OR Today July 2019 by MD Publishing

PRODUCT FOCUS TEMPERATURE MANAGEMENT

CE ARTICLE COMMUNICATION

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CORPORATE PROFILE C CHANGE SURGICAL

JULY 2019

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OR TODAY | July 2019

contents

features

POSITIONING PATIENTS SAFELY The statistics with regard to safe patient handling and mobility are not encouraging. Letâ&#x20AC;&#x2122;s start with the fact that more than half of nurses say they have experienced musculoskeletal disorder pain at work from handling patients, according to research conducted by the American Nurses Association. In addition, sprains and strains are the most often reported nature of health care worker injuries, according to OSHA.

The global temperature management market is projected to grow at a CAGR of 2.5% to reach to $2.72 billion by 2022. Some factors driving the growth include an increase in the incidence of chronic conditions, development of technologically advanced intravascular systems and growth in research funding.

Communication skills in professional nursing practice are needed for everything from de-escalating disruptive behaviors to giving and receiving constructive criticism. This course provides an overview on how to manage workplace communication challenges.

In the last 18 months, C Change Surgical upgraded its automated freezers with touchpad controls, whisper-quiet agitation and high output supply. And, it completed development on its protected containers. C Change Surgical now offers facilities a way to make slush much more efficiently, with confirmed sterility for every liter, at lower cost.

CE ARTICLE: COMMUNICATION

MARKET ANALYSIS: TEMPERATURE MANAGEMENT

CORPORATE PROFILE: C CHANGE SURGICAL

OR Today (Vol. 19, Issue #7) July 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. ÂŠ 2019

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CIRCULATION Lisa Cover Melissa Brand

WEBINARS Linda Hasluem

INDUSTRY INSIGHTS 11 News & Notes 20 C CI: CCI Launches Research Foundation to Nurture and Grow Perioperative Nurse Scientists 22 IAHCSMM: 2019 IAHCSMM Annual Conference Delivered Fresh Perspective on CS/SP Profession 25 Webinar Re-cap: OR Today Webinars Deliver Knowledge, CE credit

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IN THE OR 27 Market Analysis: Temperature Management 28 Product Focus: Temperature Management 32 CE Article: Communication

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INDUSTRY INSIGHTS

news & notes

Spacelabs Debuts Sentinel 11 Spacelabs Healthcare debuted Sentinel 11 at the 40th Annual Heart Rhythm Scientific Sessions in San Francisco. This latest release from Spacelabs advances cardiology information management with optimized workflows, expanded connectivity and robust data security capabilities. “As health care organizations face increasingly sophisticated cybersecurity threats, the need for strong privacy and security control is critical,” said Spacelabs’ President Jim Green. “At the same time, cardiologists need seamless access to patient data collected throughout the care continuum. Sentinel 11 delivers both.” Spacelabs’ latest cardiology information management system collects data from a broad range of cardiovascular monitoring devices and provides easy access to reports and analyses to aid in diagnosis and care, whether deployed in a small clinic or across a multi-site enterprise environment. Sentinel 11 provides a high level of security to protect against unauthorized access to clinical data, staff record data and a patient’s protected health information (PHI). Data is encrypted and protected in transport, on the workstation, in web and data servers, and even in backup files. For additional privacy, Spacelabs ABP (ambulatory blood pressure) and Holter devices can operate and work with the Sentinel system without requiring any PHI to be transferred to the devices. Cardiovascular care today often employs a variety of noninvasive diagnostic tools in hospitals, clinics and the home. Because Sentinel 11 supports multiple non-invasive diagnostic cardiology modalities, cardiologists can get a comprehensive view of their patients’ health, whether the data is collected at the patient’s home or in the hospital. Sentinel can be directly integrated with an organization’s electronic medical record (EMR) system, accessed on the go via mobile devices and serve as a conduit to send recordings to outside services for analysis and reporting. Sentinel’s web-based solutions are designed to meet today’s complex requirements with a simple, unified interface. •

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Advanced Medical to be Acquired by AMN Healthcare Advanced Medical Personnel Services Inc. is being acquired by AMN Healthcare Inc. “This strategic acquisition brings forth a tremendous opportunity of growth and value for our client base, network of health care professionals and Advanced employees. The Advanced team, which spans across six offices throughout the nation, will unite with AMN Healthcare counterparts to contribute to a shared vision of innovation and growth,” according to a press release. “We are ecstatic for the opportunity to expand AMN Healthcare’s reach in the health care workforce solutions market. Our commitment to quality, culture and innovation is a common thread between the two companies, and one of the reasons we believe we’ll be better together,” said Jennifer Fuicelli, CEO of Advanced. AMN Healthcare provides health care workforce solutions and staffing services to health care facilities across the nation. It provides access to a network of health care professionals through its recruitment strategies and career opportunities. AMN Healthcare helps providers optimize their workforce to successfully reduce complexity, increase efficiency and improve patient outcomes, according to a press release. The acquisition, subject to regulatory approvals and customary closing conditions, was expected to close in June 2019. •

JULY 2019 | OR TODAY |

INDUSTRY INSIGHTS

news & notes

Amolea AT2 Fluorinated Solvent Provides Cleaning of Medical Devices Amolea AT2 from AGC Chemicals Americas Inc. is a fluorinated precision cleaning solvent that provides medical device manufacturers a safe, highly effective and environmentally friendly alternative to n-propyl bromide and trichloroethylene solvents. Amolea AT2 can be used to clean a range of medical devices including orthopedic implants, catheters, tubes, scopes, needles, dental devices and surgical tools. Amolea AT2 has no ozone depletion potential, low global warming potential and is non-flammable, which lets users more easily meet environmental regulations. Amolea AT2 is also energy efficient because of its low latent heat of vaporization. “AGC developed Amolea AT2 cleaning solvent to help medical device manufacturers comply with environmental regulations more easily and to make workers’ jobs safer and easier,” said Jim Scott, AGC technical manager. Amolea AT2 demonstrates excellent solvency with a wide variety of press, cutting, silicone and refrigerant oils; greases; asphalt pitches; and fluxes used in the electronics industry. It is approved for use as a precision cleaner, defluxing agent, carrier solvent for silicone and fluorinated lubricants, and moisture displacement fluid. Amolea AT2 joins AGC’s AsahiKlin AE-3000 series of environmentally sensible fluorinated solvents, which were designed to replace halogenated solvents having unfavorable environmental properties. •

12 | OR TODAY | JULY 2019

Reflexion Health Obtains 510(k) Extension for Trunk and Upper Extremities Reflexion Health has secured 510(k) clearance from the U.S. Food and Drug Administration to extend its flagship product for use with trunk and upper extremities. Previously, Reflexion Health’s Virtual Exercise Rehabilitation Assistant (VERA) was only cleared for lower extremity. VERA is a digital therapy platform designed by Reflexion Health that integrates a broad menu of prescription rehabilitation exercises, an animated avatar coach, a 3D imaging system for measuring movement, functional assessments, an intuitive dashboard for remote clinical review, automatic report generation, and telemedicine capability to deliver a comprehensive, home-based rehabilitation experience. VERA seamlessly educates, demonstrates, measures, analyzes and records patients’ movements at home, all without the need for patients to apply or wear any sensors or monitoring devices. Reflexion Health now launches its trunk module, with the upper extremity module to be introduced later this year. The trunk module is designed for a variety of applications from helping patients recover before and after spine surgery to helping individuals who suffer from lower back pain. “We are dedicated to helping patients recover more comfortably and confidently through VERA and our 501(k) extension will enable us to help more patients,” said Joseph Smith, M.D., Ph.D., chief executive officer of Reflexion Health. “As we lead the transformation of physical rehabilitation by elevating the patient experience, we remain focused on delivering value-based, data-driven solutions.” •

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INDUSTRY INSIGHTS

news & notes

Healthmark Offers New Glove Box Dispenser Healthmark Industries has introduced the Glove Box Dispenser for Xtra Long Gloves (16”) to its Personal Protection Equipment product line. Manufactured from clear PETG Plastic-Copolyester resin, the Glove Box Dispenser is designed for boxed disposable glove storage, made to withstand heavy-duty applications and handling, as well as reduce losses due to breakage. The Glove Box Dispensers are offered in two different styles – a single dispenser that accommodates one box of extended cuff gloves, and a triple dispenser with dividers that holds three boxes of extended cuff gloves. The clear design matches any décor and enables an unobstructed view of glove package information. The Glove Box Dispenser is equipped with keyholes for wall mounting, which saves counter space while keeping gloves within easy reach. • For more information, visit www.hmark.

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Masimo Announces Halo ION Masimo has announced that after a decade of developing and testing its comprehensive, scalable and customizable continuous early warning score, with the aid of leading expert clinicians around the world, it is releasing Halo ION. Halo ION allows clinicians to aggregate trend data from as few as three physiological parameters (oxygen saturation, pulse rate and perfusion index), and as many as are available, including data from EMRs, into a single continuous early warning score. Each patient’s Halo ION score is displayed on the Masimo Patient SafetyNet Supplemental Remote Monitoring and Clinician Notification System as a number ranging from zero to 100, helping to streamline clinicians’ patient assessment workflow. In calculating scores, Halo ION not only takes advantage of immediately available patient data, but also keeps track of historical physiological data and data from other records. Halo ION thus helps to automate the process by which clinicians assess patient status over time, providing a cumulative, trended score for each patient, easily visible on the Patient SafetyNet View Stations or Replica mobile application, configured according to their clinical protocols, that can help facilitate their determination of a patient’s overall status. Trends in Halo ION scores, which are calculated according to how the hospital has chosen to configure it, help clinicians evaluate whether patients are improving or deteriorating according to their own criteria. Clinicians may then use this information to, for example, intervene with certain patients, to transfer or discharge certain patients, and to schedule nursing as-

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signment loads accordingly. Halo ION works by continuously extracting key characteristics from clinician-selected parameters that are continuously monitored on the Root Patient Monitoring and Connectivity Hub and anything connected to Root – such as oxygen saturation (SpO2 using Masimo SET pulse oximetry), noninvasive hemoglobin (SpHb), blood pressure, temperature and pulse rate – to create an overall score. Hospitals and clinicians determine which parameters to include in the overall score, how each is configured, how each is weighted, and how combinations of changes across multiple parameters affect scoring – providing the flexibility and customizability to ensure that Halo ION reflects each institution’s assessment policy. Unlike other early warning score assessment tools, which take spot-check snapshots of patient vital signs, Halo ION provides cumulative, continuous visibility into patient status over time, taking into account not only historical trend data for each parameter but also more complex characteristics, such as a parameter’s degree of stability and variability. Halo ION creates individualized, patient-specific baseline scores for each parameter – not global, one-size-fits-all thresholds – and tracks how each patient deviates from their baselines, adjusting the overall Halo ION score differently for different patients. For example, the Halo ION score might be different for two patients whose oxygen saturation drops to 89% if one patient normally has 100% SpO2 and the other 94%; those different deltas would be reflected in different amounts of change in their Halo ION scores. •

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BD Receives FDA Approval for Fully Sterile Chlorhexidine Gluconate Antiseptic Skin Preparation BD (Becton, Dickinson and Company) has received U.S. Food and Drug Administration (FDA) approval for BD ChloraPrep skin preparation with sterile solution, the only fully sterile chlorhexidine gluconate (CHG) antiseptic skin preparation commercially available in the U.S. This new BD ChloraPrep product uses a proprietary and patented process to sterilize the antiseptic solution inside the sealed ampoules located in the BD applicator. With the new sterilization process in place, the BD ChloraPrep solutions portfolio that undergo this proprietary added level of sterility will now be labeled as a “sterile solution” on all packaging. “At BD, we are constantly exploring new opportunities to protect patients and advance health,” said Michael Garrison, worldwide president of surgery at BD. “The FDA approval of BD ChloraPrep antiseptic skin preparation with sterile solution ensures that the solution inside of the applicator receives the same level of sterilization as the applicator itself to help further reduce the risk of intrinsic contamination.” Following FDA hearings in 2012 focused on sterility of skin antiseptic products and subsequent label changes in 2013, BD determined to proactively address the sterilization challenge in the U.S. Over the last six years, BD has invested in the development of a sterilization process that can handle the volume of product demanded and improve overall efficiency. “The idea of contaminated antiseptic solutions seems counter-intuitive because the function of an antiseptic is to kill bacteria,” said Donald E. Fry, M.D., a nationally recognized expert in infection prevention. “Outbreaks of highly resistant bacteria and spore contamination have been reported with contaminated antiseptic products in the past. Now with a fully sterilized skin preparation product, BD is assisting health care providers with a tool to enhance patient safety by the reduction of risk from intrinsic contamination in antiseptic solutions.” The new BD ChloraPrep sterile solution will include a mark to indicate that it is sterile. Though not required by the FDA, BD developed this mark to distinguish sterile solution from non-sterile antiseptic skin preparations. In 2013, the FDA asked manufacturers to voluntarily change labeling on products (sterile vs. non-sterile) to further educate customers on the issue. •

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DBS Targeting Software Cleared for Additional Visualization Capabilities Surgical Information Sciences (SIS), a medical device company focused on improved targeting for deep brain stimulation (DBS) surgery, announced it recently received 510(k) clearance from the U.S. Food and Drug Administration (FDA) to market new visualization capabilities. Prior to this, the SIS software was cleared for visualization of brain structures such as the subthalamic nuclei (STN) in the planning and targeting images for a DBS procedure. The STN is a key target for patients with Parkinson’s disease. The new capabilities enhance the features of the SIS software, including expanded visualization of the STN after completion of a DBS implant procedure through the fusion of MRI and CT images as well as 3D visualization of the predicted location of the STN relative to the implanted DBS leads, including the identification of the lead contacts. Another feature is an improved user interface allowing for transfer of images through the web and a DICOM interface to permit seamless connection to medical centers. “Today we announce another significant step forward in our drive to better targeting of the STN, particularly for patients undergoing a DBS procedure for the treatment of Parkinson’s,” said Jim Bullock, chairman of the board of directors. “Parkinson’s is a devastating and significantly prevalent disease around the world. The

16 | OR TODAY | JULY 2019

advancement of DBS has provided a potentially profound solution to patients who have exhausted pharmaceutical options. However, while DBS technology has advanced, it is still significantly underutilized because of lack of consistent results. Studies have shown that 15% to 34% of patients undergo a revision or removal of the implanted leads and there is no definitive or optimal method for visualization and targeting the STN prior to or post implantation of the lead.” “Surgeons are seeking significant improvements in visualizing brain anatomy for targeting in DBS procedures, and the SIS software provides the most accurate capabilities in existence,” said Brad Swatfager, president and chief executive officer. “The software has demonstrated its ability to predict the location of the STN with an average surface distance accuracy of less than 1mm. With this expanded FDA clearance, we will not only be able to assist in the planning and targeting prior to the procedure, but provide the ability to see where the lead was placed relative to the STN post procedure. We believe this post-operative feature, along with the results of ongoing clinical studies of this SIS software, will demonstrate improved accuracy related to targeting and could provide a potential solution to creating much greater consistency of results leading to higher utilization of this life-changing therapy.” •

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Getinge Launches New Products Getinge, a provider of medical technology, has announced the U.S. launch of the new S8668T model in the 86-series Washer-Disinfectors, which has been developed to increase reprocessing throughput within the Central Sterile Supply Department (CSSD). With the turbo multitasking technology available for the S-8668T model, processing time can be cut by up to 25% and thereby reduce overall utility consumption. “Health care organizations today are focused on efficient and safe operation in an everchanging environment. At Getinge, we consult with our customers to ensure that we provide solutions that promote efficiency across all our product offerings,” said Joseph Knight, senior sales director, surgical workflows at Getinge US. “The new S-8668T Washer-Disinfector provides more efficient throughput by not only saving time and resources, but also providing safe ergonomic advantages such as the automatic distribution of detergents thus reducing the need to lift heavy containers while avoiding spillage.” The 86-series now includes three models (S-8666, S-8668 and S-8668T). With the S-8668T version the CSSD can process more instruments in less time thanks to the turbomultitasking functionality. The turbo processing reduces the non-productive time needed for filling and draining of process water, and cuts process time by up to 25%. It is 160mm or 13% smaller than the previous 88-Turbo. The S-8668 and S-8668T models also provide the possibility to process EndoWrist Instruments (instruments used for laparoscopic procedures) with Getinge’s da Vinci Solution. Getinge also recently announced the U.S. launch of the Maquet Yuno II, offering the versatility of multiple configurations to support advanced orthopedic techniques with one surgical table while reducing the complexity of setup. “At Getinge, we appreciate the increased need for hospitals to reduce costs by investing in safe, flexible OR tables in conventional or minimally invasive surgery procedures,” remarked Knight. “We are excited to offer the Maquet Yuno II, which provides versatility for multiple configurations supporting a variety of procedures as well as enhanced ergonomics and accessibility for the surgeon.” Maquet Yuno II provides the versatility of multiple configurations to support advanced orthopedic techniques with one surgical table, which can improve clinical access and reduce the complexity of product setup. These configurations allow physicians to perform orthopedic, trauma, spinal and minimally invasive joint procedures, including Direct Anterior Approach (DAA) for hip procedures and shoulder arthroscopies. Interchangeable table tops increase the utilization of the Maquet Yuno II table and accommodate multiple advanced configurations. Hospitals no longer need to rely on specialty surgical tables, thereby, increasing the table’s return on investment. •

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INDUSTRY INSIGHTS

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22-Minute Automatic Endoscope Reprocessor Receives 510(k) Clearance Advanced Sterilization Products (ASP) has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for the ASP Aeroflex Automatic Endoscope Reprocessor (AER). The high-level disinfection system, which is designed to be used to clean and disinfect flexible endoscopes from a wide range of manufacturers, offers a fast complete cycle time of 22 minutes, according to a press release. Flexible endoscopes are costly, complex and fragile instruments commonly used in minimally invasive procedures and are required to be high-level disinfected between every patient use. To effectively disinfect a flexible endoscope, it is essential that the active ingredient in the high-level disinfectant (HLD) be at or above the level required to kill microorganisms. According to professional society standards and HLD instructions for use, this critical measurement, known as the minimum recommended concentration (MRC), should be taken every time an endoscope is reprocessed. The current method requires dipping a test strip into the HLD and subjectively assessing the color change of the test strip against a visual scale. Given the manual nature of this process, testing may be missed or done incorrectly. Aeroflex is the only AER with Autosure MRC Monitor, an integrated system to automatically test HLD MRC levels every cycle, eliminating the need for manual test strips. It is estimated that 32 million gastrointestinal (GI) endoscopy procedures using a flexible endoscope are performed each year in the United States. To keep pace with procedure demands, endoscopy managers are looking for ways to decrease the time and effort required to confidently reprocess endoscopes. Aeroflex with Autosure will be equipped with a touchscreen user interface and an electronic records management system designed to improve efficiency, accuracy and compliance with record keeping requirements compared to manual systems. â&#x20AC;˘

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INDUSTRY INSIGHTS CCI

CCI Launches Research Foundation to Nurture and Grow Perioperative Nurse Scientists By Lisa Alikhan ou may already know that the Competency and Credentialing Institute (CCI) is the leader in competency assessment for perioperative nurses, administering three credentials and serving more than 43,000 certificants. However, what you may not know is that in 2018 CCI entered the philanthropic sector and established an independent 501(c)3 organization, whose mission is to fund research that contributes to the advancement of perioperative nursing science and the enhancement of patient care.

In her 2017 manuscript, “The Future of Nursing Research in the West: The Best is Yet to Come,” Linda Sarner, PhD, RN, FAAN, states that “Ultimately, the vision of the future must include how research will impact nursing care, including the implementation of evidence into practice and the use of data to inform practice and health care policy. How best to share research findings, how research is funded, and what type of preparation will be needed for the next generation of scholars are all important questions for the future.” (p.1)

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The CCI Research Foundation (CCIRF), now in its inaugural operating year, agrees with Sarner and is doing its part to meet a long-standing need in the scientific perioperative nursing community. The new foundation ensures that, for the first time, a sustained source of funding to develop and cultivate perioperative nurse researchers is available. In 2019, the CCI Research Foundation will begin awarding grants to both experienced and emerging researchers and doctoral students (including both PhD and DNP). Candidates may also seek funding for dissertation research and scholarly projects. This year, CCI’s new foundation seeks to give away more than $130,000 in grants across three funding tiers. The tiers are based on the applicant’s experience level, and grants will be awarded in amounts of $5,000, $10,000 and $25,000. Projects must be completed in one year. It is not a requirement for project funding that the principal investigator is a nurse; however, an RN who holds a minimum master’s degree in nursing, (or country equivalent), must be a co-investigator on the research team. To raise awareness of its mission and funding initiatives, the foundation

kicked off this year’s grant application cycle on the road at a series of national nurse research conferences between February and May. “Thus far, the feedback within perioperative circles, and from the specialty nursing and research communities, about CCI’s decision to place a focus on nursing research has been overwhelmingly positive,” said Jim Stobinski, PhD, RN, CNOR, CSSM (e), CEO. “CCI has long been associated with the certification of OR nurses, and as we believe that certified nurses contribute to improved patient care; we are now putting our money where our mouth is and will prioritize projects whose findings may validate these beliefs with empirical evidence.” Julia A. Thompson, PhD, RN, CNOR, President, CCI Research Foundation Board of Trustees said, “Funding can have a significant impact on perioperative nursing research. Information from nursing research can directly impact the care provided to perioperative patients. We have the opportunity to support research that provides evidence linking certification to individual outcomes, such as nurses’ continued professional engagement and commitment to lifelong learning, as well as patient outcomes. The CCI ReWWW.ORTODAY.COM

INDUSTRY INSIGHTS CCI

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search Foundation’s investment in well-designed research supports the professional perioperative community, and facilitates the advancement of research in the care of perioperative patients. We recognize the importance of the nurse scientist’s role in providing perioperative patients with high-quality care through knowledge gained by research.” Although CCI’s foundation will certainly give precedence to projects whose hypothesis seeks to demonstrate the link between certified nurses in the OR and improved clinical patient outcomes, other funding priorities for the CCI Research Foundation include projects related to nursing education, nursing practice and performance, and the impact of organizational climate and leadership and management on patient care. To learn about the CCI Research Foundation, visit https://cc-researchfoundation.org/. Inquiries should be directed to inquiries@cc-researchfoundation.org or to Lisa Alikhan, Program Manager for the CCI Research Foundation.

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REFERENCE The Future of Nursing Research in the West: The Best is Yet to Come. (2017) Retrieved from https://www.winursing. org/wp-content/uploads/2017/11/Linda-Sarna-PhD-RNFAAN.pdf Lisa Alikhan is the Program Manager for the CCI Research Foundation. She can be reached at lalikhan@cc-researchfoundation.org or 303-368-6720.

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INDUSTRY INSIGHTS

IAHCSMM

2019 IAHCSMM Annual Conference Delivered Fresh Perspective on CS/SP Profession By Julie E. Williamson he 2019 IAHCSMM Annual Conference & Expo, which took place April 27-May 1 in Anaheim, California, drew record-breaking attendance and delivered a wide range of valuable and unique knowledge building and networking opportunities. A total of 1,505 attendees from across the globe descended upon the Anaheim Convention Center to glean valuable information and insights from some of the industry’s leading experts. Hundreds of attendees kickstarted their learning by participating in preconference hands-on labs and workshops, as well as the Educators Forum, A Fresh Look at CS Management, and the StrengthFinder™ Workshop.

The Conference & Expo lived up to its “A Fresh Perspective” theme. More than 30 educational sessions were presented, delivering 23 continuing education (CE) credits that attendees could apply to their recertification. Additional CEs were available to attendees who participated in vendor-provided education during the expo, and more than 80 educational poster presentations were also displayed in the expo hall for attendees to examine, study and review. Of course, knowledge-building opportunities didn’t end there. The sprawling expo was filled with leading vendors (150 in all) aligned specifically to the CS/SP profession and allowed attendees to discover industry trends, see some of the latest product and service offerings in action and meet with vendor experts to ask questions and discuss their purchasing needs. Beyond that, attendees had many opportunities to network with peers and experts, allowing them to discuss challenges and success stories and share best practices to improve customer service and patient safety.

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Tools of the trade Although the educational sessions delivered at the 2019 IAHCSMM Annual Conference covered a wide range of technical and management topics, many addressed the critical need to diligently follow the latest regulations, standards, evidencebased guidelines and manufacturers’ instructions for use (IFU). In her Joint Commission Update session, Sylvia Garcia-Houchins, MBA, RN, CIC, Director of Infection Prevention and Control in The Joint Commission’s Division of Healthcare Improvement, reminded attendees that while TJC doesn’t tell people how to do their job, surveyors will be ensuring they are following the latest regulations and standards. “Ignorance of law isn’t an excuse,” she said. Following IFU is equally critical, she noted, as is ensuring the facility has the proper equipment in place to process an item in accordance with the manufacturer’s written instructions. Facilities that are unable to follow the IFU should “take it to the highest chain of command in the organiza-

tion and tell them that you are not equipped to process that device.” Surveyors will also ensure the facility’s own policies are being consistently followed, Garcia-Houchins stressed. For example, while TJC does not require instruments to be sprayed with an enzymatic, if the facility’s own policy states that all instruments need to be moistened with an enzymatic spray then surveyors will look to ensure that’s being done. Not surprisingly, endoscope reprocessing issues also took center stage during numerous educational sessions. Epidemiologist Cori Ofstead, MSPH, President and CEO of Ofstead & Associates, and Ofstead Senior Research Associate John Eiland, RN, MS, presented their eyeopening scientific evidence to help improve the quality of endoscope reprocessing. Among the information presented pertained to their recent bronchoscope studies that revealed 58% of the bronchoscopes they assessed had bacteria and mold present after the devices had been reprocessed and deemed “patient WWW.ORTODAY.COM

“OR Today’s webinar’s ready.” While many factors can contribute to contaminated devices (e.g., challenging instrument design, confusing or inadequate IFU, insufficient staffing resources and inventory, poor water quality, inadequate point-of-use care), ongoing pressure reprocessing professionals often face to turn around endoscopes more quickly is a particularly pressing issue that can lead to dangerous shortcuts. To help mitigate those risks, Ofstead said she believes guidelines should state that two hours are needed to reprocess an endoscope. Water quality also plays a vital role in reprocessing outcomes for endoscopes and other instrumentation. John Erickson, BS, CRCST, assistant manager of the CS/SP department at Mercy Health, explained during his session “Reclaiming What’s Lost: Taking Control of Your Endoscope Process” that instruments are sometimes being recontaminated through the water being used. He also reminded that the consequences of inadequate endoscope drying, which can create an environment ripe for bacterial growth and proliferation.

Valuable lessons learned While every CS/SP professional’s ultimate goal should be to prevent infections and other negative outcomes by providing safe, wellfunctioning devices that are clean and sterile, equipment and process failures can and do sometimes occur. General surgeon Lizbeth Thomas, DO, FACS, Chief Medical Officer at Fairview Health Services, shared her unique perspective on the impact of contaminated instruments that make their way into the OR for patient use. She shared with a ballroom of attendees how two cases in the same day were impacted after bioburden was discovered on reprocessed instruments. Those discoveries then derailed the entire surgery schedule, leading to increased costs WWW.ORTODAY.COM

to the facility, added stress for the OR staff, and, above all, a domino effect of negative outcomes for the patients and their families – not the least of which included procedural delays and the need for extended anesthesia and, in one incident, the need to inform the patient and their loved one that she could now be at risk of a surgical site infection. When incidents do occur, it’s important to gather the right team – such as infection preventionists, facilities and biomedical professionals, and risk/quality managers – to assist in developing an appropriate action and response strategy, said Damien Berg, BA, BS, CRCST, Sterile Processing Manager at St. Anthony & Ortho Colorado Hospitals. “If you don’t know [these professionals], change that, and get IPs involved early.” Berg also reminded of the need to not only follow standards and policies, but to clearly document them to demonstrate compliance. “If it’s not documented, it didn’t happen.” Finally, Berg stressed the importance of recognizing the value that can come from a crisis. “Crises create opportunities. We can use what we learned to improve ourselves on the job.” Over the course of the fourday conference, attendees came away with valuable knowledge and insights to do just that. They also were reminded that their daily roles and responsibilities – often performed without acknowledgment by health care customers and patients – are essential to patient safety and positive outcomes. As opening keynote speaker Kevin Brown noted, CS/SP professionals’ contributions are extremely important and those individuals leave their proverbial fingerprints on the lives of thousands of people they’ll never have an opportunity to meet. “Heroes are the first people to serve and ask what they can do to get the job done – and make no mistake, heroes pack this room.”

presentations are timely, and spot on to the important topics facing today’s OR managers and directors.“ G. Harmon, Director of Perioperative Nursing Services

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WEBINAR SERIES

EARNwithCEUs

MONTHLY WEBINARS by industry leaders! Access our library of past webinars!

The OR Today Webinar Series is very informative and accessible in bite-sized chunks, convenient and provides CEUs ...thank you so much!!” –M. TUAZON, CLINICAL NURSE EDUCATOR

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START LEARNING TODAY! ORTODAY.COM/WEBINARS OR TODAY HAS BEEN APPROVED AND IS LICENSED TO BE A CONTINUING EDUCATION PROVIDER WITH THE STATE OF CALIFORNIA BOARD OF REGISTERED NURSING. LICENSE NO. CEP 16623

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INDUSTRY INSIGHTS

webinars

OR Today Webinars Deliver Knowledge, CE credit By John Wallace R Today’s webinars are very insightful! They educate you on issues being faced in countless hospitals around the world. They give you ideas on how to face these issues head on, how to create a culture of change, & make a difference. I’m glad I tuned into the ‘Who’s Who in the OR Zoo?’ webinar. And, I cannot wait to start receiving the OR Today magazine,” A. Hetzel, RN Infection Preventionist, said after the most recent OR Today webinar sponsored by RepScrubs. “

The webinar, which was attended by 137 people, received high marks with a 4 out of 5 rating with 5 being the highest possible rating. This continues a successful and growing webinar series. The 2019 OR Today Webinar series averages more than 100 attendees per live session with even more perioperative professionals watching a recording of the insightful webinars. Webinar attendees are eligible for one (1) continuing education (CE) hour from the State of California Board of Registered Nursing. The “Who’s Who in the OR Zoo?” webinar was presented by Deborah Hamrick, RN, MSN, CNOR, executive director of perioperative services at Grady Health System in Georgia. She discussed patient care, employee resources, perioperative infection prevention as well as who’s who in the OR team. Hamrick shared tips from her more than 25 years of extensive perioperative service experience in progressive leadership, management, quality and education. She is a proven leader with an intense focus on process redesign, performance improvement, resource management and relationship building. She is a member of the Association of Operating Room Nurses and received her BSN from Emory University and her MSN from Georgia State University. Attendees praised Hamrick’s presentation. “It is extremely helpful to hear what other institutions do to help control vendors and traffic in/out of the OR. This webinar was convenient and easy to follow along at my desk. The time was also convenient due to the busy morning/early afternoon in the OR,” said S. Acton, RN. “Webinars provide very realistic information we can use and put into practice right away. Great ideas/solutions presented,” said S. Ellis, President. “OR Today’s webinar series provides easy access for current information and addresses hot topics in the surgical environment. Keeping current with evidenced-based practice is critical WWW.ORTODAY.COM

“OR Today’s webinar series provides easy access for current information and addresses hot topics in the surgical environment.” – K Elliott, Independent Consultant in moving the perioperative department into the future, thus providing quality care for every patient, every time,” said K. Elliott, Independent Consultant. “Really enjoyed the presentation ‘Who’s Who in the OR Zoo!’ It helped to reaffirm that we are taking appropriate measures within our facility in addition to giving insight to future quality tracking indicators,” said B. Holder, QT. “The webinar “Who’s Who in the OR Zoo?” was an excellent presentation about how RepScrubs offers vendor management and cost reduction solutions. It’s a unique way for hospitals to improve infection control and adhere to regulatory guidelines, reduce costs and have a better control with vendor access,” said C. Harvey, Infection Preventionist. “This webinar was useful and helpful with looking at current vendor management structure and how to implement changes that are needed with our current process,” said K. Kendrick, Manager CSP. “I find these webinars very interesting and helpful. Although I do not work in the OR, I review surgeries as part of my job and these webinars give me a better understanding how everything works,” M. Duffy, Quality Abstractor. For more information about continuing education credits from OR Today visit ORToday.com and click on the “Webinars” tab for a schedule of upcoming presentations. For even more CEUs, visit ORTodayLive.com and register for the surgical conference being held in Las Vegas this August. Thank you to our sponsor:

JULY 2019 | OR TODAY |

Blanket & Fluid

Warming Cabinets MAC Medical offers a variety of Blanket & Fluid Warming Cabinets to help compliment and enhance your facility. As with all of our products, warming cabinets undergo stringent testing procedures during the manufacturing process to assure a long life, the highest quality, and accurate temperature settings. We offer standard sizes along with custom sizes to meet specific requirements.

D-Series – Data Logging Warming Cabinets • “Easy Log” integrated data logger with removable USB • Internal storage up to 2 years • Keyed temperature lock out • Push button digital operation • Automatically records data every 30 minutes • Displays actual temperature and set points at all times • Independent digitally controlled heating chambers • Rapid warming time (2-6 hours depending on load) • Fully insulated to provide uniform heating • Adjustable feet

TS-Series – Touch Screen Warming Cabinets D-Series

TS-Series

Many of the same features as the D-Series, but also includes: • Intuitive touch screen control • Intuitive software (supports multiple languages) • Operator audit trail • Built in Ethernet & Wi-Fi capable • Remote monitoring & control (VNC) via smart phone • Remote tech support & diagnostics • Text & email alarm notifications • File transfer via USB or FTP web page

Customer service is available to answer any questions: Phone 877-828-9975 or Email sales@macmedical.com

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market analysis

Temperature Management Market Growth Continues Staff report growth in coming years. “The global temperature management market is projected to be valued at $2.40 billion in 2017 and is expected to grow at a CAGR of 2.5% during the forecast period to reach $2.72 billion “With the rising number of surgeries be- by 2022. Base year considered for the report is 2016. Some of the key facing performed in hospitals worldwide, tors driving the growth of this market there is a growing demand for teminclude the increase in the incidence perature management devices, which of chronic conditions, development of are used to manage the human body technologically advanced intravascular temperature by providing regulations systems, large number of awareness in inside recovery rooms, operations campaigns/conferences for physicians theaters, and other types of hospital and growth in research funding.” rooms. The well-established healthcare The rising number of surgical proceinfrastructure with the high adoption dures is one of the primary drivers for rate of new technologies and increasthe temperature management market, ing surgical centers, would help North according to Mordor Intelligence. America dominate the market share,” According to Eurostat 2017, a high according to Mordor Intelligence. number of surgeries were performed in A MarketWatch press release also European countries, including cataract indicates continued market growth. surgery and colonoscopy. With that, The global patient temperature a large increase in recent years has management market will experience substantial growth from 2017 to 2024, been observed in appendectomies and hysterectomies using keyhole surgery. according to the press release. The industry will witness significant growth Also, globally cardiovascular along with musculoskeletal operations are done due to increased number of surgeries majorly in most of the regions. This along with soaring geriatric population base globally. Rising prevalence of raises the demand for temperature cancer and cardiovascular diseases will management device usage in hospital drive the patient temperature manage- rooms, intensive care units (ICUs) and other areas. ment market size. According to WHO Other driving factors for this mardata, cardiovascular disease is the ket are rising prevalence of cancer and leading reason for mortality globally. Nearly 17.7 million people died world- cardiovascular diseases, development of technologically advanced intravascular wide due CVD in the year 2015. systems and growing medical tourism, MarketsandMarkets also reports he temperature management market is expected to register a CAGR of around 3% from 2018 to 2023, according to Mordor Intelligence.

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according to Mordor Intelligence. The Mordor Intelligence report adds that the high cost associated with temperature management systems is one of the major restricting factors for the market. The surgical procedure becomes expensive due to the use of temperature management systems such as endovascular methods. The cost per treatment for single-use components also increases. “For example, Arctic 5000 and its related consumables are costly and require a team of specialists to handle the medical device. Thus, the price pressure and lack of availability of trained professionals impede this market,” according to Mordor Intelligence. Other factors impeding this market include product recalls and failures of temperature management devices, according to Mordor Intelligence. Mordor Intelligence also indicates that the Asia-Pacific region is expected to show attractive growth during the forecast period due to the presence of high growth opportunities for the unmet needs of the target population in this region. Due to growing medical tourism, countries such as Malaysia, India, China, Thailand, and Japan are gaining growth in this market. With that, the North American region is expected to dominate the market share in the forecast period due to the welldeveloped health care infrastructure, health care facilities and high adoption of new technologies. JULY 2019 | OR TODAY |

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product focus

C Change Surgical SurgiSLUSH™ Automated Sterile Slush

Attune Medical ensoETM

SurgiSLUSH™ technology elevates your slush practice automatically. At the push of a button it produces and maintains smooth slush in locked, tamper-evident containers, freeing staff to focus on priorities. High-output freezers supply multiple procedures simultaneously, slashing equipment costs. Innovative containers lock in sterility and protect slush until use and replace draped, open-basin machines in each sterile field. •

Attune Medical’s ensoETM modulates and controls patient temperature through a single-use silicone tube inserted into the esophagus, similar to a standard gastric tube, and connected to an external heat exchange unit. Positioned at the core, next to the heart and great vessels, water circulates inside the closed-loop system to efficiently warm or cool a patient. Unlike surface warming devices, the Enso’s internal placement won’t impede patient access during surgery, and allows gastric decompression and administration of fluids and medications. The ensoETM works with existing heat exchangers and can be rapidly placed by most trained health care professionals. The ensoETM is the only device cleared for use in the esophagus for whole-body temperature modulation. •

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product focus

CenTrak

Environmental Monitoring Solution

Getinge

Warming Cabinets Getinge offers a new line of blanket, fluid and combination warming cabinet models in the U.S. The blanket and fluid warming cabinet technology supports the clinical benefits of intra-operative and post-operative warming to improve patient comfort, satisfaction and outcomes. Getinge offers an extensive selection of blanket and fluid cabinet capacities to accommodate space limitations and needs in operating rooms, emergency rooms, intensive care units and patient rooms. Cabinets have optional locking doors. It's walls and shelves have patented intelligent, multi-zone heating technology that includes multiple foil panels to prevent blankets from overheating. Three independent heating systems and sensors monitor the cabinet temperature to provide evenly balanced heat. All fluid warming units can operate as blanket warmers providing additional capacity if needed. The temperature range (90° to 150°) of the top chamber of Getinge’s combination blanket/fluid warming cabinet can also be used to heat blankets or injectable/irrigation fluids. •

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CenTrak’s Environmental Monitoring Solution is designed to ensure critical items are stored at desired temperatures and humidity levels, as well as other ambient conditions. High-quality, NIST-traceable probes provide accurate and reliable read performance, with back-up storage to secure recordings at all times. Alerts are immediately generated when conditions are sensed outside user-set parameters, so corrective action can be taken. Additionally, the system provides automated logs to meet regulatory compliance, eliminating human error and the cost of manual documentation. Each sensor is equipped with two ports to support door ajar sensing, a second temperature measurement, dry contact equipment or nitrogen level alerts. •

JULY 2019 | OR TODAY |

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product focus

MAC Medical

TS-Series (Touch Screen) Warming Cabinets The TS-Series (Touch Screen) Blanket & Fluid Warming Cabinets provide a blend of smart technology, value and customer support. The intuitive touch screen provides complete system control of the warmer, while the Ethernet/Wi-Fi capability allows remote connectivity via a smartphone app. The warming cabinets are available in single and dual chamber units and have many standard and optional features. â&#x20AC;˘ For more information, visit www.macmedical.com.

Smiths Medical

Level 1 Convective Warmer The warming system consists of a highflow convective warmer with hose-end temperature control, a convective warming blanket and accessories. The convective warmer draws ambienttemperature air through a HEPA air filter and is warmed to a selected temperature. The warmed air enters the Snuggle Warm patient blanket and is distributed through delivery channels. The warmer is quiet with a sound level less than 42dBA. It provides simple push-button operation to maintain patient normothermia. It provides precise temperature management within +/- 1 degree, with over and under temperature alerts at each of the three set points. â&#x20AC;˘

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product focus

Encompass Group

Thermoflect Heat Reflective Technology Patented Patient Warming Gowns Thermoflect patented gowns feature quick-release strips on both shoulders for a comfortable fit and easy access to the patient before, during and after the procedure without compromising warming. The Total Access Gown 360-degree torso strip separates intraoperatively creating two pieces for complex positioning or maximizing coverage then easily reconnects for transport to PACU. Thermoflect Heat Reflective Technology reflects and stores radiant body heat creating a warm microclimate that follows the patient throughout the perioperative journey. Thermoflect can help a facility enhance patient comfort, improve outcomes and reduce costs. • For more information, visit www.thermoflect.com.

ZOLL

Thermogard XP (TGXP) ZOLL’s Thermogard XP (TGXP) intravascular temperature management system provides health care professionals with the power and control needed to rapidly, safely and accurately manage the core body temperature of critically ill or surgical patients with warming and cooling applications. It offers clinical efficiency in reaching and maintaining target temperature 100% of the time,1-6 while decreasing demands on nursing staff and reducing nursing workload by 74%.7 TGXP offers a variety of catheter options depending upon specific patient needs. • 1 Idris AH, et al. Circulation. 2012; 126:LBBS-22813-AHA. 2 Hoedemaekers CW, et al. Critical Care. 2007;11:R91. 3 Knapik P, et al. Kardiologia Polska. 2011;69(11):1157-1163. 4 Mayer SA, et al. Critical Care Medicine. 2004;(3)212:2508-2515. 5 Diringer MN, et al. Critical Care Medicine. 2004;(32)2:559-564. 6 Heard KJ, et al. Resuscitation. 2010;81:9-14. 7 Horn CM, et al. Journal of Neurointerventional Surgery. 2014 Mar;6(2):91-95

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JULY 2019 | OR TODAY |

CE344-60

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continuing education

Staying Cool Under Fire How Well Do You Communicate? BY CONNIE VOGEL, PHD, RN, CNE

ave you ever been surprised or upset by nasty remarks from a hostile family member? Ever been clobbered by comments from colleagues? How did you react? Were you able to defuse the situation gracefully? Did you faint and fall down or rise up and attack? When communicating therapeutically with patients, most healthcare professionals in various settings are skillful and confident. However, communicating effectively and comfortably when you are under fire from upset or angry patients, visitors, or colleagues is a challenge you may not be as well prepared to meet. Your resume may focus on your experience with the “hard skills” of providing complex and highly technical care. But experts believe that “soft skills,” such as knowing how to manage the “people” part of your job, have a major effect on job satisfaction and career advancement. The good news is — like other skills — your communication style can be improved with effort and practice.

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Your Style Makes a Difference Working in the healthcare field requires outstanding communication skills. Communication is the transfer of understanding from one person to another. Skillful communication is essential for clinical practice and team building and for maintaining a satisfying work climate. In fact, the ability to communicate effectively is one of the most important areas in which healthcare professionals need to be experts.1 We communicate verbally by using words and tone of voice to transmit information, and we communicate nonverbally through facial expressions and gestures. Although body language is always a vital part of our message, we are usually not aware of it. Thus, we should make sure that our body language is consistent with our verbal message.1 The style in which we communicate has a huge effect on creating understanding. Communication styles often are classified as passive, aggressive, or assertive. A person with a passive communication style appears to be timid, uninvolved, or uninterested. At the other end of the spectrum is the person with an aggressive style.1 People who use an aggressive style are often confrontational and choose words and use gestures that others perceive as

Relias LLC guarantees this educational program free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See Page 38 to learn how to earn CE credit for this module.

Goal and objectives The goal of this program is to provide healthcare providers with information about how to manage workplace communication challenges. After studying the information presented here, you will be able to: • Identify three primary communication styles • Discuss ways in which men and women differ in their communication style and stimuli for anger • Discuss strategies to communicate with people who are upset or angry

sarcastic or even rude. As opposed to the timid, passive communicator and the brash, aggressive communicator, a person with an assertive style communicates in a straightforward and confident manner.2 He or she speaks in a well-modulated tone and augments WWW.ORTODAY.COM

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continuing education

the oral message by using direct eye contact and appropriate gestures and facial expressions. Assertive communication involves more than standing up for oneself. Assertiveness is the ability to communicate who you are and what you want and the ability to make others feel they can respond in kind.2 There are many reasons why an individual may not communicate effectively, and even when assertiveness has been developed, there are pitfalls that can undermine effectiveness. Personal variables, as well as internal and external factors. can affect the ability to communicate effectively.3 Giving unsolicited advice; becoming defensive; allowing frustration, helplessness, and knee jerk responses; and blaming others all can sabotage effective communication.3 Although it’s tempting to give advice when another person raises an issue or problem, this advice tends to stop the communication process. It’s often more effective to allow the person to work through the problem by bouncing ideas off a willing and attentive listener. Becoming defensive is another communication barrier. Being on the receiving end of a hostile message stimulates a powerful defensive response in most people. Rather than mount a defensive, emotional response to a verbal attack, try to recognize that the other person’s communication behavior may be prompted by fear or stress.3 If you find that you are starting to communicate aggressively, look for a physiological or psychological signal that can help you identify your own distress. Stop, take a deep breath, acknowledge that the message was not the one you intended to send, and start over. Learning how to disagree in a calm and rational manner is invaluable in the workplace, as well as in personal situations.3 A sense of frustration and helpWWW.ORTODAY.COM

lessness can develop in unit cultures where problems are not spoken of openly and a team effort is not made to find solutions.3 These units are not pleasant places to work, and ultimately the quality of patient care may be affected. It is unrealistic to expect any team member to solve all problems or rescue everyone in need. A more therapeutic strategy is to openly bring concerns to the attention of team members and support people as they work through uncomfortable situations with active listening and solicited feedback. Blaming others is another communication stopper. In nearly every situation in which there is a breakdown in communication, all parties are responsible. But in clinical situations with patients and in professional situations where patient care is affected, it is the obligation of the nurse to find a means to effectively communicate.1,3 Both the sender and receiver of the message are influenced by factors such as emotions, needs, perceptions, education, cognitive ability, values, culture, and noise level.3 You always have control over your response to an uncomfortable situation, even if it is to say, “I can’t discuss that with you right now. I’d like to talk about this later when I have had time to think about it.” Understanding the workplace culture and developing effective communication strategies and self-care are ways identified by staff nurses to improve communication and to enhance success in the workplace for novice nurses.4 Gender differences also affect the communication process. Men and women usually use different communication styles, and these differences can create misunderstandings. Men tend to communicate to reach goals, while women often communicate to establish or maintain relationships. Men are conditioned to use a direct

and forceful manner of communicating, in contrast to women, who generally use a quieter and sometimes more passive or tentative approach.5 Interestingly, it is often thought that women talk more in meetings than men, but monitoring indicates the opposite to be true.5 Significant differences exist in non-verbal behaviors between men and women. For example, women tend to nod their head when someone is talking, indicating that they are listening. Men are likely to view the head nod as agreement, and leave the conversation thinking the woman has indicated agreement when she was merely indicating that she was listening.5 However, it is also important not to stereotype men and women regarding communication. We are each a product of many life factors, both personal and professional, that impact how we communicate. Communication experts suggest that men need to increase their skills in listening to women who are expressing their feelings and points of view. Women can improve their communication with men when they become more direct, explain the reasons for their views, and become more tolerant when disagreements become part of a conversation. The emotion of anger, which can range from mild irritation to rage, can have far-reaching negative effects if not managed effectively. Research finds that proactive aggression is higher in men than women; but anger rumination, effort control, and aggression were not different between the sexes.6 There are also differences in what prompts an angry response. Three studies looked at threats to masculinity and perceived power over women as a source of anger.7,8 Men who felt a concern for how people perceived them and who felt their masculinity was threatened had more anger and more concern with control over women.7 Given that nursing JULY 2019 | OR TODAY |

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continuing education remains a female-dominant profession at this time, there is certainly food for thought in this finding and its potential effect on interactions with male staff members and on interdisciplinary interactions with other healthcare professionals.

Saying ‘No’ Responding to patient requests is an integral part of a care provider’s role. Healthcare professionals of various disciplines must also respond to requests from many other people, including colleagues, visitors, and supervisors. Requests may range from a patient who asks for your home telephone number or email address to a coworker who asks you to switch days off. Each request is usually seen as reasonable from the point of view of the person making the request. Assessing whether a request is unreasonable is your decision. A request may be considered unreasonable if it

interferes with your ability to provide care in a way that is consistent with your ethics and values or if it disrupts your personal life. This is an aspect of setting boundaries that every nurse needs to be able to do.1 In some situations, you must comply with a request, such as a legitimate request made by your supervisor. However, situations arise in which people make demands on your time and skills that you should decline. It’s often hard for care providers to turn down unreasonable requests because our strong need to be helpful can interfere with our right to say “no” clearly and directly. To escape from these uncomfortable situations, we may concoct excuses about why we must say no, and as a result feel helpless and frustrated. At other times, inappropriate guilt feelings about turning down an unreasonable request prompt us to respond in a hostile and defensive way. The middle ground is to learn

how to recognize unreasonable requests and how to refuse such requests in a way that preserves your self-respect and also shows consideration for the person making the request. Saying no to a request requires an assertive, rather than an aggressive or passive, communication style.2 When you are assertive, you protect yourself by turning down a request you choose not to handle while at the same time considering the feelings of the other person by refusing in a direct but polite manner. If you plan to refuse a request, tell the person at the beginning of your conversation. Don’t give elaborate background information and bury your refusal toward the end of your reply. A simple “No, I will not be able to do that” is a clear statement that directly tells the person your intention. If there is a reason that you choose to give, that can be added as a second

A CONFRONTATION AT THE NURSES’ STATION You have just finished the changeof-shift report when Mrs. Jasper confronts you at the nurses’ station. Because of a serious fall, Mrs. Jasper’s sister, Nora Ingram, sustained a cervical fracture that, despite numerous efforts, has not yet been stabilized. During the past few days, Ms. Ingram also has shown signs of depression. Mrs. Jasper’s first words to you are, “I need you to come and check on my sister right now! She’s having pain, and I put her call light on more than 45 minutes ago. I want you to come take care of her right now. What kind of nurses are you that you don’t care if a patient is in pain?” Choose one of the following responses.

minutes because we have a policy of answering call lights within 10 minutes. We’re really understaffed this evening; as soon as a float nurse arrives, I’ll see what I can do.”

Choice A: “Please don’t talk to me like that. I’m doing the best I can and I doubt the call light was on for 45

Choice D: “I can’t be in two places at once. But if you think your sister is in such excruciating pain, I’ll drop every-

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Choice B: “You have to understand that when we’re in report, we can’t be disturbed unless it’s a real emergency. You should put her call light on at least 10 minutes before we start report.” Choice C: “I do care that your sister is in pain, but I have many other patients to take care of, and we really have some sick patients this evening. I’ll ask one of the aides to check on her as soon as possible.”

thing I’m doing and move her needs right to the top of my list.” Choice E: “I regret the delay. I know it’s frustrating to wait for someone to respond, especially if your sister seems to be in pain. I’ll meet you in her room in just a few minutes and evaluate what to do about her pain. We can also talk about how to respond to her needs, especially when we’re changing shifts.” Analysis: Mrs. Jasper thinks the nursing staff is not responding to her sister’s needs. She is also likely worried about the seriousness of her sister’s injury, her lack of progress, her recent depression, and her prognosis. Mrs. Jasper may be feeling that if it takes such a long time to answer a call light, her sister’s needs are seen as unimportant. The length of time

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continuing education

statement, such as “I won’t have time for that today.” It’s also helpful to communicate that you understand the requestor’s dilemma even if you can’t solve it. If appropriate, suggest an alternative course of action, but don’t communicate that you will take responsibility for coming up with an alternative solution. Don’t convey in any way, verbally or nonverbally, that you are unsure of your response or that with a little more pressure you could be persuaded otherwise. For example, suppose a colleague asks you to help complete her charting because she is behind in her work. A passive (and illegal) response would be to simply comply with her request. A person with an aggressive style might take this opportunity not only to refuse the request but also to lecture your colleague about how she could keep up with her work if she were better organized.

A more appropriate way to say no would be, “I’m not able to chart for care I haven’t personally given — but I know you’re running behind.” If you do have time and your own work is completed, you may choose to add “Is there something else I can do to help you catch up?”

that Mrs. Jasper perceives it takes the call light to be answered also may increase her anxiety about how fast she can obtain help in an emergency. She is making a reasonable request — that you assess her sister’s pain as soon as possible.

Choice B: This is an aggressive response. The nurse refuses any acknowledgement of or responsibility for a delay in call light response by blaming Mrs. Jasper for not following the “rules.”

Let’s look at the response choices. Choice A: This response is defensive and argumentative. The nurse has taken Mrs. Jasper’s comments as a personal attack, and her response does not demonstrate that she has read Mrs. Jasper’s distress level. Debating the length of time the call light was on is likely to escalate Mrs. Jasper’s anxiety level. Stating that the unit is understaffed and there is a need to wait for a float nurse to appear may reinforce Mrs. Jasper’s suspicion that there aren’t enough nurses (or caring nurses) to take care of her sister. WWW.ORTODAY.COM

Dealing With Anger and Distress Today’s hectic and complex healthcare environment has a major effect on the expression of distress in the workplace. Even those with outstanding communication skills may be challenged by difficult situations.3 Aspects of the healthcare environment that can make communication more stressful are patient and family emotions; the nurse’s feelings; contact between nurses, providers, and patients; and the response of the individual nurse to challenging situations.1 A study of how nurses and nursing assistants communicated under stressful

Choice C: This is a passive-aggressive response. The nurse states that she does care about Ms. Ingram, but then establishes control by informing Mrs. Jasper that she is in charge of determining in what order patients’ needs should be met. Her response also implies that Ms. Ingram is less deserving of attention because she isn’t “sick enough.” Suggesting that an aide will evaluate her sister’s pain is a patronizing response and may increase Mrs. Jasper’s view that she will need to be more demanding to ensure that her sister receives adequate care.

and non-stressful situations found that in four aspects (engagement, empathy, task orientation, and loyalty), scores were lower in stressful situations. But in another aspect, creativity scores were higher.9 The authors of the study concluded that under stressful clinical situations, nurses were more likely to engage in independent problem solving and be less task oriented and engaged in working with others.9 This study supported other studies that have found organizational factors to be a predictor of stress; these factors include short staffing, role ambiguity, and relationships among staff.9 In nursing it is not unusual to be confronted by angry patients or family members who feel that their needs are not being met. Remember that illness or injury is extremely stressful for individuals and their families and that stress may be expressed as anger. This does not make it easier to deal with, however, and learning

Choice D: This is a sarcastic response that will likely infuriate Mrs. Jasper and increase the likelihood that she will be a frequent visitor to the nurses’ station. Once the nurse calms down, she probably will regret responding in this way. Choice E: This is a responsive answer. The nurse acknowledges Mrs. Jasper’s complaint without debating the length of time the call light was on or implying that Ms. Ingram’s immediate needs aren’t important. The nurse clearly lets Mrs. Jasper know that she is being heard. The nurse’s response also sets the stage for future problem solving with Mrs. Jasper.

JULY 2019 | OR TODAY |

IN THE OR

continuing education

how to maintain your sensitivity to others and respond in a caring and professional way without distressing yourself requires good listening and assessment skills. “Transforming Nurses’ Stress and Anger: Steps Toward Healing” by Sandra Thomas, a leading nurse expert on anger, provides invaluable advice for nurses about how to recognize and manage anger and other distressing emotions.10 Expressing, suppressing, and calming are the three primary ways in which people manage anger, according to the American Psychological Association.8 Expressing angry feelings in an assertive way is the healthiest way to express anger. A person who suppresses angry feelings can convert them later into more constructive behavior. The down side of suppressing anger is that you may turn the anger inward, causing hypertension or depression, or develop a more destructive way of expressing anger, such as passive-aggressive behavior.8 Calming involves learning how to control both your outward behavior and your internal reactions.8 The instinctive way to respond to anger is to respond aggressively; however, an aggressive response is likely to incite an angry person. When confronted with a request from an angry person, stop what you are doing and listen carefully to what the person is communicating, what he or she is feeling, what he or she is requesting, and whether that request is reasonable.8 Respond with empathy and a sincere tone of voice, validate his or her concern by acknowledging you understand their complaint, stay calm, and remain firm with clear statements of what you are able to do.11 The nonverbal manner in which you respond to a distressed person is as important as the use of appropriate words. It is

36 | OR TODAY | JULY 2019

crucial for the person who is angry or upset to believe that he or she is heard. To convey this impression, stop what you are doing, face the person, eliminate distractions, and give your full attention to the speaker.11 If possible, move to a private area. Do not interrupt a person who is angry or upset; letting the person vent his or her feelings and feel he or she is being listened to can help. (See sidebar: “A Confrontation at the Nurses’ Station.”) Time is a precious commodity for most practitioners, and the person who is upset may need your attention at a less-than-optimal time. However, taking the time up front to listen to a distressed person is a wise investment because it increases the potential for more-rapid problem solving than if the person is put off or ignored. In dealing with angry coworkers, there are several strategies to get communication back on track. The American Nurses Association has recommendations in the position paper, Violence, Incivility & Bullying, for how individual nurses can respond to anger from coworkers and other members of the healthcare team. The recommendations include taking responsibility for one’s own actions, speaking directly to the other person when an issues arises, being open to other points of view and ideas, and being respectful in talking and listening.12 Following the American Nurses Association Code of Ethics is also an important part of eliminating workplace anger and improving staff relations.13 Staff disagreements are bound to happen from time to time, but they should not be allowed to become disruptive or to result in incivility or any type of abusive behavior. Most healthcare organizations have policies about incivility and bullying in the workplace, often with zero tolerance for such occurrences. Knowing the workplace policy and resources

that are available is also an important part of stopping angry exchanges between staff. To defuse a hostile encounter, first try to determine the source of the problem. Focus on feelings as well as facts. Don’t interrupt — when it’s your turn to speak, ask open-ended questions to gain clarity about why the person is upset. Asking an irate person for data can help him or her move from anger to problem solving.8 Ask clarifying questions so you can better understand the reason for the person’s angry reaction. Using “I” messages prevents you from assigning blame; blaming another tends to aggravate a person who is already angry.14 For example, you might say, “I can see that you are angry. Can you tell me what upsets you about what I did?” The next step is to increase the person’s awareness of the negative effect of the hostile communication. Describe your feelings rather than waste energy on evaluating the other person’s behavior. Redirect and reframe, giving some options for how the situation can be addressed.14 An assertive way of communicating this would be to say, “Dr. Brown, you may not realize that you are shouting at me. This is uncomfortable for me and prevents us from resolving this problem. I would be glad to talk to you when you lower your voice.” Remaining calm and in control in an aggressive situation also provides a contrast that may help the irate person realize that the aggressive behavior is inappropriate.11,14 Although responding with one’s own anger might feel good for a few minutes, the fact is that an angry outburst rarely causes someone to change his or her mind about an issue. Take some deep breaths, tell yourself to be calm, and gain emotional control before beginning to address the upset person.14 WWW.ORTODAY.COM

IN THE OR

continuing education

It is important to set limits on the inappropriate expression of anger.12 If an angry colleague will not back down, you should inform the person that you will not tolerate verbal abuse. For example, you might say, “I spoke to you earlier about the comments you made in the hallway. If they continue, I will report them to my supervisor.” If you feel physically threatened, walk away from the situation. In patient and family situations, call for security. For help in managing your own anger, talking with a trusted friend may be helpful. Other stress management strategies will also help, allowing you time to calm and cool off. One study found that educating nurses in communication skills increased their ability to deal with ineffective communication and conflict in the workplace. The result led to improvements in team relationships and the level of comfort of nurses felt in the work environment. The training improved attitudes needed for positive conversations and resolution of disagreements. 15 As healthcare providers, we encounter distressed people daily and need to find ways to relate that can help relieve their distress without upsetting us. We must be prepared to deal with the anger of patients, family members, colleagues, and even ourselves. Recognizing and minimizing communication barriers, using an assertive communication style, developing skill in refusing unreasonable requests, and knowing how to respond to an angry person can help you meet these workplace communication challenges.

OnCourse Learning guarantees this educational activity is free from bias.

Social Psychol. 2015;46(4):242-254. doi: org/10.1027/1864-9335/a000248.

Connie Vogel, PhD, RN, CNE, is an experienced psychiatric nurse and the author of a number of continuing education programs on psychiatric nursing, mental health, and communication strategies. She also is online faculty at Capella University School of Nursing.

8. American Psychological Association. Controlling anger before it controls you. APA Web site. http://www.apa.org/topics/anger/control.aspx. Accessed May 23, 2018.

EDITOR’S NOTE: Maureen Habel, MA, RN, past author of this educational activity, has not had an opportunity to influence this version.

7. Dahl J, Vescio T, Weaver K. How threats to masculinity sequentially cause public discomfort, anger, and ideological dominance over women.

WWW.ORTODAY.COM

References 1. Sheldon LK, Foust JB. Communication for Nurses. 3rd ed. Burlington, MA: Jones & Bartlett Learning. 2014:3-11, 97-105. 2. Karell D. The four types of communication styles. Alvrnia University Web site. https://online.alvernia.edu/communication-styles/. Published March 27, 2018. Accessed May 23, 2018. 3. Vertino K. Effective interpersonal communication: a practical guide to improve your life. OJIN. 2014:19(3):1. doi: 10.3912/ OJIN.Vol19No03Man01. 4. Lux KM, Hutcheson JB, Peden AR. Ending disruptive behavior: Staff nurse recommendations to nurse educators. Nurse Educ in Pract. 2014;14(1):37-42. doi: 10.1016/j.nepr.2013.06.014. 5. Gender communication differences and strategies. Experience Web site. https://www.experience.com/advice/ professional-development/gender-communication-differences-and-strategies/. Published June 29, 2017. Accessed May 23, 2018. 6. White BA, Turner KA. Anger rumination and effortful control: mediation effects on reactive but not proactive aggression. Personalit Individ Differ. 2014;56:186-189. doi 10.1016/j. paid.2013.08.012.

9. André B, Frigstad SA, Nøst TH, Sjøvold E. Exploring nursing staffs communication in stressful and non-stressful situations. J Nurs Manage. 2016;(2):E175-E182. doi: 10.1111/jonm.12319. 10. Thomas S. Transforming Nurses’ Stress and Anger: Steps Toward Healing. 3rd ed. New York, NY: Springer; 2008:99 11. How to handle patient confrontations. Texas Medical Association Web site. https://www.texmed.org/template. aspx?id=1597. Accessed May 23, 2018. 12. Position paper on incivility, bullying, and workplace violence. American Nurses Association Web site. https:// www.nursingworld.org/practice-policy/ work-environment/violence-incivilitybullying/. Published July 22, 2015. Accessed May 23, 2018. 13. Code of ethics for nurses. American Nurses Association Web site. http:// nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-Nurses.html. Accessed May 23, 2018. 14. Dealing with difficult patients. Emergency Medicine Cases Web site. https:// emergencymedicinecases.com/episode51-effective-patient-communicationmanaging-difficult-patients/. Published October 2014. Accessed May 23, 2018. 15. Nicotera AM, Mahon MM, Wright KB. Communication that builds teams: Assessing a nursing conflict intervention. Nurs Adm Q. 2014;38(3):248-260. doi: 10.1097/ NAQ.0000000000000033. JULY 2019 | OR TODAY |

Clinical Vignette Brenda is the charge nurse on a busy medical/surgical unit. It’s only two hours into her 12-hour shift, and she has already handled a family member complaint, averted a conflict between two staff members, responded to an angry physician, and counseled a staff member about her interactions with a patient. 1. Mr. Clements is complaining that a staff member has treated him rudely. Which response is most appropriate for Brenda to make?

a. “Tell me exactly what happened.” b. “I’m sorry that happened, but our staff is really busy tonight.” c. “That particular staff member is having family problems.” d. “All of our staff members have gone through customer relations training.” 2. Shirley, the staff member about whom Mr. Clements complained, admits she was rude. Which statement is most likely to help Shirley modify her future behavior?

a. “I’ll have one of the other staff members take care of Mr. Clements.” b. “I’m going to have to write you up.” c. “Let’s talk about what happened.” d. “I don’t have time to solve your interpersonal problems.” 3. James and Kayla, two nursing assistants, are arguing loudly at the nurses’ station about break times. Which statement is most appropriate in this situation?

a. “If you can’t work this out, neither one of you will have a break tonight.” b. “Let’s flip a coin.” c. “I knew I shouldn’t have come to work tonight.” d. “Let’s discuss this calmly in a more private place.” 4. Dr. Gable is upset because a lab report he needs is missing. Which nonverbal behavior is most likely to communicate disinterest and escalate his angry response?

a. Sitting down to listen to what he is saying b. Continuing to chart while he is talking c. Making eye contact with him d. Writing down the facts he is stating about the missing lab report

Clinical VignettE ANSWERS 1. A – This answer shows that Mr. Clements has Brenda’s attention. It is a respectful answer that communicates that she is willing to listen to what happened from Mr. Clements’ perspective. The other answers are dismissive non-answers that are likely to agitate Mr. Clements even further. 2. C – This reply demonstrates Brenda’s willingness to be open and objective and to listen to both sides. Giving Shirley the chance to talk about what her feelings are is likely to start a dialogue about modifying future behaviors. The other answers will not solve the problem or attempt to avoid the problem. 3. D – Moving a public altercation such as this to a private place is the appropriate response. The other answers are either sarcastic or dismissive and don’t demonstrate effective communication skills. 4. B – Continuing other tasks while a distressed person is trying to talk communicates lack of respect. Sitting down, making eye contact, or writing down the details of a problem are nonverbal behaviors that communicate sincere interest in problem solving.

38 | OR TODAY | JULY 2019

CE344-60

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

Deadline Courses must be completed by 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.

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. 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.

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Nurse.com You can take this test online or select from the list of courses available. Prices subject to change.

Questions or for a complete listing of our courses Phone: 877-843-8374 Email: nursesupport@relias.com

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SPEAKER SPOTLIGHT My first manager was influential in giving me a great start on my professional journey. My first job out of nursing school was in a tiny (19-bed) rural hospital with one OR. We were “green” before it was fashionable, using cloth drapes and re-sharpening suture needles. As soon as I was eligible, it was expected that I sit for the CNOR certification exam. Just because we only did a handful of different types of cases in a remote area did not mean that our community did not deserve access to quality surgical care. The fact that I was successful on the exam with experience only in circulating abdominal hysterectomies, tonsillectomies and cesarean sections was testament to her passion for promoting competent practice. I never dreamed that I would someday work for the organization that provides perioperative certifications. My goal is to instill in our next generations of nurses the same passion that she had for providing competent, safe and quality patient care. •

Juliana Mower, MSN, RN, CNS, CNS-CP, CNOR, Nurse Manager, Education Development, Competency and Credentialing Institute

AUGUST 18-20 | LAS VEGAS, NV

JULIANA MOWER, MSN, RN, CNS, CNS-CP, CNOR

Find out more about Juliana and her experience in competency as she presents, “Beyond the Checklist: The use of a professional portfolio to demonstrate continued competency” at the 2019 OR Today Live Surgical Conference.

www.ortodaylive.com

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JULY 2019 | OR TODAY |

CORPORATE PROFILE C Change Surgical

SurgiSLUSHTM 4-Liter & 2-Liter

°C Change SURGICAL

C Change Surgical is a small, highly focused U.S. firm formed in 2004 by a core group of variously skilled and experienced medical device executives. These executives operate a medical technology company passionately devoted to solving clinical problems and improving processes while reducing direct costs. They achieve success by developing technology that clearly delivers important, helpful improvements and costs less to use.

During research and development for C Change Surgical’s automated slush system, many clinicians expressed the need for change and improvement. And, C Change’s leadership applied the guidance provided by many experienced clinicians during system development. C Change Surgical developed an automated 21st century sterile slush system that delivers new levels of efficiency, reduces labor, increases supply output and lowers cost. C Change Surgical leaders emphasize the reduction of direct costs as a major objective when developing new technology. Listening closely to experienced cardiac, transplant and procurement clinicians paved the path of development. OR Today interviewed C Change Surgical Managing Director/CEO Patrick Kammer to find out more about the company and what it offers health care professionals.

Q: What are some advantages that your company has over the competition? A: C Change Surgical is leaner, faster and more focused than our large competitors. We leverage our expertise in automation and materials science. And, we designed a new system that specifically targeted improvements in certain key areas identified as vital by sterile slush users. Cost reduction appeared near the top of their list. Our high-output, automated

40 | OR TODAY | JULY 2019

PCS

Protective Container SystemTM

freezers reduce slush equipment costs 37% to 73% per room. Our slush container system reduces costs by 30% to 50%, compared to portable slush bricks used by many transplant and procurement teams. Clinicians asked us to design with the environment in mind. Our automated freezers utilize reusable slush containers, a green approach appreciated by clinicians concerned about our environment. And, our single-use, protective containers are recyclable and reduce waste by 30%. Because of the increased attention and importance given to infection control, clinicians asked C Change to pay special attention to the reliability and security of the sterile barrier we designed. As a result, our system employs a locked, sealed, doublecontainer system that confirms sterility for every liter prior to use. Clinician input helped us deliver a big step forward in terms of sterile security. We compete against large, wellresourced but diffusely focused companies. We have to use clinical guidance and speed of execution to gain advantage. Our customers cheer for us because we invested in and focused on improving an important clinical tool used to help very sick surgical patients in highly complex surgeries. Clinicians know and appreciate when companies are working for them.

Q: What are some challenges the company faced last year? A: We battle to increase market awareness. After decades without product choice, ensuring that clinicians are aware that there’s a significantly better option in sterile slush remains a focus. 2018 was our first full year providing a totally developed, high-output slush system that works well for and benefits programs of any size, large or small. Our biggest challenge continues to be increasing market awareness.

Q: Can you explain your company’s core competencies and unique selling points? A: We develop technology with clinicians, for clinicians and their patients. Thankfully, we have experienced, talented people who can execute and produce great technology that meets or exceeds today’s clinical demands. We develop and then produce both computerized automation and molded, polymer products super efficiently. Our slush system is many levels and several iterations better in design and function than it was four years ago. That’s just not possible in larger companies. Clinical teams are embracing our automated system, which demonstrates to us that our product development team aced it. Our sales team has a lot of experience and works very well with clinical staff WWW.ORTODAY.COM

SPECIAL ADVERTISING SECTION

CORPORATE PROFILE

C Change Surgical

C Change Surgical has developed an automated 21st century sterile slush system that delivers new levels of efficiency, reduces labor, increases supply output and lowers cost.

during evaluations. They bring a thorough, expert-level knowledge of the processes and practices of sterile slush. At C Change Surgical, we know sterile slush inside and out. That helps our clinical customers adopt and use our system efficiently. Technology Selling Points: An automated SurgiSLUSH™ freezer frees up clinical teams by making and maintaining smooth slush on its own. Push one button and go get things done. Our users typically produce slush before procedures when it’s more efficient to do so. Our system maintains slush automatically so clinical teams deliver slush wherever and whenever it is needed. Our protected containers save valuable sterile space and require no sterile field labor. Our users gain focus for priorities during complex cases because they do not make or maintain slush during procedures. Circulators deliver

" Despite our relatively small size, we work hard to support our customers and will do more as we grow. " WWW.ORTODAY.COM

their slush when needed. And, one freezer supplies multiple rooms. Previously, every procedure room required an expensive slush machine in its sterile field. Producing and maintaining slush outside the sterile field and supplying multiple procedures slashes equipment costs. Clinical and financial stakeholders find that a welcome improvement.

Q. What product or service that your company offers are you most excited about right now? A: In the last 18 months, we upgraded our automated freezers with touchpad controls, whisper-quiet agitation and high output supply. And, we completed development on our protected containers. We now offer all facilities a way to make slush much more efficiently, with confirmed sterility for every liter, at lower cost. That’s exciting. Early on, C Change executives saw the need at larger cardiac programs and transplant and procurement programs to supply large volumes of sterile slush more efficiently and at lower cost. C Change produced a high-output system that makes and maintains slush on its own without constant attention and labor. C Change Surgical’s automation and container system streamlines sterile slush

from beginning to end for programs of all sizes. High-volume slush users are now supplying more slush to more procedure rooms at lower cost with our system. The feedback has been overwhelmingly positive. It’s a big step forward and we feel very proud of that progress. And, we feel very excited to have upgraded our smaller, 2-liter automated freezers. They provide cutting-edge benefits for smaller programs that use lower volumes of sterile slush. Many small hospitals across the U.S. are financially challenged. They must reduce costs while maintaining or improving their clinical practice. It’s a huge challenge. We feel proud to deliver great technology for smaller facilities that cuts costs and elevates their clinical practice.

Q: What is most important to you about the way you do business? A: We treat our customers like we would want to be treated, improving technology and cutting costs. We designed great technology for slush users and we operate for their benefit. We could have charged more for what we feel is a clearly advanced product. We chose to charge less and reduce costs for our customers. Doing so clearly demonstrates our understanding of the challenges our clinical customers face JULY 2019 | OR TODAY |

CORPORATE PROFILE C Change Surgical

and our commitment to helping them clinically and economically.

Q: How does C Change Surgical support customers? A: We support customers in a number of ways. First, we produce innovative technology that improves clinical practices and cuts costs and we have initiated programs for different market segments that deliver additional value. Second, we attend clinical conferences and support clinical organizations. We have started to reach out to local AORN chapters to sponsor meetings on a more local level. Regional AORN leaders can contact us about this. Third, we attend meetings and contribute to organizations in the organ donor, procurement and transplant space to support efforts intended to increase organ donation and expand life-saving organ transplants. Despite our relatively small size, we work hard to support our customers and will do more as we grow.

" Our slush system is many levels and several iterations better in design and function than it was four years ago. That’s just not possible in larger companies. Clinical teams are embracing our automated system, which demonstrates to us that our product development team aced it."

We also pride ourselves on the quality of our clinical education during evaluations and our rapid response time to support our customers with any needs they may have.

Q: What is on the horizon for your company? A: At C Change Surgical, we have demonstrated that we can produce sophisticated thermo-mechanical automation with elegantly designed, highly usable polymer products made from advanced materials. And, we listen very carefully to our clinicians. We have the opportunity to use our capabilities to further address our current market and other markets where temperature and sterile fluid control matter.

Q: Can you please describe your company’s facility? A: We operate out of a 100-year-old, restored tobacco building in the Wake Forest Innovation Quarter in WinstonSalem, North Carolina. It is an old, brick building with tall, tall ceilings and beautiful wooden floors. Yet, very modern inside. I love the fact that WinstonSalem and Wake Forest Baptist Health have joined to re-purpose old tobacco buildings that now house biotech, medical technology, pharma and IT companies. We feel lucky to be here and love the energy of this beautiful, small city. Visitors simply cannot believe how nice this city is. Great place.

Q: Can you highlight any recent changes to your company? A: We have been steadily adding people in various roles who fit our culture of excellence and who want to grow our small company into the best medical device company on the planet. Not the biggest, just the best.

Q: what is most important to you about the way you do business? A: Our mission is simple: C Change Surgical makes life better for clinicians and patients while reducing direct costs. We work first and foremost with talented local suppliers and vendors, then state (North Carolina) and then national (U.S.) sources to make great products. We gain tremendous efficiency and support our community with our spending. That’s a win-win for our community and our company. We feel proud to operate the way we do.

Q: Is there anything else you want readers to know about your company? A: There is now a 21st century technology available that automatically advances and improves the clinical production and use of sterile slush at lower cost. We are often asked about the name of our company. We selected the name C Change Surgical for several reasons. First, clinicians routinely use Celsius or Centigrade when dealing with temperature. So, C with a degree symbol honors how clinicians speak about temperature. Second, the term “sea change” comes from Shakespeare’s play, The Tempest. It is used now to mean a total transformation. Our technologies transform sterile fluid into sterile slush used to cool organs and give surgeons more time to work. Our system clearly transforms the way clinicians make and use slush. So, C Change denotes Celsius and sounds exactly like the term that means “total transformation.” It fits us well and we like it. But we’re kind of nerdy, so… For more information, visit www.cchangesurgical.com or call toll-free: 877-989-3737. WWW.ORTODAY.COM

Efficiency works FOR you. As your staff gets things done, SurgiSLUSH™ automatically makes & maintains smooth, sterile slush.

Smarter Slush Locked containers = best-practice sterile protection.

SurgiSLUSH 4-Liter & 2-Liter TM

PCS

Protective Container System

Automatically Smooth & Protected. Supply More. Reduce Costs. Get Better. Email info@cchangesurgical.com Toll-free (877) 989-3737 www.cchangesurgical.com HealthTrust Contract #12318

°C Change SURGICAL

SPEAKER SPOTLIGHT My intention for becoming an RN was wanting to work at the hospital where my father worked. He was a recreational therapist at the Colorado State Hospital (now called the Colorado Mental Health Institute of Pueblo) for 30 years. As a child, I was privileged to sit in on some of his music therapy sessions. Observing how he interacted with his patients fascinated me and I worked hard to become a registered nurse so I would be able to work with these special people. I’d responded to an ad for OR nurses not knowing that the supervisor was the daughter of my favorite nursing instructor. She was kind and very honest in stating that her department was having some “low morale” issues and she needed some “positive changes” for her department. I reluctantly left my position at the state hospital not realizing that the training for my new position would be the hardest I’d faced to date. With persistence and determination, I learned how to function as an OR nurse. As new nurses were hired, I was determined to not have them struggle like I had and took them under my wing. I shared the mistakes I had made so they would avoid making the same mistakes. This gave me true purpose in training new nurses and 29 years later, I continue to pass on these lessons learned to new nurses. As an educator for perioperative nursing, taking the fear and unknown away from these novice nurses promotes their willingness to learn more and focus on becoming high-functioning and passionate nurses in the perioperative nursing specialty. •

THERESA COWGER, MSN, RN, CNOR

Theresa Cowger, MSN, RN, CNOR, Critical Care Periop Nurse Educator, Evan Army Community Hospital

AUGUST 18-20 | LAS VEGAS, NV

PROOF APPROVED CLIENT SIGN–OFF:

PROOF SH Find out more about Theresa and her experience in training as she presents, “Best Practices in Perioperative Nursing/Training Future OR Nurses” at the CHANGES NEEDED 2019 OR Today Live Surgical Conference.

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Pos ition i ng

Pat i e n t s S a f e ly

M a n y s u r g i c a l pat i e n t s a r e c o m p l e t e ly o r

pa r t i a l ly d e p e n d e n t o n t h e O R t e a m t o m o v e ,

lift and position them due to the effects of general or regional anesthesia.

The statistics with regard to

safe patient han-

dling and mobility

(SPHM) are not encouraging. Letâ&#x20AC;&#x2122;s start with the fact that more than half (51 percent) of nurses say they have experienced musculoskeletal disorder (MSD) pain at work from handling patients, according to research conducted by the American Nurses Association (ANA). In addition, sprains and strains are the most often reported nature of health care worker injuries, according to OSHA. And, the Bureau of Labor Statistics (BLS) reports that 12 percent of nurses leave the profession every year as the

By Don Sadler

result of an MSD. The average MSD claim costs $11,771, notes the BLS, while the average cost of a back injury is $37,000.

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JULY 2019 | OR TODAY |

“ T h e pat i e n t t r a n s f e r f r o m s t r e t c h e r t o O R ta b l e u s i n g m a n u a l h a n d l i n g w i l l i n vo lv e a g r e at d e a l o f f r i c t i o n a n d s k i n s h e a r a s pat i e n t s a r e p u l l e d f r o m o n e s u r fac e t o t h e o t h e r . ” – K at i e K r a m e r

H i gh e s t R ate s of M D S In jurie s “Nursing has some of the highest rates of musculoskeletal disorder injuries of any industry,” says Katie Kramer, the marketing communications manager for HoverTech International, which manufacturers safe patient handling devices. “The physically demanding nature of the profession is compounded by factors such as heavier patients and staff shortages due to an aging and injured workforce.” These MSDs affect muscles, nerves, tendons, joints, cartilage and spinal discs, says Mary J. Ogg, MSN, RN, CNOR, a Perioperative Nursing Specialist with the Association of periOperative Registered Nurses (AORN).

is also on the board of directors of the Association of Safe Patient Handling Professionals (ASPHP). “It very rarely happens after just one incident.” Adding to the problem is the aging nurse population. The average age for a registered nurse in the U.S. today is 50 years old, while the average perioperative nurse is 53 years old, according to the ANA. “The increasing prevalence of obesity is also contributing to the SPHM risks for OR personnel,” says Ogg. “More than one-third of all the patients cared for in the OR are obese.” “As the patient population gets bigger, the risks for nurses who must transfer and position patients are increasing,” adds Kramer. Of course, unsafe patient handling

“ T h e r e a r e a l s o e x p e c t a t i o n s t o g e t p a t i e n t s u p out of be d an d movi ng with i n 12 hou rs of s u r g e ry t o a s s i s t w i t h a m b u l at i o n a n d e a r ly m o b i l i z at i o n . ” – R u t h F r a n c i s “Many surgical patients are completely or partially dependent on the OR team to move, lift and position them due to the effects of general or regional anesthesia,” adds Ogg. According to the ANA research, 80 percent of nurses with MSD pain continue working even though they are in pain. “So we know it’s a big problem,” says Ruth Francis, MPH, MCHES, Senior Policy Advisor with the ANA. “MSD pain occurs over time due to the multiple twists and turns from transporting and repositioning patients manually,” adds Francis, who

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and mobility practices also pose risks for patients. The main patient risks are skin abrasions, pulled limbs and fractures due to falls, says Francis. “The patient transfer from stretcher to OR table using manual handling will involve a great deal of friction and skin shear as patients are pulled from one surface to the other,” says Kramer. “There are also expectations to get patients up out of bed and moving within 12 hours of surgery to assist with ambulation and early mobilization,” Francis adds. “This can increase SPHM risks for nurses and patients.”

Adhere to SPHM Gui del i nes Kramer says that perioperative personnel should adhere to the SPHM guidelines set forth by AORN and the National Institute for Occupational Safety and Health (NIOSH) to keep themselves and their patients safe. For example, NIOSH has recommended that health care workers not manually lift more than 35 pounds of a patient’s body weight themselves. Instead, nurses should use assistive lifting devices and technologies like air-assisted lateral transfer devices, new technology transfer boards, friction reducing sheet and ceiling lifts if they have to lift more than 35 pounds. Believe it or not, lifting the leg of a 250-pound patient could exceed the NIOSH recommendation for safe manual lifting, since a leg can account for up to 16 percent of a patient’s total body weight. “In this situation, at least two perioperative team members should raise or hold the leg in position, or a mechanical device should be used to help,” says Ogg. In fact, one of the biggest mistakes many perioperative personnel make when it comes to SPHM is not using equipment and technology designed to minimize or eliminate manual patient handling. While 73 percent of nurses say they have access to SPHM equipment and technology, only 51 percent use it every time they transfer a patient, according to the ANA. “Maybe they look at a patient and think she’s small so we don’t need to use the equipment, or maybe the equipment isn’t readily accessible,” says Francis. “That’s when injuries occur. WWW.ORTODAY.COM

Ruth Francis, MPH, MCHES, S e n i o r Po li cy Advi so r with th e ANA Kramer points to the effectiveness of air-assisted devices like the HoverMatt Air Transfer System in reducing MSDs among perioperative personnel. “With this system, OR nurses can safely and easily transfer patients in the pre-op and post-op settings with fewer staff,” she says. “The HoverMatt also significantly reduces the friction and shear on the patient’s skin during the transfer.”

U.S. L ag g i n g B e h i n d in SPH M Dan Allen, the founder and president of D.A. Surgical, believes that the U.S. is behind many other nations when it comes to SPHM. “In Europe they’ve come up with a number of ways to reduce patient handling and mobility risks to hospital personnel,” he says. “For example, the UK has legislated safe patient handling and lifting for all ORs, and a company in Germany has created a device where no one has to touch the patient to lift him or her off the bed and onto the gurney. But, I’ve never seen one of these in a U.S. hospital.” Allen believes that money is the biggest obstacle to widespread use of SPHM technology at hospitals in the U.S. “Does our health care system have the stomach to invest the money that’s needed to bring this technology into hospitals all across the country?” he asks. “Apparently not, because the solutions are there but budgets currently don’t support it.” In the meantime, he says the best thing health care workers can do to practice SPHM is to follow best practices and guidelines published by organizations like AORN and the ANA.

Dan Alle n,

th e fo u n d e r an d pres i d e nt o f D. A. S u rg i cal

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For example, AORN has created a Safe Patient Handling Toolkit that provides education for perioperative personnel about the correct and safe way to move patients and equipment in the perioperative environment. Also, AORN’s Ergonomic Tools in the Guideline for Safe Patient Handling and Movement provide guidance and algorithms for transferring and positioning patients. “Hospitals should read the Guideline and incorporate the recommendations into their policies and procedures,” says Ogg. Meanwhile, Francis says that the ANA is in the process of refreshing the Safe Patient Handling and Mobility Interprofessional National Standards that were first published in 2013. “The standards themselves haven’t changed, but we’re refreshing the background data behind them to reflect new studies that have been conducted since then,” she says. “The new guide will include assessment tools and information about new technology for practicing SPHM.” Francis says that the new guide will be available in early 2020 in hard copy form as well as an ebook. “This will make it more easily accessible to all staff members,” she says. For more information, visit www.aorn.org/guidelines/ purchase-guidelines or www.aorn.org/guidelines/clinicalresources/tool-kits.

JULY 2019 | OR TODAY |

SPOTLIGHT ON:

CNRA, and

surgical technician Laura Faust sews a mat.

BY MATT SKOUFALOS

or the past two years, surgical technologist Veronica Marella of the Providence Little Company of Mary Medical Center has been making headlines for her innovative use of what would otherwise be surgical waste. Marella was inspired to repurpose the wrappers from the surgical tool trays in her unit, called tarps, into sleeping mats for homeless people. The polypropylene wrappers are highly durable, moisture- and heat-resistant, and, with no other secondary use, were creating a significant amount of garbage in her unit. After stitching a few of them together with elastic thread, Marella began distributing the mats to homeless people in Torrance, California. She even recorded a YouTube how-to video describing her process so it could be replicated in other surgical environments. Across the country, in Camden, New Jersey, surgical technologist Dana Scarangelli caught wind of Marella’s efforts after reading a news story about the program. She reached out to Marella, offering to send over the tarps from her own workplace, the Lourdes Health System. “Why not do the program yourself?” Marella countered. Scarangelli’s colleague, nurse anesthetist Laura Faust, was the first person to say, “I’ve got to be part of this,” she remembers, and the two were off and running.

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Every time a fresh tray of sterile surgical equipment is unwrapped, a volume of waste is created. The equipment itself is reusable, yet the tarps that protect it

A collection of mats ready for distribution are seen on a table.

are often only long-lived in landfills. Faust was frustrated that there seemed to be no alternative use for them. “If you could see the amount of tarps that are thrown out every day, it’s incredible,” Faust said. “There’s probably 50 to 80 tarps, close to 100 every day, that are dumped in the trash.” Of course, unless they frequently remind colleagues to set the tarps aside for them, the tarps usually aren’t diverted

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from the garbage. Until a better system is established, Faust and Scarangelli are dependent upon voluntary contributions. “People support us here, but it kind of ends with Dana and myself, and whoever the OR tech is at the end of the day collecting them for us,” Faust said. “It’s been nice, but we need more people.” “I’d even take a hamper outside the OR that people can throw them in,” she said. “Let’s collect all these tarps. We can do something with them.” The two can do a lot of things with the tarps, actually. The largest wrappers become sleeping mats. Medium-sized tarps can become ponchos or sleeping bags, and the smaller ones can become

Laura Faust is seen with Joseph's House of Camden (homeless shelter) Director James Wynn.

reusable totes or cage liners for animal shelters. The variety of products and relative ease in constructing them lends a lot to the reproducibility of their program, Faust and Scarangelli said. “We fold two into each other, add a couple loops of elastic, roll it up, and it looks like a yoga mat when you’re finished,” Scarangelli said. “Laura added an extra loop so [users] can throw it over one of their shoulders.” Everything they make is donated to the homeless populations of nearby Camden City and Philadelphia; officers from area police departments have even WWW.ORTODAY.COM

offered to help with distribution. “We’ve made a couple hundred,” Scarangelli said. “I’ve taken some to [the Philadelphia neighborhood of] Kensington. The Lourdes OR as a group feeds the homeless twice a year, and I’ve taken a lot of them there.” The more the women distribute the tarps, the more they’re seeing them being used in the area, Faust said. One man whose mat was stolen from him rode his bike back to the hospital to ask for another, she recalled. Still, the pair are searching for any way to expand the volume and efficiency of their program. First,

they reached out to Halyard Health, the Kimberly-Clark subsidiary that produces the tarps, but that company’s Blue ReNew program is only focused on converting used tarps into pelletized resin. Scarangelli and Faust have even sought to find an entity that will collect and bale the tarps for them, but haven’t had much luck as yet. Other developments have been more positive: when sock manufacturers Bombas heard about their outreach to the homeless, the company donated 1,000 pairs of socks for Scarangelli and Faust to hand out with the mats. Other health care workers throughout the country and in Canada heard about their efforts, and asked how to help. Like Marella, Faust said they’ve tried to help by inspiring others to start their own programs, donating their time, expertise and even a sewing machine or two. “It’s humbling when people contact you and want to do this,” Scarangelli said. Even beyond continuing the tarp recycling program, Scarangelli wants to expand environmental and sustainability awareness throughout the hospital. She previously helped cut back on red-bag waste in the operating rooms in her unit by changing team behavior. Encouraging her colleagues to limit their use of the red bag to only highly contaminated waste spared some 13,000 pounds of waste. Scarangelli said she’d like the hospital to create “a true green team to focus on recycling and up-cycling initiatives; really just try to make it a greener OR.” In the meantime, neither she nor Faust is confining their creative energies to solving problems in the workplace. In addition to the time the pair spends upcycling the tarps, both are equally busy in other aspects of their lives. Faust is a mother to three boys. Scarangelli runs a candle-making business and a ferret rescue. They still find a few hours a week to sustain (and hopefully expand) their tarp repurposing efforts. “We’re getting there, it’s just very slow,” Scarangelli said.

Would you like to nominate someone for the spotlight article? Visit ortoday.com/nominations/

JULY 2019 | OR TODAY |

OUT OF THE OR fitness

Why Journey to Alkaline? By Miguel J. Ortiz he confusing journey of dieting and finding optimal nutrition that almost every individual takes can be exhausting. Let’s throw in age, genetics, trauma and general family health issues and we have a melting pot for disaster. So, where do we begin?

I highly recommend studying and reading more about the alkalinity and acidity of the foods we’re currently eating. I would not call alkaline a “diet” per say, it is merely a very important piece of chemistry we need to understand and balance accordingly. The human body has an optimal pH level of about 7.365, foods with a pH of anything less than that is considered more acidic anything higher is more alkaline. OK, so we know what our body’s ideal pH level needs to be but which foods have higher pH levels and why is this important for the body? Firstly, acidic foods inflame the body, dehydrate, cause pain and destroy cells. Alkaline foods bring down swelling, hydrate, soothe and regenerate cells. This is important because your lymph system is like your body’s sewer system. It surrounds every cell and when it backs up it turns to acid causing acidosis. And, it’s the cause of most health dysfunctions from canker sores to cancer. Acidosis is caused

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from years of consuming acid-forming foods. Dairy, grains, meat, refined sugars, high protein diets, toxins in water, cosmetics, negative thoughts, environment, anger and even general stress all produce acids. So, how do we get our power back? The answer is fruit! Fruit is alkalizing and it gets static lymph moving to the kidneys and lymph nodes where acids, toxins, viruses, parasites and unwanted bacteria can be gotten rid of. Before you go crazy and start eating lots of fruit, there is a huge detox process to consider. Please understand detoxing the body takes time depending on where you’re at in your health journey. If you have a lot of weight to lose or serious medical issues your process can be more grueling as detoxing isn’t always pretty. As always, please consult with your doctor and dietician. So, how do we begin? First, limit acid-based foods and eat more food with a higher alkaline pH level (anything above 7.35). Keep in mind that just about all fruits and veggies are above an 8.0 pH. Second, take the process slowly. Your about to completely change your metabolism for the better and it’s going to take some time. Start by eliminating your most acidic foods like sodas, processed foods and dairy. Then, you can start to eliminate some meat here and there. Keep in mind that we have

been conditioned to think we need meat at every meal and with this new mindset we definitely do not. I am not telling you to cut out meat completely however you must consider pH levels of meat. Fish has a 6.0 pH. Chicken, duck, lamb and turkey are around 5.0 pH. Beef and pork is 4.5 pH. Lobster and bacon is about 3.0 pH (before being cooked and pending preparation). Third, please talk to a professional (your doctor, dietician and/or nutrition coach) so that you can have professional guidance. Fourth, do not combine fruit with acidic foods, this will simply cause backing up in your GI tract and will lead to inconsistent results. Lastly, for more research and education please read work by Dr. Sebi as well as Dr. Robert Morse, who has a wonderful book called the “The Detox Miracle Sourcebook: Raw Foods and Herbs for Complete Cellular Regeneration.” Good luck with your health journey and always keep pushing forward. Miguel J. Ortiz is a personal trainer in Atlanta, Georgia. He is a member of the National Personal Trainer Institute and a Certified Nutritional Consultant with more than a decade of professional experience. He can be found on Instagram at @migueljortiz.

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OUT OF THE OR health

Boomeritis: Too Much By Marilynn Preston

of a Good Thing Causes Injuries

ny body, at any age, can suffer a sports injury, but we baby boomers are famous for them. There’s actually a term for it – boomeritis – and it refers to the high number of sports-related injuries that happen to people born between 1946 and 1964 – the first generation of Americans who grew up working out, with or without the Jane Fonda leg warmers. (I still have mine.)

shoulders. Overuse injuries happen when you push too hard for too long and try to do too much with a body – your body – that isn’t yet strong or flexible enough to take the strain. It’s part ego, part ignorance, and there is a cure: You must learn to tune in and listen to your own body and respect whatever limitations you feel on any given day. Boomers have never liked limitations, but when it comes to preventing injuries, they’re important.

line. A tennis racket with the wrong size grip, too big or too small, can set you up for tennis elbow. A bicycle seat that’s too low can grind out your knees. Who’s responsible for preventing these injuries? You are. Running – or, more likely, limping – to your doctor after you’ve hurt yourself is not the ideal solution; prevention is. And that means making sure your body fits your gear and your gear is cleaned, greased, well-maintained and ready to roll.

In 2019, we’re facing a classic good news-bad news scenario. On the upside, we have millions of boomers who share an enlightened view about the benefits of regular exercise – hiking, biking, downward dogging our way to stronger bodies and longer lives. The sad news is we’re going about it like maniacs, and our hips, knees, thighs, shoulders, ankles and other important body parts are wearing out in record numbers. Sports injuries and the problems they cause over time are one of the most common reasons boomers go see their doctors, and orthopedic surgeons all over America can hardly keep up with the demand for new hips, reconstructed knees and repaired rotator cuffs. Oh, no. What to do? Learn from boomer mistakes. Most sports injuries are preventable. Here are some basic do’s and don’ts, good for all ages:

DO PAY ATTENTION TO YOUR SHOES

DO GET IN SHAPE

A surprising number of sports injuries happen as a result of poor footwear. To help protect your hips, knees, ankles and feet, be sure your shoes are giving you enough cushioning and support. If your shoes get too run down and worn-out, you need a new pair, even if it means giving up a comfy pair you love. Some people do better with running shoes that have less structure, as these kinds of shoes require the muscles and bones and surrounding tendons and ligaments to do more of the work, making them stronger. You won’t know if a less structured shoe is a good style for you until you try it. Also, be sure to buy the right shoe for your sport. You shouldn’t be playing tennis in your running shoes. The side-toside motion in tennis calls for a shoe with lateral support, while running shoes are built for forward motion.

Anyone can go out and chase a ball. If you come to the field – or the basketball court, bike path, backyard badminton game – with a body that is strong, flexible, well-nourished and conscious about breathing, relaxation and other good stuff, you hugely reduce your risk of suffering a stress-and-strain injury.

DON’T OVERDO IT

DON’T FORGET TO FIT YOUR GEAR

Overdoing it is the No. 1 reason people get hurt playing sports. Painful examples include shin splints, sore knees and aching

Spring is the perfect time to inspect your gear and make sure you’re not doing something to create an injury down the

– Marilynn Preston is the author of “Energy Express,” America’s longest-running healthy lifestyle column. For more on personal wellbeing, visit www.MarilynnPreston.com.

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DON’T SKIP THE WARMUP Stretching individual muscles before a workout may or may not prevent injuries. But a warmup is an undisputed must. You warm up (pumping your muscles, juicing your joints, waking up your heart) by spending the first five to 15 minutes of your workout moving at a slow, deliberate pace. Focus on your breath. And remember to cool down and hydrate after your workout. For many boomers I know, that means one tall glass of water for every small glass of chardonnay.

JULY 2019 | OR TODAY |

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OUT OF THE OR EQ Factor

One Benefit of Valuing Differences By Daniel Bobinski ears ago, I was conducting emotional intelligence training for a large corporation. One of my friends, also a trainer and author, happened to be in town. She had written a book on diversity and was accustomed to looking at that topic through a cultural lens. Because she was available, I asked her to cofacilitate a day of training with me and provide an expert’s perspective of diversity.

Part of that day’s training was on DISC behavioral styles and how each style brings different strengths to a team. I should also state that one phrase I always use in EQ training is, “Value the differences.” My friend wasn’t too familiar with DISC language, but as the day progressed, she showed increasing interest in its application. Before I tell you why, let me first state that if you aren’t familiar with DISC language, it’s a framework for understanding behavioral and communication styles. I always use DISC when teaching EQ, in part because each of the four main behavioral styles has an affiliated emotion. Therefore, when you learn the behavioral styles, you are also able to identify someone’s WWW.ORTODAY.COM

tendency to display certain emotions. Let me outline a brief overview. Core D: The “D” stands for dominance, because people who score strongly in this area usually like to dominate problems. Whenever they see a problem, they strive to resolve it. Such people are often known for taking action and meeting deadlines. The associated emotion here is anger. That is, they’re quick to get angry, but also quick to become un-angry. Core I: The “I” stands for influence, because people scoring strong in this area usually like to influence others. With fast, creative minds, they often think outside the box. Such people are inspired by a shared vision of the future possibilities. The associated emotion is optimism and enthusiasm. Core S: The “S” stands for steady, because people scoring strongly in this area tend to prefer stable and predictable situations. They tend to be supportive and loyal, working long hours without much need for recognition. They also want to know what’s expected well in advance. The associated emotion here is actually low emotion. It’s not that they don’t have emotions, they just tend not to show them. Core C: The “C” stands for conscientious, because people scoring strongly in this area tend to be careful and

meticulous. They prefer analyzing concepts within a logical framework, and they like taking time to think through their decisions. The associated emotion is fear, because people scoring strongly in this category prefer to avoid the consequences of a bad decision. So, why did my friend find so much interest in this approach to teaching EQ? As she put it, it was, “real diversity training.” She stated that universally, behavioral differences needed to be valued, and that if more people made a choice to value behavioral differences instead of criticize them, then the workplace would be much better all the way around. I couldn’t agree more. What about you? Are you choosing to value the differences? 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 Daniel through his website, www.MyWorkplaceExcellence.com, or (208) 375-7606.

JULY 2019 | OR TODAY |

OUT OF THE OR nutrition

Food Not Tasting the Same? Here's Why. By Densie Webb, Ph.D., R.D. ou probably know that as you age, your eyesight and hearing are likely to decline, but did you know that your senses of taste and smell can go south as well? We start out with thousands of taste buds on our tongues, on our throats and on the roofs of our mouths. Some taste buds are sensitive to sweet, some to sour, some to salty and others are sensitive to bitter. When taste buds are damaged (like from a sip of scalding coffee), they are able to regenerate and are typically replaced every couple of weeks. But sensitivity to flavors and the ability to regenerate is reduced with age, beginning in your 50s or 60s.

Smell equals taste Maybe even more important than a loss of sensitive taste buds with age is a loss of smell. That’s because taste and smell are intimately connected. When you bite into

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a spicy food, you breathe in the flavor and then exhale it through your nose, where chemicals interact with receptor cells and transmit information to the brain about the taste. The loss of sensitivity that occurs with age is even greater in smell than it is in taste. But together, these losses are a double whammy and can translate to less sweetness in desserts, less sting from chili peppers and less sinus-opening effects of horseradish. That loss of taste you’re sensing could actually be a loss of smell. In addition, sensitivities to specific tastes can shift with age. It’s not uncommon for a preference for sweet tastes when you’re younger to shift to a preference for more salty flavors as you age. A loss of taste or smell, combined with a preference for salt, could wreak havoc on your diet.

Other causes While age is a common reason for a loss of taste and smell sensitivity, medications and zinc deficiencies

are two common causes of changes in taste. As many as 45 percent of adults ages 60 and older have zinc intakes below the average requirement, which can negatively affect the ability to taste. Good sources of zinc are poultry, red meat, beans, nuts and breakfast cereals. Chemotherapy, antihistamines, antidepressants, inhalers and blood pressure medications can interfere with your ability to taste, no matter your age.

What to do • Add more color to your plate; it can help boost your appetite. • Be generous with fresh herbs like sage, thyme, basil or rosemary. • Add a zing of flavor with mustard, hot pepper, onions, garlic or lime juice. • I f it worsens see a specialist (an otolaryngologist). A loss of taste can also be a sign of disease. For more information, visit www.environmentalnutrition.com.

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OUT OF THE OR

Recipe

recipe

Kale Pizza INGREDIENTS: • 2 tablespoons olive oil • 2 onions, thinly sliced • 1 large bunch of kale, stemmed, and roughly chopped • 1/4 cup vegan basil pesto • Flour (for dusting) • 1 pound pizza dough • Salt • Pepper

the

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BY Kary Osmond is a Canadian recipe developer and former television host of the popular daytime cooking show “Best Recipes Ever.” Her easy recipes include helpful tips to guide you along the way, and her love of plant-based cooking offers healthy alternatives to some of your favorite dishes. Learn more at www.karyosmond.com.

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OUT OF THE OR recipe

Getting more leafy greens with pizza ’ll take a kale pizza over a kale smoothie any day of the week. This recipe is also how I got my father to eat his greens, which he has protested to eat my entire life. He still won’t eat broccoli, but this kale pizza is getting him one step closer. I always pick up prepared pizza dough when grocery shopping and store it in my freezer. And whenever I feel like pizza for dinner, I just pop it

out of the freezer and let it thaw in the fridge or on the counter, depending on how fast I need it to thaw. Ready-made pizza dough is good for so many recipes: countless pizzas, calzones and even cinnamon buns! This pizza has a thin, crisp and chewy crust topped with pesto flavored kale and caramelized onions. It’s a quick meatless pizza that will help you get more leafy greens into your diet.

KALE PIZZA SERVES 2 TO 4 1. Adjust oven rack to the lowest position. Preheat oven to 500 F. 2. Heat large nonstick frying pan over medium-low heat. Add olive oil and onions. Cook and stir until onions start to caramelize, about 11 minutes. Add kale and 1/4 teaspoon salt, cook and stir until kale is wilted, about 3 minutes. Remove from heat, stir in pesto set aside. 3. On a lightly floured surface, roll out pizza dough to fit an 11-by-17 parchment-lined baking sheet; it should be very thin. 4. Spread kale mixture evenly on pizza dough. 5. Bake until bottom of pizza is golden and crisp, about 12 to 15 minutes. Season with a pinch of salt and pepper. Slice and serve.

Tasty tips • I get asked all the time: “How do you roll out ready-made pizza dough without it shrinking back?” The answer is simple: Keep flipping the dough over! Once you roll it out on one side, flip over the dough and stretch it out on the other side. • You can use your hands to stretch out the dough, a rolling pin or even a wine bottle. • To save time, you use a premade crust. You can also try using pita bread, naan bread, flatbread or a flour tortilla. • Although this pizza doesn’t need it, you can top it with your favorite vegan shredded cheese.

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JULY 2019 | OR TODAY |

OUT OF THE OR pinboard

OR TO DAY

• CONTEST • JU LY

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chA! P A IR IN OF CALZURO SHOES!

Email us a photo of you or a colleague reading a copy of OR Today and you could win a FREE pair of Calzuro shoes! Snap a selfie and email it to Editor@MDPublishing.com to enter. Good luck!

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s to do nothing ke ta is m l al f o t es “It is the great Do what you can.” e. tl lit o d y nl o n ca because you – Sydney Smith

OR TODAY THIS MONTH'S CONTEST WINNER Submitted by:

RN MSN, , g n u Yo Tracey

62 | OR TODAY | JULY 2019

Tracey Young MSN, RN, Nursing Professional Development Perioperative Education West Penn Hospital Allegheny Health Network Pittsburgh, PA

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The News and Photos

OUT OF THE OR

that Caught Our Eye This Month Is Poor Nutrition Keeping You Up at Night?

pinboard

sium supplementation helped with sleep onset and insomnia. This makes sense considering magnesium is needed by more than 300 human body enzymes to facilitate biochemical reactions. Foods containing magnesium include spinach, pumpkin seeds, yogurt, kefir, almonds, black beans, avocado, figs, dark chocolate and bananas.

Make sure you get enough calcium in your diet

ost of us know what sleep deprivation feels like, and it is not pleasant. If we do not get enough healthy sleep (some children need 10 hours nightly, while most adults need at least seven), we may be left feeling irritable and disoriented. It can also be dangerous to be sleep deprived. According to the AAA Foundation for Traffic Safety, drivers who usually sleep for less than five hours daily, have slept for less than seven hours in the past 24 hours or have slept for one or more hours less than their usual amount of sleep in the past 24 hours have significantly elevated crash rates. “The estimated rate ratio for crash involvement associated with driving after only 4-5 hours of sleep compared with 7 hours or more is similar to the U.S. government’s estimates of the risk associated with driving with a blood alcohol concentration equal to or slightly above the legal limit for alcohol in the U.S.,” reports AAA. You read that right. Driving sleepy may share similar risks to drunk driving. And while some of us do not get enough sleep because we go to bed too late or work through the night, there are also millions of Americans who have trouble sleeping due to disorders such as sleep apnea, insomnia and restless leg syndrome. The Centers for Disease Control and Prevention (CDC) reports, “[p] ersons experiencing sleep insufficiency are also more likely to suffer from chronic diseases such as hypertension, diabetes, depression, and obesity, as well as from cancer, increased mortality, and reduced quality of life and productivity.” The obvious solution is to get more sleep, but, of course, that is much easier said than done. You could try to get more sleep perhaps by scheduling an evening cut-off time for phones and other technology, meditating or taking a hot bath. But it’s my opinion that nutrition plays a huge role in ensuring that you get adequate sleep.

Make sure you get enough iron in your diet According to the National Institutes of Health (NIH), deficiencies in the mineral iron may be related to restless leg syndrome, a cramping in the legs that causes an irresistible urge to move them. Iron-rich foods include red meat, pork, poultry, seafoods, beans, spinach (and other leafy greens), peas, cherimoyas and iron-fortified cereals. The NIH also says B vitamins may help with nocturnal leg cramps.

Make sure you get enough vitamin D in your diet The NIH found that people with lower vitamin D serum levels had more sleep disturbances. They also found evidence of this when examining mice. “In animal studies, vitamin D receptors have been found in specific regions of the central nervous system, some of which regulate sleep…” reports NIH.

Make sure you get enough magnesium in your diet The NIH conducted a study with elderly people and found that magne-

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As a child, did your parents ever try to get you to sleep by giving you a glass of warm milk? If they did, they most likely did this to calm you down. But several studies show calcium is directly related to our sleep cycles. Calcium causes the release of melatonin, which explains why this mineral is not only important for strong bones and teeth but also for preventing insomnia and helping people get healthy sleep.

Eat more kiwis A study published by the National Institutes for Health (NIH) revealed that eating kiwis before bedtime may help people who have trouble sleeping or have actual sleep disorders. The study examined males and females between the ages of 20 to 55. The subjects consumed two kiwis one hour before bedtime for four weeks. The results revealed the subjects fell asleep quicker, had longer sleep durations and had better quality sleep. “Numerous studies have revealed that kiwifruit contains many medicinally useful compounds, among which antioxidants and serotonin may be beneficial in the treatment of the sleep disorders,” reports the NIH.

Eat more cherries Cherries, especially tart cherries, contain melatonin. Melatonin is a “sleep hormone” your body naturally produces. It is inactive during the day and starts to kick in after the sun goes down, around 9 p.m. according to the National Sleep Foundation. If you have trouble sleeping and take melatonin supplements, taking a shot of natural cherry juice at night may be a good alternative. Melatonin may help reset your sleep and wake cycles, which can also aid in alleviating jet lag.

Maintain a healthy weight Obesity and sleep problems go hand-in-hand. According to the National Sleep Foundation, “[a]n estimated 18 million Americans have sleep apnea, a sleep-related breathing disorder that leads individuals to repeatedly stop breathing during sleep. Not only does sleep apnea seriously affect one’s quality of sleep, but it can also lead to health risks such as stroke, heart attack, congestive heart failure and excessive daytime sleepiness. Sleep apnea is often associated with people who are overweight – weight gain leads to compromised respiratory function when an individual’s trunk and neck area increase from weight gain.” Along with exercising and making sure to maintain a healthy diet, there are certain minerals you may want to make sure you are getting adequate amounts of. Magnesium, phosphorus, iron and zinc are all associated with weight management. As humans, our bodies can do amazing things. Sometimes we push our limits and overexert ourselves. We have to accept that sleep is a vital piece to the puzzle of being proactive about our health. And just like with most things related to our health, eating healthy foods and getting adequate vitamins and minerals are intertwined. Healthy food is medicine! Enjoy your healthy life! – Joy Stephenson-Laws is the founder of Proactive Health Labs (www.phlabs.org), a national non-profit health information company that provides education and tools needed to achieve optimal health.

JULY 2019 | OR TODAY |

DON'T MISS OR TODAY LIVE

NEXT MONTH! AUGUST 18-20, 2019 • LAS VEGAS

EARN UP TO

16 CEUs

A Conference Made for You! 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. We will be bringing together world-class speakers in an environment designed to motivate and empower perioperative professionals just like you.

LOCATION

PALMS CASINO RESORT & SPA

REASONS TO ATTEND

CNOR® Prep Course

Prepare for the CNOR certification exam with this popular pre-conference course.

World-class Speakers

OR Today Live brings together the best speakers from across the country.

CE Super Sessions

Super sessions cover topics in depth and attendees will be rewarded with 3 CE hours.

Networking

OR Today Live provides multiple networking opportunities that are fun and engaging.

Exhibit Hall

Vendors showcase the latest technology and resources for your department.

“By far my favorite conference I have attended. This was

my first year, but I will keep coming back. The quality of

”

speakers and vendors and attendees was excellent.

- Sherry W., Director of Surgical Services

F E AT U R E D E D U C AT I O N

V I E W A L L E D U C AT I O N O N L I N E AT O R T O D AY L I V E . C O M / E D U C AT I O N

Understanding and Effectively Managing Bullying & Incivility in Your Perioperative Department Phyllis Quinlan, RN, President,MFW Consultants to Professionals

Best Practices in Perioperative Nursing/Training Future OR Nurses Theresa Cowger, MSN, RN, CNOR, Critical Care Periop Nurse Educator, Evan Army Community Hospital

Restoring Passion for Practice: Keys to combating nurse burnout and workplace stressors Vivian Jones, MSN, BSN, RN, Facility and Operating Room Nurse Educator, John D. Dingell VA Medical Center

Career Path Development in Perioperative Nurse Informatics Jessica Gruendler, DNP, MSN, RN-BC, CPHQ, Empiricist Vice President, Empiric Health

F E AT U R E D E X H I B I T O R S V I E W A C U R R E N T L I S T O F E X H I B I T O R S O N L I N E AT O R T O D AY L I V E . C O M / F LO O R - P L A N

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INDEX

advertisers

Alphabetical Action Products, Inc.……………………………………… 39

Healthmark Industries Company, Inc.………… 53

Molnlycke Health Care…………………………………… 10

Advance Medical Designs, Inc.………………………… 6

Heartland Medical Sales Service………………………13

O2COOL…………………………………………………………… 44

AIV Inc.…………………………………………………………………21

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

OR Today Webinar Series……………………………… 24

ALCO Sales & Service Co.……………………………… 54

Jet Medical Electronics Inc…………………………… 45

Pure Processing……………………………………………………19

Avante Patient Monitoring……………………………… 67

MAC Medical, Inc……………………………………………… 26

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

C Change Surgical……………………………………… 40-43

MD Technologies inc.……………………………………… 54

TBJ Incorporated………………………………………………… 4

Calzuro.com…………………………………………………………15

MedWrench……………………………………………………… 56

Cygnus Medical…………………………………………………… 9

Microsystems……………………………………………………… 5

categorical ANESTHESIA

Heartland Medical Sales Service………………………13

ASSET MANAGEMENT

Microsystems……………………………………………………… 5

CARDIAC PRODUCTS

C Change Surgical……………………………………… 40-43 Jet Medical Electronics Inc…………………………… 45

CARTS/CABINETS

ALCO Sales & Service Co.……………………………… 54 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 53 MAC Medical, Inc……………………………………………… 26 TBJ Incorporated………………………………………………… 4

CS/SPD

MD Technologies inc.……………………………………… 54 Microsystems……………………………………………………… 5 Ruhof Corporation…………………………………………… 2-3

DISINFECTION

Cygnus Medical…………………………………………………… 9 Ruhof Corporation…………………………………………… 2-3

DISPOSABLES

ALCO Sales & Service Co.……………………………… 54

ENDOSCOPY

Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 53 MD Technologies inc.……………………………………… 54 Ruhof Corporation…………………………………………… 2-3

ERGONOMIC SOLUTIONS

Pure Processing……………………………………………………19

FALL PREVENTION

ALCO Sales & Service Co.……………………………… 54

FOOTWEAR

INFECTION CONTROL

Advance Medical Designs, Inc.………………………… 6 ALCO Sales & Service Co.……………………………… 54 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 53 Pure Processing……………………………………………………19 Ruhof Corporation…………………………………………… 2-3 TBJ Incorporated………………………………………………… 4

INSTRUMENT STORAGE/TRANSPORT

Cygnus Medical…………………………………………………… 9 Ruhof Corporation…………………………………………… 2-3

INSTRUMENT TRACKING

Microsystems……………………………………………………… 5

MONITORS

Avante Patient Monitoring……………………………… 67

ONLINE RESOURCE

MedWrench……………………………………………………… 56 OR Today Webinar Series……………………………… 24

OR TABLES/BOOMS/ACCESSORIES

Action Products, Inc.……………………………………… 39 Innovative Medical Products………………………… 68

OTHER

AIV Inc.…………………………………………………………………21 O2COOL…………………………………………………………… 44

SAFETY

Calzuro.com…………………………………………………………15 Healthmark Industries Company, Inc.………… 53

SINKS

Pure Processing……………………………………………………19 Ruhof Corporation…………………………………………… 2-3 TBJ Incorporated………………………………………………… 4

STERILIZATION

Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 53 TBJ Incorporated………………………………………………… 4

SURGICAL

Heartland Medical Sales Service………………………13 MD Technologies inc.……………………………………… 54

SURGICAL INSTRUMENT/ACCESSORIES

PATIENT MONITORING

TELEMETRY

AIV Inc.…………………………………………………………………21 Avante Patient Monitoring……………………………… 67 Heartland Medical Sales Service………………………13 Jet Medical Electronics Inc…………………………… 45

POSITIONING PRODUCTS

PRESSURE ULCER MANAGEMENT

66 | OR TODAY | JULY 2019

MAC Medical, Inc……………………………………………… 26

HOSPITAL BEDS/PARTS

ALCO Sales & Service Co.……………………………… 54

REPROCESSING STATIONS

C Change Surgical……………………………………… 40-43 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 53

AIV Inc.…………………………………………………………………21

GENERAL

Avante Patient Monitoring……………………………… 67 Cygnus Medical…………………………………………………… 9 Heartland Medical Sales Service………………………13 Jet Medical Electronics Inc…………………………… 45

PATIENT DATA MANAGEMENT

Action Products, Inc.……………………………………… 39 Advance Medical Designs, Inc.………………………… 6 Cygnus Medical…………………………………………………… 9 Innovative Medical Products………………………… 68 Molnlycke Health Care…………………………………… 10

Calzuro.com…………………………………………………………15

REPAIR SERVICES

Action Products, Inc.……………………………………… 39 Molnlycke Health Care…………………………………… 10

AIV Inc.…………………………………………………………………21 Avante Patient Monitoring……………………………… 67

TEMPERATURE MANAGEMENT

C Change Surgical……………………………………… 40-43 MAC Medical, Inc……………………………………………… 26

WARMERS

MAC Medical, Inc……………………………………………… 26

WASTE MANAGEMENT

Advance Medical Designs, Inc.………………………… 6 MD Technologies inc.……………………………………… 54 TBJ Incorporated………………………………………………… 4

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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

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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.