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OR TODAY | March 2019

contents features

INTEROPERABILITY AND THE OR OF THE FUTURE In today’s technology-centric world, most people expect their various tech devices to be able to communicate with each other. If you have an iPhone and an iMac, for example, the devices are synced so that you can access data on either device from the other one. It’s surprising that many of the hightech devices in modern operating rooms don’t have this kind of data interoperability. We explore this topic and more in this article.

AORN has developed, in partnership with industry, a fully functioning OR of the future for the upcoming Global Surgical Conference & Expo. Check out our guide inside.

In some cases, health care professionals are unaware of the risks associated with social networking and their professional roles. This module helps to fill the gap in knowledge about maintaining personal and professional boundaries when using Facebook.

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OR Today (Vol. 19, Issue #3) March 2019 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 302691530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2019

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contents features

PUBLISHER John M. Krieg

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VICE PRESIDENT Kristin Leavoy

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EDITOR John Wallace

SPOTLIGHT ON

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Kathy Mertens

ART DEPARTMENT Jonathan Riley Karlee Gower Kathryn Keur

ACCOUNT EXECUTIVES Jayme McKelvey Megan Cabot Jeffrey Berman

DIGITAL SERVICES

win lunch for your department!

Tangerine, Mixed Greens and Quinoa Salad

OR TODAY CONTEST

RECIPE OF THE MONTH

Travis Saylor Cindy Galindo Kennedy Krieg

CIRCULATION Lisa Cover Melissa Brand

WEBINARS Linda Hasluem

INDUSTRY INSIGHTS

ACCOUNTING Diane Costea

10 News & Notes 14 IAHCSMM 16 CCI 18 Guide to AORN

IN THE OR

23 Market Analysis 24 Product Focus: Surgical Instruments 30 CE Article: Facebook: Know the policy before posting

OUT OF THE OR 48 Spotlight On 50 Fitness 52 Health 54 EQ Factor 56 Nutrition 58 Recipe 60 Pinboard

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news & notes SURGICAL CONFERENCE

OR Today Live Announces 2019 Location, Dates The 2019 OR Today Live Surgical Conference is a jackpot for perioperative professionals. This year, the annual conference will be held August 18-20 in Las Vegas! Perioperative nurses and SPD professionals from across the country will gather at OR Today Live to discover new opportunities, broaden their knowledge and exchange ideas. Whether you need an extra boost of motivation in your career or are looking to earn CE credits – OR Today Live is the conference

for you. The conference brings together world-class speakers in an environment designed to motivate and empower perioperative professionals. • For more information about the conference, visit ORTodayLive.com and sign up for the conference newsletter at the bottom of the webpage.

AAAHC Receives CMS Deemed Status Renewal for ASCs The Accreditation Association for Ambulatory Health Care (AAAHC), a leader in ambulatory health care accreditation, recently received the maximum six-year renewal of its deeming authority from the Centers for Medicare and Medicaid Services (CMS). CMS deeming authority recognizes that the AAAHC accreditation program continues to satisfy the Medicare Conditions for Coverage for ASCs. AAAHC has consistently held Deemed Status for ASCs since 1996. “We are pleased that CMS has again placed its confidence in AAAHC and our commitment to assessing an ASC’s compliance with the Conditions for Coverage,” said Noel M. Adachi, MBA, president and CEO of AAAHC. “As the nation’s largest accrediting body for ambulatory health care, we welcome this opportunity to continue supporting ambulatory surgery centers in their

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efforts to improve and strengthen their quality of care.” The AAAHC is a nonprofit organization that drives quality improvement in ambulatory patient care through a quality-focused, peer-based and educational accreditation process. With an exclusive focus on ambulatory health care, AAAHC has developed rigorous, comprehensive, nationally recognized standards which are used during the onsite survey to measure organizational compliance with best practices and patient safety guidelines. All AAAHC surveyors have ambulatory setting experience – ensuring an expert-guided accreditation experience from start to finish. More than 6,100 facilities have earned the AAAHC Certificate of Accreditation, an achievement which speaks to an organization’s commitment to provide safe, high-quality health care

services to its patients. “AAAHC prides itself in offering best practices and an educational experience throughout the accreditation cycle,” said Adachi. “We will continue to measurably drive quality improvement in patient care by designing standards and processes that are relevant, timely and evidencebased and through developing engaging educational resources which guide compliance and continuous improvement. Accredited organizations will have access to a greater variety of easily accessible educational resources, certification programs and other resources – all so that they can continue to deliver quality every day – 1,095 days throughout the accreditation process and for many more cycles to come.”• For more information, visit www.aaach.org.

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Author Addresses Bullying in New Book Phyllis S. Quinlan, PhD, RN-BC, has released her new book “Bringing Shadow Behavior Into the Light of Day: Understanding and Effectively Managing Bullying & Incivility in Healthcare.” The distraction of laboring within an unhealthy work environment will handicap the staff’s ability to make a genuine connection with their patients and provide safe care. This book provides health care leaders with a guideline for the assessment and management of the disruptive behaviors of bullying and incivility. The author declares that, “it is time to definitively address the behaviors that lurk in the shadows and undermine RNs and other professional caregiver’s vitality and resilience. How we treat each other is directly related to patient safety and how we engage with our patients and their families.” Readers have posted reviews and comments on Amazon. “I read her entire book in one night. Every bit of it was the hard truth, it was motivating and inspired me to make a difference in this situation as a nurse myself. Phyllis is a professional nurse, a legal consultant, and a life coach with great advice … Phyllis is a very down to earth person with wonderful advice. I highly suggest that you read this book if you are a victim or the culprit. She has a plan for both participants in the situation,” one reader shared.

“Phyllis Quinlan has a unique ability to captivate her readers. Her ability to hit head on the reality of what occurs in health care is amazing. This book highlights how we can fall victim to bullying behaviors, and how some of these behaviors can even go unrecognized as such. I highly recommend to anyone who is embedded in health care and cannot always see the forest from the trees,” another reader wrote. “Unlike a number of authors who provide way too much research and too little practical application, Phyllis has written a reader friendly and comprehensive book that can give you insights into the shadow world of bullying and incivility,” one reader wrote. “Her book can be read in about an hour and the knowledge immediately transferred to the workplace. Every health care manager should have this book in their library!” •

Baxter Signs Open Data Pledge to Improve Patient Safety The Patient Safety Movement Foundation (PSMF) announced that Baxter International Inc., a global medical products company, has signed the PSMF’s Open Data Pledge as the 89th company to demonstrate the importance of data sharing to improving patient safety. Companies that have signed the PSMF’s Open Data Pledge are committed to allowing access to the data generated by their medical devices to anyone, including researchers, software engineers and entrepreneurs, that seeks to improve patient safety. By sharing data generated by their products, in accordance with applicable patient privacy laws, these companies help further the development of predictive algorithms that can notify clinicians and patients of dangerous trends, and thus enable earlier interventions. “Every day we hear more stories about hospitals wishing to use predictive algorithms to identify deteriorating patients early,” said Joe Kiani, founder and chairman of the Patient Safety

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Movement Foundation. “The greater the number of companies that sign the Open Data Pledge, the closer we’ll be to creating a patient data superhighway that will help create predictive algorithms and decision support tools to help hospitals reach zero preventable patient deaths. We thank Baxter for joining this effort.” “We signed the Open Data Pledge as part of our ongoing commitment to help transform patient care and improve patient safety,” said Sumant Ramachandra, M.D., Ph.D., senior vice president and chief scientific and technology officer, Baxter International. “Patient safety is paramount to our mission to save and sustain lives.” The Patient Safety Movement Foundation encourages healthcare technology companies to share the data that their products are purchased for, subject to applicable patient privacy laws. They do so without disclosing any proprietary algorithms or protected data. •

MARCH 2019 | OR TODAY |

INDUSTRY INSIGHTS

news & notes

Encompass Group Awarded Group Purchasing Agreements Encompass Group LLC has been awarded new group purchasing agreements with Premier. These include disposable nonsterile protective apparel, VCT anti-embolism stockings, cubicle curtains, tracks and privacy screens, and reusable textiles and textile services. The agreements allow Premier members, at their discretion, to take advantage of special pricing and terms pre-negotiated by Premier for these four different product categories. “Encompass Group is excited about these four new agreements and we will continue to bring innovative, cost-effective solutions to the Premier membership in all markets served,” said Encompass Group’s Tom Sweatt. Disposable non-sterile protective apparel includes but is not limited to gowns; scrubs; labcoats; infant, patient and behavioral

health apparel; bedding; and patient warming. VCT anti-embolism stockings and cubicle curtains, tracks and privacy screens are USA-manufactured in Encompass’ plants in Tennessee and Minnesota. Reusable textiles and textile services include a wide range of launderable products such as patient bedding and bath products as well as patient apparel. Premier is a health care improvement company, uniting an alliance of approximately 4,000 U.S. hospitals and 165,000 other providers to transform health care. With integrated data and analytics, collaboratives, supply chain solutions, and advisory and other services, Premier enables better care and outcomes at a lower cost. •

New Predictive Analytics Model Released Perception Health, a provider of health care market prediction software, announced its inclusion on the new machine learning (ML) and artificial intelligence (AI) discovery page on Amazon Web Services (AWS) Marketplace. “Our team of data scientists has been working for the last year to create and refine multiple prediction models for specific diseases and surgical events,” said Chris McLaurin, chief technology officer, Perception Health. “Our goal is to bring our expertise to a broader market and the new machine learning and artificial intelligence discovery page on AWS Marketplace allows us to open up new channels for our predictions.” Perception Health provides proprietary CARE™ algorithms powered by Amazon SageMaker, a fully-managed platform that is designed to enable developers and data scientists to quickly and easily build, train and deploy machine learning models at any scale. Perception Health’s algorithm can be licensed by users on a per patient basis and run on AWS.

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“CentraState partnered with Perception Health two years ago to improve the ecosystem of our local referral network,” said John Ulett, chief information officer, CentraState Healthcare System Inc. “The disease predictions provided by Perception Health will allow us to use advanced analytics to predict the onset of serious diseases for the communities we serve. We believe this is the next evolution of care management and CentraState is at the forefront.” “Perception Health already brings advanced disease prediction models to the industry,” said Garth Fort, director, AWS Marketplace, Amazon Web Services Inc. “Now, with Perception Health’s CARE algorithms running on Amazon SageMaker, Perception Health can rapidly deploy disease models that utilize AI in the selection and screening of patients through the prediction models.”•

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news & notes

Healthmark Adds to Labeling Line Healthmark Industries announced the addition of the Quick Turnover 2-Part Clean-Dirty Label to its labeling line. Designed as a communication tool for health care workers transporting items considered clean or a biohazard, the Quick Turnover 2-Part Clean-Dirty Label allows individuals to note items that are required for upcoming procedures and time needed. The tags ensure that health care staff can safely identify the status of equipment as each tag is brightly colored for high visibility. The Quick Turnover 2-Part Clean-Dirty Label is roughly

3-inches by 5-inches with two perforated tabs; a green tab with “TRANSPORTATION TAG” in black text, a red bottom with “QUICK TURNOVER” in black text along with a space to indicate items and time needed, as well as a green tab with “CLEAN” in black text and a fluorescent orange bottom featuring a biohazard symbol with “DIRTY” and “BIOHAZARD” in black text. The tag has a removable OSHA compliant adhesive backing that’s easy to apply. • For more information, visit www.hmark.com.

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INDUSTRY INSIGHTS

IAHCSMM

AAMI TIR Addresses Low- and Intermediate-level Disinfection in Health Care Settings By Susan Klacik, BS, CRCST, CHL, CIS, ACE, FCS he Association for the Advancement of Medical Instrumentation (AAMI) has released its Technical Information Report (TIR) 68:2018 Low-and intermediate-level disinfection in health care settings for medical devices and patient care equipment and sterile processing environmental surfaces. Because the selection and use of disinfectants can be complex, TIR 68 provides guidance on the selection and use of low- and intermediatelevel disinfectants and disinfection processes for safe and effective use.

TIR 68 is intended to serve as a reference for all health care personnel who perform low- and intermediate-level disinfection processes on patient care medical devices and medical equipment and their accessories, and for those who oversee cleaning and disinfecting environmental surfaces in medical device processing areas. Included in this TIR is information regarding the prevalence of antibiotic-resistant infectious organisms and environmental pathogens. Prior to this publication, AAMI standards only addressed medical devices that were sterilized or high-level disinfected. Items requiring low- or intermediatelevel disinfection are typically classified (per the Spaulding Classification) as non-critical patient-contacting medical devices, non-critical patient care equipment, and environmental surfaces; those

14 | OR TODAY | MARCH 2019

devices and instruments contact only intact skin and do not penetrate it (e.g., blood pressure cuffs, stethoscopes and skin electrodes). During patient care, other surfaces that don’t come in direct patient contact can become contaminated with microorganisms and organic soil such as body fluids, even though they may not be visibly contaminated. Examples of this type of equipment and surfaces include patient care equipment, patient beds, keyboards and light cords.

Key factors for consideration Low and intermediate chemical disinfectants are classified as biocidal solutions and should be applied to inanimate objects such as medical devices and environmental surfaces. TIR 68 describes the different categories of chemical disinfectants, along with performance characteristics and considerations for use. Chemical disinfectants are available in a range of formulas, including liquids, impregnated wipes, sprays, concentrated powders, and gases or vapors. There are several factors to take into consideration when selecting the correct disinfectant for the task, including: the degree of microbicidal activity required, the characteristics of the item to be disinfected, the device manufacturer’s written instructions for use (IFU), the disinfectant manufacturer’s written IFU, and the cost and ease of use of the available products. The new TIR addresses how chemical disinfectants can be impacted by numerous factors, such as the presence of organic soil, design of the device, disinfectant dilution, contact time and temperature, mode of action, and microbial load in

reusable solution. User knowledge of the proper use of a disinfectant is critical for rendering the item safe for patient care. It is interesting to note that many of the low- to intermediate-level disinfectants used for medical device processing are under dual regulation by the Environmental Protection Agency (EPA) and the U.S. Food and Drug Administration (FDA). The FDA regulates chemical disinfectants used for liquid chemical sterilization or high-level disinfection or sterilization of reusable medical devices, the sterilant or disinfectant chemistry, and the related systems. The EPA regulates the products as antimicrobial pesticides. Safe and effective use of these chemicals requires appropriate personnel training. TIR 68 includes recommendations for such training and education. Other personnel considerations are addressed, such as using the correct personal protective equipment (PPE), and a health and hygiene section discusses vaccinations and appropriate steps to take in the event of an exposure. Specifically, TIR 68 includes information on the following: • Cleaning and disinfection of noncritical patient care items, devices and patient care equipment and accessories, electronic accessories for devices, and other non-critical devices (e.g., magnetic resonance coils, magnetic resonance/computed tomography tables, X-ray detector plates, neonatal intensive care incubators, cables, smaller console equipment, intravenous infusion pumps and poles); WWW.ORTODAY.COM

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• P rocesses for categories of items that are terminally processed with low- or intermediate-level disinfection. A table is presented for quick and easy reference. • C hemical disinfection of items, making them safe to handle through low- or intermediate-level disinfection to proceed to further processing (e.g., critical medical devices that will be terminally sterilized or semi-critical items that will be high-level disinfected); • R ecommendations for cleaning and disinfection of environmental surfaces in the sterile processing area; and • G uidance on the use of disinfectants and disinfection processes intended for medical devices that: 1. Undergo final processing prior to reuse; 2. M edical devices that undergo processing to be made safe to handle prior to high-level disinfection or sterilization; and 3. E nvironmental surfaces in medical device processing areas. Additionally, a section is included on how to read and interpret labels.

Risk assessment prudent There is always a risk when using chemicals; therefore, it is recommended to perform a risk assessment to determine potential risks to both patients and staff. A risk assessment involves an interdisciplinary team to develop policies and procedures and identify the risk of inadequate or improper use of disinfectants that could cause a disinfection failure or other weakness in the processing practice. A risk assessment helps identify potential problems and allow actions to be taken to reduce the overall likelihood of a problem occurring.

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INDUSTRY INSIGHTS CCI

Capitalizing on Disruption By James X. Stobinski few months back I had the privilege of attending a professional development meeting hosted by Prometric – the testing partner for the Competency and Credentialing Institute (CCI). The meeting featured some fine speakers but the highlight for me was Peter Sheahan, the founder and Group CEO of the Karrikins Group. The Karrikins Group helps organizations, “… to identify the current trends and marketplace changes impacting business today to help organizations across all industries find opportunity in disruption.”

Sheahan has been rated as one of the 25 most effective speakers in the world. The theme of his presentation resonated with me and I believe has direct application to CCI as we relate to our stakeholders to include certified perioperative nurses. The theme of his talk was the opportunity that is present during disruptive events. He related that many companies fail to react to events which unsettle and disrupt their business and very few companies realize the opportunity that is present when disruption happens. The example he shared in his talk began with a story of how one retailer fell into a crisis and suffered considerable financial losses when their business model was shaken off its foundation by the actions of a large tech company. When the Karrikins Group

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took a retrospective look it was clear that the warning signs of the move by that tech company had been planted, and were readily apparent, for over a decade. This retailer had been caught flat footed not due to a lack of a clear warning but rather because they could not see the threat or react in a meaningful way. This company suffered a significant loss due to their inattention and clearly did not benefit or capitalize on the disruption to the industry. A disruptive event, which Sheahan so clearly described, captures your attention and demands your focus. There is also an opportunity in disruption for those who are attentive and prepared to act. He cited several issues facing organizations such as CCI which provide certification services. These problems include the pressure to increase/validate the value of certification and the increasing speed of obsolescence of skills and knowledge. These issues present large challenges for CCI and other certification organizations, but they also represent opportunities. I took away some thoughts on these challenges as they apply to CCI in general and more specifically to our largest credential, the CNOR certification held by more than 40,000 nurses. Many perioperative nurses do not yet realize the potential impact of the rapid obsolescence of skills and knowledge in our field. CCI views this issue as an opportunity and we have responded by investing in our

information technology solutions to include a learning management system which pairs with our registration system. Working with industry partners including the OR Today Live Conference we will soon offer a wide range of services to our certificants to facilitate their acquisition of knowledge and skills. This is the new version of certification which is born of the necessity of rapid change in both perioperative nursing practice and surgical care in American health care. CCI has chosen to take ownership of this disruptive change in certification practices and health care and use that as a springboard to better serve our certificants and ultimately to provide better care to our patients. We have chosen what Peter Sheahan has described as a burning aspiration in improving how we serve our certificants. Our hope is that these enhancements prove attractive to our stakeholders as we look to the future. It will be quite a ride to address such large challenges, but we look forward to the journey. – James X Stobinski, Ph.D., RN, CNOR, CSSM (E), if the CEO of the Competency and Credentialing Institute. He may be contacted at 720-257-4372 or jstobinski@cc-institiute.org.

References Peter Sheahan [LinkedIn profile]. Accessed December 31, 2018 at: https://www.linkedin.com/ in/petersheahan/

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Guide to AORN

The OR of the Future is Here: Get ready T

he move in perioperative care toward minimally invasive surgery with the promise of patients experiencing less pain and faster recoveries is on a fast track to becoming the norm for surgical care. At the same time, new information technologies are being developed to help surgeons tap into data that can improve the delivery of patient care through the perioperative phases. These trends in perioperative practice and technology are rapidly redefining perioperative care and OR spaces, and nurses must be ready. That’s why AORN has developed, in partnership with industry, a fully functioning OR of the future for the upcoming Global Surgical Conference & Expo.

High-Tech = High-Touch Nursing Care Imagine working in an OR space where prepping for a case involves moving walls, setting integrated imaging modalities, and engaging machine learning and predictive analytics tools in one hybrid space. This hybrid care environment offers highly advanced and highly adaptable spaces to optimize all

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aspects of patient care, including the ability to diagnose and treat a surgical patient in the same space. However, many of these technologies add complexity to an already complex environment and nurses play a key role in advocating for their patients amidst this complexity, notes AORN CEO and Executive Director Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN. “Working in this type of integrated, hybrid OR space is a reality for a growing number of perioperative nurses, and it will soon be a reality for many other perioperative nurses as this trend toward hybrid ORs is projected to become the standard of perioperative care,” Groah says. “Perioperative nurses need to be at the forefront of adapting patient care in a hybrid OR environment and offering high-touch care that supports patients and families to ensure the human factor remains at the center of perioperative nursing.” To do this, perioperative nurses must be familiar with the wide range of technologies that are used in the hybrid OR of the future and the AORN Global Surgical Conference and Expo in Nashville this Spring will give nurses hands-on experience with these hybrid OR technologies, Groah says. “Having the chance to learn

about and work with these technologies at AORN’s Expo will give perioperative nurses a good opportunity to gain familiarity with these technologies so they will be better able to work and advocate for patients in a hybrid OR setting,” she says.

Experiencing the OR of the Future Getting a chance to explore the latest technologies being adopted into surgical care has always been a highlight of visiting AORN’s exhibit hall at the association’s annual meeting. This year, a focus on the OR of the future will be woven throughout the exhibit floor. Nurses will be able to walk through a complete hybrid OR surgical suite to get more familiar with a range of technologies and products unique to the OR of the future, including: • a mobile OR table and a fixed OR table that supports extreme positioning • top-of-the-line sterile supply management and traceability • image integration and distribution equipment • modular wall and ceiling structures • consumables tailored to hybrid OR use • fluid warming devices that mount to walls or counters WWW.ORTODAY.COM

INDUSTRY INSIGHTS

AORN

The AORN Global Surgical Conference & Expo will be in Nashville, April 6-11. Education is always a huge part of the conference. This year more than 200 contact hours are available from world-renowned perioperative experts delivered in a variety of formats to fit each individual’s learning style.

•

advanced designed blanket warming technology • lights and booms designed for hybrid OR use and • 3-D scanning technology A roadmap to the OR of the future will also be provided to help attendees explore other vendor booths throughout the exhibit hall with products used in a hybrid OR.

Finding Harmony in the OR of the Future With a focus on the future of surgical advances, a central theme woven throughout AORN’s annual conference will be harmonizing surgical care. WWW.ORTODAY.COM

This theme will be addressed through a wide range of educational programming offered at the meeting. Harmony will span education topics ranging from the topics of self-care, as well as interpersonal communication and collaboration among team members to stay connected. A clear understanding of the latest evidence (which also continues to emerge at a rapid pace) will also be a key focus at the conference, according to AORN President Stephanie Davis, MSHA, RN, CNOR, CSSM. “Harmonized care is the essential factor in providing safe care,” Davis stresses. “We know what harmony

feels like in the OR when we are working with the ‘A’ team of nurses, physicians and other team members who communicate well, work in sync, and respect and value each other’s roles.” With a constant struggle to balance efficiency and safety under time constraints in busy ORs, Davis also says team collaboration in using safety tools such as a surgical safety checklist, and taking time for surgical communications, including the briefing, time out and debriefing are important aspects of harmonized care that will only become more important as OR technologies continue to advance. MARCH 2019 | OR TODAY |

INDUSTRY INSIGHTS

news & notes AORN She says the key to achieving harmonized care is by advancing nursing knowledge to understand and apply the latest evidence for safe practice, even if it goes against what has been a longstanding practice. “Knowledge is our single most important tool in providing safe patient care and advocating for our patients, no matter what surgical environment we work in,” Davis says. The AORN Global Surgical Conference & Expo will be in Nashville, April 6-11. Education is always a huge part of the conference. This year more than 200 contact hours are available from world-renowned perioperative experts delivered in a variety of formats to fit each individual’s learning style. Educational options include: • Expo Education: Earn contact hours as you explore exhibits for the latest products and services. A list of exhibitors with booth education is on the conference website. • Rapid Fire: It will be easy to stay engaged at these fast-paced presentations. Sessions will consist of multiple speakers presenting on the same topic but with different angles. • Simulation Experiences: Get hands-on training on hot topics like safe patient handling. • Posters: See how your peers are changing perioperative practice. Explore hundreds of presentations and participate in an expanded meet and greet with the poster authors. Earn CE at the conference or when you return home by viewing posters online. • Global Research & Practice Studies: Research-

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•

• •

ers representing perioperative teams worldwide will discuss the latest research outcomes and evidence-based practices. Sessions will take place in intimate environments to encourage easy discussion. Interactive Buzz Sessions: Meet with other attendees in a relaxed environment to share best practices, insights and tips. Expert facilitators will begin each session with a scenario. Attendees will be asked to discuss amongst their peers to identify a solution. Collaboration Boards: We learn best when we work together to solve problems. Post a tough problem and clinical questions on the conference app to get suggestions from conference colleagues. Featured Speakers: Get ready to laugh, learn and be inspired by world-renowned speakers.. Student Nurses Program: Interested in learning more about perioperative nursing? Make plans to attend a special, interactive workshop for student nurses on April 9. Faculty Program: Attend this one-day program designed for nursing faculty. 45-Day Streaming Pass: Can’t make it to a session? Listen to a recording through AORN’s on-demand streaming service, available for up to 45 days after the conference.

For more information, visit www.aorn.org/surgicalexpo.

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INDUSTRY INSIGHTS

AORN

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Action Products, Inc. manufactures the full range of ACTION brand support surfaces and patient positioning devices for pressure injury prevention, including pediatric and bariatric sizes. Products feature exclusive AKTON polymer gel. www.actionproducts.com

BD is a global medical technology company advancing health by improving discovery, diagnostics and care delivery. Our innovative product portfolio, leadership and partnerships help make a difference for global healthcare. www.bd.com

C Change Surgical Booth: 639

Diversey provides total solutions for cleaning & disinfection, enhancing safety and improving OR turnover speed, while controlling costs. We offer leading infection prevention solutions, along with innovative productivity tools, and training. https://diversey.com

Healthmark offers infection control solutions and tools to manage the proper reprocessing of surgical instruments in compliance with AORN and AAMI guidelines. Come see our new custom printed disposable scrub hats and bouffants. www.hmark.com

Innovative Medical Products, Inc.

Microsystems delivers software solutions for managing the demands of the modern sterile processing department. The portfolio of products address all aspects of the sterile processing function. http://new.mmmicrosystems.com

Booth: 916

Mobile Instrument Service is the nationwide complete source for surgical equipment repair. As your care and repair partner, Mobile’s commitment to you is to reduce equipment costs and improve outcomes by ensuring your equipment is ready for the O.R. www.mobileinstrument.com

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SurgiSLUSH™ is the fastest growing slush technology in the US. Our smart freezers use a secure container system to produce optimal slush inside a superior sterile barrier. Supplying MORE procedures with FEWER machines = SMART. Perfect for Hybrid. www.cchangesurgical.com

Booth: 2209

Cygnus Medical

The Ruhof Corporation Kapp Surgical Instrument Inc. Booth: 1300

Booth: 640

Cygnus Medical has developed several innovative products that target some of the surgical instrument handling problems that plague hospitals. The Single Cycle Tray, the first disposable, sterilizable transport tray for clean and soiled instruments. www.cygnusmedical.com

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IMP is focused on developing and marketing innovative patient positioning products to benefit and improve efficiency in the operating room and hospital clinics especially during robotic procedures where patient stability and positioning are required. www.impmedical.com

Booth: 2035

Kapp Surgical Instrument, Inc.is a custom instrument design company that manufactures and distributes domestically and internationally. Kapp’s exclusive products are: The Cosgrove® Valve Retractor System, and Strip T’s® surgical organizer. www.kappsurgical.com

Booth:2535

For nearly 20 years OR Today has provided periop professionals with news and information about their profession. Stop by our booth to sign-up for your free subscription and learn how to earn FREE CEUs with our monthly webinar series! www.ortoday.com

Ruhof has a full line of surgical instrument and scope care and cleaning products to help you meet and exceed your decontamination challenges. Products include our multi-tiered enzymatic detergents, foam sprays, sponges, endoscopy kits and more. www.ruhof.com

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Surgical Instrument Market Growth Expected Staff report

report from Allied Market Research forecasts growth in the surgical equipment market.

logically advanced minimal invasive surgical procedures are further expected to boost the market growth during the forecast period. Stringent government regulations and lack of proper reimbursement for surgical The global surgical equipment equipment may hamper the market market was valued at $9.8 billion growth during the forecast period,” in 2016 and is expected to reach $15.71 billion by 2023, according to according to Allied Market Research. Grand View Research predicts Allied Market Research. This indigrowth in more than one surgical cates a compound annual growth rate (CAGR) of 7.0 percent during instrument area. In a report on the global handthe forecast period. Surgical equipment includes medical devices used held surgical instruments, Grand to cut, coagulate, desiccate and ful- View Research states that the market size was valued at $3.82 billion gurate body tissues during surgical in 2017 and is expected to exhibit procedures. The growth in the surgical equip- a CAGR of 7.1 percent through 2025. A rising prevalence of chronic ment market is driven by many factors including an increase in the diseases such as neurological, cardemand for surgical tools due to ris- diovascular, infectious and urological diseases is expected to drive the ing number of surgical procedures, market. according to the report. “A high number of surgical “Moreover, increasing health care procedures are performed all over expenditure, increasing demand of the world. According to OMICS plastic and reconstructive surgery International Conferences, 2015, and rising demand for techno-

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approximately 234 million surgical procedures are performed annually. This is another factor likely to drive the market in the coming years,” according to Grand View Research. In a separate report, Grand View Research reports that the global minimally invasive surgical instruments market size was valued at $18.3 billion in 2017 and is anticipated to expand at a CAGR of 9.7 percent by 2026. An Allied Market Research report states that the global powered surgical instrument market was pegged at $1.94 billion in 2017 and is expected to garner $2.73 billion by 2025, registering a CAGR of 4.2 percent through 2025. Research and Markets also predicts growth in the surgical instrument market. The analysts forecast that the global surgical instruments market will grow at a CAGR of 6.22 percent during the period 20182022.

MARCH 2019 | OR TODAY |

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Anzen

Safety Scalpel Anzen Safety Scalpel has a reusable stainless steel handle similar in weight and balance to traditional metal handle scalpels, providing surgeons and techs with necessary safety features without losing the familiarity, control and ease-of-use of their current scalpels. Features of the scalpel includes an intuitive design to provide effortless blade exposure, slim cartridge design that does not interfere with view of incision site and a single-use protected blade cartridge that makes sharps injury prevention easy and convenient. Also, the scalpelâ&#x20AC;&#x2122;s protected blade stays retracted when attaching and detaching cartridges. By minimizing unnecessary exposure to the scalpel blade, health care professionals can ensure fewer preventable workplace injuries in the operating room. â&#x20AC;˘

24 | OR TODAY | MARCH 2019

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KARL STORZ

Reusable Instrument Sets KARL STORZ provides leading endoscopy and video imaging equipment, as well as minimally invasive surgery technologies. These include reusable instrument sets developed and optimized for minilaparoscopy procedures, which have become a popular surgical technique offering a flat learning curve and enhanced cosmetic results. The minilaparoscopy set provides a comprehensive line of miniature hand instruments. Among these are 20 different graspers, scissors and punches for use with monopolar energy, as well as 3.5 mm bipolar graspers, hook cautery, palpation probe, suctionirrigation systems and needle holders. KARL STORZ also offers reusable lightweight trocars, frictionless access ports and smaller diameter telescopes. •

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MEDLINE

Spine Retractor Set With over 18,000 patterns comprising Konig and Furst portfolios, Medline offers a complete line of surgical grade, reusable surgical instrumentation to meet all your instrument needs. Medlineâ&#x20AC;&#x2122;s offerings range from basic patterns to specialty instruments and sets (Spine Retractor Set, MDSTWIGHCS, pictured), as well as incorporate unique programs and services like instrument consignment and custom instrument sets. â&#x20AC;˘ For more information, visit www.medline.com/go/instruments.

26 | OR TODAY | MARCH 2019

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Stryker

System 8 Power Tools Stryker’s System 8 family was developed by working closely with orthopaedic surgeons and hospital staff to deliver solutions to address the complex challenges of today’s health care environment. Improved ergonomics give surgeons a better neutral wrist position, and textured areas help provide a firmer grip. A quick and efficient keyless drill chuck prevents loosening through a secondary locking mechanism, and advanced material and coating on pin collets prevent sticking and slipping. The handpieces are built to be actively washed; able to be temporarily submerged when you need to do so during cleaning, prior to sterilization. •

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Symmetry Surgical

Bovie OR|Pro 300 System The Bovie OR|Pro 300 system is designed with OR clinicians to create a safe, user-friendly generator to meet all operating room procedure performance demands – with the same power at up to 86 percent less Vpeak – which translates to less harmful thermal spread. This innovative energy-based device offers 13 modes of surgical energy delivery. Special modalities include the advanced Bovie Bipolar and Auto Bipolar options as well as special laparoscopic modes for surgeons to tailor all electrosurgery needs for a wide variety of surgical application and user preferences. •

28 | OR TODAY | MARCH 2019

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WITH THE CHLORAPREP ™ PORTFOLIO, YOUR TEAM GETS THE PREOPERATIVE SKIN PREPARATION THAT’S BACKED BY CLINICAL EVIDENCE AND TRUSTED MOST BY HEALTHCARE PROFESSIONALS. Healthcare-acquired infections are deadly serious. That’s why, with nearly 4 billion applicators sold, more surgeons and facilities continue to choose the rapid, persistent antimicrobial protection of ChloraPrep™ patient preoperative skin preparation products over any other. Available in a full range of tints and sizes, ChloraPrep™ products are sold in 38 countries and backed by more than 50 clinical studies, so you can be confident that you’re protecting patients with the right skin preparation for a safer procedure. And as a BD customer, you’ll gain access to our suite of process improvement programs, including BD Prepping Protocols, our complimentary, expert-led program that helps you identify risks, implement evidence-based infection-control strategies and standardize processes to promote better patient outcomes. Discover the preoperative skin preparation solution trusted most by healthcare professionals. Discover the new BD.

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SAVE THE DATE! AUGUST 18-20, 2019 • LAS VEGAS, NV

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OR Today Live Surgical Conference has been approved and is licensed to be a Continuing Education Provider with the State of California Board of Registered Nursing. License #16623

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CE630

Facebook: Know the policy before posting By Dana Bartlett, MA, MAN, BSN, RN, CSPI hy are some nurses and other health care professionals losing their jobs because of Facebook posts? Celebrities use the popular social networking site, TV reporters use it, and chances are, you and your friends use it, too. However, users can overlook the negative effects that social networking sites can have on their careers. In health care, Facebook posts can influence the hiring process, violate patient privacy, and result in termination of employment.

The fundamental function of Facebook (and other social networking sites, such as Twitter) is allowing “friends” to share information. Friends are people who have agreed to communicate with and allow one another some level of access to personal information. Anyone with access to the Internet can join Facebook, the most popular social networking site, and connect with contacts. As of June 2017, Facebook claimed 2.01 billion monthly active users and 1.32 billion daily active users.1

Facebook and Firings A nurse practitioner was fired for criticizing the people and the community where she worked at a health clinic. She commented that her patients were “vile specimens of humanity” and said she was glad she was not born and raised in the area.2 A Philadelphia hospital employee was WWW.ORTODAY.COM

fired after her bias-ridden Facebook post about the Black Lives Matter organization was brought to the attention of hospital administrators.3 In 2010, a mortally wounded patient arrived at a California ED. His throat was slashed so severely that he was almost decapitated. According to a hospital employee, instead of focusing on treating the patient, nurses and other hospital staff members snapped photos of the man and posted them on Facebook. The man soon died. One of the photos was posted on public Facebook accounts for several days before coworkers reported the situation to hospital officials. Four staff members, but none of the nurses, were later fired.4,5 In 2016, a Canadian RN was threatened with disciplinary action and a significant monetary punishment by the Saskatchewan Registered Nurses’ Association after she used Facebook to criticize nurses who had provided end-of-life care for her grandfather.6 In her Facebook post, she had identified herself as a nurse, and the association found that by so doing, she had acted unprofessionally in several ways. An LPN working in California was fired after posting his workplace frustrations on Facebook. The post was noticed by a nursing professor, and it read in part: “Nurses shouldn’t have to take abuse from you just because you are sick. In fact, it makes me less motivated to make sure your call light gets answered every time when I know that

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Relias LLC guarantees this educational activity is free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See Page 37 to learn how to earn CE credit for this module.

Goal and objectives The purpose of this program is to make healthcare professionals aware of the risks of social networks, which break down the walls separating our personal and professional lives. After studying the information presented here, you will be able to: • Discuss how Facebook posts can lead to loss of employment • Explain two ways that using Facebook in the hiring process can pose legal risks for employers • Describe three reasons why Facebook pages can lead to not getting hired

the minute I step into the room I’ll be greeted by a deluge of insults.”7 The LPN’s workplace had a policy on social media use that stated employees were required to treat anyone they interacted with, personally or electronically, with respect, and when interacting electroniMARCH 2019 | OR TODAY |

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continuing education

cally or on social media to refrain from obscene, slanderous, violent, or bullying behavior and/or language.7 In summer 2010, a Michigan nurse was shocked when she was fired for venting on Facebook.8 Like many other Michigan residents, she was upset when a police officer was shot to death pursuing a suspect. She treated the shooter as part of her duties as a nurse. The problem resulted when she posted on Facebook that she “came face to face with a cop killer and hoped he rotted in hell.” She was fired for disseminating protected health information about a patient on Facebook. She made it easy to identify the patient without revealing his name. Her employer noted that she used disparaging comments.8 Nursing students are not immune to problems with Facebook posts. In 2010, a community college dismissed a nursing student for posting a photograph of herself on Facebook posing with a human placenta.9 However, a federal judge overturned her dismissal a few months later, noting that she had been given permission to take the photograph and there was no breach of patient confidentiality. There was nothing in the photo to identify whose placenta it was.9 Another nursing student was dismissed from a university because of a blog posting on her Myspace page.10 The student posted what many considered distasteful and offensive descriptions of her impression of attending a live birth. The university accused her of violating patient confidentiality and other policies. The dismissal was overturned by the U.S. District Court, because the blog post was not created or used in a professional context. The court said that if the school of nursing wanted the standards of professionalism as outlined in its honor code to apply to all conduct of a student everywhere, always, and in all contexts, it must give fair notice and explain this clearly.10 Of course, health care workers aren’t the only ones getting in trouble for Face-

32 | OR TODAY | MARCH 2019

book posts. Here are some examples in other fields:11 • A waitress complained about two customers on Facebook for stiffing her for the tip and keeping her late. She mentioned the name of the restaurant. She was fired for disparaging customers. • A woman on jury duty posted details of the case she was serving on. She noted that she did not know which way to go and held a poll. An anonymous tip led to her dismissal from the jury. • A woman had been living on disability insurance for years. When the insurance company viewed her Facebook account and saw her having fun at a resort, she lost her insurance benefits. • Thirteen flight attendants were fired after discussing aspects of their job on Facebook. They noted that the cabins were infested with cockroaches and insulted the passengers. • A woman called in sick claiming that it was because of a migraine. She also claimed she needed to work in a dark room. When her employer caught her using her computer to access Facebook, she was fired. • A National Football League cheerleader was cut from the squad over controversial photographs on her Facebook page. The cheerleader posed for photos with a man covered with offensive graffiti, including antiSemitic remarks, profanity, and swastikas. So, why do we have these problems? If you think of it, the substance of social networking is not new. People have always talked around the water cooler about their bosses, colleagues, and jobs. The difference is that social networking provides larger audiences and an archive of such comments.10 It might seem that

the inappropriate use of social media by health care professionals would be a relatively unusual occurrence, but it is not. Nurses, nursing students, physicians, medical students, and other health care professionals have reported that offensive and unprofessional use of social media is common, and many admit that they have done so themselves.12,13

The Need for Privacy Rules Whether intentionally or inadvertently, employees can use social media on the job or at home in ways that pose legal risks for their employers who must, in turn, answer to the offended party or face the loss of potential business. Here are four examples:14,15 • Employees can engage in inappropriate conduct by posting discriminatory comments, racial slurs, or sexual innuendos that create a hostile work environment. • Employees can create unrest in the workplace by posting gossip, rumors, or false statements about coworkers or supervisors. • Employees may inadvertently reveal information that enables others to piece together confidential or proprietary information. • Employees may harm an employer’s reputation by posting inappropriate comments or photographs that may reflect negatively on the employer. For example, if employees post statements about illegal conduct outside of work, the conduct could be ascribed to the employer. The fact that hospital employees think it is acceptable to speak publicly via social networks about patients may lead to a breach of confidentiality. Health workers are subject to strict privacy and security rules enacted in 1996 with the Health Insurance Portability and Accountability Act (HIPAA). WWW.ORTODAY.COM

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The Privacy Rule, which took effect in 2003, set national standards to protect personal health information and medical records. It also gave patients rights over their health information, including the right to examine and copy their health records. The Security Rule, which took effect in 2005, set standards for protecting health information that is held or transferred in electronic form.16 People can violate regulations by sharing patient details without mentioning the patient’s name. For example, if a hospital employee has a casual conversation about a patient on the elevator or anywhere within earshot of others not involved in the patient’s care, it could be a HIPAA violation. Nurses and other health care professionals know that it is ethically wrong to describe this information in front of others. The challenge for all health care providers is realizing that the same ethical standards also apply to online conversations. In 2009, the government strengthened enforcement of HIPAA by enacting the Health Information Technology for Economic and Clinical Health Act, which increased the penalties for HIPAA violations. For example, the original cap of $25,000 for multiple violations of a provision increased to $1.5 million.17 Organizations are required to conduct a risk analysis to determine security risks and establish procedures to reduce risks and vulnerabilities.18 Not all security risks are corrected or handled with expensive technology. Extra training and managerial oversight may also be effective and cost-efficient.19

Social Media Policies Employers, professional nursing organizations, and state nursing boards have policies that address the use of social media. For example, the American Nurses Association (ANA) and the National Council of State Boards of Nursing both note that nurses have a duty to maintain confidentiality, and this duty extends to their use of social media.20,21 WWW.ORTODAY.COM

Employees need to be informed of the risks of posting information on social networking sites during and after work. Employers need to have clear policies on social media both inside and outside the workplace. The policy will be dictated by the organization, its culture, and the nature of the work performed. Some issues addressed by health care organizations in their social media policies include: • Maintain an organization’s identity, integrity, and reputation in a manner consistent with its mission, policies, and values. • Protect patient privacy. Do not post confidential information, discriminatory statements, or defamatory statements about patients, staff, or administration. Violations are subject to disciplinary measures, including job termination. • Do not use social media during work hours or at any time on hospital equipment or property. • Use a disclaimer when your connection to the health system is apparent. Note that your views are yours alone and do not reflect the views of your employer. Write in the first person. • Avoid use of your hospital email address as your primary means of identification. Use a personal email address for personal business and views. • Do not expect privacy for anything created, received, sent, or stored on the hospital computer system. Use the system for business purposes only. Be aware that a hospital monitors social networking forums to protect its interests, monitoring compliance with policies and reducing an employee’s expectation of privacy. • Be personally responsible for everything you post. • Understand that violations are subject to disciplinary measures, including job termination.

Nurses may believe that First Amendment rights protect what they view as their free speech, but when this speech involves social media, their profession, and their place of employment, First Amendment rights are tempered. The First Amendment prevents the government from interfering with free speech, but this protection is not extended to what you say and do in the workplace.6 The First Amendment does not prevent employers or nursing boards from disciplining nurses for what they say or for social media use, and the First Amendment does not prevent negative consequences for taking to social media to address grievances.6 Violations can be avoided by respecting patient confidentiality and practicing with integrity. Health care professionals must remember to apply their ethical principles to the technical world. Consider an example with Facebook. Suppose health care professional X invites, or “friends,” person Y into his or her Facebook community. The health care professional may share something that happened in the hospital with friends. What if person Y forwards this information to someone else? Suddenly, the information can be spread all over, and health care professional X may have violated HIPAA. Anything you post can be disseminated anywhere, hang around forever, and come back to haunt you at any time. So, stop and think before you post. If you have any doubts, don’t post. The ANA has helpful guidelines for nurses who use social media.20 These are available online at http://www. nursingworld.org/FunctionalMenuCategories/AboutANA/Social-Media/SocialNetworking-Principles-Toolkit/6-Tipsfor-Nurses-Using-Social-Media-Poster. pdf and an amended version is provided below. 1. I dentifiable patient information should never be posted online. 2. N urse-patient boundaries must be respected and observed when using social media. 3. N urses should realize that patients, MARCH 2019 | OR TODAY |

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colleagues, and employers may see their postings. 4. N urses should separate personal and professional information when using social media. 5. O nline information that violates patient privacy and/or patient rights should be reported to the appropriate authorities. 6. S tandards of professionalism are the same online as in any other circumstance. 7. I nformation about the nursepatient relationship must not be shared. 8. D isparaging remarks must not be made about patients, employers, or coworkers, even if they cannot be identified. Somewhat more specific advice is:22 1. P rivacy settings are not sufficient protection for online posts. 2. D eleting a post or a photograph does not mean it is no longer available or cannot be retrieved. 3. When making online posts, efforts to hide a patient’s identity can and often do fail, even when they are made with good intentions. 4. P osting content that you consider to clearly be humorous is not a protection against possible consequences. Humor is often in the eye of the beholder. 5. You may think an online post is appropriate, but it may not seem so to colleagues, employers, or patients.

Social Networking and Hiring If you think that the ease of tapping into social media may have implications for the hiring process, you are correct. According to a 2015 article, more than one-half of employers use social networking sites to screen job applicants.23 A 2009 article noted that Facebook was the most popular site to search, and 18% of hiring managers found information that persuaded them to hire job seekers — information such as

34 | OR TODAY | MARCH 2019

Individual Identifiers Under the Privacy Rule19 While not an exclusive list, the following are considered direct identifiers of an individual under the HIPAA privacy rule: · Account numbers · All elements of dates (except year) directly related to an individual, including birth date, admission, discharge, date of death, all ages older than 89, and all elements of dates (including year) indicative of such age except when aggregated into a single category of age older than 90 · Biometric identifiers (including fingerprints and voice prints) · Certificate and license numbers · Email addresses · Fax numbers · Full-face photographic images and any comparable images · Geographic subdivisions smaller than a state · Health plan beneficiary numbers · Internet protocol address · Internet uniform resource locators · Medical device identifiers · Medical record numbers · Names · Social Security numbers · Telephone numbers · Vehicle identifiers and serial numbers · Any other unique identifying number, characteristic, or code

awards, communication skills, creativity, indications of personality, professional qualifications, and references.24 However, a more recent (2013) survey found that more than one-third of employers who scan the social media profiles of job applicants have reported that they found information that caused them to decline offering prospective candidates a job.25 Employers noted inappropriate/ provocative photographs, poor communication skills, abusive/disparaging language, discriminatory comments, and lying about qualifications.25 If the employer does not violate discrimination laws, nothing prohib-

its an employment decision based on information that an applicant places in the public domain. However, because employment laws require that all people be provided equal, nondiscriminatory treatment, employers must balance the need to obtain information against the risks associated with such information. For example, using social media may make an employer aware of a person’s protected information (such as age, disability, marital status, political affiliation, race, and sexual orientation). Social media sites may reveal information that employers are not allowed to ask for on job applications or in interviews.10,14 WWW.ORTODAY.COM

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Employers may get information about a job candidate that they cannot use in making a job decision. While you need to be added as a friend to see personal information, you don’t have to be a friend to see the profile picture. What if a Facebook picture shows a pregnant woman, an older man, or an applicant in a wheelchair? The risk is that the employer may use this protected information (pregnancy, age, and disability) not to hire an applicant. This discriminatory action could lead to a lawsuit.10,14 Some organizations try to avoid discrimination by having a person who is not a decision maker search social media sites to filter out protected information. The “scrubbed” information is provided for the decision maker to review.12 In some settings, employers alert applicants that Internet searches will be conducted on all applicants who are conditionally offered employment. If they refuse to consent to this search, they will not be considered any further — much like employers may exclude those who refuse to consent to background checks.10 Another risk of using social media to screen applicants is that the information may be inaccurate. A website that seems to be affiliated with an applicant may not have a connection to the person. False information may be posted. It is also difficult to control what friends are posting. Friends may post information that may be viewed unfavorably by an employer.10,14 Today, many organizations use social networking sites for posting jobs and searching for candidates. Recruiters can create their own profiles, invite people to a Facebook event, such as a career fair, and suggest that they become a fan of the organization. Job seekers may become friends, allowing recruiters to search and view their profiles. Recruiters can also perform a search of Facebook members and find people and groups associated with terms such as “RN.” They can then join these WWW.ORTODAY.COM

groups and ask people to be added as a friend, thus allowing access to their profile information. The popularity of social media has overshadowed the possible negative impacts. Social media presents risks and opportunities for employees, employers, and job seekers, because it breaks down the walls separating personal and professional lives. Social media can be a friend or a foe. We need to balance the social and business opportunities of social media with the opportunities to get into trouble. EDITOR'S NOTE: Kathleen D. Pagana, PhD, RN, the original author of this CE activity, has not had an opportunity to influence this version. Dana Bartlett, MA, MAN, BSN, RN, CSPI, has 16 years of ER and ICU nursing experience. He is currently employed at the Connecticut Poison Control Center as a certified specialist in poison information.

References 1. Facebook newsroom. Stats. Facebook Web site. http://newsroom.fb.com/company-info. Published 2017. Accessed February 4, 2018. 2. Kovanis G. Stop spoiling my Facebook cocktail party! Detroit Free Press Web site. http:// www.freep.com/story/life/shopping/georgeakovanis/2015/02/23/stop-spoiling-facebookcocktail-party/23704817. Published February 23, 2015. Accessed February 4, 2018. 3. Craig D. Employee at Philly hospital loses job over racially charged Facebook post. Philly Voice Web site. http://www.phillyvoice.com/ employee-philly-hospital-fired-over-raciallycharged-facebook-post. Published July 14, 2016. Accessed February 4, 2018. 4. Hennessy-Fiske M. When Facebook goes to the hospital, patients may suffer. Los Angeles Times Web site. http://articles. latimes.com/2010/aug/08/local/la-me-facebook-20100809. Published August 8, 2010. Accessed February 4, 2018. 5. Photos of dying patient posted to Facebook get four hospital workers fired. FierceHealthcare Web site. http://www.fiercehealthcare. com/story/facebook-firings-photos-dyingpatient-get-four-hospital-workers-fired-threedisciplined/2010-0. Published August 9, 2010. Accessed February 4, 2018.

6. Brous E, Olsen DP. Lessons learned from litigation: legal and ethical consequences of social media. Am J Nurs. 2017;117(9):50-54. doi: 10.1097/01.NAJ.0000524546.50943.9e. 7. West JC. Nurse can be justifiably fired for Facebook posting. Talbot v. Desert View Care Center. J Healthc Risk Manag. 2015;35(1):44-46. 8. Harrison S. Oakwood hospital employee says she was fired for posting Facebook rant about Taylor cop shooting suspect. MLive Web site. http://www.mlive.com/news/detroit/index. ssf/2010/07/oakwood_hospital_employee_says. html. Published July 31, 2010. Accessed February 4, 2018. 9. Hill K. Update: taking a photo with a placenta won’t get you kicked out of nursing school. Forbes Web site. http://www.forbes.com/sites/ kashmirhill/2011/01/07/update-taking-a-photowith-a-placenta-wont-get-you-kicked-outof-nursing-school. Published January 7, 2011. Accessed February 4, 2018. 10. McCreary JA Jr. Social media symposium: Social networking and employment law. PA Bar Assoc Q. 2010;81(2):69-80. 11. Love D. 17 people who were fired for using Facebook. http://www.businessinsider.com/17people-who-were-fired-for-using-facebook2014-7?op=1. Posted July 4, 2014. Accessed February 4, 2018. 12. Kitsis EA, Milan FB, Cohen HW, et al. Who’s misbehaving? Perceptions of unprofessional social media use by medical students and faculty. BMC Med Educ. 2016;16:67. doi: 10.1186/ s12909-016-0572-x. 13. Barnable A, Cunning G, Parcon M. Nursing students’ perceptions of confidentiality, accountability, and e-professionalism in relation to Facebook. Nurse Educ. 2018;43(1):28-31. doi: 10.1097/NNE.0000000000000441. 14. Social media in the workplace. Jackson Lewis LLP Web site. http://www.jacksonlewis. com/sites/default/files/media/pnc/3/media.1033.pdf. Posted October 2013. Accessed February 4, 2018. 15. Green J. Nurses’ online behaviour: lessons for the nursing profession. Contemp Nurse. 2017;53(3):355-367. doi: 10.1080/10376178.2017.1281749. 16. U.S. Department of Health and Human Services. Health information privacy. U.S. Department of Health and Human Services Web site. http://www.hhs.gov/ocr/privacy/index.html. Published 2003. Accessed February 4, 2018. 17. HHS strengthens HIPAA enforcement. U.S. Department of Health and Human Services Web site. https://www.hipaa.com/hhs-strength-

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IN THE OR

continuing education ens-hipaa-enforcement. Published November 3, 2009. Accessed February 4, 2018. 18. Chaput B. New white paper addresses meaningful use, HIPAA security final rule and HIPAA security risk analysis. Online PR media Web site. http://www.onlineprnews.com/ news/67010-1286469214-new-white-paperaddresses-meaningful-use-hipaa-securityfinal-rule-and-hipaa-security-risk-analysis.html. Published October 7, 2010. Accessed February 4, 2018. 19. Niner P. Meaningful use and security risk assessments. HiTechAnswers Web site. http:// www.hitechanswers.net/meaningful-use-andsecurity-risk-assessments. Published February 4, 2011. Accessed February 4, 2018. 20. 6 tips for nurses using social media. Nursing World Web site. http://www.nursingworld.org/

FunctionalMenuCategories/AboutANA/SocialMedia/Social-Networking-Principles-Toolkit/6Tips-for-Nurses-Using-Social-Media-Poster.pdf. Accessed February 4, 2018. 21. A nurse’s guide to the use of social media. National Council of State Boards of Nursing Web site. https://www.ncsbn.org/NCSBN_SocialMedia.pdf. Published November 2011. Accessed February 4, 2018. 22. Westrick SJ. Nursing students’ use of electronic and social media: law, ethics, and e-professionalism. Nurs Educ Perspect. 2016;37(1):16-22. doi: 10.5480/14-1358. 23. Perkins O. More than half of employers now use social media to screen job candidates, poll says; even send friend requests. Cleveland.Com Web site, http://www.cleveland.com/business/ index.ssf/2015/05/more_than_half_of_em-

ployers_no_1.html. Published May 14, 2015. Accessed February 4, 2018. 24. Forty-five percent of employers use social networking sites to research job candidates, CareerBuilder survey finds. CareerBuilder Web site. http://www.careerbuilder.com/share/aboutus/pressreleasesdetail.aspx?id=pr519&sd=8/1 9/2009&ed=12/31/2009. Published August 19, 2009. Accessed February 4, 2018. 25. Smith J. How social media can help (or hurt) you in your job search. Forbes Web site. https://www.forbes.com/sites/jacquelynsmith/2013/04/16/how-social-media-can-helpor-hurt-your-job-search/#8b4feee7ae24. Published April 16, 2013. Accessed February 4, 2018.

Clinical Vignette FOR CE630 Mary, a 22-year-old RN, has lots of friends from high school on Facebook. While on the surgical unit in the only hospital in her hometown, she took care of her former high school chemistry teacher. She later wrote on Facebook that she was uncomfortable when she had to catheterize him after his prostate surgery. She never mentioned the teacher’s name, but word got around town about his hospitalization, and Mary was fired.

1 Mary was fired because she: a. Mentioned discomfort with catheterization b. Provided enough information to identify the patient

c. Mentioned her job on Facebook d. Took care of a patient who had been a teacher

2 Suppose Mary had not been assigned to care for her ex-teacher. Which action would be considered a HIPAA violation on her part?

a. Saying hello to the teacher in the hall

c. Helping a visitor find the teacher’s room

b. Greeting other former teachers who came in to visit

d. Viewing the teacher’s medical records

ary’s hospital has a social media policy. Breaking which guideline 3 M probably related most directly to her firing?

a. Avoid using your hospital e-mail as your primary c. Do not use hospital equipment for your social media means of identification. purposes. b. Do not engage in social media activities during work. d. Be aware that employees are personally responsible for everything they post on Facebook

Clinical VignettE ANSWERS 1. Answer: B. Mary’s information made it easy for her high school friends to identify the teacher. Mentioning discomfort in procedures and talking about a job are acceptable if patient privacy is not compromised. 2. Answer: D. Individuals and hospitals can be fined for privacy breaches. Answers A, B, and C are courteous. 3. Answer: D. Mary’s posting led to the identification of her patient. Violations are subject to action, including firing.

36 | OR TODAY | MARCH 2019

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CE630

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

Deadline Courses must be completed by 4/30/2020 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.

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CORPORATE PROFILE ruhof

DECADES OF

INNOVATION n 1976, Frank Bass and Bernard Esquenet teamed up to create The Ruhof Corporation. Frank Bass’ initial role in the company was one of sales, marketing and research while

Bernard Esquenet was the chemist behind Ruhof’s success. Prior to the launch of Ruhof, Bass recognized the need for hospitals to use more than simple dishwashing detergent in cleaning surgical instruments. Esquenet had created cleaning solutions for the Navy that were used to clean barnacles and other crustaceous marine residues from the heat ex-changers and water evaporators of submarines and other naval vessels. When Bass approached him to develop cleaning solutions for hospital instruments, Esquenet realized that the enzymes he was using to eat away at the marine organism residues would also dissolve proteins off of surgical instruments. Thus, Protozyme, the very first enzymatic cleaner for surgical instrumentation was born along with Surgistain, a product for refurbishing corroded stainless steel instruments. Since then, Ruhof has dedicated itself to the research, development and manufacturing of state-of-the-art products to ensure the complete cleaning and reprocessing of all surgical instruments and scopes. Addressing the ever-increasing concern of cross contamination in hospitals, Ruhof’s research and development department revolutionized the cleaning industry with its enzymatic detergents, cleaning brushes and foam sprays. Additionally, the comprehensive ScopeValet™ line of endoscopy products supports the steps of the scope reprocessing cycle from bedside cleaning to transport and storage. These GI offerings help endoscopy suites improve operating efficiencies

38 | OR TODAY | MARCH 2019

while adhering to guidelines and protecting patients and staff alike.

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

innovative, continually developing new products and technologies that clean, protect, comply and verify to meet the needs of our customers.

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

A: Recent reports to the U.S. Food & Drug Administration (FDA) of processing errors with flexible endoscopes have brought much attention to the importance of this issue. In general, while flexible endoscopes are inherently difficult to clean effectively due to their long narrow lumens and because they are used in highly contaminated areas of the body, the manual component of WWW.ORTODAY.COM

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Inter operability AND THE OR OF THE FUTURE By Don Sadler

44 | OR TODAY | MARCH 2019

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n today’s technology-centric world, most people expect their various tech devices to be able to communicate with each other. If you have an iPhone and an iMac, for example, the devices are synced so that you can access data on either device from the other one. It’s surprising that many of the high-tech devices in modern operating rooms don’t have this kind of data interoperability. “OR technicians and clinicians often have to go back 25 years in technology because of this lack of interoperability,” says Kelly Aldrich, DNP, MS, RN-BC, FHIMSS and chief clinical transformation officer for the Center of Medical Interoperability. “The question I ask is: 'Why do we tolerate this for our frontline clinicians?'”

A Long Way to Go “Interoperability has a long way to go in the perioperative environment because of the vast array of medical devices, surgical equipment, supplies and technologies

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utilized in the operating room,” says Janice Kelly, MS, RN-BC, the president of AORN Syntegrity Inc. “The OR is filled with patient care devices, each of which may include information about the patient,” adds Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN vice president, Informatics with the Healthcare Information and Management Systems Society (HIMSS). “This information needs to be uploaded into the electronic health record (EHR),” Sensmeier adds. “But the lack of connectivity between the devices and the EHR creates gaps in information that can impact patient safety.” According to Kelly, perioperative nurses are required to transcribe data collected from multiple devices into the EHR. “For example, they must monitor the length of time a pneumatic tourniquet is inflated

MARCH 2019 | OR TODAY |

What is Interoperability? The Healthcare Information and Management Systems Society (HIMSS) defines health care interoperability as “the ability of different information technology systems and software applications to communicate, exchange data and use the information that has been exchanged.” According to HIMSS, there are three levels of health information technology interoperability: 1. F oundational interoperability allows data exchange from one IT system to be received by another. The receiving system doesn’t have to be able to interpret the data. 2. S tructural interoperability defines the structure or format of data exchange where there is uniform movement of health data from one system to another. The clinical or operational purpose and meaning of the data is preserved and unaltered. 3. S emantic interoperability is the highest level, which is the ability of two or more systems or elements to exchange and use information. It supports the electronic exchange of healthrelated financial data, patientcreated wellness data and patient summary information among caregivers and other authorized parties.

“The nursing staff may transition to documentation on paper, while the anesthesia machine continues to monitor the patient. This creates two records that are not synchronized.” 46 | OR TODAY | MARCH 2019

and alert the surgical team at established intervals,” she says. “Interoperability is necessary to decrease the time perioperative nurses spend at the computer and thus allow them to focus on patient-centered care,” Kelly adds. “However, it must be developed with perioperative workflows in mind.” Sensmeier believes that a lack of interoperability compromises patient care by not ensuring that OR clinicians have accurate and timely patient information. “For example, misinformation could come from a device that is not connected or an electronic system that is not identifying the correct patient information,” she says. “Lives are literally at stake.”

Challenges to Improving Interoperability Kelly lists several challenges faced by perioperative nurses when it comes to improving interoperability in the OR. “One challenge is ensuring that reliable data from multiple sources and formats can be shared and turned into actionable data for the surgical team to utilize, or for medical devices to safely initiate an intended purpose,” she says. Another challenge is aimed at the standardization of clinical data, because different terms may be used to document the same clinical observation result. “For example, nurses may document the observation for the sound heard when fluid is in the small airways as crackles or rales,” Kelly explains. “While crackles and rales represent the same clinical observation, the terms are different, which inhibits the sharing of clinical observations.” According to Bronwen Huron, BSN, RN-BC, MS, PMP, manager, Interoperability Initiatives with HIMSS, different personnel will use different systems in the same OR to document. “For example, the circulating nurse may be using the EHR system, but the anesthesia team is using the anesthesia machine, which will automatically document medication administration and vitals. “Information from the anesthesia machine may populate a note, but it may not be charted directly into the flowsheets the nursing staff are using,” she adds. “This can cause errors and double documentation.” During a code, this is even more complicated. “The nursing staff may transition to documentation on paper, while the anesthesia machine continues to monitor the patient,” says Huron. “This creates two records that are not synchronized. “Add in physician dictation and there may be multiple accounts of what happened in the OR,” she adds. “Determining which is the most accurate becomes very complex.”

Benefits of Better Interoperability Aldrich says there are many benefits to health care organizations and patients to successfully meeting interoperability challenges. WWW.ORTODAY.COM

“Patients will have a better experience because they won’t have to answer the same questions over and over again before surgery,” she says. “And better interoperability will boost overall efficiency and reduce cybersecurity risks for health care organizations, while also improving patient safety by lowering clinical risk.” Improving operability will also help reduce frustration among clinicians, who Aldrich says are being “processed to death. They work in the knowledge, not data entry, realm. I know some clinicians who have left the field because data entry isn’t what they signed up for. “Instead, imagine an OR where systems talk to each other and the OR nurse can easily manage them all from one device,” she adds. “This will give nurses more time to deliver high-quality patient care.” Aldrich believes it’s critical that perioperative leaders be engaged and vocal when it comes to connecting the needs of clinicians to technology functions. “First, you should ask clinicians what they need and listen to their frustrations,” she says. “Then, you can compare the current state to the ideal state. By looking at these differences, you can identify gaps that will shape your action plan.” And cost should not be a factor when it comes to improving interoperability, Aldrich stresses. “This should be built into the cost of health care delivery, just like the electrical or HVAC system,” she says. “Every patient has the right to the best possible outcome, and all possible barriers need to be eliminated.”

Bronwen Huron, BSN, RN-BC, MS, PMP, Manager, Interoperability Initiatives with HIMSS

Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN Vice president, Informatics with the Healthcare Information and Management Systems Society (HIMSS)

Improved Connectivity According to Sensmeier, devices will become smarter and smaller as technology advances, and connectivity will become easier. “Information will be able to be delivered more easily through headsets or other communication vehicles that are close to the surgical table,” she says. “And robotics informed by artificial intelligence will be available so that surgeons and surgical procedures are augmented with this technology,” Sensmeier adds. “Clinical decision support systems will be readily available to allow for more timely and accurate decision making at the point of care.” Kelly believes that interoperability will have a major stake in the future due to the increasingly sophisticated technology being utilized in the operating room. “The OR of the future will allow clinicians to focus on patients and their families and provide the safest, high-quality patient care,” she says.

Kelly Aldrich, DNP, MS, RN-BC, FHIMSS

Chief clinical transformation officer for the Center of Medical Interoperability.

Janice Kelly, MS, RN-BC,

President of AORN Syntegrity Inc.

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MARCH 2019 | OR TODAY |

GHT ON I L T O SP :

Kathy Mertens DNP, MPH, RN President, American Academy of Ambulatory Care Nursing

ome nurses almost seem to have been born into the profession. Kathy Mertens isn’t among them, but that hasn’t limited the impact of her work or the trajectory of her career. “I really was interested in science and math, and as I got into school, I realized I wanted to be closer to people and not under a microscope,” she said. “I learned the nursing aspect of community health, but I also learned the health services.” Mertens completed her bachelor’s of science in nursing at the University of Wisconsin in Madison, and then proceeded to the University of Washington School of Nursing, where she earned a master’s degree in community healthcare systems and public health. After she graduated, Mertens started working at the King County health department. An initial focus on school health and epidemiology helped her become “a systems thinker,” leading naturally to a concentration in health systems and organization when Mertens finished her nursing doctorate at Oregon Health Sciences. “I was always drawn to that population health and wellness focus, and I was really interested in crosscultural health,” Mertens said. “After I finished my schooling, I worked in a safety net hospital with a lot of medically vulnerable patients. Then, I did a public health research project in Alaska.” Working out of Fairbanks, Mertens flew to the interior of the state, visiting villages along the Yukon River to perform pediatric well visits, hepatitis B vaccinations

48 | OR TODAY | MARCH 2019

By Matt Skoufalos

and an influenza trial. Traveling often meant braving weather conditions in small planes; compared with her experience in acute care, it was a multidisciplinary approach, “and it was really going where individuals were around their health,” she said. “When you’re out in the community, you really rely on patients coming to you, or being as close to them as you can,” Mertens said. “We’re looking away from acute care, and focusing on the convenience, where patients are, where individuals are. It’s amazing to me, and so in line with how I’ve wanted to approach caring for patients.” Although that shift in system thinking took some decades to engineer at scale, Mertens believes nurses are ahead of the trend because they’ve always considered the patient as a whole person. From pre-surgical visits, to procedures and recovery, she described the process of meeting and managing patient expectations as part of a continuum of care that extends ever broader into a cross-disciplinary focus. “Working across various organizations with people of all areas, whether in a clinic in a small village, or in their home – we even have nurses that are going into shelters or supportive housing – it’s just amazing how health care is really transforming at a broader scale,” Mertens said. “The grand realization is that health is more than clinical care.” Only some 20 percent of health outcomes are dictated by health behaviors, Mertens said; the remainder is defined by socioeconomic factors like access to food, housing, employment and education. As such, health care workers need to build interdisciplinary partnerships outside their chosen fields to best affect health outcomes. WWW.ORTODAY.COM

“When I worked in Alaska, the villages had community health aides that would work closely with the clinic,” Mertens said. “Patients would talk to the physicians by phone to try to determine what was needed. Now, we’re starting to talk about community health workers across our cities. We need someone out there who can help the patient access care, be the eyes in the home. That longer connection where the individuals are living makes such a difference.” Forming those cross-sector partnerships can be quite successful, Mertens said. She described their benefit as continuing to improve patient health outcomes by working to build more supportive systems around a holistic approach. Driving the rest of the industry there requires “a lot of asking how we can do better,” Mertens said; staying curious and cultivating an open-minded approach to new opportunities. At the forefront of that shift is the work that must be done to better support ambulatory care nurses, whose roles are changing rapidly, she said. As president of the American Academy of Ambulatory Care Nursing (AAACN), Mertens believes leadership is necessary to help define their new and expanding specializations in care coordination and transition management. “I see a lot of work with our schools so we can train nurses to work in ambulatory care,” she said. “Very few nurses actually had clinicals in outpatient care, and that’s the key driver to get students to come into outpatient. It’s really trying new roles, training nurses in new scopes of practice, being a leader in collecting evidence, and looking at population. Community health workers are having to lead

Kathy Mertens chats with an attendee at the 2018 AAACN Annual Conference in Florida.

a lot of teams, having to oversee interventions.” Mertens believes new nurses entering the field must keep a weather eye on these care coordination roles, and not worry as much about specific settings in their efforts to remain patient-centered. From working in new technologies, like telehealth, or coordinating among multidisciplinary teams both on and offsite, nurses will likely need to become more adept at embracing a holistic approach to care in order to drive the best health outcomes. “There’s a lot more care being done between visits or in the areas beyond hospitalization,” Mertens said. “It’s all that connection and proactive work that’s happening more than it ever has. Nurses have to start doing more and more of that.” She also believes that professional societies like AACN, which help nurses learn their scope and standard of practice, continue to play a pivotal role in “keeping on the cutting-edge areas.” Whether through networking, policy and funding advocacy, education and research, and testing new care approaches, that work is more easily done in a collective fashion, and Mertens said it will only become more meaningful as those roles continue to evolve. “That communication is really critical as we look to the future,” she said. “A lot of nurses have to be change agents and advocate for things, because health care is starting to demand it as we move to more value than volume.”

Kathy Mertens at the Opening Ceremony of the 2018 AAACN Conference in Florida. WWW.ORTODAY.COM

MARCH 2019 | OR TODAY |

OUT OF THE OR fitness

The Balance Between Diet & Exercise By Miguel J. Ortiz alance can be defined as a condition in which different elements are equal or in the correct proportions.

Balance to one person can also be an extreme condition for another, so understanding where you are and where you want to be is very important. Whether you have been exercising your entire life or just starting, your goals may not change but how you get there absolutely will. Age, lifestyle, random habits, environmental changes and more can all have an effect on how you reach your goals. So, your balance will in some ways be relative along your journey. In the last two articles, I discussed training with a busy schedule and understanding whether your food is helping or hurting you. So, let’s combine the two. Schedule plays a significant factor in how we balance out our health and fitness goals. We need to make sure, regardless of how extreme we may push ourselves, that we maintain a strong and positive attitude. If you’re not very good at doing that yourself, continue to practice but also start listening to more motivational podcasts or music to keep you inspired.

50 | OR TODAY | MARCH 2019

With a good attitude, let’s break down how we can drop weight by focusing on balance in areas of diet, exercises and stress. Diet is absolutely the most important factor in everyone’s weight loss and fitness goals. Because it’s so critical, it will have a profound effect on stress and exercise when done with consistency. It will help keep the unnecessary weight off or help you jump back into harder workouts. Focus on water only, immediately start cutting out processed foods and sugars, and start making better choices. More greens, less breads, more water, more natural fruits and veggies, less chips, don’t over pour sauces, learn about the dirty dozen, eat more organic and talk to a professional. When dealing with weight loss, cravings can be very severe and the detoxing process of cutting out more then 50 pounds or so can also come with diarrhea, nausea, headaches, etc. If you’re looking to build more muscle or compete in demanding sports, your diet will still play a huge factor in your performance. I would consider someone who understands a great deal about nutrition, like a dietician or nutrition coach, as they can be

very motivating and inspiring during diet changes. For weight loss, before jumping into heavy exercise focus on more activity. Yes, it’s great to get a good workout in, but the body may not be ready for that yet. We want to shoot for consistent days in the gym, not just going once a week. This is important because if someone is already feeling stressed from life’s troubles then exercising too hard can cause more stress that the body may not need. Go for longer walks, and general stretching and yoga throughout the day can be very helpful. It will loosen up joints and help with more activity in the future. For athletes or people who love pushing themselves physically, making small and consistent changes will be the best way to understanding how your body is truly preforming. Whether you’re trying a new breakfast routine to fuel your body differently or adding extra protein to support the muscle increase you’re shooting for, pay attention to how your body is feeling. You can even take daily notes depending on your goals. This will help you determine what is working and what isn’t so you can make quick and quality pivots along your road to success. WWW.ORTODAY.COM

Regardless of your weight-loss and muscle-building goals, neither will be achieved consistently without proper rest and sleep. I know some people who don’t sleep very long, but make time to take a nap because their schedule allows it. It’s important to do what is right for you. One must understand we cannot continue to function well without proper sleep. For quality cellular, brain and bodily functions sleep is not just important, its necessary. Seven or eight hours of sleep each night is ideal and highly recommended. Good luck and keep pushing forward. 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 health

Well-Being Withers When Impulse Buying Takes Control By Marilynn Preston t’s not unusual for people to ask me: What’s the best piece of fitness gear I can buy?

My first answer is easy: buy the one you’ll use. Buy the one that gets your bliss-making chemicals pumping and your heart thumping in a way that sparks joy and builds strength. My second answer will surely irritate my Thrift Gene, inherited from my late, great, two-for-one bargain-hunting mother: Always buy the best quality you can afford, not necessarily the one that’s the best deal. Cheap, poorly designed fitness gear is no bargain. Your equipment doesn’t have to be new; it just has to feel solid and perform well for years to come. Every minute of every day, on every device we have, we are prompted to buy, buy, buy, all of us in the grip of a shopping frenzy that we can’t escape – and very often can’t afford. So what can we do? Wake up!

52 | OR TODAY | MARCH 2019

Impulse buying – a category that includes a battery-operated corkpuller in the shape of an elf – can be overcome, or at least tempered. “Hi, I’m Tara and I’m an impulse buyer!” is the lead to a timely guide to stopping impulse buying by Tara Button, the founder of BuyMeOnce. com. Her website is part of a growing movement in America dedicated to living simply, buying less, recycling more and preferring quality items over cheap junk that won’t last. Here are some of Tara’s insights, blended with my own lifelong experience with impulse buying (most recently, a pair of red fluffy socks that display the message – when I put my feet up – “Please bring me another glass of wine.” Irresistible, right?)

THE CURIOSITY IMPULSE This imp is excited by anything new: buy the latest phone, update your purses, add the hot-new-color shoes to your growing collection. It can be a good impulse – curios-

ity about the new is a plus when it comes to your well-being – but very often, it leads to spending on things you don’t need ... a lipstick that glows in the dark? “First you need to teach the imp to appreciate the items you already own,” writes Tara. After focusing on gratitude for what you have, turn the imp’s attention to what new thing you could learn about or what new place you could visit. Cultivate curiosity for the real world, and your impulse to have the latest and trendiest will subside.

THE INSECURITY IMPULSE The insecurity imp is constantly trying to persuade you that you’ll feel better, look better or be better if you had this, that or the other. Sound familiar? Of course it does. It’s the premise of 10,000 ads that invade your consciousness every day. In this category, the numero uno absurd ad comes from Mercedes Benz: “The best, or nothing!” Excuse me? Buy a Benz or walk to work? WWW.ORTODAY.COM

OUT OF THE OR health

“Disarm this imp by avoiding ads as much as possible,” Tara suggests, “and whenever you see one you can’t avoid, tell it ‘Thanks, but I’m fine the way I am.’” (You may need to repeat this 100 times a day, but eventually, the impulse to buy is replaced with a sense of serenity and contentment, as in: “I’m good enough. No material object will make me better.”)

just as much if you lost all your money” and couldn’t buy them the reindeer-theme necktie with Rudolph’s nose in LED lights. Impulse buying isn’t the end of the world, or even capitalism, but mastering it will contribute to a happier, healthier you. Isn’t that a great way to cruise through life?

THE GUILT IMPULSE

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

This impulse goes wild during gift-giving holidays. It tells you you’re a bad friend/spouse/parent unless you are constantly giving material possessions to the people around you. Wait! Breathe in. Breathe out. It’s not true, and you know it. Tara wants you to stop and remind yourself “the people who truly love and care for you would love you

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OUT OF THE OR EQ Factor

Being Intelligent About Your Anger By Daniel Bobinski veryone gets irritated or annoyed from time to time, but do you tend to show it? Are you prone to raising your voice or even slamming doors? Perhaps at some point you may have asked, “How do I control my anger?”

I confess, earlier in my life I had a problem with anger. When things happened around me that I didn’t want to happen, I got angry. My mentor, the late Alex Goodman, taught me a lot about dealing with anger. His philosophy was that whenever people get angry at others, they were really just angry with themselves. At first, that did not make sense to me. If somebody did something that upsets me, didn’t I have the right to be angry? Alex held his ground. Righteous anger aside, he said that if an event that resulted in my being angry was something I could have influenced, then no, I didn’t really have a right to be angry. Instead, I had a responsibility to act maturely and learn what I could have done differently. Alex said that displaying anger was more of an attempt to manipulate

54 | OR TODAY | MARCH 2019

than anything else. I chewed on that for a long time. And, the more I thought about it, the more I realized Alex was right. So before I answer the question of how do I control my anger, it will help if I explain a little about how anger actually helps us. Anger is a natural human emotion – a valuable emotion that keeps us alive, especially when we’re very young. When children are born, they lack the ability to talk. They have needs, but they can’t verbalize those needs. Enter “anger.” If you’ve been around newborns, you know exactly how this works. A baby fusses, and quickly the parents are trying to figure out what the baby wants. Food? A diaper change? A nap? Displaying anger is how a child gets its needs met. But there comes a time when children learn to talk. When that happens, it’s time to wean them away from using anger. They must learn to express their wants and needs verbally. For example, instead of fussing when they’re hungry, we teach them to say, “I’m hungry, may I have something to eat please?” Think about it. Temper tantrums are simply escalated efforts at using

what’s worked in the past: Relying on anger to get needs met. If parents give in, they’re teaching their children it’s okay to continue using anger to get what they want. But if parents set firm boundaries, children eventually stop relying on anger. Unfortunately, some parents don’t learn this, and their children continue using anger to get their needs met well into adulthood. So, how do I control my anger? Well, I concluded that Alex was right. Whenever I sense anger rising up, I realize I’m really just angry at myself for not being proactive in some area. And so, practicing good Emotional Intelligence, I then ask myself, “What could I have done differently so that what happened didn’t happen?” It’s part of self-awareness and selfmanagement, which is fundamental to good emotional intelligence. 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 or 208-375-7606.

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OUT OF THE OR nutrition

The Caveman Cometh By Matthew Kadey, M.S., R.D.

ince the first paleo diet book hit store shelves nearly two decades ago, this eating plan has skyrocketed in popularity. On paper, the paleo diet, (a.k.a. the “caveman” or “stone age” diet) encourages consumption of foods that would have been hunted or gathered by our ancestors during the Paleolithic era. That means following a diet rich in meats, fish, eggs, veggies, fruits, nuts and seeds. Grains, legumes and dairy are discouraged – the theory is that since these items were not a regular part of our daily menu until about 10,000 years ago, our bodies have not evolved to utilize them effectively; hence, they may have helped contribute to high rates of obesity and chronic diseases like diabetes.

56 | OR TODAY | MARCH 2019

Pros of paleo This specialized diet has its merits and drawbacks. Encouraging people to focus their eating efforts on nutrient-dense whole foods like wild salmon and sweet potatoes at the expense of processed foods rich in refined grains and sugary calories is something to be celebrated. For some individuals, this is enough to spur weight loss (eliminating food groups often leads to an initial drop in calorie intake) and there is evidence that it can improve blood sugar control, especially in those with Type 2 diabetes. The diet also advocates careful food label reading, which can make people more cognizant of what ingredients they are buying. The food industry has certainly taken notice, releasing a constant stream of new packaged products ranging from meat bars to pancake mixes to grain-free granola that meet paleo standards. The diet also

trumpets consuming less industrialized types of protein such as free-range eggs, grass-fed beef, and wild fish, which may bring more nutrition to the table.

Pitfalls of paleo Of concern, whole grains, beans, lentils, dairy – all eliminated by most paleo followers – are great sources of vitamins, minerals and antioxidants that can contribute to overall dietary needs. Indeed, by eliminating entire food groups, paleo devotees are at heightened risk for certain dietary deficiencies such as fiber, magnesium and vitamin D unless they choose their “allowed” foods wisely to make sure they get what they need. It should be noted that the vast majority of research shows that diets rich in whole grains and legumes helps in the battle against many chronic diseases. And without grains, very active individuals may WWW.ORTODAY.COM

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have a hard time eating enough carbohydrates to power their workouts (although paleo is not technically a low-carb diet). For some people, being hyper focused on eating “clean” paleo foods can set the stage for an unhealthy relationship with food and eating disorders.

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The bottom line All in all, the paleo diet may work for some people, while others will find it unsustainable. An ever-growing body of evidence suggests there’s no such thing as a single “best” diet – and you need to determine what works best for you, whether or not you choose to eat like a caveman. Reprinted with permission from Environmental Nutrition, a monthly publication of Belvoir Media Group LLC.

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MARCH 2019 | OR TODAY |

OUT OF THE OR recipe

Tangerine, Mixed Greens and Quinoa Salad

Recipe

INGREDIENTS:

the

58 | OR TODAY | MARCH 2019

For the salad: • 10 ounces arugula (10 ounce bag) • 1 1/2 cups cooked, cooled quinoa • 2 seedless tangerines like Satsumas, peeled and sectioned and cut into bite-size pieces • 3/4 cup pomegranate seeds • 1/3 cup Marcona almonds For the dressing: • • • • •

1/2 cup olive oil 1/4 cup lemon juice 2 garlic cloves, minced 1 medium shallot, minced 1 1/2 tablespoons Dijon style whole grain mustard • Salt and freshly ground pepper to taste • 1/4 cup freshly shaved Parmesan cheese, for garnish

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. WWW.ORTODAY.COM

OUT OF THE OR recipe

Seriously Simple: A healthy start tâ&#x20AC;&#x2122;s time to take stock and come up with some dishes that fall into the light and healthy arena. My caveat is that they also must taste really good. This salad is a staple at my house when we are all craving simpler dishes that make us feel good. I have many variations of this salad, but the following recipe is a good start. The lemony whole-grain mustard dressing is just the ticket to dress these slightly

bitter greens. Remember that you can use this vinaigrette with any other green salad with equally satisfying results. If you can find Meyer lemons, use them for an even deeper citrus flavor. Serve this salad as a side dish with grilled fish or poultry or as a main course for lunch. I also like to serve this with a cup of lentil soup or split pea soup for a satisfying lunch or dinner.

Tangerine, Mixed Greens and Quinoa Salad Serves 5 to 6 as a side dish or 3 to 4 as a main dish 1.

In a salad bowl combine arugula, quinoa, tangerine pieces, pomegranate seeds and almonds together, and toss to evenly blend. 2. In a mini food processor combine the salad dressing ingredients. Process until smooth. You can also use an immersion blender. Taste for seasoning. 3. Just before serving, toss with just enough of the dressing to coat the salad ingredients and garnish with the Parmesan cheese. Serve remaining dressing on the side. Serve immediately. Cookâ&#x20AC;&#x2122;s notes: To cook the quinoa, rinse 3/4 cup quinoa, combine quinoa with 1 1/2 cups water or chicken stock, and boil it for 10 minutes. Let cool.

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The News and Photos

OUT OF THE OR

that Caught Our Eye This Month

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Four Ways to Reduce Your Stress the brain that stores emotional memories. Taking the time to seek out the smells that bring back those happy memories can help reduce stress levels.

relieve stress, improve mood and treat anxiety. Some studies have also indicated that just being around an animal can reduce blood pressure. This pet therapy has been used in hospitals and nursing homes and Salt even with military veterans suffering from Stress is characterized in the human body depression. And it is not limited to dogs by high levels of the hormone cortisol, reStress. No one wants it but we all experiferred to as the “stress hormone.” Scientific and cats. Rabbits, Guinea pigs and even horses are used. An added benefit is that ence it from time to time. Higher levels of research has shown, in animals and in hustress can cause problems at work and at mans, that increased levels of salt consump- having a pet encourages exercise. home. But stress is not just hard on your tion are very effective in reducing levels of Exercise mental well-being, it is hard on your body cortisol. Research from the University of Regular exercise, even if mild, may be the and can lead to many negative health Haifa, published in the science journal Apbest stress reducer there is. When you are outcomes. petite, confirmed the relationship between active the body releases endorphins, which To help you stay calm and focused, con- salt and stress in humans. Researchers produce a feeling of well-being. Regular sider these four ways to reduce stress. found an inverse correlation between salt activity can improve your concentration and depression/stress, especially in women. as well as your sleep, which can often be Smells negatively affected by stress. Just going for Certain smells can bring back very specific Craving salty foods may very well be a biological defense mechanism we evolved a daily walk can help improve how you feel. and detailed memories. These could be to cope with daily stress. And the results of exercise can also improve of a person, event or place. Most often your self-image and confidence. the memory also has a deeply emotional Pets feeling that is recalled. This is because Animal therapy has long been used to – Brandpoint smells are processed by a specific part of

Podcasts to Tickle Your Funny Bone According to Podcast Insights, 73 million Americans listen to podcasts regularly, seven per week on average. You can find a podcast about virtually any subject that strikes your fancy, so if you’re looking for a new show to engage and delight you, there is no shortage of fun, information, news, controversy and commentary out there to choose from. But where do you start? Here are some wildly entertaining, addictive podcasts that are worth a listen. Pet Parents, Oversharing Do you have a pet you call your fur baby? Do you secretly watch cat or dog videos on company time? There’s a new podcast aimed squarely at you. Hosted by two comedians and now available for streaming, “Pet Parents, Oversharing” explores all of life’s moments shared with our best furry friends, from the endearing to the embarrassing and hilariously awkward, reminding us of the bond that pet parents share. No topic is off limits and you’ll be sure to roll over with your pup in laughter or feel inspired to strike up a friendly chat next time you head to the dog park. Developed by the folks at Freshpet, “Pet

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Parents, Oversharing” helps pet parents get through the day knowing they’re not going it alone. Tune in to Pet Parents, Oversharing for stories about all things paw, fur and tail. Find it at www.freshpet. com/pet-podcast. Keep It Daily Beast culture critic Ira Madison III and co-hosts Kara Brown and Louis Virtel are joined each Wednesday by comedians, journalists and others for a discussion of pop culture, politics, terrible celebrity tweets, events like the Oscars and more. Nothing is out of bounds, from Meghan Markle’s annoying father, to how much John McCain loved ABBA. These three hosts are talking about what everyone is thinking. It’s the ultimate virtual water cooler discussion. Find it at art19. com/shows/keep-it. This Is Love This intriguing podcast investigates life’s most persistent mystery: love. You’ll hear individual, real-life stories of true love, sacrifice and even obsession. You’ll meet Nino and Drew, who kept their relationship a secret for more than 40 years, and then they decided to do something that forced them into the national spotlight. There’s also the story of David, who went for a run in Central Park and started talk-

ing to a stranger, who turned out to be the love of his life. And Brenda Jackson, who became a bestselling novelist by writing 120 books about her first romance. Listening to the love stories of real people will make you feel that anything is possible when we bet everything on the one we love. Find it at www. thisislovepodcast.com. My Brother, My Brother and Me Justin, Travis and Griffin McElroy are brothers who are not experts in anything, but they have a popular podcast in which they dispense advice about various subjects, answer questions submitted by listeners or on Yahoo Answers, and provide addicting and hilarious commentary about nothing in particular. Known as MBMBaM by faithful listeners, the podcast features regular segments including The Munch Squad, in which they recite and ridicule news about new food products, and Haunted Doll Watch, which highlights online classifieds of haunted or possessed dolls. This is like the table conversation at the best family dinner of your life. Find it at www.stitcher.com/ podcast/my-brother-my-brother-and-me. – Brandpoint

MARCH 2019 | OR TODAY |

INDEX

advertisers

Alphabetical Action Products, Inc.…………………………………………51 AIV Inc.…………………………………………………………………15 Alco Sales Service, Co.…………………………………… 57 Avante Patient Monitoring………………………………… 4 BD……………………………………………………………………… 29 C Change Surgical…………………………………………… 63 Capital Medical Resources……………………………… 53

Cygnus Medical…………………………………………………… 9 Diversey ………………………………………………………………17 Healthmark Industries Company, Inc.…………… 6 Innovative Medical Products………………………… BC Kapp Surgical Instrument Inc……………………………13 MD Technologies inc.……………………………………… 43 Microsystems……………………………………………………… 5

Mobile Instrument Service & Repair…………… 22 Ruhof Corporation……………………………… 2,3,38-40 Soma………………………………………………………………………51 TBJ Incorporated……………………………………………… 55 OR Today Webinar Series…………………………………41

ANESTHESIA

HOSPITAL BEDS/PARTS

ASSET MANAGEMENT

INFECTION CONTROL

Cygnus Medical…………………………………………………… 9 Mobile Instrument Service & Repair…………… 22 Soma………………………………………………………………………51

categorical Soma………………………………………………………………………51 Microsystems……………………………………………………… 5

C-ARM

Soma………………………………………………………………………51

CARDIAC PRODUCTS

C Change Surgical…………………………………………… 63 Kapp Surgical Instrument Inc……………………………13

CARTS/CABINETS

Alco Sales Service, Co.…………………………………… 57 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 6 TBJ Incorporated……………………………………………… 55

CS/SPD

MD Technologies inc.……………………………………… 43 Microsystems……………………………………………………… 5

DISINFECTION

Cygnus Medical…………………………………………………… 9 Diversey ………………………………………………………………17 Ruhof Corporation……………………………… 2,3,38-40

DISPOSABLES

Alco Sales Service, Co.…………………………………… 57

ENDOSCOPY

Capital Medical Resources……………………………… 53 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 6 MD Technologies inc.……………………………………… 43 Mobile Instrument Service & Repair…………… 22 Ruhof Corporation……………………………… 2,3,38-40

Alco Sales Service, Co.…………………………………… 57 Alco Sales Service, Co.…………………………………… 57 Cygnus Medical…………………………………………………… 9 Diversey ………………………………………………………………17 Healthmark Industries Company, Inc.…………… 6 Ruhof Corporation……………………………… 2,3,38-40 TBJ Incorporated……………………………………………… 55

INSTRUMENT STORAGE/TRANSPORT

Cygnus Medical…………………………………………………… 9

INSTRUMENT TRACKING

Microsystems……………………………………………………… 5

MONITORS

Avante Patient Monitoring………………………………… 4 Soma………………………………………………………………………51

RESPIRATORY

Soma………………………………………………………………………51

SAFETY

Healthmark Industries Company, Inc.…………… 6

SINKS

TBJ Incorporated……………………………………………… 55

SKIN PREPARATION

BD……………………………………………………………………… 29

STERILIZATION

OR Today Webinar Series…………………………………41

Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 6 TBJ Incorporated……………………………………………… 55

OR TABLES/BOOMS/ACCESSORIES

SURGICAL

Action Products, Inc.…………………………………………51 Innovative Medical Products………………………… BC Soma………………………………………………………………………51

MD Technologies inc.……………………………………… 43 Soma………………………………………………………………………51

OTHER

C Change Surgical…………………………………………… 63 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 6 Kapp Surgical Instrument Inc……………………………13

AIV Inc.…………………………………………………………………15

PATIENT MONITORING

AIV Inc.…………………………………………………………………15 Avante Patient Monitoring………………………………… 4

POSITIONING PRODUCTS

ERGONOMIC SOLUTIONS

Diversey ………………………………………………………………17

FALL PREVENTION

PRESSURE ULCER MANAGEMENT

GENERAL

REPAIR SERVICES

AIV Inc.…………………………………………………………………15 Capital Medical Resources……………………………… 53

TBJ Incorporated……………………………………………… 55

ONLINE RESOURCE

Action Products, Inc.…………………………………………51 Cygnus Medical…………………………………………………… 9 Innovative Medical Products………………………… BC Kapp Surgical Instrument Inc……………………………13

Alco Sales Service, Co.…………………………………… 57

REPROCESSING STATIONS

Action Products, Inc.…………………………………………51

SURGICAL INSTRUMENT/ACCESSORIES

TELEMETRY

AIV Inc.…………………………………………………………………15 Avante Patient Monitoring………………………………… 4

TEMPERATURE MANAGEMENT

C Change Surgical…………………………………………… 63

WASTE MANAGEMENT

MD Technologies inc.……………………………………… 43 TBJ Incorporated……………………………………………… 55

Avante Patient Monitoring………………………………… 4 Capital Medical Resources……………………………… 53

SAVE THE DATE! AUGUST 18-20, 2019 • LAS VEGAS, NV ORTODAYLIVE.COM 62 | OR TODAY | MARCH 2019

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