OR Today - January 2019

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MARKET ANALYSIS ENDOSCOPY EQUIPMENT

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CE ARTICLE POSTANESTHESIA

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SPOTLIGHT ON BUNYAPORN “BONNIE” TORONJO

JANUARY 2019

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contents features

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DISASTER RECOVER PLANNING Recent events have taught us that disasters can happen anywhere, at any time and under practically any circumstances. These include natural disasters like major storms, fires and earthquakes as well as manmade disasters like terrorism, cyber attacks and mass shootings. So, it is critical that health care facilities conduct thorough disaster recovery planning. There’s often very little, if any, warning that a disaster is about to strike. Disaster preparation must occur long before events occur.

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The EQ model (self-awareness, selfmanagement, social awareness and relationship management) provides a great framework for learning and building on soft skills. And with these skills, people become more productive, effective and, yes, profitable. Feel free to read that as being more valuable to one’s organization.

The global endoscopy equipment market is projected to reach $34.82 billion by 2022, according to a MarketsandMarkets.com report. The research group also estimated the market to be $25.58 billion in 2017. The forecast reflects a compound annual growth rate of 6.4 percent during the forecast period.

Coaching is an essential skill for leadership, professional development, and patient teaching. Both leaders and staff need to be informed about it. This module will provide them with the background and updated information to help formalize coaching roles.

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MARKET ANALYSIS

CE ARTICLE

OR Today (Vol. 19, Issue #1) December 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. © 2019

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PUBLISHER John M. Krieg

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EDITOR John Wallace

SPOTLIGHT ON

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Bunyaporn “Bonnie” Toronjo

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DIGITAL SERVICES

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OR TODAY CONTEST

RECIPE OF THE MONTH

Travis Saylor Cindy Galindo Kennedy Krieg

CIRCULATION Lisa Cover Melissa Brand

WEBINARS Linda Hasluem

INDUSTRY INSIGHTS 10 News & Notes 18 CCI Commentary 20 EQ Factor 26 Webinar Recap

ACCOUNTING Diane Costea

IN THE OR

22 Market Analysis 23 Product Focus: Endoscopy Equipment 28 CE Article: Coaching Helps Nurses and Patients Succeed

OUT OF THE OR 44 Spotlight On 46 Fitness 48 Nutrition 50 Health 52 Recipe 55 Scrapbook 56 Pinboard

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INDUSTRY INSIGHTS

news & notes

Casetabs Achieves Milestone Casetabs announced one million surgeries have been coordinated through its surgery coordination platform. Surgery centers and hospitals across the country are using Casetabs’ web-based surgery coordination application as a central hub for coordinating and communicating realtime case information. Casetabs eliminates data silos and enables everyone involved in a case – physician office staff, hospital and surgery center staff, anesthesiologists and ancillary teams including medical reps, radiology and pathology – to work together seamlessly.

“Casetabs’ surgery coordination platform was officially released in 2016 as a communication tool to bridge medical reps and surgery centers,” said Gavin Fabian, CEO of Casetabs. “Since then, we have evolved case communication in ways that eliminate unnecessary OR delays and cancellations for surgery centers and hospitals, which results in more efficient use of OR space.”

Starting at the physician practice, Casetabs allows scheduling and patient demographic information to be quickly pulled from their EMRs and used to schedule into available OR times at hospitals and surgery centers.

Once the case is scheduled, Casetabs serves as a project management platform for each surgery, providing the ability to manage anesthesia assignments, staffing assignments, vendor reps and other resources critical to patient care. All members involved in the case are kept in the loop of any changes or updates to a case through automated text, email and in-app alerts.

Earlier this year the Casetabs application was expanded to include patient engagement capabilities. Integrated patient texting, including pre-op reminders and post-op check-ins improve the patient experience by providing meaningful engagement throughout the patient’s entire continuum of surgical care. Unlike traditional texting services, Casetabs offers a deeper level of care because it serves as the core hub for all communication around each case. As a result, Casetabs leverages unparalleled data and insights to enable more individualized and valuable engagement with each patient. •

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3M Unveils New Durapore Advanced Surgical Tape One of the most important, yet stressful jobs clinicians do is to ensure critical, life-sustaining tubes are safely secured because even the slightest millimeter of movement can be life-threatening for some patients. While recent adhesive advances have incrementally improved critical tube securement performance, clinicians are still facing challenges to safe securement under hard-to-adhere-to conditions like diaphoretic skin, saliva and humidity. To fill this clinician need, 3M developed 3M Durapore Advanced Surgical Tape, a high-adhesion medical tape designed to provide safe, reliable critical tube securement in challenging conditions like high-moisture environments.

Unplanned extubations or dislodgement can significantly impact clinical outcomes, patient care quality and cost targets, so it’s incredibly important that clinicians are confident that the tape they choose will perform.

As part of 3M’s ongoing mission to redefine securement performance, adhesive scientists met with numerous clinicians to learn more about the real-world obstacles they encounter securing critical tubes. The scientists replicated the conditions that most frequently led to securement failure – such as humid, moist environments and various surface textures – and put the tape through 3M’s most rigorous medical adhesive research, development and testing process to date to make sure vast performance improvements were achieved in high-adhesion to skin, tubing and the tape itself.

“When patient outcomes rely upon effective securement, choosing the right medical tape is crucial,” shared Mel Wong from the 3M Medical Solutions Division. “We understand there’s absolutely zero margin for error in safely securing patient tubes and devices. That’s why we are committed to continuously challenging adhesive capability boundaries.

We want every clinician to have complete confidence that their critical applications will stay in place, so they can focus entirely on providing patient care.” • For more information, visit 3M.com/DuraporeAdvanced

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

According to the Agency for Healthcare Research and Quality (AHRQ), the demand for joint replacement procedures is expected to grow at an unprecedented rate and become one of the nation’s most common elective procedures. While the majority of these are performed in hospital settings, the American Academy of Orthopaedic Surgeons cites more procedures are taking place in the ASC setting in an effort to reduce costs and increase efficiency.

“Advancements in surgical procedures and prosthetics, coupled with reduced length of stay in hospitals, are leading to more orthopaedic procedures being performed in the outpatient setting,” said Tess Poland, RN, BSN, MSN Senior Vice President, Accreditation Services for AAAHC. “ASCs embody the principles of value-based care by delivering high-quality services at a fraction of the cost of a hospital visit.”

The Orthopaedic Certification program builds off the AAAHC ASC Accreditation offering or accreditation from another organization. After an ASC has achieved overall accreditation, it can acquire the certification to demonstrate excellence in the orthopaedic specialty by meeting specific industry standards.

The requirements touch on several aspects of the ASC

INDUSTRY INSIGHTS

news & notes

orthopaedic specialty including: • Credentialing and privileging of providers • Rigorous prescreening criteria to ensure optimal patient outcomes • Clinical care based on current evidence-based guidelines AAAHC-accredited ASCs requested an orthopaedic certification be developed to create an organized structure toward ensuring high-quality delivery of care and strong patient outcomes in orthopaedic procedures.

The certification demonstrates a center’s high-reliability and culture driven to excellence, creating a competitive advantage over other ASCs and providing assurance to patients, referrers and the industry.

“The goal of the certification program is to provide a highly clinical-relevant resource that recognizes centers of specialty excellence,” said Poland. “We plan to extend our certification programs to include more specialties in the future.”

The Orthopaedic Certification program Standards can be found in the 2018 Accreditation Handbook for Ambulatory Health Care, which includes updated Standards for 2018 and the Centers for Medicare and Medicaid Services (CMS) Emergency Preparedness requirements.

To obtain a copy of the 2018 handbook. • For more information, visit www.aaahc.org/publications

Clorox Professional Products Company Debuts CloroxPro At the ISSA Show North America 2018, Clorox Professional Products Company unveiled CloroxPro, a unifying new brand encompassing its health care and commercial cleaning products. The new brand acknowledges the common challenges and unique needs of the commercial cleaning industry and the importance of cleaner, healthier shared spaces in all our lives.

“Commercial facilities, like schools, offices, gyms, hotels and hospitals all need to maintain clean, pleasant environments and kill germs that can cause illnesses

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and outbreaks,” said Lynda Lurie, Director-Marketing, CloroxPro. “CloroxPro recognizes the dual imperative of cleaning for aesthetics and cleaning for health and the value that a comprehensive, unified portfolio brings to facilities that need to do both.”

The new CloroxPro brand and tagline, “Where clean means everything,” will come to life in a variety of ways, including a new logo, updated packaging and a new website. • For more information, visit www.CloroxPro.com.

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INDUSTRY INSIGHTS

news & notes

CLARIFIRE Receives Baycare Health Award Baycare Health System has awarded CLARIFIRE, an innovative healthcare workflow application, and their internal teams, their Extraordinary Care Award for 2018. The award recognizes Baycare’s multi-disciplinary approach to managing clinical pathways using CLARIFIRE workflow. The specific clinical pathway workflows recognized with this award are congestive heart failure, chronic obstructive pulmonary disease, and total hip/knee and hip fracture. In just a few months, Baycare has experienced reductions in readmissions, improved outcomes, cost reductions, improved patient care and organizational visibility into variations by implementing CLARIFIRE workflow automation.

CLARIFIRE workflow takes manual fragmented steps, and scattered critical fields from the EMR, in a discrete disease pathway, and cohesively standardizes and automates the processes using evidence-based care models (pathways) and best practices. Clinical protocols and best practices are monitored

across the physician service lines as well as patient experience.

Variations in care and costs coupled with focused changes to operational processes are now in a continuous state of improvement. Real time access to relevant, critical data elements has created a better delivery of care experience for the patients and for the care providers, such as physicians.

Baycare, believing in innovation, uses their navigators and multi-disciplinary teams, to monitor the workflow and provide real-time actionable snapshots to physicians, surgeons and other stakeholders. They report the CLARIFIRE automated views of critical data are invaluable and a game changer for how they make patient care decisions, patient discharge determinations and medication adjustments through the continuum of care.

Baycare plans to expand their pathway workflows with CLARIFIRE across the Baycare Health system for all key service lines. •

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First Hospital Implements BEACON Advanced Energy Dual CO2 Laser System OmniGuide Holdings Inc., the parent company of OmniGuide Surgical, announced that Atlantic Health System’s Morristown Medical Center is the first hospital to implement OmniGuide’s BEACON Advanced Energy Laser System. The BEACON Laser System offers the versatility of two distinct methods of tissue sparing CO2 laser delivery to accommodate multiple surgical specialties and physician preferences.

BEACON’s first method of CO2 laser energy delivery is through OmniGuide’s patented Enhanced Safety flexible fiber technology, which utilizes multiple mirrors as well as a protective outer cladding to enable precision and maneuverability within close proximity to vital anatomy. Alternatively, as some minimally invasive surgical cases may require a fixated aiming beam to work in conjunction with microscopes and other optics, BEACON also features line-of-sight CO2 energy delivery via a direct-beam articulating arm. BEACON’s articulating arm offers multiple configurations given the surgical specialty for which it is required. BEACON introduces a new, user-friendly interface replete with intuitive smartphone-like navigation as well as audio/visual guidance to benefit the surgical team’s focus on the patient while conducting complex surgical procedures. Since BEACON was intended to accommodate multiple surgical specialties such as gynecology and otolaryngology, its internal components were designed to be insulated from vibration to enable greater mobility. The end result is a laser that can be easily transported without the inconvenience of CO2 laser misalignment.

The BEACON Advanced Energy Laser System has been cleared by the U.S. Food and Drug Administration and is currently available for resale. •

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INDUSTRY INSIGHTS

news & notes

Inova Health System Prevents Alarm Fatigue with Spok Clinical Alerting Spok Inc. announced that Inova Health System has chosen Spok Care Connect clinical alerting to deliver priority clinical alarms. The solution helps prevent potential alarm fatigue by delivering alarm notifications from nurse call and patient monitoring systems to clinicians’ health care-grade mobile devices.

Inova is a five-hospital health system serving more than two million people each year from throughout the Washington, D.C. metro area and beyond. Spok clinical alerting is fully deployed at Inova Fairfax Hospital, and is being rolled out systemwide over the next year, encompassing more than 2,500 users.

“We were already using Spok in a variety of ways for clinical communication within Inova, and we knew we had a solid, reliable platform to build on,” said Jill Briggs, RN, CPN, pediatrics project manager, at Inova Fairfax Hospital. “Across multiple critical care units, Spok enables us to take an enterprise approach to alarm management. We are preventing alarm fatigue with technology that adapts to our workflows to eliminate ‘nuisance alarms’ and improve patient safety.”

Spok clinical alerting integrates with Inova nurse call systems, Rauland Responder 5 and Hill-Rom NaviCare, as well as the patient monitoring network of bedside devices, which are primarily GE Healthcare. Spok enables Inova to have the flexibility to customize alarm management for each clinical unit.

Assignment sync, patient identification, workflow rules, keyword logic and unique tones for different patient events help

ensure the right clinicians receive alerts that matter to them on Inova-issued Spectralink clinical smartphones. Automated escalations, audit trails, and analytics support timely response to patients in need.

“Spok works very well with the other systems our care teams use to communicate,” said Rebecca Arthur, CPHIMS, ITIL, manager of biomedical information systems at Inova. “That level of interoperability means technology adapts to our workflows, rather than the other way around, and provides timely information to the caregiver in order to make more informed care decisions.”

Spok clinical alerts are received by Inova clinicians on Spectralink PIVOT 87-Series clinical smartphones. Inova selected Spectralink, a Spok partner, for the seamless integration with Spok and its EHR system, Epic. Deciding factors for choosing PIVOT include its screen size, which is large enough to clearly read complete alert notifications and messages and effectively navigate the EHR, and its rugged durability.

“Inova has worked diligently to develop a unified communication system, and Spok is proud to be the platform that supports their vision,” said Vincent D. Kelly, chief executive officer of Spok Inc. “Intelligent clinical alerting combats alarm fatigue and reduces clinician burnout, which are two top challenges for health care today.” •

Smith & Nephew Launches PICO 7Y Smith & Nephew announced the European launch of the new PICO 7Y Single Use Negative Pressure Wound Therapy System (sNPWT) with AIRLOCK Technology. This is the first sNPWT system to include an innovative integrated Y extension enabling the utilization of two dressings concurrently from one pump, in practice allowing for two wounds to be addressed at the same time, thereby potentially reducing cost.

PICO 7Y sNPWT includes extended soft port and multisite dressings, designed to conform to complex anatomies. It is

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particularly suited for use on multiple wounds, such as breast surgical procedures. PICO 7Y also includes a check dressing indicator, which is intended to reduce unnecessary dressing changes and wastage, and is 23 percent quieter than the first generation PICO, making it less intrusive for patients.

PICO 7Y is the latest addition to the PICO family of sNPWT products. It was confirmed that PICO 7Y met all relevant regulatory European requirements in August 2018. Regulatory clearance in the U.S. is pending. •

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INDUSTRY INSIGHTS

news & notes

RTI Surgical to Acquire Paradigm Spine RTI Surgical Inc. has entered into a definitive agreement whereby RTI will acquire all outstanding equity interest of Paradigm Spine in a cash and stock transaction valued at up to $300 million, consisting of $150 million at closing plus potential future milestone payments. RTI believes this transaction underscores its significant progress executing against its strategic transformation to reduce complexity, drive operational excellence and accelerate growth.

Under the terms of the agreement, RTI shall pay $100 million in cash and 10,729,614 shares of RTI common stock at closing.

The potential milestone payments are payable in a combination of cash and RTI common stock. The shares of RTI stock to be issued at closing were valued based on the volume weighted average closing trading price of RTI common stock on the NASDAQ for the five business trading days prior to the date of execution of the definitive agreement, representing $50 million of value. The transaction has been approved by the Board of Directors of RTI and the Board of Managers of Paradigm Spine, and is expected to close in the first quarter of 2019.

Established in 2005, Paradigm Spine’s primary product is the coflex interlaminar stabilization device, a differentiated and minimally invasive motion preserving stabilization implant that is FDA PMA approved for the treatment of moderate to severe lumbar spinal stenosis (LSS) in conjunction with decompression. •

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INDUSTRY INSIGHTS

news & notes

Innovative Medical Products Offers Value Added Commitment Program Innovative Medical Products customers have one less thing to worry about – unexpected downtime. With membership in IMP’s Value Added Commitment (VAC) program, customers get a free loaner positioner if theirs ever needs to be repaired. IMP ground ships the loaner free of charge and lets customers use the replacement until repairs are made, with minimal interruption in surgical procedures.

By qualifying as VAC participants, customers receive, in writing, a one-year parts and labor warranty on hardware, plus these benefits: • Repairs made to IMP’s specifications with factoryauthorized replacement parts • Certified testing after repairs to ensure equipment is within specification • Free product training for SPD staff on proper sterile processing of IMP positioning devices, as needed (where available)

• Free surgical staff in-service for all shifts, as needed (where available) • Proof of insurance protection “VAC is the gold standard for customer service and a ‘win-win-win’ for its participants,” Innovative Medical Products Vice President Earl Cole said. “With VAC support on their side, customers not only save money but are able to deliver a higher level of service by minimizing downtime with free loaners and our expert support. VAC participation also mitigates patient risk, as it requires customers to use IMP’s superior Softgoods exclusively, with over 30 years of safe protection to our patients without one reported incident. Only IMP’s ‘VAC’ gives customers the support to keep them operating.” • For more information, visit www.impmedical.com.

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INDUSTRY INSIGHTS

CCI Commentary

Taking Time for Yourself… and for your Patients

By James x. Stobinski

s the CEO of the Competency and Credentialing Institute (CCI), I attended the 2018 Executive Summit hosted by our testing partner Prometric. These meetings are held at 18-month intervals and each has a theme. The theme for this year was “Performance Leadership: Building Strong Teams.” I had a short conversation with one of the speakers during this meeting, John Foley, but he gave me much to think about. I would like to share some of my thoughts on his presentation and my subsequent reflection.

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He is a former member of the Blue Angels, the United States Navy and Marine Corps elite flight demonstration team, the epitome of a highperforming team. He is now retired from the Navy and is a nationally recognized speaker on how to enhance the performance of teams. He stressed in his presentation that a team could reach previously unreachable performance through a process of reflection and striving to improve. During his presentation, he also spoke of the concept of the “Tyranny of the Urgent,” That phrase is attributed to Charles E. Hummel who tells us that, “Your greatest danger is letting the urgent things crowd out the important.”

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During this short meeting, he and I spoke twice and he asked me, someone he had just met, the same question: each time he inquired how he could improve as a speaker, first in his own presentation and then relative to another speaker. These requests for feedback from someone in his audience gave me pause to think how perioperative nursing could apply this mindset to improve performance. In his presentation, he spoke to the value of taking feedback, in fact soliciting feedback, and using that to improve your performance. How do these two seemingly disparate thoughts on setting priorities and taking feedback pertain to the practice of perioperative nursing?

I think the utility to perioperative nurses of Foley’s approach is how perioperative nurses attend to their own professional development needs.

That is, how do they take the time to reflect on their own needs. I would say that often we are so focused on our patients that we neglect our own needs. The OR has always been a time-sensitive and intense environment where it is very easy to dismiss reflection and our professional and personal development. That is, it is very easy to succumb to what Foley referred to as the “Tyranny of the Urgent” and lose sight of the important things such as our own needs.

Another key takeaway from his approach is the act of soliciting feedback. I noted that he actively seeks feedback and that this act is an organic feature of how he approaches life and his work. This striving to improve and incorporating feedback appears natural and reflexive to him.

In his presentation, he stressed that the use of feedback is a key process which is integrated into the daily work of the Blue Angels. John Foley is a great example of how focus and a willingness to improve can facilitate high levels of performance.

I cannot argue that all perioperative nurses must function at the level of professional speakers or fighter pilots. However, I do think that if we take feedback and then take time to reflect we could make meaningful improvement in our work and personal lives. That improvement may then ultimately manifest in better outcomes for ourselves, our families and our patients. I urge you to take a bit of time to put aside the tyranny of the urgent and consider how you can take feedback, reflect and consider how you can improve personally and professionally.

James X. Stobinski, Ph.D., RN, CNOR, CSSM (E), is the CEO of the Competency and Credentialing Institute. He may be reached at jstobinski@cc-institiute.org.

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INDUSTRY INSIGHTS

EQ Factor

Can Emotional Intelligence Help you be Successful?

By Daniel Bobinski

ou’ve probably heard the terms soft skills, people skills and emotional intelligence (EQ). Whatever you call it, the ability to know your own strengths, weaknesses, preferences and tendencies – and to be able to read these in other people – are vital skills needed for success.

Y

The EQ model (self-awareness, selfmanagement, social awareness and relationship management) provides a great framework for learning and building on these skills. And with these skills, people become more productive, effective and, yes, profitable. Feel free to read that as being more valuable to one’s organization.

Everything starts with knowing yourself. From there, the progression is straightforward: self-management, work management and relationship management.

Having taught emotional intelligence for nearly 30 years, I contend that emotional intelligence is easier to learn if you don’t make emotions the central focus of your learning.

That’s because the three core aspects of our personality (behavioral styles, cognitive styles and motivators) have emotional components to them. Learn about those three as-

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pects, and by default you’re learning EQ along the way.

For instance, if someone has a strong driver personality (DISC type “D” / Colors type red), the affiliated emotion is anger. More specifically, such a person tends to have a short fuse. For the analytical type (DISC type “C” / Colors type blue), the affiliated emotion is fear. More specifically, a person with this core style is afraid of the consequences of making a bad decision.

This is useful information by itself, but note that by studying up on the four behavioral styles, not only are you discovering the emotional components, you’ll also learn the strengths, weaknesses, preferences and tendencies of each style. This can greatly enhance your effectiveness in relationship management – part of the EQ model.

By the way, when it comes to styles, there is no good or bad. Each style has strengths and each has weaknesses. I prefer to think of it as being more effective or less effective in given situations.

As an example, the strong driver personality tends to be more effective in situations that require quick, bold decisions. They are less effective in environments that required a lot of interpersonal patience or

attention-to-detail. Conversely, the strong analytic personality tends to be more effective when there’s mounds of data to pour over and accuracy is a must. Such a person tends to be less effective in environments that require reaching out and engaging new people.

I should also point out that no matter their style, most people are capable of adapting to what is required for a given situation. That said, adapting takes a lot of energy and usually causes stress. Put people in situations where they are less effective and you may receive some push back! Having this awareness helps boost your EQ. Bottom line, the more you understand the different styles, the better you can make good self-management, work management and relationship management decisions.

And so, the answer to our question is, “Yes.” Emotional intelligence can definitely help you be successful.

Daniel Bobinski, M.Ed. teaches teams and individuals how to use Emotional Intelligence, and his videos and blogs on that topic appear regularly at www.eqfactor.net. He’s also a best-selling author and a popular speaker at conferences and retreats. Reach him at daniel@ eqfactor.net.

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IN THE OR

product focus

Endoscopy Equipment Market Worth Billions Staff report ndoscopy is the process of looking inside the body because of various medical reasons by directly inserting endoscopes into the organs. The acceptance of endoscopy is on the increase, led by the benefits offered by minimally invasive categories.

Capsule endoscopy is one of the fastest rising among all the endoscope product types.

The high predominance of gastrointestinal disorders like ulcers, Crohn’s disease, inflammatory bowel disease and other diseases in the colon are growing the use of endoscopy devices.

billion in 2017. The forecast reflects a compound annual growth rate (CAGR) of 6.4 percent during the forecast period.

“The key factors driving the growth of this market include favorable government initiatives, rising number of hospitals and growing hospital investments in endoscopy facilities, technological advancements, and rising prevalence of diseases that require endoscopy,” according to MarketsandMarkets.com.

Allied Market Research also predicts growth in the market in the near future and lists some factors pushing the market to new highs.

“Rise in incidences of cancer, gastrointestinal diseases and other chronic diseases worldwide, owing to The global endoscopy devices market the growth in geriatric population, is expected to exceed more than $33 obesity, and changes in demographbillion by 2020, according to Market ics and lifestyle are the major factors Watch. that drive the growth of the endosA recent report on the endoscopy copy devices market,” according to equipment market by MarketsandAllied Market Research. “In addiMarkets.com predicts continued tion, technological advancement in growth. visualization, diagnosis and surgical The global endoscopy equipendoscopic treatment; and increase ment market is projected to reach in awareness of endoscopic technolo$34.82 billion by 2022, according to gies and its advantages among the the report. The research group also patients and medical professionals estimated the market to be $25.58 stimulate the demand for endoscopic

E

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devices, thus boosting the market growth.”

Allied Market Research also listed some factors that could hinder growth but still expect continued growth.

“However, numerous factors are expected to restrain the market development. The impact of the drivers is estimated to be higher than the restraints. Moreover, an increase in the effects of drivers and restraints is anticipated to reveal new market opportunities for key players manufacturing endoscopy devices, especially flexible and capsule endoscopy systems,” according to the report.

The global endoscopy devices market is anticipated to grow at a CAGR of 5.7 percent from 2016 to 2022, and reach $40.8 billion by 2022, according to Allied Market Research.

Some key players that operate in the global endoscopy devices market include Olympus Corporation, HOYA Corporation, Fujifilm, Holdings Corporation, Boston Scientific Corporation, CONMED Corporation, Stryker Corporation, Smith & Nephew Plc, Medtronic Plc, KARL STORZ GmbH & Co. KG, and Johnson & Johnson.

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product focus

CapsoVision Inc. CapsoCam Plus Capsule Endoscopy

The device is the size of a large vitamin capsule and holds four cameras and LED lights that capture images as the pill progresses through the GI tract. Similar devices on the market have a single forward-facing camera that sometimes misses pathology. The CapsoCam Plus cameras, which look sideways, get a very up-close and detailed view of the interior of the intestines.

And, unlike other devices, this one is wireless and can be used on patients with pacemakers. A convenient CapsoCloud service allows the physician to review the video and create reports from anywhere. •

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Fujifilm

Endoscope Portfolios Fujifilm’s 700 Series Endoscopes are designed with physician input to enhance visualization and usability. The 700 Series feature Fujifilm’s CMOS technology and are compatible with white light and proprietary observation modes. Fujifilm has also debuted its HD Advanced Surgical Visualization System featuring high-quality optical systems designed to deliver bright, even illumination, a wide range of contrast and outstanding color reproduction. Fujifilm’s surgical scopes are designed to aid surgeons in a variety of clinical specialties. •

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product focus

Healthmark EndoCheck

Test the cleanliness of the biopsy channel of the flexible endoscope. The EndoCheck is a miniature chemistry kit that is simple to use and interpret. Simply swab the biopsy channel of the scope with the included soft-tipped long probe, clip off the swab into the vial. Mix the activating agent, shake vigorously, wait and then check for a color change.

Depending on the type of test used, a color change indicates that blood residue or protein residue remains in the channel, and should be reprocessed.

EndoCheck complies with ASTM Guide D7225. • .

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KARL STORZ

No-Wrap Sterilization Containers KARL STORZ offers simple yet effective nowrap sterilization containers to protect its products during sterilization, transport and storage. Available in multiple sizes and configurations, KARL STORZ no-wrap containers provide a reusable alternative for most specialties, including neurosurgery, ENT, laparoscopy, urology, pediatric surgery and others. Containers include single- or multilayered basket trays, based on their application. Basket trays for each container come pre-assembled with a combination of silicone brackets, holders and inserts that are fixed securely to the tray. •

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product focus

Olympus

BF-MP190F The Olympus BF-MP190F is a fully rotatable, ultra-slim bronchoscope featuring an optimal ratio of working channel to outer diameter size, compatible with the radial endobronchial ultrasound (EBUS) probe and an array of sampling devices to expand access to smaller, more distal airways. The BF-MP190F’s ratio of a 1.7 mm working channel to 3.0 mm distal-end outer diameter provides pulmonologists with benefits during access, sampling and diagnosis of lung diseases such as cancer. • .

Ruhof

ScopeValet TipGuard The ScopeValet TipGuard is an endoscopic tip protector that provides a simple, safe, and highly effective method of protecting the delicate optics of an endoscope, while allowing the tip to aerate, decreasing the likelihood of microbiological growth. • For more information, visit www.ruhof.com.

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INDUSTRY INSIGHTS

news & notes webinar

Webinar Shares the Low Down on ‘Street Scrubs’ Staff report he RepScrubs-sponsored webinar “Are ‘StreetScrubs’ Contaminating Your OR?” was presented by Dr. John Kutz, F.A.C.S. Chief Medical Officer at RepScrubs.

He reviewed operating room history, personnel, individual roles and the impact of outside scrub attire, a.k.a. street scrubs, on the sterile environment and patient outcomes.

T

Almost 400 people registered for this OR Today webinar with 169 logging in to view the live presentation The webinar was well received among perioperative professionals and the readers of OR Today magazine. In a post-webinar survey, attendees stated that the presentation provided excellent information and “provided some great data to help present to the C-Suite and surgeons.”

“The webinar was informative and made several good points for me to consider,” said T. Jackson, surgical services nurse educator.

“This webinar was very informative! It has given me knowledge that I can share with my staff and continue to decrease any change of contamination in the OR,” shared J. Smith,

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assistant director, surgical services.

“This type of education is much needed as the health care system is ever changing so changing of mind set will also bring compliance of standards,” stated K. Noland, OR clinical manager.

“Today’s webinar provided some great data to help present to the CSuite and surgeons. This is another opportunity to manage the vendors and keep our patients safe from infections,” said K. Short, regulatory affairs ISO auditor.

“OR Today is ahead of the trend by presenting a subject that we all know is crucial for safe surgical patient care. I much rather be proactive than reactive regarding this subject,” said R. Evangelista, director of surgery.

“We especially appreciated the evidence-based approach and historical context regarding infection prevention that this webinar provided,” said T. Weeks, clinical director.

“Very informative of new technology for rep scrub management.

Will look into it further to see if it is something my facility may be interested in,” C. Edmonds, surgical service vascular/transplant coordinator.

“Dr. Kutz did an excellent job providing us with the history of operating rooms and how far we have come with proper surgical

attire. He gets an A+ for his passion in keeping his patients safe from SSIs,” shared M. Anthony, director of surgical services.

The overall webinar series, which provided educational materials to more than a thousand attendees in 2018, also received positive feedback.

“I find OR Today webinars useful for my role in understanding the OR better and what is expected as I work in regulatory and not in the OR itself,” said M. Johler, regulatory readiness manager.

“I enjoy OR Today webinars!

They cover current hot topics and the speakers are very knowledgeable and I like being able to ask questions through the chat! I definitely recommend OR Today webinars,” said M. Portenier, OR supervisor.

“OR Today’s webinar series is always timely, pertinent and very well presented. The speakers are very knowledgeable about the topic and very well spoken. I love these webinars,” said S. White, RN, CNOR, CIC. For more information about the webinar series, visit ORToday.com.

Webinar sponsored by:

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28 | OR TODAY | JANUARY 2019

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CE432

continuing education

Coaching Helps Nurses and Patients Succeed Rosalinda Alfaro-LeFevre, MSN, RN, ANEF

ulie, a staff nurse, feels she has reached a plateau after working on her unit for two years. She has a good relationship with her nurse manager and meets with her to explain her concerns. Her nurse manager listens carefully and tells Julie she is doing a wonderful job, but perhaps she is ready for additional challenges. They discuss having Julie take a charge nurse course. The nurse manager also wants to send Julie to a national nursing conference in the local area.

After the charge nurse course, Julie will practice as a charge nurse on shifts with a more experienced charge nurse as a resource. After the conference, Julie will provide inservices on what she learned about patient care and evidence-based practice. Julie leaves the meeting with her nurse manager feeling clear about her goals and expectations, as well as those of her manager.

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A significant career development relationship took place in the above meeting: coaching.

Coaching can make the difference between achieving your goals and failing to progress and reach your potential. Think about the following statements.

“I absolutely believe that people, unless coached, never reach their maximum capabilities” Bob Nardelli, former CEO, The Home Depot “Each person holds so much power within themselves that needs to be let out. Sometimes they just need a little nudge, a little direction, a little support, a little coaching, and the greatest things can happen.” Pete Carroll, head coach

and executive vice president of the Seattle Seahawks of the National Football League WWW.ORTODAY.COM

Let’s first consider the role of coaching in professional development and then go on to address the importance of knowing how to coach patients to manage their care and achieve independence.

Coaching is a critical relationship between managers and their staff. It plays a key role in developing talent within organizations, improving patient outcomes, and promoting job satisfaction. As the use of coaching has increased in the past few years, several leaders, educators, and authors have addressed the important role it plays in the following situations:1-3,6 • Developing critical nursing competencies • Improving nursing performance and patient outcomes • Developing necessary leadership skills • Transitioning from one nursing specialty to another • Helping clinical nurses transition to academic faculty roles • Navigating change within organizations • Enhancing job satisfaction and retaining staff • Promoting innovation and quality care practices

What Is Coaching?

Coaching is a continual, two-way process in which a professional with well-developed abilities partners with someone who needs to acquire those abilities to achieve mutually agreed-upon skills, goals, and outcomes.2 The concept of partnering to build a successful coaching relationship is an important one.

When coaches build empowered partnerships and encourage the people who they coach to be actively involved in all decisions they make, progress flows freely. When they don’t, there

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

Goal and objectives The goal of this program is to provide nurses with information about the critical relationships among coaching, career development, and goal and outcome achievement.

After studying the information presented here, you will be able to: • Name the two key components crucial to coaching • Explain the role of coaching in helping nurses and patients develop new skills • Describe supportive and initiating behaviors in the coaching relationship

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continuing education can be frustration and feelings of failure on both parts.2 There are two key components in staff and patient coaching: 1. A nurse, supervisor, or educator (coach) who’s willing to invest time and energy into the development of a nurse, student, or patient (coachees) 2. A nurse, student, or patient who is open to development2 Coaching doesn’t focus on teaching someone to do tasks and specifying how to do them. The goal of coaching is to help people discover their potential, become involved in new situations, develop new skills, and learn from the decisions they make.

Coaching isn’t the same as mentoring or precepting. Rather, coaching is an intentional strategy that a skilled mentor or preceptor uses. For example, you may have a mentor (a colleague or more experienced nurse) who supports you by listening, discussing the struggles you’re experiencing, and giving suggestions. If this mentor decides to coach you to a higher level of responsibility, he or she will make it a point to clearly identify challenges, encourage you to move out of your comfort zone, and do what you need to do to achieve your goals. Suppose you have a preceptor (a professional staff member who’s assigned to help you adjust to a new unit and learn specific skills, such as cardiac monitoring and respiratory care). To apply coaching principles, the preceptor will encourage you to seek out opportunities to learn from hands-on immersion experiences, rather than observational, experiences. Powerful lessons are learned by being immersed in real situations.

An Essential Link Coaching is an essential link to workforce development because it focuses on providing a supportive environment and encouraging employees to be proactive in their own growth through thoughtful interactions with their leaders.5 Coaches help staff members realize that answers to questions and solutions to problems lie

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within themselves.5 Because nursing is a profession that requires gaining many complex technical skills, a lot of coaching is devoted to instrumental (task-focused) skills. However, since clinical reasoning and building relationships are also crucial to nursing success, an equal amount of time coaching is often needed to develop cognitive and psychosocial skills (for example, helping nurses develop sound clinical decisionmaking and communication skills).2 To form a successful coaching relationship, both the coach and coachee must be active listeners, genuinely helpful, honest, and nonjudgmental.6 Overall, the goal for nurse coaches is to achieve measurable change or improved development in the staff (or patients) that they supervise.

Ideally, coaches focus on skill development, teamwork, leadership, and preparation for increased clinical or managerial responsibilities. Coaching is useful for strengthening delegation skills. It boosts productivity, overcomes costly and timeconsuming performance problems, and fosters a positive work environment. As a result, there’s more job satisfaction, motivation and employee retention. Staff who are encouraged to grow and develop and feel supported by their leaders tend to be loyal to their organization.6 As coaches, nurse leaders are expected to encourage growth and risk-taking, support team members when they make mistakes, and celebrate their successes.

Coaches assess talent and give employees progressively more responsibility so that they can grow and achieve their potential in the organization. By recognizing people with talent and helping them grow, coaches often determine who will replace them as leaders if they are promoted.

Coaching staff members, rather than replacing them, is an effective way to deal with staff performance issues. Many nurses work with people who have difficulties at first, but who later become valuable team members.

What to Expect Staff nurses need to understand what

to expect in a coaching relationship and how to maximize the benefits. Coaching starts when the coach (leader, educator, or preceptor) defines or expresses the desired outcome — in other words, describes what success looks like. The next step is to convey clear expectations and ensure that staff members understand and agree to the expected behaviors and outcomes.2,5.6 After setting the stage with staff, effective coaches provide challenging assignments and structured learning as well as feedback on performance and results. When an assignment is beyond a coachee’s experience, skill, and training, the coachee needs the coach’s involvement. As a coachee learns, the coach allows more independence.

The best coaches demonstrate a mixture of initiating and supportive behaviors.5 Initiating behaviors consist of attempts by the coach to initiate and structure an action-oriented, problemfocused, or development-focused discussion. Initiating behaviors may consist of encouraging a nurse to give an inservice about a timely clinical topic or discussing the need to provide more training to a staff member who has made several medication errors. Supportive behaviors consist of words and actions that demonstrate consideration, concern, and acceptance of the employee (e.g., “I know this isn’t easy at first” or “I realize that this is out of your comfort zone”). These behaviors tend to reduce tension and make open communication easier. An effective coach doesn’t fix a performance problem or demand or threaten. Coaching works best in a safe environment, but creating an environment safe for coaching may be one of the hardest steps. If nurses don’t feel safe sharing their ideas with leaders, the nurse, nursing unit, and organization will not benefit.6 The goal for coaches is to achieve longterm, measurable changes in behavior or skill improvement rather than popularity.

The best coaches expect the best of themselves and others. The most vital aspect of coaching is building relationships with employees.3 Employees should view the coaching relationship as helpful.

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An effective coach doesn’t wait for critical incidents to address performance problems. He or she analyzes and intervenes to correct problems or skill deficiencies as soon as they are evident.6 A coach’s feedback should be specific and directed at behavior. It should not criticize the coachee. Rather, it should recognize and encourage the nurse’s development.

Asking nurses to evaluate their own skills and behaviors to reach an understanding of their strengths and weaknesses is an important part of coaching. Strategies for both coaches and coachees include to:2-6 • Let go of the past. It’s best to focus on the future and on making the most of your relationship with your leaders and coworkers.

• Be helpful and supportive, not cynical, judgmental, or sarcastic.

People respond better to positive, yet realistic, attitudes toward problems and change.

• Be honest about learning needs or goals for improvement. Everyone has areas in which to improve.

• Recognize that we were all new once and that no one’s perfect.

If you’re not making mistakes, you’re probably not trying new things.

• Keep patients safe by building “safety nets” in all important patient care situations (e.g., assess patients yourself after care from inexperienced nurses; if you’re an inexperienced nurse, ask someone to double check your patient assessment).

Even the most unmotivated nurses are usually coachable. When you make an effort to coach and help nurses to grow, it helps them feel valued and engaged in their practice. Through coaching, you can turn uninspired nurses into ones who see reasons to develop their knowledge and skills, therefore motivating them to be more engaged and seek out learning experiences. Good coaches work with unmotivated nurses before their apathy affects other team members and patient care. The best leaders are those who value WWW.ORTODAY.COM

each team members’ contributions and know how to coach the whole team to work together toward the common goal of exceptional patient care.

Coachable Moments Coaching should be part of everyday development. Effective coaches recognize opportunities for “coachable moments,” picking up on employees’ words and actions that indicate openness to developmental feedback. Leaders must take time to talk with those that they coach to help them understand developmental opportunities. They should suggest, on the spot, steps individuals can take to develop their potential. Common cues that show when employees are open to a coachable moment include when:5-7 • A nurse demonstrates a new skill or interest and seeks feedback. For example, a new charge nurse on the evening shift asks her manager for feedback about her performance and any ideas the manager may have for improvement.

• A nurse is thinking about a change within the organization. For example, a nurse tells his manager that he has heard the hospital is starting a palliative care team and wants to know how he can be considered for it.

• The nurse is experiencing a poor job fit. For example, a nurse in the ED seems to be unhappy and struggling. When her manager asks her about this problem, she says, “I was really excited about coming to work in the ED, but the pace and the stress are making me too anxious. I think I would do better back in the step-down unit.”

• A nurse is looking for developmental opportunities for more responsibility. For example, an energetic staff nurse feels constrained in her work environment. She believes she is at a developmental standstill and would like to be considered for the Magnet status coordinator position to learn more

about the organization beyond her unit.

Today’s workforce is diverse. Coaches must apply adult learning principles and be aware of individuals’ specific learning preferences. They need to understand generational differences that affect learning and performance.8 For example, how you coach baby boomers is likely to differ from how you coach Millennials. (See Bridging the Generation Gaps.)

Before, During, and After The coaching role includes creating simulated learning experiences before actual events (e.g., disaster drills); leading employees through events as they’re happening (called concurrent coaching); and discussing events afterward to clarify or replay them (this is often called debriefing and consists of asking questions like “What did you learn from that situation?” or “How might you have handled that situation differently?”).

With practice, seizing coachable moments becomes second nature for leaders who want to create a caring and dynamic environment that reduces frustrations related to staff development and growth.

Conversely, staff nurses can use the cues described earlier to demonstrate the desire for coaching and the willingness to accept advice. Staff nurses and managers can maximize coaching when they:5,6 • Keep notes on what went well and what seemed a problem • Listen and work to understand the coachee’s perspective on how things are going • Schedule a time free of interruptions • Summarize what was learned and agreed on during the session and the outcomes or actions that are expected • Use a factual approach: who, what, where, when, how Because developing a comprehensive plan for coaching each individual is a complex undertaking, pre-established clinical coaching plans can improve the process and outcomes of coaching.9 These JANUARY 2019 | OR TODAY |

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plans, which outline the knowledge and competencies needed to achieve overall goals, are developed by nurse professional development specialists. Educators and leaders can then individualize the plans to meet the needs of the nurses involved.

Each plan makes the purpose of learning explicit and guides the nurses to consider with specific reflections (e.g., What were the challenges in this situation? What went well? What would you do differently if you had the chance?).9 Good communication skills and concrete suggestions can help alleviate staff nurses’ stress. Strategies to use with nurses who are upset about interpersonal issues include listening, offering reassurance, giving advice, taking action, validating the nurse’s feelings (this does not mean agreeing), and helping them understand the perspectives of other employees, physicians and patients. Knowing how to give constructive feedback and overcome “the sting” of receiving it is key.2 Coaching is typically initiated by the coach, but staff nurses should be proactive about their development and ask for feedback regularly, especially when part of a large staff. If you want to benefit from a coaching relationship, tell your manager, educator, or other leaders about your goals and willingness to learn and take on more responsibility. Ask if there’s someone available who could coach you through your journey. Because some nurse managers have so many responsibilities, they may ask charge nurses, senior experienced staff nurses, and advanced practice nurses to help with coaching. This help is important, especially in relation to advancing staff clinical skills, dealing with complex interpersonal issues, or evaluating competencies. Some nurses, especially novices, may need more coaching time no matter how busy the day is. Leaders should give staff the time they need or ask a clinical nurse specialist, charge nurse, or assistant nurse manager to help work with them.

Coaching Takes Time In a national survey, nurse mangers said

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they would like to have more time to assess and coach their staff nurses.10 The primary reason nurse managers did not provide coaching was a lack of time because of the number of people they managed. Both the leaders and staffs of these managers believed the managers needed to improve their coaching skills; 52% of nursing executives thought nurse managers should learn more about coaching. Seventy percent to 73% of staff nurses said they did not receive enough feedback to maximize their daily performance, did not have discussions with their managers to help them be more effective, or did not receive explanations about how performance measures were tied to strategic priorities of the nursing unit or the organization.10

Part of the Equation The key variable that determines the success of coaching is the coachee. If you are a coachee, never put the responsibility for your change on the coach; you are the one who has to do the work. For coaching to be successful, there must be self-direction.

You must look within to decide what you want and value and are willing to be courageous about. You have to be selfmotivated and willing to move out of your comfort zone. Realize that taking risks and challenging yourself can recharge batteries and spark new enthusiasm.

Those who are being coached have a responsibility to reflect on their strengths and limitations and discuss them with their coach. Doing this speeds up the professional development process because there are fewer assumptions made and plans can be tailored to individual needs.

Coaching prepares someone for the next level of responsibility, whether it is to attain clinical expertise, become a charge nurse or nurse manager, or reach senior leadership levels. Each nurse has a personal responsibility to be active rather than passive in his or her personal career planning. Ask yourself questions like “What are my goals? Where do I want to be in the future? What is my plan to attain

my goals?” Working from a clear sense of purpose is important.

Just as staff nurses want their needs to be understood, they must also keep in mind the needs of nurse leaders. The best coaching relationships allow the staff to know the manager better and therefore see the manager in a more human, nonjudgmental way. Novice managers may think that when they develop their staff to function more independently through coaching, it may lead to their own obsolescence. Other concerns related to coaching may include the following:10 • Chaos: Managers who are driven to perfection may find it difficult to delegate work in the coaching process because of the variability in the outcome of the product, especially when staff is learning new skills, such as revising a care protocol.

• Failure: Giving more responsibility and accountability to staff risks the possibility of mistakes and the appearance of failure.

• Failure of support: If senior leadership undermines or undervalues the manager’s efforts to develop staff through clinical and educational growth opportunities, the manager may be unable to follow through on promises or plans for staff support (e.g., tuition assistance).

• Invisibility: As staff nurses become active in committee work, selfscheduling, or self-governance through the manager’s coaching, they often receive praise and recognition that previously went to the manager. This decentralization of power at the unit level may be a difficult adjustment for the manager.

• Loss of power: As staff nurses develop as informal leaders, they gain power by virtue of their accomplishments. This may create an informal power structure within the unit that may threaten WWW.ORTODAY.COM

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the manager.

No rewards: Typical hierarchical evaluation and reward structures in healthcare organizations do not always recognize or reward nurse managers for developing staff nurses.

More experienced leaders understand that when they take the time to coach, it will produce more effective and efficient people (in turn, team productivity and results improve). Moreover, as staff members are recognized for their accomplishments, the leader is recognized for producing and maintaining a successful team. That success creates a positive situation for everybody.

•

Is It Worth It? While coaching takes time, effort, and resources, numerous publications point out that the rewards outweigh the challenges. For example, skilled coaching has a positive effect on the following:5,6 • Improved patient outcomes and customer satisfaction • Better-performing individuals and teams • Improved autonomy and productivity • Increased job satisfaction and employee retention • Improved organizational performance and success, including financial performance.

Organizations that wait to coach employees until they are in formal leadership/management roles may miss an opportunity for improved employee performance across the organization — and may set up new managers for failure — when they provide coaching only at the last minute. Nurse leaders need to create cultures in which coaching is an everyday event; in such a culture, nurses can thrive and grow.5,6 Numerous articles, editorials, and blogs address why nurses leave organizations and even the profession. Problems with retention include the intensity of the work, long work hours, staffing issues, WWW.ORTODAY.COM

incivility, lack of recognition and growth opportunities, not feeling supported by management, scheduling issues, and poor compensation.5,6,11-13 Whether nurses stay with an organization may be determined by the (supportive or not supportive) actions of managers, charge nurses, and clinical leaders, such as clinical nurse specialists.

Magnet status hospitals — recognized for outstanding nursing care — value and encourage feedback from direct-care nurses. Magnet hospitals encourage nurses in leadership positions to be visible and accessible and to communicate effectively with clinical staff members.

Staff nurses want to be integral members of the healthcare team, helping with decision making and shared governance at the unit level. However, they often need additional administrative, clinical, and interpersonal skills to be more effective with patients, families, and fellow healthcare professionals. Coaching requires time and a genuine desire to invest in directcare nurses. But, when staff nurses work with good leaders who value them, they will typically perform at their best and rise to whatever challenges the changing healthcare environment presents. Just as people use personal trainers to achieve physical fitness goals, just-in-time feedback from an experienced colleague can help nurses take advantage of a myriad learning opportunities in the workplace.14

Coaching Patients As more patients manage complex health issues at home, the role of nurses as patient coaches is becoming the key to better outcomes. For example, a major role of today’s telehealth nurses is to call patients at home and coach them to manage chronic diseases like diabetes, kidney failure, chronic lung disease, and congestive heart failure. By helping these patients stay well and out of the hospital, telehealth nurses improve the quality of their patients’ lives and save unnecessary costs of acute care.

According to the International Nurse Coach Association, nurse coaching is

grounded in the principles and core values of professional nursing (e.g., promotion of well-being and patients’ rights). This group stresses that “the therapeutic presence and interaction between a nurse and patient can be a healing moment, providing comfort and support, and lowering the stress response. An integrative nurse coach promotes wellness and resiliency by guiding clients/patients to deepen connection to their inner healing resources and their capacity to make meaningful choices and by helping establish goals and strategies for healthy lifestyle behaviors.”15

Research and Performance Improvement Projects While there are numerous publications that address the benefits of coaching as an integral part of teaching, learning, leading, and empowerment, research specifically on coaching is still in the preliminary stages and difficult to do; it’s hard to isolate coaching from teaching, counseling, and other performance improvement approaches.

One recent qualitative study aimed to capture the lived experiences of adults seeking integrative health coaching to improve management of chronic health conditions. Analysis of recorded in-depth interviews and photo-elicitation interviews with nine participants suggested that the IHC experience is one that helps patients feel like they are taking part in transformative change. Researchers also determined that mindfulness (being present in the moment) contributed to the coaching relationship as well as helped patients to feel engaged, competent, and autonomous in achieving their goals.16 Another qualitative cross-sectional study in Journal of Nursing Administration measured satisfaction and expectations regarding the healthcare coach role among hospitalists and staff RNs. On a Likert scale of 1 to 5, staff nurse satisfaction with the HCC role averaged 3 (neutral), and hospitalists’ mean satisfaction was 4 (satisfied). The authors recommend further evaluation of the HCC role in other orgaJANUARY 2019 | OR TODAY |

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nizations and across care settings.17 A systematic review of the literature that aimed to examine strategies used by preceptors to promote critical thinking of new graduate nurses has been published in the Journal for Nurses in Professional Development. The authors of this study concluded that coaching, experiential learning, and feedback are best practices that should be employed.18 One of the most extensive studies in recent years is the International Coaching Federation’s 2016 Global Coaching Study.19 Having completed two international surveys in previous years the ICF commissioned PricewaterhouseCoopers to conduct an online survey that was completed in nine languages by professionals from 137 countries. The study results give an up-to-date picture of the use of coaching today by analyzing information from more than 15,000 professional coach practitioners and managers and leaders.

Capturing insights from professionals using coaching skills across the world, this study shows that the use of coaching skills and approaches has expanded beyond professionally trained coach practitioners to include managers, leaders, and human resources and talent development professionals who apply these skills their daily workplace interactions.

Coaching has also become a part of performance improvement projects. For example, A group of researchers describe a performance improvement project to help nurses transition to specialty practice.9 In this project, clinical coaching was one of four key components used to help nurses in a residency program. After nurses completed the program, the researchers surveyed preceptors and leaders to determine the impact of the program.

It was determined that while the program required commitment of time and resources, the project outcomes justified the investment. Building a standardized transitional support system that included coaching and clinical coaching plans had a positive impact on skill development.

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Making a Difference The role of professional coaching continues to evolve, creating opportunities and challenges. Can one person really make a difference? The answer: Staff nurses repeatedly identify nurse leaders as being the critical link to creating a climate for improved care quality, enhanced safety and performance improvement initiatives, higher staff and patient satisfaction, and increased nurse retention. Through coaching, nurse leaders make a difference in helping staff reach their potential. By developing coaching skills, all nurses can help patients discover ways to become healthier and more independent. Together, nurse managers and staff nurses contribute to an improved healthcare environment.

EDITOR’S NOTE: Linda H. Yoder, PhD, MBA, RN, AOCN, FAAN, and Maureen Habel, MA, RN, past authors of this educational activity, have not had an opportunity to influence the content of this version.

On Course Learning guarantees this educational activity is free of bias.

Rosalinda Alfaro-LeFevre, MSN, RN, ANEF, is the president of Teaching, Smart/Learning Easy in Stuart, Fla. She’s known nationally and internationally for her writings and programs on teaching critical thinking and improving personal and professional performance.

Coaching Resources •

Journals •B est Professional Journals & Magazines in Coaching, Mentoring, and Peer Assistance. http://www.peer.ca/Best_Pubs.html •C oaching: An International Journal of Theory, Research and Practice. http:// www.tandfonline.com/toc/rcoa20/current • I nternational Journal of Evidence-Based Coaching and Mentoring. http:// ijebcm.brookes.ac.uk

•

Organizations •A ssociation for Coaching. http://www.associationforcoaching.com • I nternational Coaching Association. http://internationalcoachingassociation.com • I nternational Coaching Federation. https://coachfederation.org • I nternational Nurse Coach Association. http://inursecoach.com •T he Ken Blanchard Cos. http://www.kenblanchard.com

•

Other Publications •A dams M. Change Your Questions, Change Your Life: 12 Powerful Tools for Leadership, Coaching, and Life. 3rd ed. Oakland, CA. Berrett-Koehler Publishers; 2016.

•D ossey B, Luck S, Schaub B. Nurse Coaching: Integrative Approaches for Health and Wellbeing. Miami, FL: International Nurse Coach Association; 2014.

•P hillippe-Welton C. Research paper: coaching and nursing. International Coach Academy Web site. http://coachcampus.com/coach-portfolios/ research-papers/carmen-philippe-welton-coaching-and-nursing.

•S herman R. Five strategies to more effectively coach nursing staff. EmergingRNLeader Web site. http://www.emergingrnleader.com/5-strategies-tomore-effectively-coach-nursing-staff.

WWW.ORTODAY.COM

CE432

References 1. Vermont Nurses in Partnership Newsletter Web site. http://www.vnip.org. Accessed November 17, 2017.

2. Alfaro-LeFevre R. Critical Thinking, Clinical Reasoning and Clinical Judgment: A Practical Approach. 7th ed. Philadelphia, PA: Elsevier-Saunders.

3. Jeffers S, Mariani B. The effect of a formal mentoring program on career satisfaction and intent to stay in the faculty role for novice nurse faculty. Nurs Educ Perspect.

2017;38(1):18-22. doi: 10.1097/01.

NEP.0000000000000104.

4. Bhimani H. Coaching and mentoring framework for nursing leadership development.

Registered Nurses’ Association of Ontario Web Site: http:// rnao.ca/bpg/get-involved/acpf/ executive-summaries/hamidabhimani. Published 2014. Accessed November 17, 2017.

5. Grossman SC, Valiga TM. The New Leadership Challenge: Creating the Future of Nursing.

5th ed. Philadelphia, PA: FA Davis; 2016.

6. Sullivan EJ. Effective Leadership and Management in Nursing.

9th ed. Upper Saddle River, NJ: Pearson Publishers; 2017 7. Kaye B. Coaching for engagement. In: Morgan H, Harkins P, Goldsmith M, eds. The Art and Practice of Leadership Coaching: 50 Top Executive Coaches Reveal Their Secrets. Hoboken, NJ: John Wiley and Sons; 2005:97-99.

8. Alfaro-LeFevre R. Bridging the generation gaps. Nurse.com Web site. https://www.nurse. com/ce/bridging-the-generation-gaps. Accessed November 17, 2017.

9. Boyer SA, Valdez-Delgado KK, Huss JL, et al. Impact of a nurse residency program on transition to specialty practice. J Nurs Professional Dev. 2017;33(5):220227. doi:10.1097/ NND.0000000000000384.

10. Advisory Board. Realizing Staff Potential. Washington, DC: Advisory Board; 2004.

WWW.ORTODAY.COM

11. Buttaccio J. 3 Reasons many nurses are leaving the profession. DailyNurse Web site. http://dailynurse.com/3reasons-many-nurses-leavingprofession. Published March 22, 2017. Accessed November 17, 2017.

12. Johnson N. Why good nurses leave the profession. Minority Nurse Web site. http://minoritynurse.com/why-good-nursesleave-the-profession. Published May 6, 2015. Accessed November 17, 2017.

13. Gupta S. Why America’s nurses are burning out. Everyday Health Web site. http:// www.everydayhealth.com/ news/why-americas-nursesare-burning-out. Updated May 6, 2016, Accessed November 17, 2017.

14. Parsons ML, Stonestreet J. Staff nurse retention: laying the groundwork by listening. Nurs Leadership Forum.

2004;8(3):107-113.

15. International Nurse Coach Association Web site. http:// inursecoach.com. Accessed November 17, 2017.

16. Goble K, Knight S, Burke S, et al. Transformative change to ‘a new me’: a qualitative study of clients’ lived experience with integrative health coaching.

Coaching: Int J Theory Res Pract. 2017;10(1);18-36. doi: 10.1080/17521882.2016.1266004.

17. Kohlbry P, Daugherty JS, Gorzeman J, Parker J. Expectations and satisfaction with the healthcare coach role. J Nurs Admin.

2017;47(2):108-115. doi: 10.1097/ NNA.0000000000000449.

18. Schuelke S, Barnason S. Interventions used by nurse preceptors to develop critical thinking of new graduate nurses: a systematic review.

J Nurs Professional Dev. 2017;33(1):E1-E7. doi: 10.1097/ NND.0000000000000318.

19. 2016 ICF Global Coaching Study. International Coaching Federation Web site. https://www.coachfederation.org/about/landing. cfm?ItemNumber=3936. Accessed November 17, 2017.

IN THE OR

continuing How to Earn Continuing Education Credit education 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 2/15/2020 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer.

4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test.

5. All users must complete the evaluation process to complete course. You will be able to view a certificate on screen and print or save it for your records.

Accredited In support of improving patient care, OnCourse Learning is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

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35

IN THE OR

continuing education

Clinical VignettE For CE432 Sarah is a new graduate on a med/surg unit. She has completed a six-week precepting program provided by the hospital. Feeling fairly confident of her clinical skills, Sarah receives a new admission with a percutaneous IV central catheter (PICC) line in place for antibiotic therapy. Sarah receives the patient’s antibiotic from the pharmacy and tries to infuse the 2 p.m. dose. However, the fluid doesn’t flow into the catheter. Sarah tries to flush the catheter with normal saline, but she encounters resistance, so she telephones the physician. The physician tells her to send the patient to the special procedures lab, located in another building of the medical center, to have the PICC line removed and a new one inserted. The patient is prepared for the trip, which requires several staff members and an ambulance because the lab is a half a mile from the inpatient bed tower.

When the patient arrives at the special procedures lab, the nurse assisting the physician removes the dressing and finds the catheter kinked. She unkinks the catheter and flushes the PICC line easily. She redresses the line, sends the patient back to the unit, and notifies the patient’s physician. The physician telephones the unit and expresses his displeasure to the charge nurse that the patient was needlessly transferred because of an insufficient nursing assessment of the problem. The charge nurse elevates the problem to the level of the nurse manager. Sarah is clearly upset when she learns what happened. he nurse manager asks to speak with Sarah. During that meeting the nurse manager should use her 1 T coaching skills to:

a. Tell Sarah to write an incident report and go to an inservice about PICC lines b. Give Sarah constructive criticism and tell her to be more careful next time

c. Ask Sarah to explain what happened and discuss how to avoid this in the future d. Tell Sarah that if a similar problem happens again, she’ll be placed on probation

he charge nurse knew Sarah was unable to flush the PICC line and facilitated the transfer of the 2 T

patient to the special procedures lab. If she were acting as a coach, the charge nurse could have:

a. Told Sarah the patient was her responsibility and she needed to deal with the problem

c. Assessed the PICC line without Sarah and confronted her about judgment error later

b. Gone with Sarah to double-check the assessment of the PICC line together

d. Asked Sarah what she did to create a problem with a “perfectly good” PICC line

fterward, it was discovered that the unit had an outdated PICC line policy, which stated that only 3 A charge nurses and CNSs could change PICC dressings. In her role as a coach, the manager should:

a. Ask Sarah to work with the unit CNS to develop the new policy because her perspective will be helpful

c. Tell Sarah that a new policy wouldn’t be needed if she hadn’t made such a huge mistake with the PICC line.

b. Tell Sarah she must work with the CNS to write the new policy so she won’t make mistakes like this in the future

d. Tell Sarah to develop an inservice on how to assess PICC lines to avoid unnecessary evaluations and transfers

ecause Sarah felt supported by her manager, she took a proactive approach to further her 4 B understanding of assessing and managing PICC lines. Such an approach includes:

a. Memorizing unit PICC line policies and procedures b. Asking other new nurses how they manage PICC lines

c. Accepting responsibility for the PICC line problem and learning how to prevent it in the future d. Learning how technology helps manage PICC lines

Clinical VignettE ANSWERS 1. Answer: C. Sarah should be allowed to explain the process she used to make the assessment that the PICC line was clotted. As a new graduate, Sarah is clearly vulnerable, especially in light of her upset reaction to the situation. Providing expert advice to Sarah in a nonjudgmental, caring manner will make her feel supported and help her “hear” the expert advice she is receiving.

2. Answer: B. Coaching is about putting patients first while helping employees learn from mistakes without humiliation.

3. Answer: A. In a coaching relationship, the manager does not denigrate or humiliate the employee, especially in front of other staff. However, the manager would want to involve the novice nurse in revising the policy to make sure the policy covers all aspects of the issue at hand and is easy to understand.

4. Answer: C. In a coaching relationship, the nurse being coached accepts responsibility for personal actions and proactively seeks improvement. Blaming someone else is not consistent with behavior supported in a coaching relationship.

36 | OR TODAY | JANUARY 2019

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“ With mass casualty events taking place more often, there is increased discussion about planning for such events.� Wilton C. Levine

By Don Sadler

R

ecent events have taught us that disasters can happen anywhere, at any time and under practically any circumstances. These include natural disasters like major storms, fires and earthquakes as well as man-made disasters like terrorism, cyber attacks and mass shootings.

So, it is critical that health care facilities conduct thorough disaster recovery planning. There’s often very little, if any, warning that a disaster is about to strike.

Disaster preparation must occur long before events occur.

Experiencing Disaster First-Hand Janet L. David-Lustina RN, MBA, BSN, BAP, the Director or Perioperative Services at

the University Medical Center of Southern Nevada in Las Vegas, experienced a disaster first-hand in the form of a mass casualty event when a gunman opened fire on a crowd of concertgoers in Las Vegas on October 1, 2017.

“I truly believe that most facilities, both large and small, have come to realize that we all need to be prepared for both internal and external disasters,” she says. “When this attack occurred, it was an awakening that was felt throughout the nation and we started to question our vulnerabilities.”“As health care professionals, we asked ourselves valid questions about preparedness and recovery after a major disaster,”

David-Lustina adds. “It would be remiss for any health care facility to think they will not at some point be affected by a disaster of some kind.”

According to Byron L. Burlingame, MS, RN, BSN, CNOR, Senior Perioperative Practice Specialist with the Association of periOperative Registered Nurses (AORN), larger health systems and facilities have been developing disaster plans and conducting readiness drills for years.

“They are more prepared for disasters now than they used to be,” says Burlingame.

“But for smaller facilities like surgery centers, there is work to be done in order for them to support their community’s disaster plans.”

" As more mass casualty events occur, hospitals are starting to reach out for direction when it comes to disaster recovery planning.” Sherry L. Buxton

During her travels to speak at events in the U.S. and internationally, Sherry L. Buxton, MBA, BSN, RN, NEA-BC, Chief Surgical Services Officer, AHG Administration at ORMC/Orlando Health, says she encounters many hospitals and health care organizations that do not have a disaster recovery plan.

“Or, if they do have a plan, it hasn’t been updated or exercised,” Buxton adds. “And, some facilities can’t get executive support for their plan. As more mass casualty events occur, hospitals are starting to reach out for direction when it comes to disaster recovery planning.”

“With mass casualty events taking place more often, there is increased discussion about planning for such events,” adds Wilton C. Levine, Medical Director, Perioperative Services at Massachusetts General Hospital in Boston. Levin was in the hospital when victims of the Boston Marathon bombing that occurred in 2013 began arriving.

says. “These range in scale from small table top drills to unit-based drills, hospital-wide drills and regionally coordinated multi-hospital drills.”

“A table top drill is an effective method for evaluating your plan,” adds Burlingame. “This drill would include an assessment of the facility’s utilities and an evaluation as

Disaster Recovery Plan Components

to how they would stand up to potential disasters.”

Mock disaster code and debriefing, meanwhile, are a good way to evaluate the effectiveness of your disaster plan before a disaster strikes.

“Each mock code should involve different team members from their respective departments so different perspectives and perceived challenges are addressed,” says David-Lustina. “The more perspective and feedback you obtain, the better.”

Levine lists a number of components that should be part of a health care facility’s disaster recovery plan: leadership involvement, clear communication, broad training, knowledge of resources, security, and downtime procedures.

David-Lustina concurs: “Strong administrative leadership that is involved and engaged is especially critical,” she says. “So is facility-wide engagement, role play, mock code and debriefing of strengths and weaknesses of the plan.”

Buxton stress the importance of continuity of operations in the event of a disaster. “Or in other words, ensuring that you can continue to function and provide health care services to the community you serve,” she says. “Your plan needs to emphasize people, systems, resources and facilities.”

Burlingame notes that AORN members can obtain a toolkit on emergency preparedness that provides resources for creating a disaster plan. “This includes both mass-casualty events and non-utility based events,” he says.

Simulation and training are critical when it comes to disaster planning, says Levine.

“We conduct disaster drills throughout the year,” he

42 | OR TODAY | JANUARY 2019

“ Facilities need to be sure their plan is thorough, with clear measures for each type of failure, and then provide education and perform competency verification on the entire perioperative team. All team members have roles to perform during a disaster.” - Byron L. Burlingame

Shortcomings of Disaster Plans One problem that Buxton sees with some health care facilities’ disaster recovery plans is how “spiderwebbed” their computer systems are and how systems are reliant on one another. “If one goes down, this can affect all the others and negatively impact patient care,” she says.

Meanwhile, Burlingame says it’s not uncommon for facilities to have small plans for various situations while lacking an overarching plan that would cover multiple scenarios with specific steps for each one.

“Facilities need to be sure their plan is thorough, with clear measures for each type of failure, and then provide education and perform competency verification on the entire perioperative team,” says Burlingame. “All WWW.ORTODAY.COM

article contributOrs

Janet L. David-Lustina

Byron L. Burlingame

Sherry L. Buxton

Wilton C. Levine

hospital personnel had to make sure they were not team members have roles to perform during a disaster.”

Buxton places communication at the top of her di- violating patient privacy. “We were fortunate in that we saster planning priority list. “You’ve got to have a way to had a designated public speaker for the facility,” says communicate with your staff at all David-Lustina. times, both day and night,” she says.

“We also had a patient advocate who "when the event is over, “Disaster plans are fluid and evertightly managed patient privacy and changing based on lessons learned health care workers need ensured that the correct patients were from real incidents and disaster paired with the correct family members,” to know that they’ve done she adds. “All in all, we were well-predrills,” Buxton adds. “Every disasthe best job they can and pared for this event considering it was ter is different – no two incidents our first and hopefully our last disaster of are the same – and there are always provide ongoing support this magnitude.” lessons to be learned and areas for for each other.” improvement.”

- Janet L. David-Lustina

Inside the Las Vegas Shooting In Las Vegas on the night of October 1, 2017, David-Lustina says the first University Medical Center trauma activation alert notification for a “full trauma activation for GSW” went out just two minutes after the last shots were fired.

“This tells me that the Las Vegas disaster communication plan was intact and effective in notifying key stakeholders that a disaster had occurred,” DavidLustina says. “Upon activation of the disaster code, we were ready when patients started arriving – there was no delay in providing immediate care.”

“Physicians, residents, attendings, military partners, nursing and ancillary staff were all readily available,” David-Lustina adds. “And more were either arriving or calling in to see if their assistance was needed. Administrative team members also arrived, rounded on all units and provided assistance as needed.”

Patient flow, tracking and identification were among the biggest challenges at UMC during this disaster. “The faster patients arrived, the harder it was to keep track of everyone,” she says.

As families started calling looking for loved ones, WWW.ORTODAY.COM

Take Disaster Planning Seriously

Buxton’s advice to hospitals and health care facilities when it comes to disaster planning? “Take it seriously and start to plan now,” she says.

“For example, what are you going to do if 15 patients from a disaster urgently need to get into ORs in the middle of the night?” she asks. “Who is going to staff the ORs and do you have enough supplies for this type of incident?”

David-Lustina urges hospitals to recognize that doctors, surgeons, nurses and other health care providers are deeply affected by disasters and may need help coping with the ongoing physical, emotional and physiological effects.

“During the event we’re running on adrenaline and endorphins but afterward we often crash,” she says.

“Sometimes we’re unable to shut our brains off or sleep, which can take a toll both mentally and physically.

“Therefore, health care facilities need to provide support resources to their employees,” David-Lustina adds. “And when the event is over, health care workers need to know that they’ve done the best job they can and provide ongoing support for each other.”

JANUARY 2019 | OR TODAY |

43

SPOTLIGHT

ON

Bunyaporn “Bonnie” Toronjo

BY MATT SKOUFALOS

n the 15 years that she has worked in medicine, surgical technologist Bunyaporn “Bonnie” Toronjo has supported countless patients during their most vulnerable moments.

I

She’s held the hand of a still-conscious Parkinson’s patient during an open cranial operation, listening as the surgeon asked whether the tremors subsided as the procedure progressed. She’s worked an 18hour on-call during the separation of conjoined twins. She’s helped children through repeat operations to repair trauma sustained in accidents.

Through it all, Toronjo has relished being part of a team that made patients’ lives better.

“Before I had kids, it made me feel fulfilled to be part of a team that made their lives better,” she said. “We helped get them back to a little sense of normalcy.”

Toronjo began her career in medicine with a certificate program at Oklahoma City Community College, and continued on with a bachelor’s in applied science at Siena Heights University. Now she’s pursuing an MBA while

helping train the next generation of scrub techs at North Central Texas College in Corinth, Texas.

Born in Bangkok, Thailand, Toronjo moved with her parents to Norman, Oklahoma as a child. After high school, she “spent a little bit of time lost,” having gone straight to college without a concentration in mind. Browsing through the course catalogue led her to an information session about the school’s surgical technologist program, and Toronjo “decided I wanted to go out in the world and make something of myself.”

It was a little intimidating at first.

“I was one of those people who didn’t like the sight of blood,” Toronjo said. “It was like the difference between watching the Discovery Channel versus having things happening to you.

I would pass out every time someone would come at me with a needle.”

“For the first few months, I was a deer in the headlights because it was so much stimulation,” she said. “It was amazing to be able to go into surgery and see how it all happened.”

After a while, however, Toronjo knew she was in the right place. She found her groove in the rhythm of the work, and was good enough to land a job offer before she’d even graduated.

She picked up and headed out to Children’s Medical Center in Dallas, Texas

Bunyaporn ‘Bonnie’ Toronjo poses with a cake from her goingaway party at Children’s Medical Center, Dallas, where she worked for a number of years as a surgical technician.

Bonnie (lower left) with coworkers from her surgical team at Children's Medical Center, Dallas.

“ O nce I started at Children’s, I became family. It was quite amazing how surgery and surgeons and the team in general could affect people’s lives.”

– just far enough away to move out of her family home, just close enough to visit on weekends.

“I always knew that I wanted to work in a big city,” Toronjo said. “When I did clinicals, Oklahoma University Medical Center was my favorite site. It was a level-one trauma center; they had all the up-to-date type of technology, and really exciting cases. I knew that I wanted to go to a city where I could see that. Dallas was the most obvious.”

From 2003 to 2007, Toronjo scrubbed as an orthopedic trauma tech, and then moved into supply chain, where she spent another four years before taking time off to have her second child. When she returned to work, Toronjo joined the surgery center at Children’s Medical Center, remaining until August 2018, when she took her current teaching assignment at North Central Texas College.

Toronjo describes her time at Children’s Medical Center as “nothing short of amazing.”

“The doctors there are incredible,” she said. “Once I started at Children’s, I WWW.ORTODAY.COM

became family. It was quite amazing how surgery and surgeons and the team in general could affect people’s lives.”

Teaching is different; here, Toronjo sees her work as “building a new generation of techs.” She tries to instill in them the breadth of her experience in the field, condensed in the brevity of a classroom course. Her students vary in age from teenagers to fifty-year-olds, and they all have different priorities.

“Some of them are so driven,” Toronjo said. “They want trauma, lots of neuro and cardiac. There are basically cases for everybody of all walks of life.

It’s amazing to be able to teach them from scratch.”

With each generation that comes through the OR, there’s more emphasis on efficiency, she said.

Technicians are expected to be able to adapt to changes in equipment, in instrumentation, in personnel; to integrate new priorities seamlessly and handle constant transition.

“There’s always new people coming through the door,” Toronjo said; “new doctors, new residents, new

staff, and you have to adapt in order to be successful.”

The most critical bit of wisdom she seeks to impart to her charges is how to slip into the flow of the surgical team. The effortless synchrony of everyone working together becomes akin to “a hive mentality,” she said, one born of repetition and a willingness to support one another amid that constant transition.

“It just works,” Toronjo said. “Once you’re in it, and you can do it well, you almost can move without having to say anything.”

“Scrub techs, we’re a little bit psychic,” she said. “You just learn how to read people. You live, day in and day out, with all these surgeons.

You do the same cases with them over and over again. You learn what their preferences are and how to do it. It just comes naturally after a few cases.”

In addition to her work in the classroom and on her own degree program, Toronjo is a married mother of two children. Her daughter, Alexandria, 8, is a competitive figure skater; her son Max, 5, is “a ball of energy.” When the family isn’t juggling their busy schedules, she and her husband Mark enjoy travel and connecting with nature in West Texas.

JANUARY 2019 | OR TODAY |

45

OUT OF THE OR fitness

Busy Schedule with Serious Health Goals?

By Miguel J. Ortiz

e cannot change the necessary tasks that await us every day. However, we might be able to redirect or organize ourselves a little better, so that we can celebrate our own progress in health while still being able to succeed within our professional environments. Regardless of how busy you are, the road to a healthier lifestyle requires positive sacrifices in order to make progress. So, let’s categorize our goals into three general interests and start processing how we organize our time into these necessary exercise routines.

W

Weight Loss Those wanting to trim body fat and drop some pounds will need to focus on two important areas – diet changes and activity. It’s tough losing weight with a high amount of stress. It is vital to focus on stress-releasing activities. The activity doesn’t matter as long as it involves movement and sweating. Light walking and jogging, yoga, foam rolling, and sauna time are great activities to consider when starting out. Try these activities three to five days a week beginning with 5 to 10 minutes of stretching, followed by 10-20 minutes of light jogging and a 5-minute cool down period that includes some light stretching. High stress jobs and

46 | OR TODAY | JANUARY 2019

lifestyles can create increased carb and sugar cravings, but you need to fight this and take control of your metabolism.

Be sure to drink lots of water, absolutely no carbonated drinks and no alcohol.

Consume less dairy and breads and more veggies, fruits and all things organic.

General Strength So, you want to build a little muscle, get ready for a 10K, a marathon or some other event? Whatever it is, you understand your body and you want to challenge yourself. You will need to create/manage your time accordingly to provide enough of an appropriate stress for the body to change. If you want to get better at running, run more.

If you want to get stronger, break down more muscle. Either way, creating time management is key so use the following types of workouts to keep it efficient – As Many Rounds/Reps As Possible (AMRAP), Every Minute On the Minute (EMOM), Tabata (8 rounds, 20 seconds on and 10 seconds off). These workout routines are sure to give you a great challenge in a short amount of time. Start with 5-10 minutes of light stretching, a warm up, foam roll, 10-20 minutes of a strength routine in one of the formats above, followed by 5-10 minutes of light stretching and cool down.

Pain Management-Corrective Getting out of pain and correcting the body is not an easy task. Be patient and you’ll ensure success. Diet is crucial here as you need to help the body heal internally as well as externally/physically.

Don’t add unnecessary stress to the body.

Have bad shoulders? Stop doing push ups. Have bad knees? Stop running! This is where slower, more corrective work comes in handy. Consider activites such as yoga, Pilates and water aerobics as they require slow and controlled movements to ensure proper muscular development.

General foam rolling and stretching routines will assist recovery. You must lengthen before you strengthen. Try 5-10 minutes of foam rolling, followed by 1020 minutes of yoga, Pilates, swimming, etc., and finish with 5-10 minutes of cool down stretch.

For all routines make sure diet continues to be improved, drink lost of water and get plenty of sleep. Catch me next month, as we dive deeper into more specific routines. Have a healthy and wonderful day!

Miguel J Ortiz is a personal trainer in Atlanta, Georgia. He is a member of the National Personal Trainer Institute and a Certified Nutritional Consultant with more than a decade of professional experience. He can be found on Instagram at @ migueljortiz.

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OUT OF THE OR nutrition

The Future of Protein

By Matthew Kadey here is a shift in America toward eating more protein. Protein-first diets like paleo are all the rage. So why are so many people hyper-focused on protein? Well, there are some good reasons to make sure you’re getting enough.

The amino acids that form the protein in foods are the basic building blocks of the human body, making up everything from muscles to bones to cartilage. Protein-rich foods may also help people feel fuller longer to avoid overeating.

But despite all the finer points of protein, it’s also true that our current consumption patterns are unsustainable. High intakes of meat sourced from resource-intensive and polluting industrialized feedlots are having a big environmental impact. The Worldwatch Institute estimates that livestock production is responsible for up to 51 percent of global greenhouse gas emissions, and mounting research shows that excess meat intake is bad for our long-term health. Yet, it’s not all protein doom and gloom. Movements are afoot to make protein healthier for us and the planet. Here’s what the protein of the future might look like.

of people are working to include more plant-based foods into their diets, and sales are rising yearly. Packaged foods fortified with pea and other plant proteins, vegan butchers and plant-forward restaurants are all part of the trend toward eating more protein that grows from soil.

Eating plant-based proteins is associated with a smaller carbon footprint and boasts a health-boosting benefit too.

Among 131,342 study participants, a study in JAMA Internal Medicine found that there was a 10 percent lower risk of death from all causes and a 12 percent lower risk of death from heart disease for every 3 percent increase in total calories people gleaned from plant protein.

“Plant foods provide a number of disease-fighting items, such as fiber and phytonutrients that are not found in animal-based proteins,” says dietitian Julieanna Hever, author of “Plant-Based Nutrition (Idiot’s Guide).” Plant proteins can also play a role in improving the diversity of our microbiome – beneficial bacteria in our guts that have a hand in nearly all areas of health.

Back to nature

With increasing interest among home cooks and restaurant chefs in practicing nose-to-tail cookery and reducing the

T

People are increasingly trading in beef for beans. In America, about 39 percent

48 | OR TODAY | JANUARY 2019

Offal-y good

waste of nutritious protein, appetites are rising again for offal – which literally means “off fall,” or the pieces including tongue, heart and liver that fall off a carcass when it’s butchered. When prepared correctly, their great flavors may just surprise you.

Game on For a more sustainable, diversified food system, there is a trend toward searing venison steaks and making a pot of chili with ground bison. In general, game meats like bison, elk, ostrich and boar are more likely to be free-roaming, grass-fed and humanely raised without the use of antibiotics and hormones.

With increasing demand, there is more game meat available at butchers, farmers’ markets and even large supermarkets.

Their higher price tag can also encourage people to savor smaller portions.

Rise of the impostors Veggie burgers and meat substitutes have come a long way. Forward-thinking food companies like Beyond Meat and Impossible Foods are spending a lot on R&D to produce faux meat products from plants that are more nutritious and deliver a flavor, aroma and texture that even unyielding carnivores can appreci-

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OUT OF THE OR nutrition

ate. Changes like these require only a fraction of the resources required for beef production. These products can also make it easier for people to transition into a plant-focused diet.

Catch of the day There aren’t enough fish in the sea to feed our planet’s rising population, especially with recommendations to eat two or more servings of fish per week. The best solution for keeping seafood on our dinner plates without depleting our oceans is aquaculture. Following years of serious environmental concerns, our future looks like it may be easier to reel-in sustainable protein from farmed fish. For instance, farmed mussels (which are able to clean their water as they grow) may be one of the most sustainable non-plant protein sources you can buy.

Going big on micro-livestock Some future-minded food companies want crickets, ants, beetles and mealworms to crawl into the American diet. Ounce for ounce, insects can contain more protein than poultry or beef.

More good nutrition news: A Journal of Agricultural and Food Chemistry study determined that grasshoppers, crickets and mealworms contain higher amounts of bioavailable minerals, including iron, copper, magnesium and zinc, than beef. Insect cultivation also requires dramatically fewer resources, including water and land, and they produce far less pollution than the farming of livestock. To make them easier for the squeamish to swallow, manufacturers are sneaking the dried and ground critters into familiar foods including energy bars, pasta bolognese and baked goods like cookies for a protein boost.

– Reprinted with permission from Environmental Nutrition

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OUT OF THE OR health

Warm Up to Thermograms

By Marilynn Preston very woman I know worries about breast cancer, including me. It doesn’t just run in my family; it gallops. My grandmother, mother, sister, niece and way too many more women I know and love have all been diagnosed, so when I tell you I keep abreast of this subject, you’ll know I’m not just punning you.

E

And here’s what I’ve discovered about the war on breast cancer that has nothing to do with the commercial power of pink: The battle is far from over, and women need to include thermograms as part of their breast health regimen.

What are thermograms? That’s the problem! I’ll bet you’re still not aware of how important thermograms are if you want to discover and prevent cancer in your breasts.

Please don’t wait for your doctor to suggest you get one. Chances are excellent that he, even she, is unaware of this safe and non-invasive screening tool. It’s had lousy PR ever since it was approved by the FDA in 1982. Mainstream doctors and hospitals in the multibilliondollar breast cancer industry are heavily invested in mammography,

50 | OR TODAY | JANUARY 2019

not thermography. It’s just not pink enough, which makes me see red.

Breast thermography – using a state-of-the-art digital infrared camera – is safe, effective and involves no radiation or squishing of the breast. It’s better than a mammogram in terms of early detection of growths.

And early detection is everything.

“When treated in its earliest stages, most breast cancer has a cure rate of 95 percent,” says Dr. Kathryn Ater, a primary care physician with a master’s degree in oriental medicine. She gave me my first, second and third thermograms over the last several years.

Ater’s very informative website, thermographynewmexico.com, states her practice’s mission simply: To help women take care of themselves.

“You are the one who decides when and how you’re going to monitor your breast health,” says Ater, who’s been analyzing thermograms for more than 14 years.

“Thermography is a tool. It’s a piece of the puzzle that we can offer to help find abnormalities in the breast tissue before abnormal growth begins.”

Mammograms – and I’m not going to get into all the pros and cons that have women so confused – are simply not useful for early detection.

“A cancer has been growing 8 to 10 years before it’s big enough or dense enough to be detected by mammography,” explains Sandra Fields, a certified clinical thermographer with a master’s in nursing and more than 35 years experience in women’s health care.

The science is simple and makes sense to anyone with a breast or a brain: By the time a tumor is the size of a pinhead (after about two years of growing), it requires its own blood supply.

The process of developing that blood supply is called angiogenesis.

Thermography is the best technology for detecting angiogenesis because it detects abnormal activity in the breast – increased heat, blood flow and changing vascular patterns.

All of these are early indicators that something suspicious is happening in the breast tissue and needs follow-up.

It’s an easy, painless procedure that takes about 30 minutes. In my case, I stood naked from the waist WWW.ORTODAY.COM

OUT OF THE OR health

up, turning in different directions while Dr. Kate clicked away, using a state-of-the-art infrared thermal camera.

A few minutes after the imaging ended, I got the results. No waiting, no worrying. Dr. Kate sat down with me and we both looked at the result, worthy of framing, a swirling psychedelic Peter Max-like pattern of red, blue, green and yellow.

“Looks good,” she said. I cheered.

She compared the new one with the one from last year. No new vascular supply, no suspicious heat patterns,

no new asymmetries.

“Nothing’s really changed,” she said, and we both knew that’s very good news.

The cost of thermograms will vary, but I paid $199 out-of-pocket, and $50 more for Dr. Kate’s careful review of the results. Insurance doesn’t cover it. Sad. I’m not saying that thermograms can or should replace mammograms.

You must decide for yourself. But it’s a credible first line of defense and prevention, and it’s not getting the media attention it merits.

Marilynn Preston is the author of “Energy Express,” America’s longestrunning healthy lifestyle column. For more on personal well-being, visit www.

MarilynnPreston.com.

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51

OUT OF THE OR recipe

Baked Mint Rice with Pomegranate and Olive Salsa

Recipe

INGREDIENTS: For the rice:

the

52 | OR TODAY | JANUARY 2019

• • • • • • •

2 cups basmati rice Salt Black pepper 1/4 cup unsalted butter, melted 3 1/3 cups boiling water 1 1/2 ounces mint sprigs 5 1/4 ounces feta, crumbled into 1/2- to 3/4-inch pieces

For the salsa: • 1/3 cup pitted green olives, thinly sliced • Seeds from 1 small pomegranate (2/3 cup) • 1/2 cup walnut halves, lightly roasted and roughly broken • 3 tablespoons olive oil • 1 tablespoons pomegranate molasses • 1 small garlic clove, crushed • 1/2 cup mint leaves • 1/4 teaspoon salt

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 Awardwinning radio show host. You can contact her at www.seriouslysimple.com.

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OUT OF THE OR recipe

Color your Guests Impressed with this Simple, Vibrant Dish ondon resident Yotam Ottolenghi, best-selling cookbook author and chef, has just released “Simple: A Cookbook” (Ten Speed Press, $35). The book concentrates on simpler, quicker recipes that showcase his creative, flavor-packed take on modern Middle Eastern cooking.

His streamlined approach to Middle Eastern spices and other ingredients is highly appealing. He eschews hours in the kitchen and instead offers up an amazing array of delectable dishes that include vegetables, meat, fish and poultry.

As a Seriously Simple cook, I was particularly thrilled to read Ottolenghi’s philosophy on simple cooking. He categorizes dishes into “Short on Time,” “10 Ingredients or Less,” “Make Ahead,” “Pantry Items,” “Lazy” and “Easier than You Think” bullet points for each recipe. This is such a

L

helpful tip for the reader. Recipes are divided by courses (brunch, dessert) and ingredients (raw veg, cooked veg, etc.). In addition you’ll find a chapter on Meal Suggestions and Feasts.

It was honestly tough to select one dish to share with you from this colorful volume of simple recipes.

This rice dish was calling my name. I like Ottolenghi’s technique for cooking rice. He explains, “Cooking rice perfectly is one of those things that shouldn’t be complicated but can be surprisingly difficult, for some, to get right. Baking it in the oven, on the other hand, as I do here, is a completely foolproof method (and one that worked, incidentally, when feeding 700 people during two sittings at Wilderness Festival in 2017!). This is such a great side to all sorts of dishes, such as roasted root vegetables or slow-cooked lamb or pork.”

Baked Mint Rice with Pomegranate and Olive Salsa Serves 6 1. Preheat the oven to 475 F, or as high as your oven will go.

2. Place the rice in a high-sided ovenproof dish, measuring 8 by 12 inches. Season with 3/4 teaspoon of salt and plenty of pepper, then pour in the butter and boiling water. Top with the sprigs of mint, and cover the dish tightly with foil so that the rice is well sealed. Bake for 25 minutes, until the rice is light and fluffy and all the liquid has been absorbed.

3. Meanwhile, make the salsa: place the olives, pomegranate, walnuts, olive oil, pomegranate molasses, garlic, mint and salt in a medium bowl. Mix well, and set aside.

4. Take the rice out of the oven, and remove and discard the foil. Pull the leaves off the mint sprigs – the stalks can be discarded – then place them back on the rice and sprinkle with the feta. Just before serving, spoon the salsa evenly over the rice. Serve hot.

PHOTO CREDIT: Art courtesy of Yotam Ottolenghi, “Simple: A Cookbook” (Ten Speed Press).

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Note: To get ahead, the salsa can be made a few hours in advance and kept in the fridge.

JANUARY 2019 | OR TODAY |

53

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Perioperative Professionals Attend Annual Carolinas Conference The 18th annual AORN North Carolina/South Carolina Perioperative Conference, sponsored by the Coastal Carolina AORN Chapter of South Carolina #4106 and the Capital AORN Chapter of North Carolina #3413, was a big success. The late October conference with the theme “Keys to Safety: Harmonized Care for Our Patients� was held in Conway, South Carolina.

The Coastal Carolina AORN Chapter of South Carolina #4106 provided the venue site, food, etc.

The Capital AORN Chapter of North Carolina #3413 was responsible for the education portion. Several attendees left with items they won at auction or via a door prize drawing.

Attendees included professionals from the Carolinas, Georgia, Tennessee, New York and more.

1. David Wyatt won one of the door prizes donated by OR Today at the annual conference.

2. Bill Duffy from Loyola University in Chicago, Jamie

OUT OF THE OR scrapbook

Ridout(center) from Capital City Surgery Center in Raleigh, North Carolina and Sharon A. McNamara(right), RN, BSN, OR Dx + Rx Solutions for Surgical Safety in Boston are seen reading an issue of OR Today magazine.

3. AORN North Carolina/South Carolina Perioperative Conference attendees are seen with their OR Today bags.

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1

3 WWW.ORTODAY.COM

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OUT OF THE OR pinboard

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The News and Photos

that Caught Our Eye This Month Sensory-based Food Education Encourages Kids to Eat Healthy

OUT OF THE OR pinboard

duce different vegetables, berries and fruit to children in hands-on sessions, they can involve children in baking and cooking, and they can offer children opportunities for growing their own vegetables in Sensory-based food education given to 3- the kindergarten backyard. Food-related to 5-year-old children increases their will- themes can also be included in books and ingness to choose vegetables, berries and games. fruit, according to a new study from the “There are several different ways to University of Eastern Finland. The findings do this. However, it always starts from were published in Public Health Nutrition. sensory-based learning, child-orientation The researchers used the sensory-based and child engagement. Doing and experifood education method Sapere, which encing things together is also an important makes use of children’s natural way of rely- aspect,” says Researcher and Nutritionist ing on all of the five senses when learning Kaisa Kähkönen from the University of new things: by looking at, smelling, tasting, Eastern Finland. touching and listening to new things. In The researchers compared children the Sapere method, children are given in different kindergarten groups. Some an active role around food, and they are were offered sensory-based food educaencouraged to share their sensory experi- tion, while others weren’t. Children were ences. Sensory-based food education is offered a snack buffet containing different well suited to the everyday life of kindervegetables, berries and fruit to choose gartens, where children eat several meals from, and the researchers took photos of every day and participate in pedagogically their plates to analyze their willingness to oriented group activities. choose and eat these food items.

Kindergartens have a variety of methThe findings show that sensory-based ods to choose from when delivering food food education given in kindergarten education. For example, they can introincreased children’s willingness to choose

vegetables, berries and fruit – especially among children whose mothers have a lower educational background. On average, children of lower educated parents tend to eat less vegetables, berries and fruit. This is how food education given in the kindergarten can help even out dietary differences between families.

Positive and personal food-related experiences gained in the kindergarten can help modify dietary preferences in a direction that is beneficial for health.

Dietary preferences learned in early childhood often stick with a person all the way to adolescence and adulthood.

The study was carried out in collaboration between researchers from the Universities of Eastern Finland and Jyväskylä. The study was funded by the Jenny and Antti Wihuri Foundation.

Reasons for Weight Loss Troubles

to try and combat the hormonal hold on the weight.

• Metabolic syndrome: This health condition is associated with a larger waist, as well as a variety of health problems.

Metabolic syndrome can affect the hormone secretions, which can lead to weight gain. Some lifestyle changes and/or medications may be able to help address this condition.

• Brain games: The gut plays an important role because it helps to communicate with the brain so that there are “full” signals that are sent out. Some people may need a brain reboot, because their body is not sending the signal that says they are full. Their satiety hormone is essentially off, which leads them to continuously overeat.

• Slow metabolism: Your metabolism can be influenced by your body size, sex, and your age. There are conditions that can lead to a slow metabolism, which will help to pack on the weight and make it difficult to lose it.

According to the Centers for Disease Control and Prevention, the prevalence of obesity in the country among adults is around 40 percent. They estimate that over 93 million adults are considered obese. It’s estimated that around 80 percent of the people try to lose weight on their own, but most fail.

We all know someone who has tried

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to lose weight, so it’s not for a lack of trying that some people can’t shed the pounds. There are some underlying conditions that are often overlooked that can keep people from reaching their healthy goal weight.

“It’s often not all your fault if you can’t lose weight,” explains Dr. Michael Russo, a board certified bariatric surgeon. “Weight loss is a complicated procedure. There’s a lot that goes into it, and they are not alone. Millions of people try to lose weight only to find that the scale doesn’t budge or it creeps up in the opposite direction.”

There are some often-overlooked reasons they find that it’s difficult for people to lose weight, including: • Hormones: The hormonal piece to the puzzle can play a big role in weight gain and in difficulty losing it. Fluctuations in hormones can help people pack on the pounds even though they haven’t changed anything in their lifestyle.

Increasing physical activity is one way

JANUARY 2019 | OR TODAY |

57

INDEX

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Alphabetical AIV Inc.…………………………………………………………………13

Cygnus Medical…………………………………………………… 9

Microsystems……………………………………………………… 5

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

Diversey ……………………………………………………………… 6

Medwrench………………………………………………………… 37

AORN……………………………………………………………………21

GelPro……………………………………………………………………15

OR Today Live……………………………………………… 38-39

Avante Patient Monitoring……………………………… 47

Healthmark Industries Company, Inc.…………… 4

Paragon Services……………………………………………… 27

C Change Surgical……………………………………………IBC

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

Ruhof Corporation…………………………………………… 2-3

Capital Medical Resources…………………………………12

MD Technologies inc.……………………………………… 49

TIDI…………………………………………………………………… 17,19

ANESTHESIA

FALL PREVENTION

PATIENT MONITORING

ASSET MANAGEMENT

GENERAL

categorical Paragon Services……………………………………………… 27 Microsystems……………………………………………………… 5

ASSOCIATION

AORN……………………………………………………………………21

CARDIAC PRODUCTS

C Change Surgical……………………………………………IBC

CARTS/CABINETS

Alco Sales Service, Co.………………………………………51 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4

CONFERENCE

OR Today Live……………………………………………… 38-39

Alco Sales Service, Co.………………………………………51 AIV Inc.…………………………………………………………………13 Capital Medical Resources…………………………………12

HOSPITAL BEDS/PARTS

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

REPAIR SERVICES

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

INFECTION CONTROL

SAFETY

INFECTION CONTROL

STERILIZATION

Cygnus Medical…………………………………………………… 9 Diversey ……………………………………………………………… 6 Healthmark Industries Company, Inc.…………… 4

DISINFECTION

INSTRUMENT STORAGE/TRANSPORT

DISINFECTION

Cygnus Medical…………………………………………………… 9 Innovative Medical Products………………………… BC Avante Patient Monitoring……………………………… 47 Capital Medical Resources…………………………………12 Cygnus Medical…………………………………………………… 9

MD Technologies inc.……………………………………… 49 Microsystems……………………………………………………… 5 Cygnus Medical…………………………………………………… 9

POSITIONING PRODUCTS

INFECTION CONTROL

Ruhof Corporation…………………………………………… 2-3 TIDI…………………………………………………………………… 17,19 Infection Control TIDI…………………………………………………………………… 17,19

CS/SPD

AIV Inc.…………………………………………………………………13 Avante Patient Monitoring……………………………… 47

Cygnus Medical…………………………………………………… 9 TIDI…………………………………………………………………… 17,19

GelPro……………………………………………………………………15 Healthmark Industries Company, Inc.…………… 4 TIDI…………………………………………………………………… 17,19 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4

SURGICAL

MD Technologies inc.……………………………………… 49 TIDI…………………………………………………………………… 17,19 Surgical Instrument/Accessories C Change Surgical……………………………………………IBC Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4

Diversey ……………………………………………………………… 6 Ruhof Corporation…………………………………………… 2-3

INSTRUMENT TRACKING

DISPOSABLES

MONITORS

Avante Patient Monitoring……………………………… 47

AIV Inc.…………………………………………………………………13 Avante Patient Monitoring……………………………… 47

ENDOSCOPY

OR TABLES/BOOMS/ACCESSORIES

TEMPERATURE MANAGEMENT

Alco Sales Service, Co.………………………………………51 Capital Medical Resources…………………………………12 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4 MD Technologies inc.……………………………………… 49 Ruhof Corporation…………………………………………… 2-3

ERGONOMIC SOLUTIONS

Diversey ……………………………………………………………… 6

Microsystems……………………………………………………… 5

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

OTHER

AIV Inc.…………………………………………………………………13 Medwrench………………………………………………………… 37

OTHER: FLOOR MATS

GelPro……………………………………………………………………15

SAVE THE DATE! AUGUST 18-20, 2019 • LAS VEGAS, NV ORTODAYLIVE.COM 58 | OR TODAY | JANUARY 2019

TELEMETRY

C Change Surgical……………………………………………IBC

WASTE MANAGEMENT

MD Technologies inc.……………………………………… 49

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