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ANESTHESIA PRODUCT FOCUS
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CE ARTICLE SHARED GOVERNANCE
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OUT OF THE OR EMOTIONAL INTELLIGENCE
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CORPORATE PROFILE
MAY 2019
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contents
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features
LOOKING INSIDE ENDOSCOPE TRENDS Flexible endoscopes are some of the most critical pieces of equipment used in operating rooms today. This makes proper endoscope cleaning and processing one of the most important tasks that perioperative nurses must perform. Failure to properly clean and process endoscopes can lead to many different problems. These range from increased risk of infections and exposure of patients to hazardous and toxic chemicals to surgical delays that cost hospitals time and money.
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Nurses often struggle to understand the concept of shared governance and how to implement it effectively. This module speaks to that gap in knowledge and application.
In December 2018, Advanced Clinical Technology (ACT) purchased the assets of Paragon Service. This brings together ACT’s biomedical expertise and one of the nation’s most successful thirdparty anesthesia equipment specialty companies. The newly rebranded ACT-Paragon offers a full menu of biomedical services for a wide range of health care environments. ACT-Paragon also offers new and refurbished equipment.
CE ARTICLE: SHARED GOVERNANCE
PRODUCT FOCUS: ANESTHESIA The global anesthesia devices market was valued at $9.563 billion in 2016, and is projected to reach $15.463 billion by 2023, registering a compound annual growth rate (CAGR) of 7.1 percent from 2017 to 2023, according to the report. The anesthesia delivery machine segment dominated the global market, accounting for a share of nearly half of the total market in 2016.
CORPORATE PROFILE: ACT-PARAGON
OR Today (Vol. 19, Issue #5) May 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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SPOTLIGHT ON
ART DEPARTMENT
Jill Conklin, RN, BSN
Jonathan Riley Karlee Gower Kathryn Keur
ACCOUNT EXECUTIVES Jayme McKelvey Megan Cabot
DIGITAL SERVICES Cindy Galindo Kennedy Krieg
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11 News & Notes 18 C CI: Navigating the Possibilities + Influencing the Outcomes = Shaping the future 20 IAHCSMM: Diligent Inspection Critical for Positive OUtcomes 22 Process Improvement Teams 24 Webinar Re-cap: What's coming home with your scrubs? 26 Vegas Welcomes OR Today Live
IN THE OR 29 Market Analysis: Anesthesia Devices 30 Product Focus: Anesthesia 34 CE Article: Shared Governance
OUT OF THE OR 54 Spotlight On 54 Fitness 57 Health 58 EQ Factor 60 Nutrition 62 Recipe 64 Pinboard
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Time to be smarter about drying your channels.
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Halyard Wins First GPO Contract as Part of the Owens & Minor Family Halyard, now part of the Owens & Minor family and a global provider of solutions for the prevention of healthcare-associated infections, was awarded a new, three-year contract for facial protection with Vizient Inc., a member-driven health care performance improvement company. Halyard is the provider of facial protection for hospitals and health systems utilizing the Vizient contract portfolio for these products. As an additional part of the agreement, Halyard will also manufacture Vizient’s new Novaplus line of facial protection. Novaplus is Vizient’s private-label brand of products that deliver financial value on products and services that hospitals use most frequently. “We are continually impressed by Vizient’s commitment to delivering value for their members,” said Alex Hodges, vice president & general manager, surgical & infection prevention,
INDUSTRY INSIGHTS
news & notes
Halyard. “We are honored to have the opportunity to provide our market-leading Halyard facial protection products, reliable supply and new value with this Novaplus contract to Vizient’s broad membership base.” “Proper facial protection is critical in helping to prevent the spread of infection and we’re thrilled to offer our members products from Halyard, a leader in this space,” said Brent Gee, Vizient associate vice president of strategic programs. “The breadth of products in the Halyard line, combined with the new Novaplus portfolio, ensures a fit for each of our members plus the value they have come to expect.” While Halyard and Vizient have worked together for more than 18 years, this marks the first Vizient contract signed with Owens & Minor Halyard. •
HFAP Joint Replacement Certification Named to BCBS Blue Distinction Program The Joint Replacement Certification with Distinction for Ambulatory Surgery Centers (ASC) program from HFAP, a health care accreditation program, was recently approved to be included in the Blue Cross Blue Shield (BCBS) Blue Distinction Specialty Care program, a national designation recognizing health care facilities that demonstrate expertise in delivering quality specialty care – safely, effectively and cost-efficiently. The goal of the BCBS Blue Distinction Specialty Care program is to help consumers find both quality and value for their specialty care needs, while encouraging health care professionals to improve the overall quality and delivery of health care nationwide. The Blue Distinction Specialty Care program offers two levels of designation: • Blue Distinction Centers (BDC): Recognized for their expertise in delivering specialty care. • Blue Distinction Centers+ (BDC+): Recognized for their expertise and cost-efficiency in delivering specialty care. “Many of the HFAP Standards for the Joint Replacement Certification with Distinction overlap with the criteria for acceptance into the BCBS Blue Distinction Specialty Care program – focusing on quality, cost-efficiency and access to care,” said Deanna Scatena, RN, BSN, assistant director, certification operations for HFAP. “Both programs aim to help well-performing ASCs and hospitals differentiate themselves to consumers, while enabling them to gain BCBS reimbursement at a higher level for total joint replacement procedures.”
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To achieve the Joint Replacement Certification with Distinction from HFAP, organizations must meet the following criteria: • Hold current accreditation with deemed status or Medicare certification by the state • Meet licensure requirements within the state • Maintain compliance with all applicable HFAP certification standards • Define the population served by its joint replacement program within its protocols • Provide a minimum of 12 consecutive months of applicable performance measures (or one month of data prior to submitting an application for initial certification) Health care organizations that meet these requirements demonstrate their commitment to quality care, treatment expertise and better overall patient results, earning them a place on the list of BCBS Blue Distinction Centers for Knee and Hip Replacement. “As more patients seek joint replacement surgeries and especially as the number of procedures performed in the outpatient setting continues to rise, it is important for provider organizations to articulate their dedication to safety and quality to both patients and payers,” said Scatena. “With the HFAP certification, ASCs performing total joint replacement procedures can stand out from competitors and strengthen the bottom line.” • For more information, visit hfap.org.
MAY 2019 | OR TODAY |
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INDUSTRY INSIGHTS
news & notes
IAHCSMM Names 2019 Award Recipients Through its awards program, the International Association of Healthcare Central Service Materiel Management (IAHCSMM) honors Central Service/ Sterile Processing (CS/SP) professionals each year who demonstrate exceptional leadership, dedication and service in the CS/SP discipline. Many qualified candidates submitted nominations for the 2019 IAHCSMM Awards. The IAHCSMM Board of Directors carefully reviewed each submission. This year’s award recipients, who will receive their awards during the 2019 IAHCSMM Annual Conference and Expo, are as follows: • CS Leadership Award – Elizabeth Kanzler, CRCST, Director of Materials Management, Community Health Network, Indianapolis, Ind. • Decontaminator of the Year Award – Sunny Vestal, MS, CST, CRCST, CIS, CHL, CER, Regional Manager of Sterile Processing Services, Baylor Scott & White Medical Center, Temple, Texas • Golden Slipper for Service Excellence Award – Teresa Young, CRCST, CER, BLS, Endoscopy Technician, Indiana University Health, Indianapolis, Ind • Technician Achievement Award – Ellen Mushock, CRCST, CIS, CHL, CER, Certified Registered Medical Supply Technician, Department of Veterans Affairs – Eastern Kansas Health Care System, Topeka, Kan. • Chapter of the Year Award – Large Chapter: Pacific Northwest Chapter Central Service Supply Department Professionals; Medium Chapter: Western Wisconsin Chapter of IAHCSMM; Small Chapter: Grand Canyon Chapter. •
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New ASTM International Standards Address Cleaning Brushes Two new ASTM International standards help describe methods for characterizing the performance of brush parts that clean medical devices. The new standards (one available as F3275 and one soon to be published as F3276) were developed by ASTM International’s committee on medical and surgical materials and devices (F04). According to committee member Ralph Basile, the standards describe how programmable force testers – configurable motorized test stands used for tension and compression testing applications – are used to eliminate the human element in testing. This allows for reproducibility within and among labs and for a variety of brush parts. “Brushes play a critical role in cleaning used medical devices,” says Basile, vice president of marketing and regulatory affairs, Healthmark Industries. “Brushes help dislodge and remove organic and other soils deposited on instruments, flexible endoscopes and other devices during patient procedures. Before these standards were developed, there had not been published consensus standards for characterizing and evaluating the performance of such brushes.” Brush manufacturers will be able to use the standards to compare the performance of different brush part designs, while makers of medical devices will be able to describe and define brush designs that are effective at cleaning their devices. In addition, the standards could help regulators review cleaning instructions submitted by device manufacturers. Also, health care professionals will have more and better information, allowing them to compare one commercially available brush to another. The medical and surgical materials and devices committee plans on developing more medical brush standards and all are invited to participate. The next meeting of the committee is May 14-17 in Denver, Colorado. • For more information, visit www.astm.org.
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Multi-disciplinary Speakers Bureau Created Beyond Clean, a sterile processing education and consulting firm, has announced the creation of a Speakers Bureau, a global resource for multi-disciplinary subject matter expertise in the decontamination, cleaning, disinfection and sterilization of medical devices, according to a news release. “Through the reach of its weekly international podcast, downloaded in over 125 countries around the world, Beyond Clean has developed one of the largest networks of thought-leaders and subject matter experts in the sterile processing field,” the release states. “The Beyond Clean Speakers Bureau will provide perioperative, infection control and sterile processing leaders the opportunity to bring recognized innovators, disruptors and educators into their personal networks and in front of their conference audiences to help their teams #FightDirty across the globe. From international conference settings to regional educational seminars, the Speakers Bureau will provide access to the passion and expertise of these high-quality speakers.” “At no other time in the history of the medical device reprocessing industry has there been as much regulatory focus from government agencies across the globe or greater attention given from media sources regarding the quality challenges in our hospitals. But the question remains: How will we respond?” explains Hank Balch, Beyond Clean co-founder and principal consultant. “The Beyond Clean Speakers Bureau will help equip health care teams with the tools to fight the war being waged on bioburden in their sterile processing departments – protecting the mothers, fathers, sisters, brothers, children and complete strangers who are relying on these teams to get it right, every instrument, every time.” The web portal allows health care professionals – including hospital leaders, medical device vendors and equipment manufacturers – to request speakers for industry conferences, training seminars or media engagements. The Speakers Bureau currently consists of more than 30 subject matter experts, including sterile processing professionals, surgeons, scientists, engineers, nursing leaders, entrepreneurs and supply chain specialists. Beyond Clean speakers have participated in numerous conferences and seminars at premier educational and strategic events hosted by industry organizations including the World Sterilization Congress (WFHSS), International Biofilm Summit (IBS), International Association of Healthcare Central Service Materiel Management (IAHCSMM), Association of periOperative Nurses (AORN), Association for Professionals in Infection Control and Epidemiology (APIC), Circle of Care (COC) and more. • For more information, visit www.beyondclean.net.
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MAY 2019 | OR TODAY |
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INDUSTRY INSIGHTS
news & notes
Philips Launches Zenition Mobile C-arm Platform Royal Philips has launched the Philips Zenition, its new mobile C-arm imaging platform. The Zenition mobile C-arm platform brings together innovations in image capture, image processing, ease-of-use and versatility pioneered on Philips’ highly successful Azurion platform. Zenition allows hospitals to maximize OR performance, enhance their clinical capabilities, and offer their staff an outstanding user experience. Zenition will be introduced in the U.S., Germany, Austria and Switzerland in the first half of 2019, and will subsequently be rolled out in further markets. The scope and complexity of surgical interventions – especially in the rapidly growing area of image-guided minimally invasive surgery – continues to increase, as does the number of patients requiring treatment. In order to treat more patients at a lower cost, hospitals require a versatile fleet of C-arms with varying capabilities that easily adapt to the needs of different types of surgery and different operators. Zenition mobile C-arms are easy to move between operating rooms, simple to position around the patient and intuitive to operate. Philips Zenition supports increased OR performance across the health care facility. The platform’s tablet-like user interface and simple ‘Unify’ workflow mean that once an operator has learned to use one system on the platform, it is easy for them to operate them all. The systems make point-and-shoot image capture fast and intuitive during any interventional or surgical procedure. Zenition’s compact design, Position Memory feature1 and BodySmart software, which captures fast and consistent images even at the edge of the image intensifier or flat detector, reduce the need for C-arm repositioning by 45 percent2. For crisp high-quality image viewing, Zenition C-arm
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systems incorporate the same image processing algorithms used on the company’s Azurion platform, offering high-definition visualization of patient anatomies and a greater viewing area. Image quality is assured by features such as Philips’ MetalSmart software, which automatically adjusts the contrast and brightness of images to improve image quality when metal objects such as implants are present in the field of view – a feature that makes Zenition systems especially useful in orthopedics. The Philips Zenition platform is designed for the future, allowing for longer clinical relevance of the systems. With two different detector and image intensifier options and the ability to subscribe to Philips’ Technology Maximizer program, Zenition offers users the latest software and hardware technology releases for a fraction of the cost of purchasing them individually. Philips’ Zenition C-arms are CE marked and have received 510(k) clearance from the U.S. Food and Drug Administration (FDA). They were showcased at the 2019 European Congress of Radiology (ECR) Exhibition. • 1 Only available on Zenition 70. 2 Results obtained during user tests performed in November 2013 by Use-Lab GmbH, an independent company. The tests involved 30 USA based clinicians (15 physicians teamed up with 15 nurses or X-ray technicians), who performed simulated procedures in a simulated OR environment. None of them had worked with a Philips C-arm or with each other before.
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INDUSTRY INSIGHTS
news & notes
Healthmark Industries 12-Day Indicator Announced Healthmark Industries has added its 12-Day Indicator Hangtime Label to its endoscopy product line. Designed as a visual reminder for health care workers, the label features a 12-day elapsed time indicator adhered to a blue 8.5 x 2.5-inch self-looping hangtime label, allowing for quick and ongoing observable clarification of how long it’s been since an endoscope has been reprocessed. The label allows staff to document critical information including the scope serial number and health care worker initials, as well
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as the date and time the indicator was activated. No preconditioning is required, there are no moving parts, and there is no power source. To activate the indicator, firmly press the blister on the strip, and upon activation a safe dye migrates along a 12-day display run-out window, which shows elapsed time (Accurate to within +/- 10%.). Additionally, Healthmark Industries offers related products. • For more information, visit www.hmark.com.
MAY 2019 | OR TODAY |
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INDUSTRY INSIGHTS
news & notes
New Single Port Robot Changing Robotic Surgery at UAB The University of Alabama at Birmingham, one of the nation’s leading hospitals in robotic surgery volume, is enhancing its robotic surgery portfolio. The School of Medicine recently added the new da Vinci SP Single Port Surgical System by Intuitive Surgical, making UAB one of only 15 medical sites in the country with the single port robot. The state-of-the-art technology of the SP robot paired with its innovative design — which enables surgeons to enter the body through one small abdominal incision before deploying the robot’s surgical instruments — improves patient outcomes and recovery time. This is particularly noticeable in cancer cases, where surgeons can now access more narrow spaces without compromising precision. Currently, the SP robot is only FDAapproved for urological surgeries. “To be able to add the SP robot as an
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option for our urologic patients here at UAB cements us as a premier provider of surgical care,” said Jeffrey Nix, M.D., assistant professor in UAB’s Department of Urology, director of robotic surgery-urology and associate scientist in the O’Neal Comprehensive Cancer Center. “We are beyond proud that this unique surgical approach is available in our hospital. We believe the SP robot will help us continue to better our patients’ health outcomes.” In January of 2019, Nix and his surgical team successfully completed one of the first surgeries in the Southeast with the SP robot. Brothers Bob Agee of Auburn, Alabama, and Rick Agee of Muscle Shoals, Alabama, both underwent a prostatectomy on the same day. “Prostate cancer runs in our family what makes our case interesting really is that my dad is one of six boys, and it was like checking them off the list —
each and every one had prostate cancer,” Bob said. “We kind of knew that it was something we would have. I think when my cancer was found that it got more important for Rick to see if he was at risk, too.” When the brothers started the process of identifying an oncologist and developing their course of treatment, Nix presented the SP robot surgical option to them. “With our family history, we know a bit more about it than we wish we did,” Rick said. “When we met with Dr. Nix he said, ‘Well, do you want the best?’ Well of course we do, and it’s pretty monumental that we’re doing this together.” While both surgeries went seamlessly, the potential of the SP robot and its impact in future surgeries in other medical fields like gynecology, otolaryngology and general surgery are exciting. •
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Tissue burns due to insulation failure are
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INDUSTRY INSIGHTS CCI
Navigating the Possibilities + Influencing the Outcomes = Shaping the Future By Lisa Rosenfield, M.A. uring my tenure working with CCI’s Board of Directors, I have made observations, identified benchmarks, and recognized trends regarding successful, purposeful, and effective CCI Board service. There is growing awareness surrounding the need for nurses to participate in board service, as it is vital for advancing the profession, influencing decision making, cultivating continuous professional development, and building leadership skills.
D
The Institute of Medicine’s (IOM) 2010 report, Future of Nursing: Leading Change, Advancing Health indicates that “strong leadership will be required to transform the U.S. health care system.” (p. 32). It also addresses the value of nurses serving “actively on advisory committees, commissions, and boards where policy decisions are made to advance health systems to improve patient care.” (p. 33). In addition, the Nurses on Boards Coalition (NOBC) has identified a focus to involve more nurses on boards in order to build healthier communities. (NOBC, 2019, Our Story). The Competency & Credentialing Institute (CCI) mobilizes a board of directors who share our vision
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of being “a growing community of lifelong learners for whom CCI is a catalyst and integral partner.” (CCI, 2019, Mission, Values, Focus). The CCI Board of Directors consists of eight nurses and two public members. Each board member serves a three-year term, with the option to extend service for an additional three years. The CCI Board of Directors has four standing committees. The Executive Committee manages the performance and compensation of the CEO. The Finance Committee monitors financial performance, approves budgets, and reviews investments. The Governance Committee prepares and presents a slate for elections, re-elections, and vacant Board positions. The TrueNorth Committee reviews and scores applications from facilities who apply to be recognized for certification excellence. The board also convenes Ad Hoc committees on an as-needed basis. One particular focus with respect to board service is the concept of competencies. CCI’s competencies for board service are aligned with our organizational values and strategic priorities. Our application therefore establishes connections between five required competencies and the skills necessary for meaningful and successful board service.
Foundational thinking includes critical thinking skills and utilization of key performance indicators. Communication involves interpersonal skills and the ability to contribute in a diverse group setting. Decision making encompasses organizational planning, policy setting, and strategic planning. Collaboration incorporates group interaction and engagement of differing viewpoints. Analytical skills require managing resources, promoting fiscal responsibility, and demonstrating financial stewardship. In his book, Good to Great (2001), Jim Collins speaks often of the importance of having the right people in the right seats on the bus before deciding on the direction of the bus. When considering service on a board, it is important to reflect on a variety of factors in order to promote an optimal partnership: • Your knowledge of the organization and your alignment with its basic tenets • Your willingness to promote the mission, vision, and values of the organization • Your ability to make contributions which promote long-term success for the organization. Board service provides unique and valuable opportunities to cultivate, develop, and expand personal WWW.ORTODAY.COM
TREAT YOUR FEET
and professional growth. CCI offers an array of volunteer opportunities on your journey to board service: Educational Products Committee, Test Development Committee, the Recertification Committee and the Certification Council. As you’re preparing to move toward the goal of joining a board, I encourage you to prepare in a variety of ways. Reflect on your expertise. Examine your priorities. Explore the possibilities. Pursue multiple opportunities for participation. It may take more than one attempt but remain persistent in your endeavors. Because, per Collins (p. 42), “great vision without great people is irrelevant.”
PREVENT CONTAMINATION IN THE OR WITH CALZURO THE AUTOCLAVABLE CLOG
References Collins, J. (2001). Good to great. New York NY: HarperCollins Publishers Inc. Competency & Credentialing Institute. (2019). Board of Directors. Retrieved from: https://www.cc-institute.org/ more/about-us/board. Competency & Credentialing Institute. (2019). Mission, Values, Focus. Retrieved from: https://www.cc-institute. org/more/about-us/mission. Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington D.C.: The National Academies Press.
PERSONALIZE SCRUBS WITH AN ARRAY OF COLORS
Nurses on Boards Coalition (2019). Our Story. Retrieved from: https://www.nursesonboardscoalition.org/.
Lisa Rosenfield, M.A., is the Executive Assistant to the CEO and CCI Board of Directors. She can be reached at 303.368.6722 or at lrosenfield@cc-institute.org.
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INDUSTRY INSIGHTS
IAHCSMM
Diligent Inspection Critical for Positive Outcomes By Rose Seavey, MBA, BS, RN, CNOR, CRCST, CSPDT ealth care professionals have the important responsibility of inspecting, detecting and examining multiple processes and products throughout the instrument reprocessing steps. What follows are some of the steps and tools necessary for completing these important tasks.
H
Sufficient lighting Adequate illumination of work surfaces should be provided in accordance with the recommendations of the Illuminating Engineering Society of North America (IES). Ancillary lighting should be considered for areas where instruments are manually cleaned and inspected. Three main things should be considered regarding lighting: employees’ age; the importance of the speed and accuracy of the work being performed; and the amount of light reflection in the work areas. The Association for the Advancement of Medical Instrumentation (AAMI) recommends that an illumination engineer, in consultation with the departmental manager, determine the appropriate lighting for each area. Table 1 in ANSI/AAMI ST79:2017, Comprehensive guide to steam sterilization and sterility assurance in health care facilities, provides recommended illuminance levels for work environments.
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Cleaning inspection and verification Inspection using enhanced visualization tools, such as lighted magnification and borescopes, are extremely helpful in identifying residue that is not observable by the unaided eye. The most common method is visual inspection, which should include the use of a lighted magnifying glass. Central Service/Sterile Processing (CS/ SP) professionals should inspect every device for visible organic soil and contamination; this is typically done as part of the inspection, preparation and packaging procedure. Visual inspection alone might not be sufficient for assessing the efficacy of cleaning processes; therefore, methods that are able to measure or detect organic residues should be considered in facility cleaning policy and procedures. Mechanical cleaning equipment performance should be tested each day the equipment is used, and all results should be recorded. After cleaning, personnel should visually inspect each item carefully for any residual soil. Sterilization cannot be assured unless proper cleaning of the device and reduced bioburden and soil was achieved. Verification and documentation of automated cleaning processes is an important aspect of quality control. Annex D in ANSI/AAMI ST79:2017 lists available methods for cleaning verification tests [e.g., adenosine triphosphate (ATP) and
chemical reagent tests for detecting clinically relevant soils such as proteins or carbohydrates]. The effectiveness of both manual and mechanical cleaning processes should be monitored and documented on an ongoing, periodic basis. Brushing is a cleaning function and therefore should not be performed in the clean (preparation and assembly) area. If a medical device is found to be dirty upon inspection in the assembly area, the device should be returned to the decontamination area for recleaning.
Unloading the sterilizer All items removed from the sterilizer, including items packaged in rigid sterilization container systems, should remain on the sterilizer cart and not be touched until adequately cooled. Facility policies should stress the importance of minimal handling of sterile items. When items are removed from the sterilizer cart, they should be visually inspected for external chemical indicators (CIs) that have reached their endpoint and for torn packaging or packages that appears to be wet. If a pack is torn or wet, it should not be used.
Handling and inspection Sterile packages should be handled carefully. The contamination of a sterile item is event-related, and the WWW.ORTODAY.COM
Mechanical equipment Mechanical equipment should be inspected and cleaned daily, in accordance with the manufacturer’s IFU. Examples of items that require daily inspection and/or cleaning include recording charts; printers; printer ribbons; marking pens and ink; door gaskets; chamber drain screens; the internal chamber; and external surfaces. Weekly or other prescribed inspections and cleaning should be performed as specified in the manufacturer’s IFU.
Point-of-use inspection
probability of its occurrence increases over time and with increased handling. Health care professionals should avoid dragging, sliding, crushing, bending, compressing, puncturing or otherwise compromising the sterility of the contents. All sterile items should be thoroughly inspected visually to identify any damage to the integrity of the packaging materials before the items are dispensed.
Before being opened, sterile packages should be inspected for the appropriate appearance of the external CI and the physical integrity of the packaging. If the packaging is a rigid sterilization container system, the external latch filters, valves and tamper-evident devices should be inspected for integrity. The external CI should be examined after sterilization and before the item is used to verify that the item has been exposed to the sterilization process. For all sterile packages, the internal CI should be inspected to confirm the appropriate response. Prior to placing the contents on the sterile
field, the bottom of the wrapper or container system should be visually inspected for integrity and moisture. The circulator should inspect container systems for the integrity and proper alignment of the plate and filter or valve. Rigid container lids should be inspected for the integrity of the filter or valve and gasket. – Rose Seavey, MBA, BS, RN, CNOR, CRCST, CSPDT, is President/CEO of Seavey Healthcare Consulting and former Director of the Sterile Processing department at The Children’s Hospital of Denver. Seavey served on the Association of periOperative Registered Nurses (AORN) Board from 2008 to 2010 and is a Past President of ASHCSP. She received numerous awards, including AORN’s Award for Mentorship in 2012 and Outstanding Achievement in Nurse Education in 2001, and the IAHCSMM Award of Honor in 2013. Seavey authored the book "Sterile Processing in Healthcare Facilities: Preparing for Accreditation Surveys," published by the Association for the Advancement of Medical Instrumentation (AAMI) and she serves on several AAMI committees where she helps write standards.
AED / Defibrillators
Infant Warmers
Anesthesia Machines Infusion Pumps Bladder Scanners
Patient Monitors
Blanket Warmers
Sterilizers
C-Arms / Mini C-Arms Surgical Lights EKG Machines
Surgical Microscopes
Electrosurgical Units
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MAY 2019 | OR TODAY |
21
INDUSTRY INSIGHTS
Operating Rooms
Process Improvement Teams A collaborative approach to meet the challenges of today’s operating rooms By David L. Taylor III, MSN, RN, CNOR
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he most relevant resource an organization has is its people. To stay nimble in today’s health care market, organizations need to develop and empower employees with greater responsibilities to develop sustainable solutions for complex situations health care organizations face. Perioperative leaders cannot be everywhere, and they don’t need to be. Employees should be trusted to make decisions. The OR is too complex of a department for this not to happen. Allowing employees to implement ideas will produce lasting effects. While he was the CEO of General Electric, Jack Welch spent half of his time developing people with special emphasis on developing future leaders.1 Teamwork and interdisciplinary collaboration can increase employee awareness leading to better communication and decision-making. This shared and participatory governance model gives employees a voice helping them to feel vested in the company which maximizes their efforts, having an immediate effect on patient outcomes.
Fostering and Empowering Your Teams Leaders have an obligation to bring their employees together and strive for one goal. That is to work harmoniously to support safe patient care. Ef-
22 | OR TODAY | MAY 2019
fective leaders recognize that organizational collaboration is an important part of being a transformational leader who encourages team participation as part of the problem solving process.2 By relinquishing control and advocating for decision making to come from those responsible for doing the work, a collaborative environment is created where employee opinions matter. This can have a lasting impact on the organization’s culture.
Process Improvement Teams Creating process improvement (PI) teams creates an environment that promotes the ideas of the employees; leaders who use PI teams will gain a greater share of employee’s expertise, opening new opportunities to improved quality, safety and financial performance. By recognizing the skills and expertise of employees and the willingness to share information not only helps generate ideas but develops skills within the service line as well. This supports quality and improved practice standards, which in turn reduces operating costs. Leaders who make the effort to bring the right people together create pockets of excellence that allow employees to take on greater responsibility for organizational performance. The concept of using frontline employees, in a semi-formal setting such as PI teams can produced some amazing results. Leaders who partner with their employees can address numerous difficulties within their service line, removing the silo mentality and
creating a culture of empowerment. Employees’ ideas help provide focus. Delegating authority will unite the PI teams toward a common goal. In turn these teams will push boundaries to improve performance and reduce the risks patients face when entering the health care environment. Employees who participate in a professional forum deliver results.
Building Your Team from Within When developing an effective PI teams leaders should consider including frontline employees at all levels from inside and outside of their service line. Front-line employees provide insights to everyday situations and act as live sounding boards for new process recommendations that can have an impact on the care environment. By including staff from various departments, the PI teams gain insight to the issues faced by all, bringing new perspectives to everyone. Leaders who create an environment that promote safety, accountability and collaboration will optimize the working relationship between the people of various departments. Supporting one another throughout the collaborative process helps inspire innovations that improve the delivery of safe and effective care. Exposing PI members to each other’s departments and work processes can have a positive effect as well. Observing how decisions are made and the impact those decisions will have on workload will help employees understand the importance of working together. It can also underscore WWW.ORTODAY.COM
the importance of their roles in the entire process. These experiences provide both parties with an in-depth understanding and allows members a chance to ask specific questions about points they may not fully understand, which in turn develops a more robust process. Overall transformation and cultural changes can be accomplished by implementing a series of PI teams that can be used to lead change in areas such as efficiency, staff education and safety, technology and value analysis. Leaders who utilize this type of method should know how important it is to listen to the input of the PI teams and take action. This prevents the team from becoming dissatisfied and feeling as if their efforts are being wasted. Leaders who build confidence among their employees help them to realize their ideas will be valued.3 Examples of PI teams and their responsibilities could include:
Efficiency and Safety • Include parallel processing • Review of key performance indicators and benchmarks, such as: »» First case on time starts »» Turnover times »» Block time and OR capacity • Create a safer surgery culture
IT/Communications/Education • Develop dashboards, scorecards and reports • Update IT and communication technologies throughout service line • Develop cross training initiatives that incorporate best practices
Value Analysis • Evaluate new equipment and review high cost supply spend • Review outsourced functions • Improve supply chain management
Financial Implications Organizations who are quality minded and focused on initiatives that put the ideas of their employees as a top priority have created high reliability services lines. Leaders who have WWW.ORTODAY.COM
incorporated direct engagement and embraced collaboration have not only aligned priorities that lessen the risks associated with health care, they have created tremendous financial opportunities for their organization as well. As a result of using PI teams several organizations have: • Rebuilt their staffing models around new block schedules that resulted in a $1.7M savings • Redesigned a perpetual inventory system resulted in $1.2M in savings • Through a multipronged approach, the organization decreased its cancelation rate to less than 2%, grew surgical volume 22% in a higher acuity platform, and gained a net income improvement of $7M • Developed a comprehensive capital equipment campaign to create competitive differentiation and first-to-market strategy that resulted in a 31% increase in surgical volume • Restructured a perioperative education, orientation and competency training program, resulted in a 50% reduction in staff orientation, reduced overtime by 33% and improved employee engagement 39% Although the financial considerations of a PI project are important, process improvement teams can also improve the quality of patient care by incorporating best practices and following the recommended guidelines of AORN, APIC, AAMI, TJC and CMS, creating an overall safer surgery culture. As a result of these management practices leaders who effectively empower their employees can deliver long-term results associated with real benefits for health care organizations and can: • Inspire creative thinking • Improve quality of work • Develop mutual respect and understanding • Increase employee and job satisfaction • Increase productivity while reducing costs
• • • •
Reduce employee turnover Better communication Learn to be flexible Show appreciation for a job well done
Conclusion Embracing the challenges and discovering opportunities in the unpredictable business of health care will create new approaches and help health care organizations uncover opportunities when employees have the autonomy and flexibility to question and connect with one another. Leaders who cultivate their employees allowing them to discover themselves, their passions and their commitment to the organization will produce a passionate workforce that is more committed to finding solutions and welcoming opportunities to try something new.
References 1. Hymowitz C, Murray M. General Electric’s Welch discusses his ideal on motivating employees. Wall Street Journal. June 21, 1999. http://www.wright.edu/~tdung/ welch.htm Accessed Feb 3, 2018. 2. Schwartz DB, Spencer T, Wilson B, Wood K. Transformational leadership: implications for nursing leaders in facilities seeking magnet designation. AORN J. 2011; 93(6):737-748. 3. Taylor, DL. Surgical Services Leadership: Insights, Priorities and Tools for Managing Change in the OR, AORN Journal July 2014, VOL 100, NO 1.
David L. Taylor III, MSN, RN, CNOR, is an independent hospital and ambulatory surgery center consultant and the principal of Resolute Advisory Group LLC, in San Antonio, Texas. He has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
MAY 2019 | OR TODAY |
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INDUSTRY INSIGHTS
WEBINAR SERIES
webinars
‘What’s Coming Home with your Scrubs?’ Presentation Delivers Knowledge Staff report he recent OR Today webinar “What’s Coming Home with your Scrubs?” featured Dr. John Kutz, F.A.C.S. Medical Advisor at RepScrubs. Kutz reviewed the impact of unclean hospital attire. The webinar, which was sponsored by RepScrubs, was well received by attendees and earned positive reviews.
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The webinar shared information about the history of hospital staff attire, the transition from formal to casual attire and the impact of scrubs on hospital function and efficiency. Kutz also discussed hospital scrub attire as a vector for infection transmission and the accompanying economic impact. The webinar drew 149 attendees for the live presentation and more have watched a recording of the presentation on the OR Today website. Attendees shared positive remarks regarding the webinar and the overall OR Today webinar series. “The webinar on health care scrubs presented by John Kutz, M.D., was informative and delivered by a medical professional both knowledgeable and passionate about the subject matter. Doctor Kutz understands the potential role scrubs and hospital attire can play in the disease infection cycle, specifically to compromised persons, both in the health care setting and the home,” said K. McLaren, director, research and development.
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“I count on your webinars to stay informed. Speakers are great, and it is a practical way to earn CE credit,” said M. Blacharski, surgery center advisor. “This webinar was eye opening to the amount of risk we take as health care professionals, by wearing our scrubs to and from the hospital. The presenter showed how we are not only putting our patients at risk, but ourselves, our families and the general public. Great presentation and extremely relevant to all positions in health care,” said M. Keel, staff nurse OR. “I love that they have webinars that I can ask questions as needed. I love that I can hear what other facilities struggle with as well. I would love to be the first facility to bring RepScrubs to Hawaii if not already here,” said J. Lesa, APRN/ CNS, surgical services. “Scrub attire is a hot topic and we learned that doing everything possible to protect our patients is not only possible, but a reasonable professional expectation. Having an automated and system-supported process can have positive impact on end-user behaviors and compliance,” said B. Bennett, CEO. “This is the second webinar that I have attended and I very much enjoyed it. This topic is relevant to all that work in health care and the speaker was knowledgeable and reasonable in his responses to questions,” M. Nguyen, senior manager clinical informatics. “OR Today’s webinars provide up-todate topics and discussion to keep attend-
ees in the communication loop,” said C. Bitler, staff RN. “Great presentation by Dr. Kutz! I love the history and I don’t understand why some people would want to launder their scrubs themselves. With all the multiantibiotic-resistant organisms nowadays, that’s something you don’t want to take home with you. For us in the operating room, all are required to return our scrubs in the machine otherwise we will not have anything to wear,” said C. Anonuevo, OR resource RN. “This webinar really hits home on the reality that is happening in health care today and the attire of health care staff. It is easy to become blinded to what we see every day in our facilities,” said A. McGonegie, RN, infection prevention specialist. “Excellent topic to generate awareness in health care professionals and public about potential infections from wearing scrubs in public,” said M. Tuazon, clinical nurse educator. For more information about the webinar series, visit ORToday.com.
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INDUSTRY INSIGHTS update
EARN UP TO
16 CEUs at
VEGAS WELCOMES OR TODAY LIVE CONFERENCE PREVIEW By John Wallace he conference tailor-made for you – OR Today readers – is headed to Vegas! Enjoy extreme luxury along with exceptional education, energizing networking and an excellent exhibit hall at OR Today Live! Join colleagues from around the nation August 18-20 at the newly renovated the Palms Casino Resort. Register at ORTodayLIve.com before May 31 and save!
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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. It provides world-class speakers in an environment designed to
26 | OR TODAY | MAY 2019
motivate and empower perioperative professionals just like you. Internationally recognized for its exceptional accommodations, highenergy nightlife, extravagant pools and world-renowned restaurants, the Palms Casino Resort captures all the excitement and energy of Las Vegas in one vibrant setting. Situated on nearly 30 acres, Palms is a boutique property with three distinct towers – each offering unparalleled views of the iconic Las Vegas Strip. Having recently undergone a multi-million dollar transformation that has left nothing untouched, the Palms has redesigned its rooms, added new culinary experiences, and created even more distinctive nightlife and daytime experiences. Also, the campus boats some of the most impressive artwork seen in any hotel including Damien Hirst’s shark art dubbed “The Unknown (Explored,
“ It was an excellent conference. The speakers were well informed, professional and engaging. The atmosphere was energetic, and fostered a professional learning environment.” Megan Beaton, Director of Surgical Services
Explained, Exploded).” The 13-foot tiger shark, caught by a fisherman in Australia, sits in three segments of steel and glass tanks, preserved in formaldehyde. The host hotel’s renovation and atmosphere will no doubt add to and maintain the intimate OR Today WWW.ORTODAY.COM
INDUSTRY INSIGHTS update
5 REASONS TO ATTEND
CNOR® Prep Course Prepare for the CNOR certification exam with this popular pre-conference course.
World-class Speakers
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OR Today Live brings together the best speakers from across the country.
Super sessions cover topics in depth and attendees will be rewarded with 3 CE hours.
Live experience. Unlike some other conferences, OR Today is designed to foster interactions and the sharing of ideas. Attendees will be actively involved from the minute they pick up their materials at the registration desk, to their first class, the exhibit hall, the welcome reception and all the way to the moment their leave for the airport. OR Today Live’s educational panel seeks out top-notch courses, yet some of the best lessons are learned from simple interactions with a colleague at one of the networking events at OR Today Live. It is all part of the design. The educational offerings include Super Sessions and a Keynote Address as well as more than 20 hour-long presentations! Attendees can earn up to 16 CEUs. An additional offering is a CNOR Prep Course. Whether you have registered for the CNOR exam or WWW.ORTODAY.COM
Networking OR Today Live provides multiple networking opportunities that are fun and engaging.
are thinking about it, preparation is the key to earning your credential. During this interactive course, you will prepare for the CNOR exam, with focused attention from a CNOR-certified professional in a live classroom setting. OR Today Live continues to be a smaller and more intimate perioperative conference. It has grown and continues to do so but the goal is to always maintain the unique blend or engagement and entertainment that makes it stand out to today’s perioperative leaders. “It was an excellent conference. The speakers were well informed, professional and engaging. The atmosphere was energetic, and fostered a professional learning environment,” Megan Beaton, Director of Surgical Services, said after a previous OR Today Live. This is a conference designed for you. It just happens to be in one of
Exhibit Hall Vendors showcase the latest technology and resources for your department.
the most popular destinations in the world. Don’t miss your chance to visit Las Vegas and leave with the latest information, education and a long list of new professional contacts from peers and businesses that can help you continue to succeed. Don’t miss early bird registration. Register now for only $250 and receive access to the CE Super Sessions, Welcome Reception, Education Sunday-Tuesday, Exhibit Hall and ORTL Finale Party. The price will go back to $300 after May 31. For more information, visit ORTodayLive.com. 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 MAY 2019 | OR TODAY |
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Anesthesia Devices Market to Hit $15.4 Billion by 2023 Staff report he “Anesthesia Devices Market by Product: Global Opportunity Analysis and Industry Forecast, 2017-2023” report has been added to Research and Markets’ offering.
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The global anesthesia devices market was valued at $9.563 billion in 2016, and is projected to reach $15.463 billion by 2023, registering a compound annual growth rate (CAGR) of 7.1 percent from 2017 to 2023, according to the report. The anesthesia delivery machine segment dominated the global market, accounting for a share of nearly half of the total market in 2016. Anesthesia is a medical procedure that is used to control pain during the course of a surgery. It is provided through pharmaceutical drugs called anesthetics with the help of anesthesia devices. Anesthesia devices are used during various surgical procedures, such as ophthalmology, dental, cardiology, and neurology for sedation to control breathing, blood pressure, blood flow, heart rate and rhythm, and manage pain. The anesthesia devices market is driven by an increase in the number of surgical procedures globally, advancements in technology and a rise in the geriatric popuWWW.ORTODAY.COM
lation, which is a population of people prone to surgical procedures. However, the high cost of anesthesia devices poses as a major hindrance to the growth of the market. Emerging nations are expected to serve major opportunities to the manufacturers of anesthesia devices. “The anesthesia delivery machine segment accounted for the major share in the anesthesia devices market and is expected to continue its dominance throughout the forecast period,” according to a press release. “This segment is expected to grow at a CAGR of 6.3 percent from 2017 to 2023, owing to high adoption of these devices during the surgical procedures.” A report from Mordor Intelligence that looks at the market from 2019 to 2024 also forecasts growth. “The anesthesia devices market is expected to register a CAGR of around 6.4 percent during the forecast period, according to the report. The most commonly used device is the continuous-flow anesthetic machine, which provides a continuous flow of air, containing a regulated supply of gas. Modern anesthesia devices include monitor and touch screen display, which help in monitoring heartbeat.” “The vast increase in the number of surgical procedures undertaken across the globe every year has played a major role
in the growth of the anesthesia devices market,” according to Mordor Intelligence. “The most rapid increase was observed for laparoscopic hysterectomies. As every surgical procedure can be painful, anesthesia is administered to the patient during surgical procedures to keep patients pain free and unconscious during the procedure. The increasing number of surgeries and anesthesia practices is driving the global anesthesia devices market in the forecast period. Other factors, such as technological advancements in the devices sector, large patient pool, and increased disposable income in emerging markets will boost the market in the forecast period.” North America is expected to maintain market dominance. “North America has the largest share worldwide. Geographically, North America dominates the market for anesthesia devices as it has many companies engaged in this sector,” Mordor Intelligence states. “Additionally, the disposable incomes of consumers and health insurance cover for life-threatening diseases in North America are very high, which boosts the growth of this market. Also, owing to a large number of patents in the United States, multinational companies and research organizations make substantial investments on research and development.” MAY 2019 | OR TODAY |
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IN THE OR
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30 | OR TODAY | MAY 2019
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IN THE OR
product focus
GE Healthcare Aisys CS2
The Aisys CS2 is a fully digital system – vaporizer, ventilator and gas delivery – designed for seamless connectivity with other medical devices and network infrastructure. It is designed with a highspeed, dedicated network connection that gives it a plug-and-play usability and 300 data points with each breath. This data can be connected to a cloud-based application to analyze the data. The system uses a digitally controlled flow valve ventilator for fast response times and a small 3.0 liter modular breathing system. The platform offers software features such as the ecoFLOW option for graphical representation of oxygen flow and anesthetic agent usage as well as advanced ventilation software. •
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MAY 2019 | OR TODAY |
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32 | OR TODAY | MAY 2019
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continuing education
Shared Governance: What it Can Mean for Nurses Robert G. Hess Jr., PhD, RN, FAAN, and Diana Swihart, PhD, DMin, MSN, APN CS, RN-BC, P-PCA, FAAN
he words “shared governance” have echoed in hospital hallways for decades, but many nurses remain unclear about its significance or application. Nurses who have only worked in traditional bureaucratic healthcare organizations may wonder why their leaders would allow, much less support, such a “fad.” They are concerned that managers may be restructuring themselves out
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of their jobs. These nurses may be puzzled how unit-level councils could be any different than routine staff meetings and be perturbed by what exactly should or could happen in them. They may remain skeptical about how participation in shared governance could possibly benefit them or their work, figuring it is one more managementcontrived obstruction to the care of their patients. And they’re wrong.
What Is Being Shared? In its nearly 40-year history in nursing, shared governance has been called many things: a concept, construct, model, system, philosophy — and even a movement. Also called collaborative governance, it is frequently referred to as shared decision making or shared leadership. Shared governance is all these things — and more. Shared governance is an organizational model that provides a structure for shared decision making among professionals about practice and clinical outcomes.1 With successful implementation, shared governance legitimizes the decision-making control of nurses over their practice while extending nurses’ influence to some administrative areas previously controlled by managers.2 Shared governance looks different in every organization because it is shaped by the mission, vision, values, and human factors of that particular organization.
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However, common to all models are the four foundations of every profession’s work: practice, quality, learning, and generation of new knowledge (research). In shared governance, these formal professional foundations are often organized into decision-making councils.1,3 Renewed and growing popularity of shared governance in healthcare is largely due to the continuing rise of the American Nurses Credentialing Center Magnet Recognition Program’s acknowledgment that professionals need a professional structure to sustain professional behaviors and excellence in clinical outcomes. Magnet applicant hospitals must meet the criteria for the structural empowerment of nurses — that is, demonstrate structures and processes that enable nurses from all settings and roles to participate in organizational decision-making groups that affect nursing practice.4 A successful shared
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 40 to learn how to earn CE credit for this module.
Goal and objectives The goal of this continuing education program is to help nurses better understand shared governance and how to implement a successful program. After studying the information presented here, you will be able to: • Describe shared governance and its main components • Identify barriers to successfully implement a shared governance model • List four ways to incorporate shared governance into organizational and unit activities
governance program satisfies this requirement. More importantly, shared decision making empowers nurses at every level to make decisions in areas of practice, quality, and competence, as well as the generation of new knowledge related to the profession and to patient care. WWW.ORTODAY.COM
IN THE OR
continuing education
This empowerment comes about through the principles of partnership, equity, accountability and ownership as espoused by Tim Porter-O’Grady, DM, EdD, ScD(h), APRN, FAAN, a leading authority in this area:3 • Partnership, which is essential to building relationships, involves nurses at every level in decisions and processes, inferring that each interprofessional and interdisciplinary team member is key in fulfilling the mission and purpose of the organization and is critical to the safe, effective, efficient care of patients at points of service and care. • Equity, which maintains a focus on services, patients, and staff, is the foundation and measure of value. Equity does not mean equality in terms of scope of practice, knowledge, authority, accountability, or responsibility. However, it does mean that each team member is essential to quality patient care outcomes and that no role is more important than another. • Accountability is the requisite to invest in decision making and express ownership in those decisions; accountability is the core of shared governance. • Ownership is the recognition and acceptance of the value of the profession’s work and how well individual staff members perform their professional roles. It designates where work is done and by whom to enable participation and contributions from all team members. Shared governance depends on how people interact within interprofessional and interdisciplinary teams, work groups, committees, councils, and communities of practice. ThereWWW.ORTODAY.COM
fore, nurses engaged in shared governance must be competent and confident when working with others. A set of principles integrating concepts in motivation and behavior (that is, the interactions among people and systems) are called human factors. They are the underlying elements of human behavior affecting organizational performance and outcomes. Behaviors — in conjunction with structures, processes, and strategies — can make or break any attempt to implement shared governance. The objective is to maximize teamwork and relationships to achieve common goals and overcome objections, such as “I’m too busy for one more meeting,” “It takes too much time away from patient care,” “I cannot see how this is going to help me be a better nurse,” “It doesn’t get me more money or better benefits, so why should I bother?” or “I don’t have enough staff to let them keep going off to meetings or have more meetings on the unit. We have patients who need them here!” In these comments, direct-care nurses and managers express concerns about how shared governance might affect them directly and their patient care indirectly. Nurses at all levels may be hesitant to engage in more meetings, committees, or councils, or to commit themselves to additional demands without incentives. These are opinions formed from working in autocratic top-down, rules-based practice settings. The idea of working in the autonomous, values-driven, participative, professional work environment that is part of shared governance may be difficult to envision. A decentralized management structure can help change the attitudes of staff nurses and managers accustomed to hierarchical management and leadership. Employee partnership, equity, accountability and ownership occur at points of service
(e.g., in patient care settings), where at least 90% of the decisions need to be made and owned by staff. Control in the professional practice environment shifts to practitioners in matters of practice, quality and competence. Only 10% of the decisions at the unit level belong to management.1,4 Ideally, all employees become “stakeholders” invested in the success of the units and the organization through shared governance. When they experience a supportive management system and work environment that engages the diversity of human factors through shared governance, anecdotal testimonials in the literature have suggested greater longevity of employment with increased employee satisfaction; improved safety, quality, and healthcare outcomes; and enhanced patient satisfaction and shorter lengths of stay. A growing body of solid research substantiates that shared governance is associated with empowerment, higher job satisfaction, enhanced self-concept, and increased selfconfidence in nurses.1,5,6 Additionally, preliminary studies are in progress linking shared governance to better patient outcomes.1,7 Ultimately, those who are happy in their jobs take greater ownership of their decisions and are more invested in patient outcomes. Employees, patients, the organization, and the surrounding communities benefit from shared governance.1
A New Order Many professional nurses long ago identified shared governance as a key indicator of excellence in nursing practice. The traditional, centralized management structures for command and control simply do not work well in recruiting and retaining qualified nurses. Micromanaged, hierarchical decision-making processes create barriers to employee autonomy and empowerment undermining service and quality MAY 2019 | OR TODAY |
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IN THE OR
continuing education of care — often generating distrust and the marginalization of employees.6 Today’s transformational, relationship-based, patient-centered healthcare environments demand a new paradigm in organizational cultures driven by technology. Leaders, administrators, and employees are learning and implementing new ways of thinking and working. In so doing, they see more clearly how nurses at points of service are critical to organizational success associated with changing these environments of care.1,3,8 Nurses are the critical professionals who do the work and connect the organization to the recipients of its care at points of service. An entirely different sense and set of variables now affect the design of the organization. Organizations that fail to initiate shared governance may be more prone to isolated work groups, breakdowns in communication, and reductions in workforce and productivity. For shared governance to work effectively, nurses must engage in shared decision making and shared leadership as part of their “business as usual.” Direct-care nurses identify problems to be resolved and opportunities to improve their practice, competencies, and patient care outcomes. Nurse managers help inform staff about decision making, providing important information, such as new hospital policies, directives, or financial concerns, that will influence staff deliberation and give staff the tools needed to help them arrive at effective decisions. Nurse managers then provide support and boundaries for their decisions and encouragement to the team as it implements them.
Building and Sustaining With shared governance, systems and teams drive the organization. The goal shifts to reshaping processes to fit people and their work.8 Power is
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transferred through shared leadership. Shared decision-making moves to points of service to facilitate cost-effective service delivery and nurse empowerment. This next step can be the most difficult: building a sustainable infrastructure for shared governance:1,3 • Communicate the strategic plan for building and sustaining the organizational management model for shared governance. All leadership and management must support the plan. Human, material, and fiscal resources must be committed to education and communication among interprofessional and interdisciplinary team members. • Establish a design team. When moving to sustainment, this team often transitions into the operations or coordinating council or committee with continuing oversight of the shared governance processes, bylaws, and charters. • Design a shared governance model and structure that fit the vision, philosophy, and culture of the organization, the nursing service, and the team-based care provided by interprofessional partners. Once a healthcare organization has adopted shared governance, practicing in a shared governance infrastructure and professional practice model is not optional. Ownership of and engagement and participation in the professional communities of practice are essential and must not be by convenience. If participation in shared governance is optional, then the option eventually becomes the rule.
How Organizations Lose Their Way “We tried shared governance, and it did not work here. The nurses really do not want shared governance —
they like things the way they are.” Misconceptions, pitfalls, and barriers will derail even with the best of intentions. Because organizations can easily lose their way, here are a few things to avoid: 1. Establishing shared governance only in a single department or an isolated “pilot” unit 2. Fostering competition rather than collaboration among units and disciplines 3. Tolerating nurse leadership at executive or middle management levels that fails to support or participate in shared governance • Having leadership that discounts the concept of shared governance at the unit level • Not providing enough resources for the implementation and ongoing work of shared governance at unit, departmental, or organizational levels • Not inviting nurses, nurse leaders, or interprofessional partners to participate in decision making at all levels of the organization • Not addressing the disengaged or even “toxic” employees (e.g., finding ways to engage them or helping them find a better fit elsewhere) • Not benchmarking, measuring, or monitoring progress in shared-governance activities and accomplishments • Failing to see the value of shared governance or to recognize the benefits of nurses engaged in autonomous professional practice “My nurse manager does not support shared governance on our unit.” Nurses with this concern report that their managers disengage from shared WWW.ORTODAY.COM
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governance by not allowing time for staff to attend council meetings, including unit-level council meetings; by taking over the unit-level council meetings and turning them into staff meetings, usually with the manager running the meeting; and, by providing limited support and resources for the units and nurses at points of service. Some nurse managers may refuse to allow staff to participate in any shared governance activities or facilitate involvement of direct-care nurses in organizational task groups and discount decisions made by direct-care nurses. At times, managers may need to confront nurses who use counterproductive and passive-aggressive behaviors to disrupt the work environment. However, some managers still will not relinquish their tight control and continue to use their authority autocratically. Over time, experienced nurses become frustrated and angry and may leave those managers. Too often, they also leave the organizations. Effective managers work with nurses through shared leadership. They hold staff accountable for a strong work ethic, intrinsic motivation, a positive attitude, and constructive conduct toward others. These managers maintain standards for professional integrity and accountability, engaged teamwork, and patient-centered care.9 Successful partnerships among leaders, managers, and staff require that each understand and respect the roles of the other. If not, they will have problems collaborating, acting responsibly, and being accountable for decisions and care.
Supporting Nurses How does a healthcare organization move toward shared governance? Here are some of the steps:1,3 1. Engage frontline staff and leadership in creating a plan for a shared governance model and WWW.ORTODAY.COM
bylaws regarding nursing practice, quality and competence 2. Build relationships to support shared governance at the unit level, including leadership and administrative relationships, interprofessional and interdisciplinary team members, and collaboration and collegiality 3. Establish unit-level councils and bylaws based on the overall strategic plan for organizational shared governance • Identify membership and roles of members (who should be on the unit council and why) in the bylaws • Identify the roles of the nurses, nurse manager, unlicensed assistive personnel, interdisciplinary team members, and interprofessional partners in shared governance • Delineate degrees of autonomy, responsibility, and accountability for shared decision making in unit-level councils • Identify a unit council facilitator to coordinate council activities and work closely with the nurse manager and direct-care nurses to determine which activities, projects, tasks, and unit issues/ concerns to bring before the council and what to communicate back to staff on all shifts • Always have an agenda for council meetings with targets for discussion and completion • Manage the meeting time carefully and facilitate group and individual opportunities to participate • Measure and monitor progress in building and sustaining shared governance processes and outcomes at
unit and service levels • Document, evaluate and report activities and progress related to shared decisionmaking processes for each unit • Create a quarterly report of activities, accomplishments, outcomes, and celebrations to record and communicate progress in improving and advancing professional nursing practice, quality, and competency through shared governance and influencing decisions across the organization • Provide continuing education and staff development through inservices and other venues to support shared governance (e.g., strategic planning; relationship building; negotiation skills and conflict management; time management; how to set up and conduct a meeting; nurse professionalism, such as participating in nurse specialty organizations and contributing to research; writing and presentation skills; participative scheduling; how to write and revise evidence-based practice policies and procedures; and how to navigate technology to access information and data) • Let nurses explore possibilities and try new ideas for improving practice in care settings — evaluate outcomes and implement successful changes (e.g., improved safety, efficiency, and efficacy of care provided) • Help nurses measure their growth and development in shared governance (e.g., have them take the Index for Professional Nursing Governance (IPNG), survey each MAY 2019 | OR TODAY |
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continuing education year to see how far they have come and to get ideas for continuing to advance in each of the six dimensions) and then report their challenges and achievements to other nurses, leadership and community partners3,5 • Address challenges and celebrate successes as they occur
Direct-Care RNs and Managers Together How can direct-care nurses and nurse managers partner to build shared governance into organizational and unit activities to engage nurses and others in the process and outcomes along the way?1,3,5,9 1. Communicate from directcare nurses to managers and vice versa. 2. Schedule a day-long retreat away from the organization to prepare organizational and nursing leaders to implement shared governance. 3. Create expectations for staff participation beginning in the new employee orientation. 4. Use journal clubs, for example, to bring nursing research to the bedside and engage direct-care nurses in evidencebased practice for developing and implementing advanced decision making, critical thinking, and clinical judgment. 5. Include direct-care nurses in the annual review of organizational competencies and unit/area needs and determine which competencies they will focus on for that year (highrisk/time-sensitive, changed, problematic, or new). 6. Train every RN on each unit/ area to be a charge or lead nurse and rotate the role and responsibilities to encourage the development of leadership skills and shared decision mak-
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ing among all team members. 7. Involve all staff members in adapting their schedules to accommodate the needs of their work area with nurse leaders stepping in only if stalemates occur or to help nurses with the process, and couple responsibility with appropriate levels of authority and accountability. 8. Communicate the process, expectations, roles, and responsibilities for nurses engaged in shared decision making. 9. Address management and leadership styles. 10. Make sure all nurse executives, directors, supervisors, and managers are trained and engaged in developing the shared governance process model before bringing staff into the mix. Otherwise, nursing leaders may become confused or uncomfortable and inadvertently sabotage the work before it even begins. 11. Recognize and celebrate direct-care nurses who represent their peers and patients on the central and unit-level shared governance councils and in communities of practice. 12. Display unit exhibits, bulletin boards, and other learning events, staff activities, certifications, and staff celebrations and awards. 13. Prepare, educate, and support managers about staff ownership and the need for management support, as this might be a new way of managing nurses for many; and precept and mentor them in their roles, responsibilities, and accountabilities in shared decision processes. 14. Take time to build an effective, efficient, safe infrastruc-
ture that supports behaviors related to ownership, autonomous practice, and shared decision making. 15. Remember to look at the big picture — think long-term and avoid short-term fixes, decisions, and actions, but pay close attention to the details — and participate in strategic planning. 16. Let people make mistakes — as long as they don’t jeopardize patient safety — as it is an excellent way to encourage learning and influence change. 17. Learn how to turn mistakes and missteps into building blocks and identify a point of stepping back to renew and refine your structures and processes. 18. Think proactive, not reactive; stop and take a deep breath before moving forward, speaking, or acting; ask questions; step back and look at the situation or event from a new perspective; and approach problems, crises, and disasters — potential and real — like a transformational leader. 19. Create, maintain, and share professional portfolios, and follow one another’s professional activities: presentations, academic advancements, certifications, and contributions through professional organizations, affiliations, committees, and advisory boards. 20. Listen actively (invest in what is being said) to learn from others and adapt to include their perspectives, as teams need active listening to consider any issue or point of discussion from all sides to make clear and accurate decisions together. 21. Be open and available to one WWW.ORTODAY.COM
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Resources Among abundant articles addressing shared governance, only a few guides for implementation exist: · Tim Porter-O’Grady, DM, EdD, ScD (h), APRN, FAAN, an expert in shared governance and governance leadership, provides resources for building healthy communities and facilitating the partnerships necessary to sustain them. His book, “Implementing Shared Governance, Creating a Professional Organization,” and its accompanying manual can be downloaded free of charge at http://tpogassociates.com/sharedgovernance/index.htm. · Barbara Haag-Heitman, PhD, RN, PHCNS, BC, and Vicki George, PhD, RN, FAAN, consultants and educators, have written a soup-to-nuts “Guide for Establishing Shared Governance: A Starter’s Toolkit,” published by the American Nurses Credentialing Center. Unfortunately, this is no longer being published, but copies are still floating around. · Diana Swihart, PhD, DMin, MSN, APN CS, RN-BC, P-PCA, FAAN, with Robert G. Hess, Jr., PhD, RN, FAAN, consultants and co-authors on shared governance, provide templates and resources for implementation in the third edition of “Shared Governance: A Practical Approach to Transforming Interprofessional Healthcare,” published by HCPro. · The Advisory Board Co. in Washington, D.C., has published its own guide for implementation, “Toward Staff-Driven Decision Making; Assessing, Building and Sustaining a Shared Governance Model,” available to its member organizations. · The Forum for Shared Governance, a clearinghouse for promoting and disseminating research and other information about shared governance and similar organizational innovations, maintains a free website at http://sharedgovernance.org.
another and set clear goals with time for feedback in both directions so there are no surprises at evaluation time. 22. Make provisions for the council chair to receive information, questions, ideas, requests, and cautions from nurse managers before each unit council meeting, as sometimes a unit council agenda will change with new information; then take a few minutes at the end of each unit council meeting to review what was learned, answer questions, and set goals for the next meeting. 23. Administer periodic surveys with instruments, such as the Index of Professional Nursing Governance, (IPNG) to assess how your organization measures up in building and sustaining shared governance.
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The IPNG can help guide the establishment, work, and progress of shared governance within nursing service. This valid, reliable instrument is expressly designed to assess overall shared governance in an organization through six dimensions related to control over personnel, influence over resources, participation in committees or councils, access to information, control over practice, and the ability to set goals and resolve conflict. The original 86item tool has been recently reduced to 50-items in the 3.0 version. The IPNG and the related Index of Professional Governance for measuring shared governance with nurses and allied health professionals are the only instruments of their kind and have been used in about 250 hospitals in the U.S. and internationally, translated in eight languages. Additionally, a new 25-item instrument, Council Health, has been created to evaluate the structure, activities,
and membership of divisional-wide and unit-based shared governance councils. Currently, use of the IPNG/ IPG is free of charge for academic researchers and students and Council Health is free to everyone with permission from the Forum for Shared Governance website. New investigations with these instruments populate the literature every year.1,10-15 Some considerations in selecting resources for implementing, managing, and sustaining your shared governance activities are: • Using templates for meetings, agendas, and minutes • Choosing appropriate guidelines to facilitate self- or participatory scheduling in your facility • Finding tips on how to support staff covering for nurses to attend their meetings • Reading the most recent research on shared governance • Comparing outcomes of Magnet organizations measuring their progress using the IPNG measurement instrument All of the above resources offer an excellent way to begin — and continue — your own successful, sustainable, shared governance journey. Robert G. Hess Jr., PhD, RN, FAAN, is executive vice president, chief clinical executive at OnCourse Learning; founder and CEO of the Forum for Shared Governance; and author of the Index of Professional Nursing Governance. Diana Swihart, PhD, DMin, MSN, APN CS, RN-BC, P-PCA, FAAN, is chief executive officer, American Academy for Preceptor Advancement; and nurse coordinator and analyst, National Center for Patient Safety, Department of Veterans Affairs, Office of Quality, Safety and Value. Swihart has provided operational leadership for the shared governance processes for multiple organizations nationally and internationally.
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continuing education
References 1. Swihart D, Hess RG. Shared Governance: A Practical Approach to Transforming Interprofessional Healthcare. 3rd ed.
CE635
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.
Danvers, MA: HCPro Inc.; 2014. 2. Hess RG Jr. Measuring nursing governance. Nurs Res. 1998;47(1):35-42. 3. Porter-O’Grady T. Interdisciplinary Shared Governance: Integrating Practice, Transforming Health Care. Boston, MA: Jones & Bartlett Learning; 2009. 4. American Nurses Credentialing Center. 2019 Magnet Application Manual. Silver Spring, MD: ANCC; 2017. 5. Anderson EF. A case for measuring governance. Nurs Adm Q. 2011;35(3):197-203. doi: 10.1097/NAQ.0b013e3181ff3f42. 6. Barden AM, Griffin MT, Donahue M, Fitzpatrick JJ. Shared governance and empowerment in registered nurses working in a hospital setting. Nurs Admin Q. 2011;35(3):212-218. doi: 10.1097/NAQ.0b013e3181ff3845. 7. Rheingans JI. The alchemy of shared governance: turning steel (and sweat) into gold. Nurs Leader. 2012;10(1):40-42. doi: 10.1016/j.mnl.2011.11.007.
Deadline Courses must be completed by 6/15/2020 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer. 4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test. 5. All users must complete the evaluation process to complete course. You will be able to view a certificate on screen and print or save it for your records.
8. Altman SH, Butler AS, Shern L, eds. Assessing Progress on the Institute of Medicine Report The Future of Nursing. Washington, DC: National Academies Press; 2016. 9. Wright D. Competency Assessment Field Guide: A Real World Guide for Implementation and Application. Minneapolis, MN: Creative Health Care Management, Inc.; 2015. 10. Measurement & accreditation: download the IPNG/IPG and council health files. Forum for Shared Governance Web site. http://sharedgovernance.org/?page_id=66. Accessed May 29 2018. 11. Al-Dib’i O, Al-Subhi S, Haines F. Nurses’ perception of professional shared governance at a multicultural hospital in Saudi
Accredited In support of improving patient care, OnCourse Learning (a Relias LLC company) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Arabia. Presented at: American Nurses Credentialing Center National Magnet Conference; October 5-7, 2016; Orlando, FL. 12. Tono R. Professional Nursing Governance: A Qualitative Systematic Review and Transcultural Adaptation From the IPNG to Use in Brazil [master’s thesis]. Florianópolis, Brazil: Federal University of Santa Catalina; 2015. 13. Cadmus E, Helms P, Christopher MA, Hawkey R. Interprofessional shared governance: the VNSNY experi-
OnCourse Learning is also an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider #50-1489). OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. Relias LLC is approved by the California Board of Registered Nursing, provider # CEP13791.
ence. Nurs Manage. 2015;46(9):34-41. doi: 10.1097/01. NUMA.0000470773.94859.2d. 14. Meyers MM, Costanzo C. Shared governance in a clinic system. Nurs Adm Q. 2015;39(1):51-57. doi: 10.1097/ NAQ.0000000000000068. 15. Hartley LA. Implementing shared governance in a patient care support industry: information technology leading the way. J Nurs Adm. 2014;44(6):315-317. doi: 10.1097/
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CORPORATE PROFILE
ACT-Paragon
THE NEW ACT-PARAGON
I
n December 2018, Jeff Ross, owner and CEO of Advanced Clinical Technology (ACT), made the spirited decision to purchase the assets of Paragon Service. This blending of two companies brings together the strength of Michigan’s biomedical powerhouse, ACT, and one of the nation’s most successful third-party anesthesia equipment specialty companies, Paragon Service. The newly rebranded ACT-Paragon now offers a full menu of biomedical services for a wide range of health care environments from clinic and surgery centers to hospitals and the O.R. environment that expands well beyond the Michigan border. ACT-Paragon also offers new and refurbished equipment to outfit any of the aforementioned settings. ACT-Paragon is a source for new Mindray Anesthesia machines and monitors, refurbished Sterilizers, Surgical lights, Surgical tables, Stretchers, all makes and models of Anesthesia machines and much more. ACT-Paragon is a “one-stop
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shop” for customers whether they are outfitting a new surgical center or adding to an existing portfolio. A full list of products and services can be found on the company’s website at www.AdvancedClinicalTechnology.com. The mission of the newly rebranded ACT-Paragon is to provide innovative health care equipment solutions from the initial purchase and set-up through the ongoing maintenance of the equipment. ACT-Paragon prides itself on making the process as simple as possible for its partners and providing the best customer service available.
A TALE OF TWO COMPANIES With 20 years of experience in the medical equipment field, Jeff Ross started Advanced Clinical Technology in 2009. Jeff Ross had a vision to create a company that could provide health care facilities with biomedical equipment services that would be able to support clinics, surgery centers and hospitals. By 2018, ACT had grown to service health care equipment at more than 50 facilities, maintaining a database that included tens of thousands of pieces of equipment and lending support on an asneeded basis to some of Michigan’s largest health care systems. However, this story starts even earlier. In 1991, Paragon Service was created following 10 years of anesthesia equipment sales and service. What started as a one-man operation grew into a successful company that marketed specifically to clients in periWWW.ORTODAY.COM
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CORPORATE PROFILE
ACT-Paragon
Q: Can you share a little bit about your company’s history and how you achieved success? Jeff Ross: Long hours and a lot of grit. Advanced Clinical Technology has worked hard for its great success with the biomedical and clinical engineering community while Paragon Service had accomplished the same with the Anesthesia market. The opportunity to combine the two businesses has been beneficial for all involved – the companies, the health care facilities and patients.
Q: What are some advantages that your company has over the competition?
operative environments and, more recently, the surgery center niche. Jeff Ross was Paragon Service’s first employee. Paragon Service specialized in anesthesia offering customers new Mindray anesthesia systems and monitors, as well as refurbished anesthesia systems from GE/Ohmeda, North American Drager and Penlon as well as a wide variety of monitoring solutions. Paragon Service also had a highly experienced service force in the Michigan/Ohio/Indiana region. Paragon Service was founded on the basic principles of excellent customer service and customer satisfaction. For over 20 years, they aimed to be the very best at providing innovative solutions for customers’ needs. Jeff Ross was an important part of the growth Paragon Service experienced. He designed some of the processes still being used today. Jeff Ross left Paragon Service and worked as an equipment coordinaWWW.ORTODAY.COM
tor and anesthesia tech at a local health system. Next, he went on to be Director of Operations for a Biomedical company that serviced seven states. Growing and learning prepared him to start ACT in 2009. ACT enjoyed success and grew through the years behind its quality service and specialized expertise in regard to medical equipment. With the purchase of the assets of Paragon Service in December 2018, another dynamic has been added to the ACT family. Along with an additional 70-plus hospitals and surgery centers, ACT-Paragon now provides a full Medical Equipment Management Plan (MEMP), Alternative Equipment Programs (AEP), life cycle planning, ASC consultations and the same service and support that its partners have come to admire and trust. Jeff Ross shared more information about ACT-Paragon in a questionand-answer session.
Jeff Ross: ACT-Paragon provides the perfect combination of anesthesia, sterilizer and biomedical sales and service. We can offer our customers a one-stop shopping experience. We also have decades of experience helping customers in a variety of health care settings including, but not limited to, experts in the perioperative setting.
Jeff Ross, owner and CEO of Advanced Clinical Technology (ACT)
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CORPORATE PROFILE
ACT-Paragon
Q: What is on the horizon for your company? How will it evolve in the coming years? Jeff Ross: We are on track to become one of the largest biomed/anesthesia service and sales companies in the Midwest. We continue to see the company grow as our reputation for quality and customer service continues to grow and attract new customers via word of mouth reviews and advertising.
Q: Can you please describe your company’s facility? Jeff Ross: We are located in small town America. We utilize 10,000 square feet of warehouse space with office suites and a conference area. We embrace the small-town America vibe while also growing to meet the needs of our growing customer base and corporate America.
" We continue to see the company grow as our reputation for quality and customer service continues to grow" – Jeff Ross
Q: Please tell me about your employees? Jeff Ross: ACT-Paragon consists of 17 highly skilled equipment specialists. Each brings their own unique passion to our new endeavors. We are fortunate to have talented team members who are dedicated to customer service. We would not be as successful as we have been, and continue to be, without the contributions of our talented and loyal team. Also, many of our customers have said that they would like to come work for us over the years. Currently, we have added two of our former customers to our dynamic team. For more information, call 800-448-0814 or visit www.actbiomed.com .
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LOOKING INSIDE ENDOSCOPE TRENDS BY DON SADLER
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lexible endoscopes are some of the most critical pieces of equipment used in operating rooms today. This makes proper endoscope cleaning and processing one of the most important tasks that perioperative nurses must perform.
F
Failure to properly clean and process endoscopes can lead to many different problems. These range from increased risk of infections and exposure of patients to hazardous and toxic chemicals to surgical delays that cost hospitals time and money.
High Infection Risk According to Mary Ann Drosnock, MS, FAPIC, CIC, CFER, RM (NRCM), senior manager of clinical education with Healthmark Industries, infections are at the top of the list of potential negative outcomes from failing to properly process endoscopes. “If an endoscope is not thoroughly manually cleaned and verified by inspection and cleaning monitors, organisms can survive the disinfection or sterilization process,” says Drosnock. “These organisms could be infectious to subsequent patients.” Natalie Lind, CRCST, CHL, FCS, education director with the International Association of Healthcare Central Service Material Management (IAHCSMM), says that the main priority when it comes to endoscope processing is making sure scopes are safe for use on the next patient. “We must produce a device that’s safe and poses no risk of infection to the next patient,” she says. “We also need to be concerned about damaging the endoscope.” Not all damage renders an endoscope unusable, Lind adds. “For example, cloudy lenses diminish WWW.ORTODAY.COM
the ability to visualize tissue, which fold process encompassing a visual could cause the physician to miss inspection with lighted magnification, something.” enhanced inspection into internal Improper handling of endoscopes channels using a borescope and a after processing can also lead to problems. “ If an endoscope is not thoroughly “Endoscopes must be manually cleaned and verified handled in a manner that by inspection and cleaning prevents contamination,” monitors, organisms can survive says Lind. “They must be the disinfection or sterilization stored dry and delivered safely to the patient process.” - Mary Ann Drosnock bedside.”
Increased Attention and Focus The good news when it comes to proper endoscope cleaning and processing is that the subject has gotten a lot of interdisciplinary attention over the past few years, says Erin Kyle, DNP, RN, CNOR, NEABC, perioperative practice specialist with the Association of periOperative Registered Nurses (AORN). “Because of this, a greater degree of interprofessional collaborative focus has now been placed on the whole process and how professionals can work together to improve it,” says Kyle. One result of this increased focus on proper endoscope cleaning and processing is that health care professionals are leveraging technology to streamline and standardize endoscope processing steps, she adds. Examples of this technology are automated endoscope reprocessors (AER), visual inspection with borescopes and endoscope drying cabinets. “These cabinets include continuous forced filtered air through the endoscope channels,” says Kyle. According to Drosnock, another result is the addition of a new inspection step after manual cleaning and prior to disinfection or sterilization. She explains that this new inspection step is a three-
cleaning verification test. “This is an exciting trend in endoscope processing,” Drosnock says. “A true state of the endoscope can now be assessed by showing whether there is residual debris left on the scope that could interfere with the disinfection or sterilization process,” says Drosnock. “It can also show whether there is damage to the endoscope that would render the item unsafe to use.” J. Scot Mackeil, CBET, senior anesthesia BMET, believes that adding a “pass through” reprocessing facility to provide separation between the dirty and clean sides of the cleaning facility is “one of the most significant upgrades to the practice.” “I also give a lot of credit to ECRI and AAMI for safety alerts, standards, education and outreach, as well as raising awareness and providing practical, effective and actionable scope safety practices, procedures and standards,” says Mackeil. “ECRI’s annual top 10 safety lists have focused on scope safety year after year,” Mackeil adds “AAMI standards on scope processing are key tools as well.”
National Best Practice Standard The national standard for best practices in endoscope processing is ANSI/AAMI ST91, “Flexible and MAY 2019 | OR TODAY |
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ENDOSCOPE TRENDS Semi Rigid Endoscope Processing in Healthcare Facilities.” Drosnock says this document was originally published in 2015 and is currently in the revision process. “The document provides guidelines for processing all types of flexible endoscopes and for all stages of reprocessing, including HLD and sterilization steps,” says Drosnock. “Information can be found for any type of flexible scope, including bronchoscopes, ureteroscopes, gastroscopes and colonoscopes.” ST91is applicable to all health care settings, not just hospital-based facilities. “This means all health care facilities that process endoscopes are held to the same standard of care,” says Drosnock. Meanwhile, the “AORN Guideline for Processing Flexible Endoscopes” was last updated for the 2017 edition of the “AORN Guidelines for Perioperative Practice.” “It’s great to see that many of the recommendations in these guidelines have become trends in current practice,” says Kyle. She notes a few of these recommendations in particular. For example, Recommendation VIII.c. indicates a preference for automated processing over manual methods. And Recommendation VII.c.1 specifies that internal channels of flexible endoscopes may be inspected using an endoscopic camera or borescope. “Visual inspection is a fundamental step in ensuring complete cleaning of all reusable medical devices,” says Kyle. “The use of borescopes is essential to achieve this crucial step when inspecting the most difficult to clean portions of endoscopes like the lumens, channels and elevator mechanisms.” In addition, Recommendation IX.b.1. states that flexible endoscopes
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should be stored in a drying cabinet. “This facilitates complete drying, decreases the potential for contamination, and provides protection from environmental contaminants,” says Kyle. Drosnock believes that these and other best practices for endoscope cleaning and processing should be engineered into the process as part of a quality management system. “They provide immediate feedback on the inspection and cleaning
soon as the scope is removed from the patient and is no longer needed in the procedure, complete decontamination is easier and takes less time,” she says. Finally, it’s imperative that decontamination personnel know whether point-of-use treatment occurred once they receive the endoscope. “This makes a difference in how they clean the endoscope,” she says. The endoscope manufacturer’s instructions for use (IFU) also must be
“ True endoscope safety requires adoption of best practices, vigilance and proven processing technologies. It also requires a pervasive infusion of training, excellence and safety mindedness on the part of all health care providers along the continuum of patient care.” - J. Scot Mackeil verification process and help prevent poor outcomes such as biofilm development, which can happen during drying prior to storage,” she says.
Collaboration and Communication Kyle stresses the importance of interdisciplinary collaboration and strong team communication when it comes to successful endoscope cleaning and processing. She mentions physicians, point-of-use personnel and decontamination personnel specifically. “Physicians should be knowledgeable about endoscope processing and supportive of the team doing the processing so they can perform all the steps correctly and never feel rushed,” she says. Expedient and correct point-ofuse treatment, commonly known as “precleaning,” is also essential to the process, Kyle adds. “When point-of-use treatment occurs with the correct solutions as
carefully followed. Lind says there is often tremendous pressure to quickly process endoscopes so they can be used again. “This pressure can tempt staff to shorten or skip steps in the IFU to meet time demands,” says Lind. “However, the IFU should always be followed exactly as written.”
A Culture of Safety Mackeil believes that proper endoscope cleaning and processing comes down to health care organizations fostering a culture of safety and performance excellence at all levels. “True endoscope safety requires adoption of best practices, vigilance and proven processing technologies,” he says. “It also requires a pervasive infusion of training, excellence and safety mindedness on the part of all health care providers along the continuum of patient care.”
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SPOTLIGHT
ON Nursing is a career of tremendous diversity, both in terms of the specializations it offers and the people who choose them. For Jill Conklin of Pennsauken, New Jersey, it wasn’t her occupation, but it has become the one most resonant with her life experience. After college, Conklin entered the nonprofit fundraising world. But when her father developed a degenerative illness that left him requiring 24-hour in-home care, she quickly became proficient in all the medical technology and protocols that supported him. “Just learning the whole picture of a critical care patient happened long before I got into nursing,” Conklin said. Within a few years, she realized that helping to care for her father had unlocked something within her. “I thoroughly enjoyed taking care
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BY MATT SKOUFALOS
Jill Conklin,
of my dad, and decided it wasn’t just because it was my dad,” Conklin said. “I wanted to learn more of the medical field, and decided to put myself through nursing school.” In 2012, she joined a 15-month accelerated nursing program at Rutgers University-Camden, and fully embraced the pace of her practical education. While rotating through teaching hospitals on both sides of the Delaware River, she eventually landed at Cooper University Hospital in Camden, New Jersey. Along the way, Conklin honed her understanding of medically complicated patients that had been informed by the experiences of caring for her father. In her final semester of nursing school, however, she found herself pressed to demonstrate that knowledge on the spot. Conklin chose the cardiac ICU for her last rotation assignment because it wasn’t an area of strength, and she wanted to become more familiar with the work. One night, her preceptor brought her into the room to help revive a patient who was deeply ill. It was effectively a crash course in cardiac care. “You learn from being thrown in,” Conklin said. And then, exactly seven days
RN, BSN
later, when her father’s respirator malfunctioned at home, Conklin calmly sprang into action. “If it hadn’t been for that room I was in, I wouldn’t have known to kick myself into gear,” she remembers. “I was able to bring him back.” The experience so stuck with her that Conklin decided to transfer to the cardiac care unit at Cooper after spending the early years of her career in a step-down unit. “It’s a neat thing to be on that unit now,” she said. “I wanted to get to that spot again; I needed some time to understand what the profession really is.” Conklin doesn’t discount the time she spent in critical care, either. With 90 percent of her patients in that unit being post-surgical, she learned to manage the needs of multiple vulnerable patients simultaneously. “It can be a little hectic for the nurse that doesn’t really have a grasp on what they’re doing,” Conklin said. “The patients were just that much sicker.” Although she came to nursing as a second career, Conklin appreciates the myriad opportunities it offers for her future. When she wanted to work more hours, she added a perdiem position at a nearby hospital.
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I HAVE SHADOWED QUITE “ A FEW FLIGHT NURSES ON A FEW 12-HOUR SHIFTS, AND IT IS PROBABLY ONE OF
THE COOLEST RUSHES YOU COULD EVER HAVE.
Were she to start a family, she could switch assignments to find a more compatible schedule. And were she to pursue an advanced degree, working at a teaching hospital affords her the chance to do so affordably. “A nurse should never get bored in her profession,” Conklin said. “The second you get bored, you should start looking for a different avenue.” “I can work as much or as little as I want,” she said. “You can be exposed to more or to less; [you can] pick your specialty and stick with it.” Nursing is also the field in which she could synthesize those diverse experiences into her horizon goal, which is a broader, more adventurous assignment — flight nursing. “I have shadowed quite a few flight nurses on a few 12-hour shifts, and it is probably one of the coolest rushes you could ever have,” Conklin said. “That’s next on the to-do list.” Among the “whole heckuva lot of certifications you have to obtain to
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get there” are reasonably lengthy turns in cardiac and intensive care, which only means the years she spent in previous assignments haven’t been wasted. “I’m in the right position right now to start that journey,” Conklin said. “It’s just a matter of putting the time in and seeing where it leads.” If bedside care becomes too physically demanding, Conklin also knows she can push into a master’s in nursing administration; her background in finance would certainly accommodate such a transition, and colleagues have already told her as much. For the time being, she is happy to leverage her personal and professional perspectives on patient care in her current role. Conklin believes that both are necessary to do her job well. “I know how it feels to be on both
”
sides of the coin,” Conklin said. “I understand what it feels like to be that family member and hear an alarm go off and have no idea what it means. I understand how it feels to be a family member who knows quite a bit about how to care for someone and having a nurse who doesn’t respect that.” “I’ve been through it,” she said; “I was there for 14 years. I have that experience. I can take that and just run with it.” Or, in a few more years, fly with it.
Would you like to nominate someone for the spotlight article? Visit ortoday.com/nominations/
MAY 2019 | OR TODAY |
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OUT OF THE OR fitness
Stressful Day? Start with a Peaceful Morning! By Miguel J. Ortiz ith stress playing such a huge role in our lives sometimes it’s hard to unwind from the day. We all have those stressful days that tend to bleed into the rest of the week and it can be difficult to manage depending the type of stress you’re dealing with. Whether you have to adjust your schedule constantly or are dealing with general work and life stress, a morning routine that helps clear the mind will ensure you start your day strong. It will absolutely help the stresses you’re dealing with.
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I have studied a lot of different morning routines done by celebrities, CEOs and entrepreneurs. I have found, that regardless of each individual’s stress level, they all have a very consistent morning routine. No matter how extreme one might perceive another’s morning routine to be, the science undoubtedly proves that starting your day with focused intention will add a tremendous amount of quality to your
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life. Some routines are as simple as taking a cold shower to help wake up or listening to relaxing music while you get ready for work and some enjoy a brisk run. Whether you’re going to be more efficient with your time or wake up earlier, a change must be made. What’s important is understanding what you need in the morning to help start your day? Is your behavior during the day sluggish and tired? Are you simply looking to add some energy to your day? Or, do you want better focus without being distracted easily? These are questions you need to answer for yourself as it will help create a goal and find a routine that is appropriate for you. For people looking for a little more focus, start with either guided meditation or increased intention toward a goal within your first 10 minutes of the morning. I personally started by focusing either on gratitude and appreciation for previous events or sometimes playing out meetings and conversations in my head that I know I would embark on that day. As the weeks went on, I started feeling way less rushed and
had more confidence throughout the day. I had less stress and even started adding small bits of yoga poses and music into my morning routine. The more consistent I was with my intentions, the more aware I became and the stress continued to fall off my shoulders. When starting your morning and practicing a routine remember that consistency and practice are the keys to success when it comes to eliminating stress and opening up clarity. Take your time, and try different routines. Whether you’re going out for a quick 30 minute run or just meditating in the living room, focus on the now. Focus on what you want to accomplish or eliminate. Lose yourself in the movement and start your day with purpose. 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
Survey We Want Better Sleep, But Only if it Comes Easily oyal Philips, a global leader in health technology, recently announced the findings from its annual global sleep survey in a report, “The Global Pursuit of Better Sleep Health.” The survey, executed each year in recognition of World Sleep Day (March 15), surveyed adults in 12 countries to capture attitudes, perceptions and behaviors around sleep. Results showed that while awareness of sleep’s impact on overall health is on the rise, for many across the globe, achieving quality sleep health remains elusive.
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Despite 77% of surveyed adults recognizing that sleep has an impact on health, 62% admitted they sleep only somewhat well and 44% stated that their sleep has worsened in the past five years. According to the Centers for Disease Control and Prevention, about 70 million Americans suffer from chronic sleep problems1 and poor sleep health resulting in sleep deprivation, which has a high correlation to depression, obesity, diabetes, heart disease, stroke, neurocognitive disease and even cancer2. The survey, executed by KJT Group on behalf of Philips, interviewed 11,006 WWW.ORTODAY.COM
respondents in Australia, Brazil, Canada, China, France, Germany, India, Japan, Netherlands, Singapore, South Korea and the United States. The findings showed that most respondents would rather consult the Internet than a physician when it comes to sleep-related issues. Eight in 10 global adults want to improve the quality of their sleep, but the majority (60%) have not sought help from a medical professional. When struggling with sleep issues, those surveyed said they’re also most likely to turn to online information sources for their sleep concerns. Even more concerning, 65% of those who reported having sleep apnea have either never used or are no longer using sleep apnea therapy to treat their disease. “This data suggests that while people are waking up to the reality that sleep is fundamentally important, for most people, achieving quality sleep is still out of reach,” said Mark Aloia, Ph.D., global lead for behavior change, sleep & respiratory care at Philips. “If we want to take sleep seriously and address the social and emotional aspects of poor sleep, we must begin to demonstrate that we can address these problems in both easy and meaningful ways that are supported by strong clinical science. Part of what we’re working toward at Philips is evolving our offering of clinically validated solu-
tions with a hope of addressing 80% of sleep issues across the globe in the near future. The hope is that people who have struggled with varieties of sleep issues for so long will have options available to them to sleep and live better.” The survey also found that 76% of adults surveyed globally experience at least one listed condition that impacts their sleep, with insomnia (37%) and snoring (29%) being the most common, an increase from the 2018 survey which showed 26% reporting insomnia, and 21% reporting snoring, respectively. With so many potential factors impacting a good night’s rest, Philips aims to use this data to help people across the globe understand not only the value of sleep, but how to start improving their sleep habits. For more information, visit Philips.com/ WorldSleepDay. 1 https://www.cdc.gov/sleep/about_us.html 2 https://www.ncbi.nlm.nih.gov/books/ NBK19961/
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OUT OF THE OR EQ Factor
How Managers use the EQ Model By Daniel Bobinski f you’re wondering how managers use emotional intelligence (EQ), I suppose it depends on how effective those managers want to be. If they want to be top performers, they need to use it well.
I
Why? Because a strong correlation exists between how well managers use emotional intelligence and their performance ratings. Research in over 200 companies worldwide shows that in middle management positions, two-thirds of the difference between average performers and top performers is emotional intelligence. This means that if you’re rated as an average manager and you’d like to be a top performer, the biggest bang for your buck will be studying EQ. How does one use it? The four-step EQ model provides
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a great foundational framework. It starts with step one, self-awareness. Managers need to know their own strengths, their weaknesses, their personal goals and motivations, and also their behavioral and cognitive styles. Multiple assessment tools, such as a DISC behavioral style assessment or the Cognitive Style Indicator, help a lot in this effort. The second step is self-management. I often refer to this as “work management.” In other words, what are the best ways to do our own work effectively? As a hint, we’ll need to use what we learned in step one so we can capitalize on our strengths and also know when to ask for help. To borrow a line from a famous Clint Eastwood movie, a man’s got to know his limitations. Step three is called social awareness. In the workplace, it starts with
knowing the strengths and weaknesses of the people on our team. This is a core responsibility of management that is rarely emphasized in management schools. As one client told me, “In my business degree, they taught me project management and accounting, but never how to run a team.” One thing to realize here is that understanding people doesn’t happen by osmosis. A manager must become a student and purposefully learn the strengths, weaknesses and motivations for each person on his or her team. With that knowledge, managers are equipped to excel in step four, relationship management. In this step, managers know how to best interact with each employee, as well as to how to best delegate. All of this makes managers more productive, effective and profitable. And isn’t that what we expect from managers? Don’t we want them to WWW.ORTODAY.COM
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Daniel Bobinski, M.Ed., is a certified behavioral analyst, a best-selling author and a popular speaker at conferences and retreats. He loves working with teams and individuals to help them achieve workplace excellence. Reach him through his website, www. MyWorkplaceExcellence.com, or 208 375-7606. WWW.ORTODAY.COM
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create productive, effective and profitable workplaces? Let me also state that if you’re a manager, you’re never too old or too young to learn EQ. The other day I read that people can’t learn EQ after their 40s. What nonsense! I’ve had lots of clients in their 50s and 60s who’ve learned EQ and put it to work right away with excellent results. As I’ve observed in my 30 years of working with teams and team leaders, managers and supervisors who become students of their people are the most effective managers. Why? Because when they’re aware of each team member's strengths, weaknesses and motivators, they know how each person performs best. The result is a top-performing team and a highly rated manager.
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MAY 2019 | OR TODAY |
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OUT OF THE OR nutrition
The 10 Things You Should be Eating for your Health By Joy Stephenson-Laws erhaps one of the greatest lessons I have learned during my three decades in health care is that good nutrition is the foundation for a healthy life. The body needs a balance of six essential nutrients (carbohydrates, protein, vitamins, minerals, fats and water) to function at its best. And it’s best to aim to get as much of these six nutrients as possible from fresh vegetables, fruits and grains.
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In my opinion, the following 10 foods fit the bill because they are nutrient-dense, available throughout most of the year and easy-toprepare: • C oconut Water – Not to be confused with coconut milk, coconut water is the clear liquid from inside the coconut and it is great for hydration. The minerals in coconut water such as potassium, calcium, magnesium and phosphorous facilitate bone health, digestion, weight management and reduce blood pressure. • Organic Brown Rice – One of my favorite carbohydrates. It is usually referred to as a “good
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carb” because it is rich in fiber as well as minerals such as magnesium, selenium and manganese. It is a low glycemic food which means it helps to keep your blood sugar in check. • Black Beans – Some people use black beans as a meat substitute by making black bean burgers. You can also serve black beans over brown rice for a nutritious meal. They are low in fat and a great source of calcium, magnesium, folate, vitamin K, protein and other nutrients. • Kale – This green leafy vegetable has earned its reputation as a “super food.” Kale, which can be prepared in a variety of ways, is full of vitamin C, vitamin A, vitamin K1, vitamin B6, potassium, magnesium, calcium, manganese and copper. As an added bonus, it is rich in chlorophyll which some researchers suggest may be helpful in treating anemia. An average serving only has about 50 calories and even has fiber and protein! • Garlic – Another powerhouse, garlic contains a number of antioxidant and sulfur compounds that have been shown to be helpful in the prevention of
cancer, as well as cardiovascular, neurological and liver diseases. It also has antibacterial effects, boosts the immune system and increases insulin sensitivities. • Potato – This ubiquitous and humble food has a little bit of everything. It has a variety of vitamins and minerals, including manganese, potassium, vitamin C, vitamin B, iron and copper. It’s also very versatile and filling. Yams and sweet potatoes are more complex than regular potatoes, so they may be a better choice for many people. • Eggs – Eggs are usually referred to as “nature’s multivitamin pill” because they contain significant amounts of vitamins A, D, E, and a range of B vitamins. They also contain a ton of minerals – 10 of them! They include zinc, potassium, sodium, copper, iodine, magnesium and iron. And, according to the Heart Foundation, eating 6-7 eggs a week will not increase your risk of heart disease when eaten as part of a healthy eating pattern. • Avocados – They are full of critical minerals and vitamins. Avocados are also known for having a ton of healthy fats WWW.ORTODAY.COM
including monounsaturated fatty acids (MUFAs) which helps prevent accumulation of abdominal fat and diabetic health complications. They are a perfect addition to your salad, sandwich or side dish. • B lueberries – In addition to tasting great, blueberries (which are full of antioxidants) may help fight cervical cancer, improve memory, and help control blood pressure and cholesterol. • Dark Chocolate – Of course, there has to be a “fun food” on the list. Dark chocolate is full of antioxidants and minerals such as copper, iron and manganese. Research indicates that it offers a variety of benefits, including lower stress hormones, improved cardiovascular health, lower blood pressure and improved brain function. Joy Stephenson-Laws is the founder of Proactive Health Labs (www.phlabs.org), a national 501c3 nonprofit health information company that provides education and tools needed to achieve optimal health.
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OUT OF THE OR
Recipe
recipe
the
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Caramelized Onion and Short Rib Soup INGREDIENTS: For the soup: • 2 tablespoons olive oil • 8 large sweet onions, like Maui or Vidalia, thinly sliced • 1 teaspoon sugar • 1 cup dry red wine • 10 cups short rib stock (see following recipe) • 4 garlic cloves, minced • 1 bay leaf • 1/2 teaspoon minced fresh thyme or 1/4 teaspoon dried • Salt and freshly ground black pepper For the topping: • 12 (1/4-inch) slices French bread, baguette style • 1/2 cup shredded Gruyere cheese (just under 2 ounces) • 1/4 cup freshly grated Parmesan cheese • 2 tablespoons finely chopped parsley, for garnish For the short rib stock: • 3 tablespoons olive oil • 2 pounds short ribs with bones attached • 2 celery stalks, cut into 2-inch pieces • 2 medium carrots, peeled and cut into 2-inch pieces • 1 large onion, root end cut off, cut in half • 1 cup dry red wine • 1 bay leaf • A few whole parsley stems • Salt
Diane Rossen Worthington is an authority on new American cooking. She is the author of 18 cookbooks, including “Seriously Simple Parties,” and a James Beard Awardwinning radio show host. You can contact her at www.seriouslysimple.com. WWW.ORTODAY.COM
Maui Onion Soup is Worth the Time have been chilled to the bone with uncharacteristically freezing weather this year. (I live in Los Angeles, and cold for me is 60 degrees!) I think I’ve cooked more soups and stew this season than any other dishes. After all, when it’s cold outside we crave comfort food. And this dish is it. Oddly enough, I tasted this creative and hearty version at the Montage Kapalua Bay Hotel’s Cane & Canoe restaurant on a warm Hawaiian evening. I was surprised that this rustic soup was on the menu, given the tropical weather. It didn’t seem to matter what the outdoor temperature was, because the soup was that delicious. It was so good that my family ordered it twice during our stay. When I asked Chef Christopher Damskey what made this soup such a standout, he gave me his recipe. It requires the cook to make a short rib stock first and then caramelize the onions. The key is to slowly caramelize the onions in order to bring an especially rich flavor to the soup. It is amazing to watch a mountain of onions become only a few cups after cooking. A reduction of
I
OUT OF THE OR recipe
red wine in the cooked onions offers an extra flavor layer. And then blending the onions with the savory short rib stock brings the intense tastes together. Finally, adding small shredded or cut-up short rib pieces to the soup adds a substantial component to the soup. I’ve tried to streamline Damskey’s recipe while leaving in the important components. This is the soup to make on a weekend when you have the time to make the stock one day and then the soup the next. Remember, that you need to make the stock before you can make the soup. I also noticed that the soup was served two different ways during out visit. Once it had cheesy croutons on top; another time it was served with a giant baguette slice covered with melted cheese. I like my baguette cheese croutons that are easy to put together and lighter than the usual fondue-style onion soups. Try varying the crouton topping with different melting cheeses like fresh goat cheese, teleme or Italian fontina. I like to accompany this dish with a red wine like zinfandel or a Rhone-style red to stand up to the deep rich flavors.
Caramelized Onion and Short Rib Soup Serves 3 to 4 as a main dish; 6 as a first course 1. 2. 3.
4.
5.
In a large non-aluminum Dutch oven, heat the oil over medium-high heat. Sauté the onions until wilted, tossing and turning frequently, about 15 minutes until lightly browned. (Tongs work well for this) Add the sugar, turn down heat to medium and continue cooking, stirring frequently, until caramelized, about 30 to 45 more minutes. You are looking for a dark caramel color. Add the wine and reduce until it is almost gone, about 10 minutes. Add the stock, garlic, bay leaf and thyme, and simmer for another 20 minutes. Add salt and pepper, and taste for seasoning. Discard the bay leaf. Add the cooked short rib pieces, and simmer another 5 minutes. Taste for seasoning. When ready to serve, ladle the soup into heated soup bowls. While the soup is cooking, place the bread slices on a cookie sheet and under a preheated broiler; broil until golden, watching carefully to prevent burning, about 1 1/2 to 2 minutes. Sprinkle each slice of bread with an equal amount of Gruyere and Parmesan cheese, and reserve. Just before serving, broil the croutons for 1 to 2 minutes more, or until the cheese is just melted. To serve, float 2 or 3 croutons on the top of each bowl of soup. Sprinkle remaining cheese mixture and a little chopped parsley over each soup bowl for garnish. Advance Preparation: This dish may be prepared up to three days ahead through Step 3, covered and refrigerated. Re heat gently. It also freezes well. Adjust the seasonings when you reheat the frozen soup.
Short Rib Stock Makes about 2 quarts 1.
In a 6-quart stock pot add the oil on medium-high heat. Add the short ribs and brown on all sides, about 5 minutes. Add the celery, carrot and onion, and sauté until nicely softened, about 4 minutes. 2. Add enough cold water to fill the pot 3/4 full (about 10 cups). Add wine, bay leaf and parsley stems. Slowly bring to a boil over medium-high heat, uncovered. Turn down the heat as low as possible, partially cover and simmer for 2 1/2 to 3 hours. Check to see if the short ribs are tender. Taste for seasoning. Add salt to taste. 3. Remove the short ribs to a cutting board, and let cool slightly. When cool, remove bones and fat, and cut the meat into 1-inch pieces. Place in small bowl, cover and refrigerate until using. 4. Strain the stock through a colander or strainer lined with cheesecloth. Let it cool and refrigerate. When chilled, with large spoon remove the fat from the surface and discard it. Refrigerate until using. WWW.ORTODAY.COM
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Cooking Tips to Save Money
5. Cook once, eat twice. Try doubling recipes so that you can get ahead on cooking and have a dinner or lunch ready for later. Recipes that freeze well are great ones to double. Also, consider cooking an extra chicken or more meat than you need. The leftovers are great in soups, salads, quesadillas or hash later in the week.
6. Pack a lunch. If you’re making a salad for dinner, make a little extra and put it in a container, undressed, for lunch the next day. Packing lunch is a great way to make sure you’re not wasting any leftooking and eating healthy, bud2. Cook ‘em low and slow. overs – and to help you eat healthy, get-friendly meals takes a little Tougher cuts of beef and pork are a save money and save time throughout planning, but it’s well worth the effort. lot cheaper than steaks and chops. The the day. Once you’ve made a weekly meal plan best way to cook tough cuts of meat: and gone shopping for the ingredicook them low and slow, usually for 7. Feed yourself (not the birds) with ents, it’s time to roll up your sleeves three or more hours, often in liquid, to stale bread. in the kitchen. You can save money make them melt-in-your-mouth tender. Turn stale bread into croutons for in this department, too; get familiar salads or soups. Just toss cubes with with the best cooking techniques for 3. Add pasta or rice. oil and some seasonings and bake inexpensive ingredients. Be prepared Got a few vegetables or a little leftthem. Or make breadcrumbs to use in with clever ways to use leftovers or over meat? Pasta and rice are cheap, recipes that call for breadcrumbs. foods that are a bit past their prime. healthy pantry items that let you turn And, of course, know how to properly a few leftovers into a meal. Try quickly 8. Hold onto brown bananas. store leftovers and extra ingredients sautéing peppers and onions and toss- Peel and freeze overripe bananas if to avoid waste. Here are some tips to ing them with noodles, herbs and a you don’t have time to use them imhelp you save money in the kitchen. little cheese, or add rice into a vegeta- mediately. Throw them into smoothble soup to make it more satisfying. ies or defrost them when you want to 1. Cook and serve the right portions. make some banana bread or muffins. If you’re eating meat for dinner, aim for 4. Make stir-fry for dinner. it to take up no more than one-quarter Stir-frying with plenty of vegetables – EatingWell is a magazine and webof your plate. Fill half the plate with and just a little bit of meat is an obvi- site devoted to healthy eating as a way vegetables and the final quarter with a ous choice when you want to make a of life. Online at www.eatingwell.com. whole grain. Eating less meat is better quick and healthy dinner. for your health and your budget.
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INDEX
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Alphabetical ACT-Paragon……………………………………………… 42-45
Cygnus Medical…………………………………………………… 9
Mobile Instrument Service & Repair………………17
Action Products, Inc.……………………………………… 59
Healthmark Industries Company, Inc.…………… 4
Molnlycke Health Care…………………………………… 25
AIV Inc.…………………………………………………………………13
Heartland Medical Sales Service………………………15
oneSOURCE Document Site………………………… 28
ALCO Sales & Service Co.…………………………………61
Innovative Medical Products………………………… 68
OR Today Webinar Series…………………………………41
Avante Patient Monitoring……………………………… 10
Jet Medical Electronics Inc…………………………… 59
Pure Processing………………………………………………… 33
C Change Surgical……………………………………………… 6
MD Technologies inc.……………………………………… 55
Ruhof Corporation…………………………………………… 2-3
Calzuro.com…………………………………………………………19
MedWrench……………………………………………………… 46
Soma………………………………………………………………………21
Capital Medical Resources…………………………………61
Microsystems……………………………………………………… 5
TBJ Incorporated…………………………………………………51
GENERAL
REPAIR SERVICES
categorical ANESTHESIA
ACT-Paragon……………………………………………… 42-45 Heartland Medical Sales Service………………………15 Soma………………………………………………………………………21
ASSET MANAGEMENT
Microsystems……………………………………………………… 5
BIOMEDICAL
ACT-Paragon……………………………………………… 42-45
C-ARM
Soma………………………………………………………………………21
CARDIAC PRODUCTS
AIV Inc.…………………………………………………………………13 Capital Medical Resources…………………………………61
HOSPITAL BEDS/PARTS
ALCO Sales & Service Co.…………………………………61
INFECTION CONTROL
ALCO Sales & Service Co.…………………………………61 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4 Pure Processing………………………………………………… 33 Ruhof Corporation…………………………………………… 2-3 TBJ Incorporated…………………………………………………51
C Change Surgical……………………………………………… 6 Jet Medical Electronics Inc…………………………… 59
INSTRUMENT STORAGE/TRANSPORT
CARTS/CABINETS
INSTRUMENT TRACKING
ACT-Paragon……………………………………………… 42-45 ALCO Sales & Service Co.…………………………………61 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4 TBJ Incorporated…………………………………………………51
CS/SPD
MD Technologies inc.……………………………………… 55 Microsystems……………………………………………………… 5
DISINFECTION
Cygnus Medical…………………………………………………… 9 Ruhof Corporation…………………………………………… 2-3
DISPOSABLES
ALCO Sales & Service Co.…………………………………61
ENDOSCOPY
Capital Medical Resources…………………………………61 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4 MD Technologies inc.……………………………………… 55 Mobile Instrument Service & Repair………………17 Ruhof Corporation…………………………………………… 2-3
ERGONOMIC SOLUTIONS
Cygnus Medical…………………………………………………… 9
Soma………………………………………………………………………21
SAFETY SINKS
Avante Patient Monitoring……………………………… 10 Soma………………………………………………………………………21
Pure Processing………………………………………………… 33 TBJ Incorporated…………………………………………………51
ONLINE RESOURCE
STERILIZATION
MedWrench……………………………………………………… 46 oneSOURCE Document Site………………………… 28 OR Today Webinar Series…………………………………41
Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4 TBJ Incorporated…………………………………………………51
OR TABLES/BOOMS/ACCESSORIES
SURGICAL
Action Products, Inc.……………………………………… 59 Innovative Medical Products………………………… 68 Soma………………………………………………………………………21
OTHER
AIV Inc.…………………………………………………………………13
PATIENT MONITORING
AIV Inc.…………………………………………………………………13 Avante Patient Monitoring……………………………… 10 Heartland Medical Sales Service………………………15 Jet Medical Electronics Inc…………………………… 59
POSITIONING PRODUCTS
PRESSURE ULCER MANAGEMENT
66 | OR TODAY | MAY 2019
RESPIRATORY
MONITORS
FOOTWEAR
Calzuro.com…………………………………………………………19
Pure Processing………………………………………………… 33 TBJ Incorporated…………………………………………………51
Calzuro.com…………………………………………………………19 Healthmark Industries Company, Inc.…………… 4
ALCO Sales & Service Co.…………………………………61
FALL PREVENTION
REPROCESSING STATIONS
Microsystems……………………………………………………… 5
Action Products, Inc.……………………………………… 59 Cygnus Medical…………………………………………………… 9 Innovative Medical Products………………………… 68 Molnlycke Health Care…………………………………… 25
Pure Processing………………………………………………… 33
ACT-Paragon……………………………………………… 42-45 Avante Patient Monitoring……………………………… 10 Capital Medical Resources…………………………………61 Cygnus Medical…………………………………………………… 9 Heartland Medical Sales Service………………………15 Jet Medical Electronics Inc…………………………… 59 Mobile Instrument Service & Repair………………17 Soma………………………………………………………………………21
Heartland Medical Sales Service………………………15 MD Technologies inc.……………………………………… 55 Soma………………………………………………………………………21
SURGICAL INSTRUMENT/ACCESSORIES
C Change Surgical……………………………………………… 6 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4
TELEMETRY
AIV Inc.…………………………………………………………………13 Avante Patient Monitoring……………………………… 10
TEMPERATURE MANAGEMENT
C Change Surgical……………………………………………… 6
WASTE MANAGEMENT
MD Technologies inc.……………………………………… 55 TBJ Incorporated…………………………………………………51
Action Products, Inc.……………………………………… 59 Molnlycke Health Care…………………………………… 25
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Designed by an Anesthesiologist
who understands patient and surgeon needs Enhanced Humbles LapWrap® Positioning Pad
Loop the LapWrap® tab around the side rail of the OR table.
The LapWrap’s® tab configuration also makes positioning bariatric patients easier.
>
Bariatric Patients are no problem.
>
Now you can secure your patient in place.
Designed to prevent tissue injury. Arms stay where you put them during the procedure.
Use the optional extensions to secure the extremely obese.
>
Adaptable to all size patients.
>
Keep arms securely positioned.
Now even more secure with two-way performance! Anesthesiologist Frank Humbles, M.D. knows the importance of patient positioning. The Enhanced Humbles LapWrap®. • • • •
Positions patients arms while allowing easy access for leads and IV’s Secures patient to OR table Is dual sided for increased flexibility Optional extensions can be attached for the extremely obese
Free Sample Evaluation
Call 800-467-4944 and reference promo code “Secure” for your free Humbles LapWrap® sample today.*
The operative word in patient positioning. www.impmedical.com
For more info or to order call 1-800-467-4944
Designed to meet
AORN
recommendations *While supplies last
The LapWrap® was designed to meet AORN recommendations in “Recommended practices for positioning the patient in the perioperative practice setting” to prevent tissue injury and ischemia that may be caused by tucking a patient’s arms at his or her side.
US Patent No. 8,001,635 AORN is a registered trademark of AORN, Inc. AORN does not endorse any commercial company’s products or services.
© 2019 IMP