelized.

4. Place on a wooden carving board, and let sit for 10 minutes. Thinly slice the meat and accompany with the reserved marinade.

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The News and Photos

that Caught Our Eye This Month

2

Have them help as soon as possible.

Kids can start learning their way around the kitchen as soon as they can walk. “Can you choose a piece of fruit?” “Please go to

5 Tips

to help kids pack lunches

the fridge and pick turkey or ham for your sandwich.” “Can you pass me the bread, please, and get out a knife for the mus-

1

Talk to them about food.

I’m willing to bet most foodies

with kids do talk about food with them: what tastes good, what’s healthy, what herbs and spices

The time has come for DIY lunches.

The kids will love the newfound freedom, and you’ll love the extra few minutes of sleep.

If you’re like me, and you’d rather get in bed a little earlier at night or get out a little later in the morning, here’s how you can get your children to DIY school lunches.

3

are best used in homemade vinaigrette. You know, the usual stuff.

The sooner they know how to build a healthy meal, the better.

tard?” You’re doing this already, right? They’re clearing dishes, cleaning their rooms and feeding the family dog. Familiarizing children with routines makes the transition to doing it themselves easier. This is why we let them help, because goodness knows a 3-year-old is never as much help as you’d like them to be.

Once they can make their own lunches, they’re only a year or two away from getting dinner on the table for the whole family!

Make it easy. Give them a formula.

Although some parents are creative with lunches, a lot of us have a

formula. Ours is sandwich, fruit and an extra thing (usually something crunchy, but occasionally something sweet). We don’t always stick to it, and dinner leftovers that make for a good lunch are in high demand (hello, fried rice). But if your children know the drill, it’s easy for them to put together a decent lunch. Remember to keep the goods in places they can access easily. Depending on when the growth spurt hits, you may need to reserve the bottom shelf for a while.

5

Don’t judge. It’s just one meal When you’re ready to cut the

cord and let the kids run wild and free in the kitchen, get ready to really let go. What if one day they make a fluffernutter and choose a chocolate chip granola bar? Well, it’ll be OK. It can be tempting to tell them to remake the lunch or

4

Give them choices. But not too many choices!

Choices are the most fun part of making lunch. When you go shop-

ping, ask what they’d like you to buy for their lunches. If he’s always wanted to try the pumpernickel and rye swirl bread, go for it. Let her choose a different kind of fruit every day, or eat the same one if that’s what she prefers. And I’m not trying to tell you how to parent, but I will

substitute a better choice, but just let it go (and serve extra vegetables for dinner). And maybe next time don’t have marshmallow fluff and chocolate chip granola bars in the house at the same time.

tell you what works for me: I give my crew choices, but not so many they think they own the world. We as adults don’t get whatever we want to eat, whenever we want it, and kids can learn early that limited choices help us save money and waste less.

WWW.ORTODAY.COM

Anne Wolfe Postic is a contributor to TheKitchn.com, a nationally known blog for people who love food and home cooking.

Submit any comments or questions to editorial@thekitchn.com

OCTOBER 2018 | OR TODAY |

61

INDEX

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Alphabetical 3M……………………………………………………………………… 10 AIV Inc.…………………………………………………………………51 Alco Sales Service, Co.………………………………………51 AORN……………………………………………………………………17 ASCA………………………………………………………………… 58 Avante Health Solutions………………………………… 29 C Change Surgical………………………………………………13 Case Medical, Inc.…………………………………………… 22 Cygnus Medical…………………………………………………… 9

D. A. Surgical…………………………………………………… 63 Doctors Depot………………………………………………… 55 Encompass Group………………………………………………16 Fobi………………………………………………………………………21 Healthmark Industries Company, Inc.… 4, 40-41 Innovative Medical Products………………………… 64 Jet Medical Electronics Inc………………………………21 MAC Medical, Inc……………………………………………… 38 MD Technologies inc.……………………………………… 52

Microsystems…………………………………………………… 47 Mobile Instrument Service & Repair…………… 24 Pacific Medical………………………………………………… 59 Paragon Services……………………………………………… 39 Parkdale Center for Professionals………………… 58 Ruhof Corporation……………………………………………2, 3 Soma………………………………………………………………………15 TBJ Incorporated………………………………………………… 5 TIDI C-Armor……………………………………………………… 6

INFECTION CONTROL

REPROCESSING STATIONS

categorical ANESTHESIA

Doctors Depot………………………………………………… 55 Paragon Services……………………………………………… 39 Soma………………………………………………………………………15

ASSET MANAGEMENT

Microsystems…………………………………………………… 47

ASSOCIATION

AORN……………………………………………………………………17 ASCA………………………………………………………………… 58

C-ARM

Soma………………………………………………………………………15

CARDIAC PRODUCTS

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

CARTS/CABINETS

Alco Sales Service, Co.………………………………………51 Case Medical, Inc.…………………………………………… 22 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…… 4, 40-41 MAC Medical, Inc……………………………………………… 38 TBJ Incorporated………………………………………………… 5

CS/SPD

Case Medical, Inc.…………………………………………… 22 MD Technologies inc.……………………………………… 52 Microsystems…………………………………………………… 47

DISINFECTION

Alco Sales Service, Co.………………………………………51 Cygnus Medical…………………………………………………… 9 Encompass Group………………………………………………16 Healthmark Industries Company, Inc.…… 4, 40-41 Ruhof Corporation……………………………………………2, 3 TBJ Incorporated………………………………………………… 5 TIDI C-Armor……………………………………………………… 6

INSTRUMENT STORAGE/TRANSPORT

TBJ Incorporated………………………………………………… 5

RESPIRATORY

Soma………………………………………………………………………15

SAFETY

Healthmark Industries Company, Inc.…… 4, 40-41 TIDI C-Armor……………………………………………………… 6

Case Medical, Inc.…………………………………………… 22 Cygnus Medical…………………………………………………… 9

SINKS

INSTRUMENT TRACKING

STERILIZATION

TBJ Incorporated………………………………………………… 5

Case Medical, Inc.…………………………………………… 22 Microsystems…………………………………………………… 47

3M……………………………………………………………………… 10

MEDICAL GAS

Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…… 4, 40-41 TBJ Incorporated………………………………………………… 5 Avante Health Solutions………………………………… 29 Fobi………………………………………………………………………21 MD Technologies inc.……………………………………… 52 Soma………………………………………………………………………15 TIDI C-Armor……………………………………………………… 6

Fobi………………………………………………………………………21

MONITORS

Doctors Depot………………………………………………… 55 Pacific Medical………………………………………………… 59 Soma………………………………………………………………………15

ONCOLOGY SERVICES

Avante Health Solutions………………………………… 29

OR TABLES/BOOMS/ACCESSORIES

D. A. Surgical…………………………………………………… 63 Innovative Medical Products………………………… 64 Soma………………………………………………………………………15

OTHER

STERILIZATION

SURGICAL INSTRUMENT/ACCESSORIES

C Change Surgical………………………………………………13 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…… 4, 40-41

SURGICAL LAMPS

Fobi………………………………………………………………………21

Case Medical, Inc.…………………………………………… 22 Cygnus Medical…………………………………………………… 9 Ruhof Corporation……………………………………………2, 3

AIV Inc.…………………………………………………………………51 Parkdale Center for Professionals………………… 58

SURGICAL TABLE

DISPOSABLES

PATIENT MONITORING

TELEMETRY

Alco Sales Service, Co.………………………………………51

ENDOSCOPY

Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…… 4, 40-41 MD Technologies inc.……………………………………… 52 Mobile Instrument Service & Repair…………… 24 Ruhof Corporation……………………………………………2, 3

AIV Inc.…………………………………………………………………51 Avante Health Solutions………………………………… 29 Jet Medical Electronics Inc………………………………21 Pacific Medical………………………………………………… 59

PATIENT WARMING

Encompass Group………………………………………………16

POSITIONING PRODUCTS

Alco Sales Service, Co.………………………………………51 Encompass Group………………………………………………16

Cygnus Medical…………………………………………………… 9 D. A. Surgical…………………………………………………… 63 Innovative Medical Products………………………… 64

GENERAL

RENTAL/LEASING

AIV Inc.…………………………………………………………………51

Avante Health Solutions………………………………… 29

HOSPITAL BEDS/PARTS

REPAIR SERVICES

FALL PREVENTION

Alco Sales Service, Co.………………………………………51

62 | OR TODAY | OCTOBER 2018

Fobi………………………………………………………………………21 AIV Inc.…………………………………………………………………51 Pacific Medical………………………………………………… 59

TEMPERATURE MANAGEMENT

C Change Surgical………………………………………………13 MAC Medical, Inc……………………………………………… 38

TEMPERATURE MANAGEMENT

Encompass Group………………………………………………16

WARMERS MAC Medical, Inc……………………………………………… 38

WASTE MANAGEMENT

MD Technologies inc.……………………………………… 52 TBJ Incorporated………………………………………………… 5

Cygnus Medical…………………………………………………… 9 Doctors Depot………………………………………………… 55 Jet Medical Electronics Inc………………………………21 Mobile Instrument Service & Repair…………… 24 Pacific Medical………………………………………………… 59 Soma………………………………………………………………………15 WWW.ORTODAY.COM

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