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References: 1. Barakat-Johnson M et al. Evaluation of a fluidised positioner to reduce occipital pressure injuries in intensive care patients: A pilot study. Int Wound J. 2018;1–9. 2. Katzengold R, Gefen A. What makes a good head positioner for preventing occipital pressure ulcers. Int Wound J. 2017;1–7.

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OR TODAY | April 2020

contents features

SMOKE IN THE OR Concerns about air quality in the OR during surgical procedures have been around for a long time. The good news is that momentum is starting to build toward the passage of legislation requiring hospitals and ASCs to adopt and implement policies that prevent human exposure to surgical smoke.

STERILIZATION MARKET ANALYSIS

The global sterilization services market is projected to reach $3.31 billion by 2022. The growth of the market can be attributed to factors such as an increasing focus on the outsourcing of sterilization processes among pharmaceutical companies, hospitals and medical device manufacturers; increasing prevalence of hospital-acquired infections; and growing number of surgical procedures.

CE ARTICLE Preceptors are needed to foster the competence of new graduates and nurses who change positions. This course fills a gap in knowledge about the role of the preceptor and preceptee.

SPOTLIGHT ON TOM CATENA Tom Catena has dedicated the last 20 years of his life working as a medical missionary in Africa. Nine of them he spent amid almost ceaseless civil conflict in war-torn Sudan.

OR Today (Vol. 20, Issue #4) April 2020 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to OR Today at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. 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 2020

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INDUSTRY INSIGHTS 11 News & Notes 21 CCI: Let's Have the Emeritus Discussion 22 IAHCSMM: Do you know the roles of your SPD teammates? 25 ASCA: ASCs Raise the Bar on Quality of the Patient Experience 26 Webinars: A Care, Handling, Inspection and Prevention Program for GI Endoscopy Professionals

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ACCOUNTING

Beyond Clean

29 Market Analysis: Sterilization 30 Product Focus: Sterilization 34 CE Article: Precepting: The chance to shape nursing's future

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IN THE OR

50 Spotlight On 52 Fitness 54 Health 56 EQ Factor 57 Nutrition 58 Recipe 60 Pinboard

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INDUSTRY INSIGHTS

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U.S. Health System Uses Medtronic Stealth Autoguide Cranial Robotic Guidance Platform Phoenix Children’s Hospital is the first-ever health system in the U.S. to receive and deploy the FDA-cleared Medtronic Stealth Autoguide platform. Medtronic chose Barrow Neurological Institute (BNI) at Phoenix Children’s as its first partner using this robotic technology. The highly advanced surgical tool is intended for use with the Medtronic StealthStation system, and Phoenix Children’s Hospital will use it in surgery for pediatric patients suffering from a range of neurological conditions. “Phoenix Children’s is proud to invest in the best possible technology for use while we provide outstanding care to children,” said Daniel Ostlie, M.D., surgeon in chief and chair of surgery at Phoenix Children’s. “We are committed to being at the forefront of surgical innovation and having the most advanced solutions for pediatric patients.”

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BNI at Phoenix Children’s surgical staff have undergone comprehensive training with the Medtronic team as they prepared to use the Stealth Autoguide robotic guidance system in patient neurosurgery cases in early January. “The Stealth Autoguide is a tremendous addition to the neurosurgical team’s tools at Phoenix Children’s,” said P. David Adelson, division chief of neurosurgery and director of BNI at Phoenix Children’s. “Neurosurgery is such an intricate specialty, and having this technology at our fingertips perfectly aligns with our mission to provide state-of-the-art care to improve the health and quality of life for the children we see here.” BNI at Phoenix Children’s is eager to combine its clinical talent with Medtronic’s innovation. “With our new technology deployed, we are thrilled to work with

Phoenix Children’s and to support their mission of providing exceptional care for pediatric patients,” said Dave Anderson, vice president and general manager, Enabling Technologies, which is part of the Restorative Therapies Group at Medtronic. Phoenix Children’s Hospital Foundation received funding for the Stealth Autoguide from close community partners who support Phoenix Children’s in providing the best care by advancing pediatric medical solutions. “We are extremely appreciative of the community’s support of the Stealth Autoguide,” said Steve Schnall, senior vice president at Phoenix Children’s Hospital Foundation. “We are grateful to the Del E. Webb Foundation, Thunderbirds Charities and WINGS, the women’s auxiliary board of Phoenix Children’s, for investing in this state-of-the-art technology.”•

APRIL 2020 | OR TODAY |

INDUSTRY INSIGHTS

news & notes

Getinge Introduces Torin OR Management Software Globally Getinge has globally launched Torin – a complete OR management software that helps surgical departments advance their surgery planning, execute efficiently on the schedule, and continuously improve the utilization of resources in and across collaborating departments. “Torin will make a difference for all hospitals that are looking to work more efficiently with their surgical planning and daily management of appointments. With Torin, Getinge provides one tool for both optimized long-term planning and reliable real-time execution. The goal is to minimize disruptions, reduce costs and improve patient care,” explains Charlotte Enlund, vice president integrated workflow solutions at Getinge. The user-friendly scheduling tool promotes planning, prioritization and rescheduling of both day-to-day and long-term appointments. Torin automatically checks for resource and staff conflicts to avoid double bookings as well as inconvenient and expensive waiting time. Additionally, it provides a business intelligence tool that enables management to identify trends and potential inefficiencies and act accordingly. “Overall, Torin creates a calm environment for the patients, as they get to experience the reassurance of a wellorganized hospital with surgeries that run on time and that always have the necessary resources and staff available in the right place,” according to a press release. Torin is available in three levels, each focusing on different hospital needs. Torin Planning is the user-friendly planning tool with visual overviews for optimized surgery scheduling and increased OR utilization. Torin Progress levels it up by also ensuring on-time execution of the daily schedule and complete documentation of all surgery steps. “Then we have Torin Optimization, which captures and provides access to an extensive business intelligence tool, allowing hospital management to learn from their data and further optimize the way their surgical department is run,” according to a press release. •

Cook Medical TriForce Peripheral Crossing Set Available Cook Medical’s TriForce Peripheral Crossing Set is commercially available. As of January 2020, these products are available to physicians in the United States to support procedures to treat patients with vascular obstructions. The TriForce Peripheral Crossing Set is designed to be percutaneously introduced into blood vessels and support a wire guide while performing a peripheral intervention. This device is also intended for injection of radiopaque contrast media for the purpose of angiography. TriForce is offered in two lengths and four configurations, which means physicians have several product options to treat blocked or restricted vessels in a variety of locations in the body. “We are excited to have this tool available for our physicians to treat complex peripheral vascular disease,” Mark Breedlove, vice president of Cook Medical’s Vascular division, said. •

For more information, visit Getinge.com.

12 | OR TODAY | APRIL 2020

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ASP Unveils Fastest Biological Indicator For Hydrogen Peroxide Sterilization Advanced Sterilization Products (ASP) has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for a 15-minute time to result on the STERRAD VELOCITY Biological Indicator (BI)/Process Challenge Device (PCD) for use in STERRAD Systems.* The 15-minute time to result is up to 38% faster than the competition and offers the fastest way to provide instrument sterility assurance for health care professionals. † “Every minute matters in sterile processing,” notes Amy Smith, vice president global marketing for ASP. “ASP Innovation to cut the BI read time in half allows customers to assure sterility for every instrument per AAMI guidelines while keeping up with the pace of a busy SPD. This is just another way ASP continues to partner with the health care community to elevate the standard of care by protecting patients at their most critical moments.” STERRAD VELOCITY BI/PCD is used to monitor loads and assess process performance for vaporized hydrogen peroxide (H2O2) sterilization. This is a crucial step to verify load sterility for critical and semi-critical surgical instruments prior to releasing them to the operating room. AAMI ST58:2013/(R) 2018 states frequent monitoring may mitigate the many factors that could affect cycle variation and reduce risk to patients. It is for this reason AAMI ST58 recommends using a PCD with the appropriate BI daily, but preferably in every sterilization cycle. STERRAD VELOCITY BI/PCD is the only rapid-read PCD validated for STERRAD Systems that meets AAMI guidelines. STERRAD VELOCITY BI/PCD is commercially available in the United States. Existing STERRAD VELOCITY System customers should contact ASP to get the 15-minute result with a software upgrade to their reader. •

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INDUSTRY INSIGHTS

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HFAP Celebrates 75 Years HFAP is celebrating its diamond anniversary – marking 75 years in health care accreditation and quality improvement. Since its founding in 1945, HFAP has driven advancement in patient safety and quality of care through a collaborative, informative and peer-based approach to the accreditation experience. “HFAP’s continued success over the years is due in great part to our dedication to creating a supportive and collegial environment when working with different health care organizations,” said Gary Ley, board chair of HFAP’s parent AAHHS. “We team up with our customers to help them identify areas for improvement, develop targeted strategies, and analyze results to ensure long-term learning and innovation.” Originally created to conduct an objective review of services provided by osteopathic hospitals, HFAP has grown to work with a variety of health care organizations and has maintained its deeming authority continuously since the inception of the Centers for Medicare and Medicaid Services (CMS) in 1965. “Our enthusiastic experts, devoted surveyors and incredible customers have made HFAP’s enduring industry leadership possible these past 75 years,” said Meg Gravesmill, CEO. “It is truly a team effort, and we are committed to preserving our culture of collaboration as we enter a new decade.” HFAP provides customers with clear and direct survey standards, access to collaborative surveyors and support teams, and a comprehensive survey process. “We believe it is important for health care organizations to not only meet the requirements for accreditation, but also fully understand the intention behind each standard,” said Graves-

mill. “Our educational resources are designed to address any questions surrounding the standards, provide guidance on realworld applications and showcase best practices.” In addition, HFAP strives to create a strong relationship with its customers that centers on a sincere, helpful attitude and ongoing expert support before, during and after the survey is complete. “The standards support a process of continuous quality improvement based on a cycle of policy review, implementation, assessment of performance, appropriate change management, and effective communications to ensure the focus is always on patient safety and quality of care,” said Gravesmill. “We do not focus solely on a checklist of requirements or take a punitive approach to standards compliance. Rather, we create an open dialogue with our customers through which our teams can provide expert insight and ongoing educational opportunities to enhance an organization’s efficiency and growth beyond the survey experience.” HFAP offers accreditation for hospitals, ambulatory surgery centers, clinical laboratories and critical access hospitals that includes deeming authority from CMS. In addition, HFAP offers accreditation programs without deemed status for these and other types of health care organizations and specialty certification for four levels of stroke care, laser and lithotripsy services, compounding pharmacies, joint replacement and wound care. • For more information, visit HFAP.org.

Healthmark Offers New HydroCheck Healthmark Industries has announced the introduction of the HydroCheck to its ProFormance Cleaning Verification line. Designed for detecting residual moisture in channels, the single-use HydroCheck is a user-friendly test kit can detect as little as 0.05 μL of residual moisture, providing immediate results. Swabs are available in the following sizes: 1.7mm, 2.8mm, 3.8mm, and 5.0mm. If a detectable amount of residual moisture is present on the swab, there will be a visual color change to purple on the swab. • For more information, visit hmark.com.

14 | OR TODAY | APRIL 2020

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INDUSTRY INSIGHTS

CS Medical LLC Announces Strategic Partnership with APIC CS Medical has announced a strategic partnership with the Association for Professionals in Infection Control and Epidemiology (APIC), the largest association for infection prevention and control (IPC) professionals. CS Medical LLC has signed on as a 2020 APIC Strategic Partner. APICâ&#x20AC;&#x2122;s infection preventionist (IP) members work to prevent healthcare-associated infections (HAIs) in health care facilities. An estimated 633,000 hospitalized patients get HAIs each year and 72,000 die during their hospital stay, according to the Centers for Disease Control and Prevention. The APIC Strategic Partner program establishes longterm relationships with industry partners united in the common goal of reducing the risk of infection. Partners play an important role in supporting many of the educational initiatives and services that make the APIC membership valuable to IPs on the front-lines in the fight against HAIs. â&#x20AC;&#x153;CS Medical is pleased to partner with APIC to help prevent HAIs and expand education and resources for IPs,â&#x20AC;? said Mark Leath, president of CS Medical. â&#x20AC;&#x153;We share

news & notes

APICâ&#x20AC;&#x2122;s patient safety mission and hope this partnership will help to strengthen APICâ&#x20AC;&#x2122;s efforts to create a safer world through the prevention of infection.â&#x20AC;? APIC Strategic Partners fully support the Competency Advancement Assistance (CAA) Program to help IPs manage the cost associated with obtaining the Certification in Infection Prevention and Control (CIC) credential. The CAA program covers exam fees and study resources for up to 50 IPs annually. Scientific studies have shown that certified IPs are better prepared to interpret evidence and act as champions for key infection prevention practices. Hospitals with IPC programs led by certified IPs reported significantly lower rates of MRSA bloodstream infections. â&#x20AC;&#x153;We are excited to welcome CS Medical as an APIC Strategic Partner,â&#x20AC;? said APIC CEO Katrina Crist, MBA, CAE. â&#x20AC;&#x153;Together, APIC and CS Medical will work together to improve healthcare outcomes and advance education and certification for IPC professionals.â&#x20AC;? â&#x20AC;˘

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INDUSTRY INSIGHTS

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PENTAX Medical Launches IMAGINA Endoscopy System in U.S. PENTAX Medical has received US FDA 510(k) clearance for its IMAGINA Endoscopy System, an endoscopy platform for gastrointestinal (GI) procedures at ambulatory surgery centers (ASCs). IMAGINA offers practitioners a modern user interface and unique endoscope design to provide excellent visualization, improve the operator experience and positively influence longterm patient care costs. ASCs across the United States are currently experiencing exponential growth, most notably in gastroenterology. ASCs are positioned to perform fundamental GI procedures efficiently and cost-effectively, leading to increases in procedure volume. However, rising capital equipment costs and declining reimbursement rates present a significant challenge for clinics looking to provide quality care at a lower cost per procedure. With this in mind, PENTAX Medical developed a solution that meets the needs of ASC’s and eliminates the trade-off between cost and quality care. The IMAGINA System features a sleek, touch-screen LCD interface on the processor and displays brilliant images in crisp 1080p resolution, all while providing greater cost predictability by eliminating the need for expensive periodic bulb replacements. IMAGINA includes PENTAX i-SCANT, a real-time, digital image enhancement technology that provides the user with an enhanced view of the texture of the mucosal surface and the blood vessels.

“What I really like about the IMAGINA is that it’s not just a small improvement to what we already have,” said Dr. Stepan Suchanek, Centre for Gastrointestinal Endoscopy, Prague, Czech Republic. “It’s a completely new concept in endoscopy, featuring new technology that delivers superior visualization with an attractive cost model. Overall, it helps us provide efficient and effective treatment while reducing financial burdens to the health system.” Additionally, the IMAGINA i10c series is the only endoscope platform to provide distally mounted LED lights, an HD+ CMOS image sensor, and PENTAX i-SCAN – features that provide pristine, crystal-clear visualization for confident assessment of the GI tract. “We feel that today’s ASC market is underserved,” said David Woods, president and CEO of PENTAX Medical, Americas. “These practices are often limited to used or previous-generation equipment to stay within budget. The launch of the IMAGINA allows us to best serve the needs of the core GI market and our system provides maximum cost predictability without compromising on the standard of care delivered to patients. IMAGINA eliminates the costliest components of a premium GI endoscopy system and still adheres to the highest imaging standards in the industry: a true testament to our commitment to better patient outcomes, improved patient experience and a lower overall cost of care.” •

Symmetry Surgical Inc. Acquires The O.R. Company Symmetry Surgical Inc. has completed its acquisition of The O.R. Company. The O.R. Company develops, manufactures and markets surgical devices. The acquisition complements Symmetry’s existing instrumentation portfolio and expands its minimally invasive surgical instrument offering with products that have high clinical acceptance and strong price positions in the market. By integrating The O.R. Company portfolio of devices and technologies into the Symmetry family of trusted brands, Symmetry strengthens its commitment to deliver best-

16 | OR TODAY | APRIL 2020

in-class products and cost-effective solutions that have a meaningful impact to patient care, specifically, in laparoscopy and gynecological procedures. “We are extremely pleased to welcome the outstanding O.R. Company team to Symmetry Surgical. This acquisition reinforces our commitment to helping our customers deliver the highest quality care while reducing costs through our best-in-class surgical products and solutions portfolio,” said Brian Straeb, CEO Symmetry Surgical.•

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Nihon Kohden Launches NKV-550 Series Ventilator System Nihon Kohden has announced the commercial launch of its NKV-550 Series Ventilator System, which offers a full suite of applications necessary in a critical care setting for patients of all ages – from neonate through adult. The NKV-550, which was first introduced at the annual American Association for Respiratory Care Congress 2019 in November, features an integrated touchscreen, intuitive user interface and onscreen help functions. The NKV-550 was developed to seamlessly transition between invasive ventilation, noninvasive ventilation and high-flow oxygen therapy, allowing clinicians to respond to a patient’s respiratory support needs without having to change devices. “We have received an overwhelming amount of positive feedback about the NKV-550 since we first introduced it at AARC,” said Genoveffa Devers DNP, MSHA, RN, CPHQ, vice president of clinical and strategic alliances at Nihon Kohden. “Hospitals and health systems are eager for a sleek and intuitive ventilator that offers the latest in respiratory technology and eliminates the need for different devices for invasive and noninvasive ventilation. We developed the NKV-550 to fulfill this need in the market and help advance respiratory care.” The NKV-550 was created based on the lung protective approach to ventilation and features the Gentle Lung suite of applications to provide clinically relevant, easy-to-use tools for the open-lung approach to ventilation. The ventilator offers highly customizable screen configurations, including on-screen help tools, enabling the ventilator to fit into your paradigm rather than requiring you to adapt to it. The app-based design provides guided processes to help create a more streamlined, systematic way for clinicians to optimize care of their ventilated patients. The NKV-550 also offers Protective Control, a feature that uses a second graphic user interface placed outside the isolation room of a contagious patient who is being mechanically ventilated. The respiratory therapists and clinicians can view the ventilator monitors and alarms, adjust ventilation and alarm settings, and pause the alarm through the second graphic user interface outside the isolation room, as long as the patient is within the sight of the clinician through the room’s glass window. When managing a patient who has a communicable disease case and is in isolation, this feature protects the clinician and the patient. •

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Sony Announces FDA Clearance for NUCLeUS Sony Electronics has received FDA 510(k) clearance from the Food and Drug Administration for the company’s NUCLeUS Operating Room, Imaging Management and Collaboration Control platform. Proven in Europe with more than 500 operating room installations at leading hospitals in the UK, Belgium, Sweden and other locations, Sony is cleared to begin the marketing and sales of the network-based platform in the United States. Supporting up to 4K resolution using existing network infrastructure, NUCLeUS provides an enhanced, streamlined workflow for operating rooms and clinical spaces with direct access to imaging data from an easy-to-use central dashboard. With secure, managed access, professionals can capture and manage video and audio content in near real-time for collaboration and teaching purposes. “We are eager to put NUCLeUS in the hands of doctors, nurses and OR managers in the U.S. so they can experience first-hand how the platform can dramatically improve surgical collaboration and potentially contribute to better patient outcomes,” said Theresa Alesso, president of Sony Electronics’

Pro division. “With the ongoing development of unique ‘smart applications,’ NUCLeUS will continue to push the boundaries of what is possible in the OR.” Capabilities that are a part of NUCLeUS include: • providing hospitals with a secure, encrypted means of recording, archiving, distributing and managing surgical video and other types of medical imaging and patient data without requiring expensive network infrastructure upgrades • a software-based platform that greatly reduces room hardware requirements • a fully scalable solution that can be easily extended to serve additional rooms or hospital buildings at any time • smart applications and additional optional features can be added remotely as they are released • support for third-party applications via APIs and a variety of mechanisms and tools • secure HIS integration, fully HL7 and DICOM compliant • For more information, visit pro.sony/medical.

Smartphone Solution Tackles Chronic Wound Issue Healthy.io has announced the launch of a digital wound management solution. The solution is an extension of Healthy.io’s clinical grade color recognition products, in use by tens of thousands of people worldwide, and helps health care professionals objectively assess chronic wounds and track their progress over time through a repeatable process. The solution was successfully registered with the U.S. Food and Drug Administration (FDA) in December 2019. The current method for measuring and documenting chronic wounds is inconsistent and rudimentary. Measurement by nurses is done with basic tools like paper rulers, and it is difficult to share and track results over time. This can lead to incorrect treatment, prolonged healing times and growing distress for patients. “Nurses, already overextended, are on the front line of wound care and are the real heroes but the tools they are using today haven’t changed in decades. We believe this is the heart of the problem and why we have created a solution that will help

18 | OR TODAY | APRIL 2020

them accurately track wound progress over time,” said Yonatan Adiri, founder and CEO of Healthy.io. Using a smartphone app and two calibration stickers placed around a wound to track dimensions, nurses can now scan the wound and get a measurement quickly and effectively. Healthy. io’s technology builds a 3D image, enabling more comprehensive documentation. The app measures wounds and captures standardized visual records over time, eliminating human error and discrepancies that are common in today’s methods due to subjective analysis and inaccurate measurement. “The biggest impact for us is having photographs of the wound. It has given us the chance to review wounds and to think about wound care before the patient even enters the room,” says Gill Cooper, clinical lead nurse at Wokingham Medical Centre in the United Kingdom, where the solution is being used. • For more information, visit healthy.io/wound.

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• Color display

• 7900 Smartvent includes PSV Pro SW

• Advances Breathing System(ABS)

INDUSTRY INSIGHTS CCI

Letâ&#x20AC;&#x2122;s Have the Emeritus Discussion By Benjamin Dennis and James X. Stobinski he year 2020 has started very well for the Competency and Credentialing Institute (CCI). In early January, we closed the files on 2019 with record numbers for recertification activity; 82.25% of certificants took action to maintain their credential. This is the highest rate we have ever seen for this activity and the largest pool of eligible nurses for recertification ever. Included in the 2019 group were 690 nurses who elected to transition to emeritus status. The emeritus numbers were also the largest we have ever experienced by a large margin and that occurrence prompted us to write this article.

The exact demographic makeup of the perioperative nursing community is not well known. There is survey information and anecdotal evidence that perioperative nurses are a mature, seasoned group. We also know that perioperative nurses tend to have long careers and that they highly value their certifications, especially the CNOR credential. After a review of our statistics, CCI had forecasted a large turnover of nurses as early as 2012. It appears that demographic wave is now upon us and the trend

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of emeritus applications that began in 2018 and continued into 2019 was not an aberration. We would like to discuss the emeritus option for CNOR certificants. We think it is a discussion worth having even if uncomfortable for some. CCI established emeritus status in 1995 for the CNOR credential to recognize retired nurses for their service and commitment in holding the credential. A one-time fee is paid, and the nurse maintains the credential for the remainder of their lifetime. We would like to speak to why nurses should make this choice. There are many benefits to electing emeritus status. First among these benefits is that you can continue to use the certification designation, albeit with a small change. In emeritus status your credentials would read â&#x20AC;&#x201C; Jane Doe, BSN, RN, CNOR(E). In this status, anyone attempting to verify your credential would see this status on the CCI website and CCI can provide verification for employment. A certificate is also given to those holding emeritus status. Those with emeritus status can list it on their CV or resume as noted above. The alternative to making the proactive choice for emeritus status is to simply do nothing and let the credential lapse at the end of the recertification period. That choice, while

costing nothing, would conclude your active records with CCI. While you can claim to have held the CNOR credential in the past, you would no longer be entitled to use the designation as part of your title. Electing to transition to emeritus status is an intensely personal decision which marks a clear demarcation in the career path of a perioperative nurse. This designation means that there is less ahead in a career versus all that has been previously accomplished. A nurse who elected emeritus status in 2019 summed up her choice well. She stated that she held her CNOR credential in high regard but was ready to move to another phase in her life. She went on to state that while she enjoyed the recognition of holding the CNOR(E) status, she was ready for other things and new adventures. CCI is proud to assist perioperative nurses in their credentialing needs throughout the span of their career. As an organization, we give our thanks for their service and commitment to certification and we are ready to facilitate their choice on emeritus status. Benjamin Dennis, AD, is a credentialing associate for Competency and Credentialing Institute and James X. Stobinski, Ph.D., RN, CNOR, CSSM(E), is CEO of the Competency and Credentialing Institute.

APRIL 2020 | OR TODAY |

INDUSTRY INSIGHTS

IAHCSMM

OR Professionals: Do you know the roles of your SPD teammates? By Lawayne Perkins n the realm of sterile processing (SP), there are many vital roles in which surgical services professionals should be aware. Every role and position on the SP team is critical to the department’s success and, ultimately, to the success of the OR and the outcome of the procedure.

When I first began working as an entry-level technician, I was explained the unofficial rules of professional advancement: “You start off as a technician and if you prove yourself and obtain your certification, you can progress to lead worker and maybe make supervisor in a year or two, depending upon your efforts.” As a new hire, this was a dream job, but for an eager, career-minded young adult looking for a profession, the job offered little opportunity for advanced growth or development. As I grew in the profession, however, I began discovering additional roles that were not considered advancement opportunities, but essentially were just that. The SP educator and instrument coordinator were two such examples. The SP discipline offers many different career ladders that allow individuals to attain success and a greater professional purpose, and each serves a valuable purpose for the OR and other departments. Along my own career journey, I was introduced to an array of opportunities and job functions. The department where I worked at the time generously provided a dedicated staff educator. This individual was an exemplary model and taught us the sciences and technical procedures behind successful instrument processing. I considered myself lucky to have started my career with a clear example of how a professional educator benefited and served the department and team. As I began to communicate with the surgical team, I also quickly learned the importance of a sterile processing/operating room liaison and instrument coordinator. Both provide critical services to enhance customer satis-

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faction and positive patient outcomes.

Job title vs. job function A job title describes a specific group of tasks performed by an individual for a business or another enterprise. Many job titles don’t fully represent the job duties or daily activities performed in the role given. Take, for example, the titles instrument coordinator and inventory control clerk. The instrument coordinator typically is responsible for providing support and coordination for instrument management functions. Some of these duties include purchasing, inventory, repair and maintenance. The instrument coordinator is also the super-user for instrument tracking systems. This individual must ensure a collaborative working relationship with the customer and manage instrumentation for multiple departments (this often involves instrumentation budgeting for each department, as well). Last, but not least, the instrument coordinator may, at times, be expected to fill the shoes of an SP lead technician and, occasionally, that of department supervisor. Each supportive duty in the role of instrument coordinator can technically have its own subset of functions and duties. As a new instrument is introduced into the department, for example, the instrument coordinator is responsible for scheduling in-services and education to the item(s). This same person may also play a significant role as an educator within the SP department (SPD) as she/he purchases new surgical instruments and reviews/

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previews the instructions for use (IFU) with the SP team. He or she may also help schedule vendor in-services within the SPD to assist in the training and proper reprocessing of newly purchased instrumentation. The OR develops a strong relationship with the instrument coordinator. It is always helpful to have a collaborative working relationship with the person responsible for understanding the location of the surgical instrumentation and the person who serves as a liaison between the SPD and OR. Although the roles of educator, instrument coordinator and liaison may all be career ladder positions within the SPD, it is important to note that each role may consist of additional part- or full-time duties. Each role within the profession requires a degree of focused multitasking and good communication skills to work successfully under pressure and within tight deadlines.

In Conclusion There are many career paths and critical roles in the SP community, even though one’s official job title may or may not adequately reflect them. SP professionals wear many critical hats in the name of patient safety and quality customer service, and their roles are essential to the success that takes place in the OR. It’s essential that facilities and the departments that the SP professionals serve understand, recognize and appreciate the critically important roles and responsibilities SP professionals serve consistently each day in the name of patient safety and quality service. Lawayne Perkins, CDA, CRCST, CHL, is a health care executive for CSA, and the former Director of Operations for Advantage Support Services Inc.

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WEBINAR SERIES

WEBINAR SERIES ortoday.com/webinars APRIL 2020 | OR TODAY |

AUGUST 16-18 | DENVER, CO

SPEAKER Spotlight

“

THE MISSION AND GOAL OF MY COACHING PRACTICE IS NOW RE-FOCUSED ON WORKING WITH PROFESSIONAL AND FAMILY CAREGIVERS TO BUILD THEIR RESILIENCE AND RECONNECT WITH THE JOY OF WHAT THEY DO. – Phyllis S. Quinlan, PhD, RN-BC Founder, President of MFW Consultants to Professionals, Inc.

”

Phyllis is the Keynote speaker at OR Today Live! To learn more, visit www.ortodaylive.com.

Running concurrently with SAMBA 2020— the annual meeting of the Society for Ambulatory Anesthesia

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INDUSTRY INSIGHTS ASCA

ASCs Raise the Bar on Quality of the Patient Experience By Bill Prentice s part of our ongoing commitment to putting patients first, ASCA and ASCs across the country are involved in a wide range of projects aimed at improving the patient experience in ASCs.

One hot-button topic we have turned new attention to recently is helping our patients avoid surprise medical bills. Although surprise bills are most often tied to emergency medical care, when patients cannot choose their care provider, anytime a patient gets care in any medical facility and a provider who is outside the patient’s insurance network helps deliver some part of that care, the potential for a surprise medical bill exists. From coast to coast, patients are fed up with these unexpected invoices, which can be for substantial amounts that create significant hardship for families. In response to constituent complaints, members of Congress have taken up this cause, proposing a diverse set of legislative fixes. Unfortunately, most of those proposals are still winding their way through the rule-making process. Recognizing that ASCs don’t need complicated legislation or regulatory policy to do the right thing by their patients, ASCA is supporting its members’ efforts to help their patients avoid surprise medical bills by supplying a reminder of the steps ASCs and patients can take to eliminate these bills. One step it emphasizes is encouraging patients to call their insurance provider to determine if all the health professionals who will provide their care at the ASC are in or out of the insurer’s network. While we recognize that most ASCs already have systems in place to help their patients understand the full costs of their care, this added reminder could help some ASCs improve even WWW.ORTODAY.COM

more patients’ lives in this important way. On another front, April 1 marks the opening of the one-month reporting window for the first quarter of ASCA’s 2020 Clinical and Operational Benchmarking program. This program is no longer new, but every ASC that participates changes the experience every other ASC in the program has. The more data ASCs contribute to this program, the more valuable the survey reports become. ASC management experts say benchmarking can lead to improvements in everything from staffing matrices and operating room turnover times to billing practices and an ASC’s bottom line. As these operational elements improve inside an ASC, so does the patient experience. To help ASCs use benchmarking as effectively as possible, ASCA is working now on a new benchmarking guide that will walk users through the steps involved. Of course, when it comes to best practices in patient safety, quality of care and customer service in ASCs, many ASC professionals have come to rely on ASCA’s annual conferences. Between May 13 and May 16 of this year, ASCA will conduct the ASCA 2020 Conference & Expo in Orlando, Florida. This meeting features in-depth regulatory compliance advice, extensive networking opportunities and hundreds of exhibitors who will be showcasing products and services that target the special needs of ASCs. This meeting will also deliver the information and expert advice ASCs need to be able to provide the safest, highest quality care to their patients and a personalized, caring experience that their patients will talk about for years to come. At ASCA 2020, new ASC staff can learn what they need to perform their jobs and how to fit best into their new environment. More experienced administrators and staff will have multiple opportunities

to connect with their colleagues and tap into their real-world experiences to find new ways of enhancing all the services their own facility provides. Of course, nursing contact hours, administrator education units (AEUs) and infection prevention contact hours (IPCHs) will be available. Another resource coming soon from ASCA is a new Culture of Safety Survey that ASCs will be able to use to evaluate their internal operations and staff relationships and identify areas where improvements can be made. ASCA will then help its members get resources they can use to make the improvements they want to make. The patient experience of care in the ASC setting is so closely aligned with the way patients interact with the ASC’s staff that any improvements in an ASC’s culture are likely to quickly translate to an improved experience for patients. Of course, at the same time ASCA is working with the ASC community to improve the patient experience, the association continues to work to support ASCs on many other fronts. For example, we continue to talk to Medicare officials about improvements needed in the program’s ASC payment system, to reach out to the media to promote a better understanding of the services and top-quality care ASCs provide and to work with others in the health care community in the pursuit of more meaningful and more useful health care quality reporting across providers. For more information on any of these programs to visit ASCA’s website (www.ascassociation.org). If the information you need is not yet available there, please call us (703.836.8808) or send us an email at asc@ascassociation.org.

APRIL 2020 | OR TODAY |

INDUSTRY INSIGHTS

news & notes webinars

WEBINAR SERIES

Attendees Praise Ruhof-sponsored Webinar Staff report he pre-recorded webinar “A Care, Handling, Inspection and Prevention Program (CHIP) for GI Endoscopy Professionals: A Q&A Webinar” was sponsored by Ruhof and presented on January 30.

Presented by Dr. Lawrence Muscarella and Ron Banach, attendees who tuned in for the webinar were eligible to earn one (1) continuing education (CE) hour by the State of California Board of Registered Nursing. Muscarella, consultant for Ruhof, and Banach, director of clinical training for Ruhof, received high marks for their presentation. Attendees shared positive comments in a post-webinar survey. “The scope cleaning process is constantly changing. I love learning about the latest and greatest information so I can keep my patients safe,” said R. Koval, LPN/CRCST. “We are having to go over all our facilities to find high-level disinfection areas. This was helpful in giving an overview of key things I need to look for in an audit,” said J. Hall, infection preventionist. “The OR Today webinar was very informative. It provided the most current information and explained rationales in detail. It will definitely help facilities in staying up with current and potentially coming practices,” said C. Burns, perioperative educator. “This was a very informative lecture. I especially found the information that was provided regarding the FDA and the disposable scopes and removable cap ends very helpful. I also found the information/clarification regarding manufacturers IFUs versus guidelines very helpful, this has come up more than once on our unit. Now, I know what to do,” shared D. Kohler, endoscopy manager. “Appreciated the Q&A format for the presentation. Speakers were very knowledgeable and addressed multiple issues,” said L. Perri, consultant. “Thank you for this webinar. It provided a lot of impor-

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“ Being able to listen to your webinars enables myself and my staff to continue to grow our knowledge in health care growth and issues.” – S. Sauve, surgical manager tant information for our endoscopy staff/department,” said J. Nelson, clinical care leader, surgery. “Understanding the why of performing proper handling, care and infection prevention is vital to the integrity of our community, colleagues and patients. This webinar helps to explain the ‘why’ and where our health care system is moving toward regarding infections on the rise and our action plan,” said H. Adams, patient care coordinator. “Being able to listen to your webinars enables myself and my staff to continue to grow our knowledge in health care growth and issues,” said S. Sauve, surgical manager. “Excellent information! Very professional and easy to understand presentation,” said R. Miles, reusable medical equipment coordinator. For more information about the OR Today webinar series, including recordings of previous webinars and registration for upcoming sessions, visit ORToday.com and click on the “Webinars” tab.

Thank you to our sponsor:

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Your facility is only as good as your SPD. MAC Medical has your SPD covered with a full line of products to help keep your facility sterile, and your patients safer. Visit www.macmedical.com/room-layouts to see our SPD products in interactive room settings.

Processing Sinks Case Carts Utility Carts Casework Tables Scope Cabinets Prep & Pack Workstations Pass Through Windows Wall Shelves Any other stainless steel need

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market analysis

Sterilization Market Faces Challenges Staff report he global sterilization services market is projected to reach $3.31 billion by 2022, according to MarketandMarkets. This indicates a compound annual growth rate (CAGR) of 6.7% from 2017 to 2022.

The growth of the market can be attributed to factors such as an increasing focus on the outsourcing of sterilization processes among pharmaceutical companies, hospitals and medical device manufacturers; increasing prevalence of hospital-acquired infections; growing number of surgical procedures and an increased focus on food sterilization. A Grand View Research study also predicts market growth. The global medical device cleaning market size was valued at $9.74 billion in 2017. It is projected to witness a CAGR of 6.3% through 2025, according to Grand View Research. “Increasing adoption of preventive measures to reduce hospital-acquired infections coupled with introduction of advanced materials and methods for reprocessing of medical equipment is augmenting the market,” the report states. “Strict regulations for reprocessing reusable medical equipment to reduce incidences of hospital-acquired infections are playing a significant role in proWWW.ORTODAY.COM

pelling the market. This, combined with an increasing number of hospitals and clinics, is expected to generate strong demand for medical device reprocessing materials.” However, recent developments may have a negative impact on market growth. The recent closure of sterilization plants due to ethylene oxide (EtO) concerns are impacting the U.S. market. Medline Industries closed one of its sterilization facilities in Waukegan, Illinois, in December 2019, because it failed to meet new state standards for ethylene oxide, according to MedTech Dive. A Lake County Health Department update on January 17 reports that Medline began installing additional pollution controls in late November, but did not finish by the end of 2019. The facility reported it expects to resume operations after the testing of millions of dollars worth of new emissions controls. In late January 2020, the FDA issued a report stating “The FDA is closely monitoring the supply chain effects of closures and potential closures of certain facilities that use ethylene oxide to sterilize medical devices prior to their use. The Agency is concerned about the future availability of sterile medical devices and the potential for medical device shortages that might impact patient care.”

“Additionally, the FDA is working with device manufacturers and health care delivery organizations to ensure they are aware of the issues and preparing to reduce the patient impact if medical devices sterilized at these sterilization facilities become unavailable,” the report adds. Grand View Research indicates that the North America market is the largest. “North America dominated the market in 2017. Presence of well-established health care infrastructure, strict regulations for infection control at health care facilities and high adoption of advanced infection prevention solutions are among the primary factors contributing to the dominance of the region,” Grand View Research states. “Europe followed North America in 2017 in terms of revenue. The region witnessed lucrative growth in demand for sterilization equipment in hospitals. Presence of major market players in Germany is one of the key factors driving the regional market,” the report adds. “Asia Pacific is expected to emerge as fastest growing region during the forecast period. Rapid economic growth, coupled with rising disposable income and increasing demand for world-class health care facilities, is playing an important role in boosting the demand for advanced infection prevention methods in health care facilities of Asia Pacific.” APRIL 2020 | OR TODAY |

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product focus

BELIMED ASP

STERRAD VELOCITY System The STERRAD VELOCITY System offers 15-minute time to results, the fastest biological indicator on the market.* It’s also the only rapid read process challenge device validated for STERRAD Systems that meets AAMI recommended guidelines for verifying sterility assurance. •

WD 290 IQ The WD 290 IQ is Belimed’s solution for medium and large SPDs, where consistent performance, high throughput, efficiency and tailored automation enables busy departments to meet the increasing processing and growing productivity demands of today and the future. As with its siblings, the WD 250 and WD 200, a high-volume water flow, with lower pressure, provides a better way to clean while using very little water and resources. •

*Fastest Biological Indicator/Process Challenge Device currently marketed for STERRAD Sterilization Systems. 15 or 30 minutes to result dependent on the software version on the STERRAD VELOCITY® Reader. 15 minutes to result for SW version 1139260410 or greater; 30 minutes to result for SW version 1139260317 or below.

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IN THE OR

product focus

Case Solutions

Multi-Enzymatic Cleaners and Wipes

Tackle pretreatment at point-of-use with Case Solutions Multi-Enzymatic cleaners and wipes, harnessing the power of enzymes. PentaPrep MultiEnzymatic Pre-Soak uses protease, lipase, amylase and several cellulases to target specific types of organic material, accelerate the breakdown of those materials and suspend them within the free-rinsing treatment to be easily carried away. Penta Wipes contain the same highly effective enzymes and surfactant in convenient nonlinting cloths. And, CasePrep Pre-Soak is an ideal solution for applications where facilities prefer a non-enzymatic pretreatment. Remove bioburden, maintain moisture, enhance and speed cleaning effectiveness, and disrupt the formation of biofilm with pretreatment at point-of-use. â&#x20AC;˘

GETINGE

Pack Rotary Sealer Packaging small and large instruments can be time consuming and sometimes troublesome. The Getinge Pack Rotary Sealer provides a best-in-class combination of sterility protection and workflow efficiency by reducing the need for human judgment and intervention that often produces inconsistent heat sealing results. Fail-safe rotary technology helps ensure a high-quality seal each and every time to eliminate the clinical consequences of compromised sterile packaging. â&#x20AC;˘

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APRIL 2020 | OR TODAY |

IN THE OR

product focus

Healthmark

Insulation Tester with optional Bi-Polar Fixture and Wire Tester Designed for testing electrosurgical instruments, the low frequency high voltage Insulation Tester is used to detect and locate defects such as pinholes, cracks and bare spots in the jacket or coating of laparoscopic and bi-polar electrosurgical instruments. Compromised insulation can lead to patient burns during electrosurgical instrument procedures. The Insulation Tester is a handheld, portable unit that tests the insulation integrity of electrosurgical equipment for flaws in protective coatings applied over conductive instrument surfaces. •

Medline

Advanced Mini Bowie Dick Test Medline has launched its Advanced Mini Bowie Dick Test (MDS200425). Primarily intended to detect air leaks within pre-vacuum sterilizers, the mini has advanced diagnostic capabilities, such as the ability to detect wet steam or excessive dry time, due to its purple to green chemical indicator technology. Also, it’s miniature size uses ~1/50th the amount of paper as a traditional Bowie Dick Test Pack, making it a space-saving, green alternative. •

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IN THE OR

product focus

STERIS SPM

The relationship between the OR and SPD is complex and interdependent. With collaboration and clear communication, facilities can reduce processing time and improve prioritization of work so that products are delivered on time and fit for use in the OR. SPM provides tools such as an EMR-driven Needs ListÂ to ensure trays that are needed by the OR in order of criticality are given priority status in SPD. SPM helps the SPD and OR to communicate more efficiently and effectively in order to deliver high-quality clinical outcomes. â&#x20AC;˘ For more information, visit www.mmmicrosystems.com

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APRIL 2020 | OR TODAY |

CE393-60F

IN THE OR

continuing education

Precepting: The chance to shape nursing’s future By Sheila J. Leis, MS, RN-BC n experienced medical/ surgical nurse preceptor realizes that the new graduate nurse has missed several subtle but critical criteria that indicate a patient is experiencing a rapidly deteriorating change in condition. The preceptor steps in quickly, outlining the clinical issues that the new graduate has missed as she calls the physician and the rapid response team. Later, the preceptor and the new graduate nurse debrief and review the events that just occurred. The preceptor asks the graduate nurse questions to facilitate learning and reviews the progression of the situation to identify key condition changes that the new graduate nurse did not see as critical. At the close of the day, the new graduate nurse tells the preceptor, “I don’t think I will ever forget this day. Thank you.”

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Nurse preceptors are experienced nurses who fulfill their job responsibilities according to established policies and procedures, using established, evidence-based nursing practice standards when providing patient care.1 The preceptor’s role is to help the less experienced nurse identify learning needs and set goals for improvement while providing feedback on the nurse’s progress.1 Preceptors are role models for professionalism and best practices in the clinical setting, helping to socialize nurses into the work group and provide education and orientation. Nursing preceptors are in demand for a profession that, according to the U.S. Bureau of Labor Statistics is expected to grow from 2.95 million RN positions in 2016 to nearly 3.4 million RN positions in 2026.2 There are also significant numbers of nursing graduates each year. The National Council of State Boards of Nursing reported that over 230,000 took the NCLEX

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

Goal and objectives The goal of this program is to provide nurses with knowledge and insight into the preceptor role. After studying the information presented here, you will be able to: •

Discuss why preceptors are critical to the professional future of nursing.

•

Identify the essential elements and techniques to strengthen the preceptor role.

•

Discuss how preceptors improve retention and recruitment.

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IN THE OR

continuing education exam in 2017, with a passage rate of 72%.3 All new graduate nurses have common needs during the transition from their graduation into practice in their first nursing job. These needs include assessment of knowledge, development of time management skills, and establishing socialization to the work group. An extended precepted orientation helps meet these needs, which in turn requires more preceptors to keep nurses moving through preceptorships. Besides working with new graduates, preceptors help nurses who change positions, whether they move within an organization when switching specialties or enter a new facility. Preceptors also are needed for nursing students receiving their clinical education in a healthcare facility. Academic hospitals have a particularly high need for preceptors, because they often serve large

numbers of nursing students from the undergraduate level to the advanced practice level. The role of preceptor was formalized more than 30 years ago when advances in technology and treatment made nursing care more complex. With the development of specialty units, a different type of orientation became necessary to ensure that newly hired nurses could safely manage patient care in complex environments. Preceptorship programs are now found in many healthcare facilities across the country. Many facilities, organizations, and institutions of higher learning have contributed to a consensus on the competencies that preceptors need. Besides being clinically competent, a successful preceptor needs to be a coach, advocate, cheerleader, and role model. Preceptors need to be respectful when talking with others and display a professional demeanor. They also

Preceptor Competencies4,5 • • • • • • • • • • • • •

Use of evidence-based professional nursing practice Effective communication and teaching skills Effective listening Ability to evaluate and provide constructive criticism and praise Ability to minimize reality shock Facilitation of conflict resolution Assessment of learning needs Assistance in setting daily goals and plans Encouragement and motivational skills Knowledge of agency standards, professional issues, and healthcare policy Time management and critical thinking skills to ascertain patient priorities Reporting and documentation of patient care Ability to transition patient care from preceptor to preceptee safely over time

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need to possess certain skills. The preceptor role is a unique, intense relationship between an expert nurse and a novice nurse. Even though the relationship may last only for a short time, it can benefit the preceptee significantly. Nurses describe the best preceptors as patient, kind, clinically astute, excellent communicators, and extraordinary role models who possess the qualities one aspires to as a developing professional. Nurse preceptors are called on to support the development of another over time, a challenge in the fast-paced healthcare environment. Preceptors can make the difference between a successful launch of a nursing career or losing a new nurse who becomes so overwhelmed and frustrated that the nurse leaves the career altogether.6 Considering national patient safety expectations, regulatory agencies require preceptors to add to their roles and responsibilities elements such as surveillance and protection of the patient during the preceptor process. One model of these changes emphasizes the critical role of the preceptor to ensure patient safety. Using core competencies from the Quality and Safety Education for Nurses initiative and simulation of safety risks, preceptors are educated on improving safety in healthcare. Pre- and post-training surveys reveal increased confidence toward the preceptor role after this training.7

Phases of the Relationship Many nurses become preceptors for the rewards of sharing expertise and knowledge, the personal growth gained from teaching others, and the satisfaction of seeing nurses develop professionally. There are two phases of the preceptorship experience. The first establishes the relationship between the preceptor and the preceptee.

APRIL 2020 | OR TODAY |

IN THE OR

continuing education Establishing trust is critical and provides the foundation for the relationship as it matures. The preceptor helps establish trust by providing structure and consistency. During this phase, the preceptor helps the preceptee by clarifying roles and reviewing with the preceptee their experiences and learning needs. It also is the time to discuss agency policies and unit procedures. Next is the working phase. Discussing patients and strategies for optimal patient care, sharing observations, and eliciting regular feedback from the preceptor helps develop the preceptee into a valuable team member for the unit.1

Select the Best Finding enough clinical nurses who are patient, inspiring teachers and also have the required competencies to be preceptors can be a challenge. Ideally, the preceptor should be motivated to support the novice nurse, be an expert clinician, and a role model for the clinical service, interprofessional collaboration, and the profession. Healthcare facilities usually utilize criteria for selecting preceptors, which may include a requirement of a certain number of years of employment in clinical service and approval of the nurse manager. As many institutions experience nursing shortages, less stringent criteria have become more common. Some hospitals make serving as a preceptor part of nurses’ job descriptions, particularly if teaching is a part of the hospital’s mission. Today’s complex clinical staffing situations may make it challenging for facilities to meet the ideal criteria for preceptor selection. In a crunch, nurses who thought they did not want to be preceptors may be called on to serve and then find the role surprisingly rewarding, performing with skill despite earlier reservations. Nurses with limited experience may also be called on to

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serve as preceptors, requiring additional support from unit educators or more experienced preceptors. Nurse managers and clinical nurse educators face challenges in covering the needs of their preceptors. To maintain the integrity of the program and prevent preceptor burnout, institutions may match the level of preceptor experience with that of the novice nurse. New preceptors may be matched with nursing students; experienced preceptors who perform best with short preceptor assignments may be given the new experienced nurse in that specialty; and preceptors who enjoy the longer-term, more committed experiences may be assigned to graduate nurses. Whatever process an institution chooses for selection of preceptors, the impact of preceptors on the outcomes of nursing orientation, nursing turnover, and patient care must be examined carefully. This includes an opportunity for the preceptee to evaluate the preceptor, as the quality of a preceptor significantly affects clinical setting experiences as well as nurse performance and retention. The quality and safety of orienting nurses to new positions are also maintained through the support of the clinical nurse educator. This professional development specialist, who functions under specific standards,8 provides the educational and clinical expertise to oversee the precepting process and is a resource for both the preceptor and the preceptee. Although the role may vary from setting to setting, professional development specialists support both preceptors and new employees to ensure successful orientations.

Learning to Be a Preceptor Many healthcare institutions offer extensive programs to instruct and support preceptors. The programs usually include instruction on adult learning styles, conflict management, instructional techniques, critical thinking, vali-

dating clinical competence, and ways to manage and document performance issues. Through these programs, many seasoned nurses change their thinking from “new nurses need to learn the hard way, like I did” to “I need to consider how to support their learning.” Usually, clinical nurse educators in the facility are assigned to design a centralized program that includes preceptor selection criteria, an outline of expectations for the role, a staff development program to provide educational support, guidelines for staffing when precepting, ways to recognize and select preceptors, continuous evaluations, and membership on an oversight committee. Some facilities hold activities, such as “preceptor action days,” to support and retain preceptors by providing them with training on topics, such as teaching methods, which may include role playing and interactive sessions for sharing among preceptors. Many instructional methods are available for preceptor development, including classroom instruction, vendor-generated CDs, online programs, textbooks, and journal literature. Academic institutions also may provide education for preceptors as partnerships develop between programs of nursing and clinical facilities.1,9 One expert developed the Preceptor Orientation Self-Learning Education module as a teaching/learning tool for preparing preceptors for senior nursing students. In a pilot study, this tool was found to be an effective and convenient teaching/learning option in preparing nurses for their roles as clinical preceptors to nursing students.10 Academic educators have become increasingly involved in the function of the preceptor role as healthcare institutions assume a more active role in supervising nursing students during clinical experiences. Nursing schools often post their preceptor handbooks online, making them readily available to others.1,11 Conducting research on the precep-

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IN THE OR

continuing education tor experience provides evidence on how to improve it. Twelve nurse educators from the Quality and Safety Education for Nurses (QSEN) Academic Task Force, located at nine schools of nursing across the nation, examined the responses of 923 students to identify seven themes. Re-framing constructive feedback as a vehicle for professional development and self-improvement was the most prominent theme identified.12 A literature review that explored the role of the staff nurse preceptor identified a positive effect in 10 studies of preceptor training on positive outcomes for new graduate nurses. The most common factors affected were retention, critical thinking, and stress levels.13 The authors of one study found that new graduate registered nurses who had learned from trained preceptors recorded a higher one-year retention rate at 89.5%, compared with 82.7% for the new graduate registered nurses with untrained preceptors.14 Successes and failures of preceptorpreceptee relationships and the efficacy of preceptor programs need to be reported continually in the nursing literature so that we can develop an exhaustive library of processes that work and those that do not. Additional research on the effect of preceptorship programs on patient safety, nursing turnover, and nurse career advancement also needs to be available for review. Preceptors need to know, understand, and share the importance of evidence-based practice with their preceptees. Otherwise, the traditional ways of caring for patients will continue to be perpetuated, without the use of evidence as the foundation for nursing practice. Preceptors are key in emphasizing the importance of evidence to newly hired nurses.15

When Challenges Occur Sometimes issues arise that require additional support and interventions to

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A Preceptor Checklist All preceptors touch other nurses’ lives in unique and lasting ways through how they interact with new nurses, teach specialized skills, and model professionalism. Preceptors must ask themselves: •

Do I introduce new employees to other hospital staff and physicians so they feel welcomed?

•

Am I modeling evidence-based practice?

•

Do I stimulate the new nurse to question practice and search for evidence thereof?

•

Do I guide the new nurse or student to look up standards, policies, and procedures?

•

Do I stimulate critical thinking by asking questions about what is happening to the patient rather than telling the preceptee what I observe and think?

•

Do I ask the preceptee to differentiate care priorities and outline what should happen next or do I just tell them what to do?

•

Do I help new graduate nurses practice how to handle difficult situations, or do I just tell them how to do it?

•

Do I welcome experienced nurses by validating competencies during orientation in a way that demonstrates respect for their experience and by accepting them onto the team?

•

Do I provide feedback that is objective and specific in an affirming manner?

•

Do I provide support and suggestions for remediation plans when needed?

prevent preceptor burnout and dissatisfaction. Common issues include stressful work-related circumstances, difficult orientations, and the added responsibility for supporting novice nurses during orientation or when moving into new clinical situations. When preceptors feel their increased responsibilities are a burden, preceptees may be aware that their preceptors are not pleased to be in the role and may feel anxious about the outcome. Common sources of stressful circumstances for preceptors include perceptions of added responsibilities and the increased time it takes to be a preceptor while managing a heavy

patient workload. Techniques for reducing preceptor stress need to be developed. One way to reduce stress is to rotate preceptor assignments by providing a scheduled “vacation” from precepting, particularly when preceptees are numerous on a unit. Another option is alternating types of assignments, such as giving the stressed preceptor a short student-practicum assignment rather than a series of more intense graduate nurse resident orientations. Another method is for the preceptor to meet regularly with the clinical nurse educator or the nurse manager to share concerns and develop techniques to reduce stress. Educators

APRIL 2020 | OR TODAY |

IN THE OR

continuing education need to be alert to preceptor burnout. Establishing an education council for preceptors is another successful approach. Sharing with other preceptors helps to create a strong cohort group and provides a forum for preceptors to exercise decision making at the level of their practice and to contribute to shared leadership goals. The role of the preceptor becomes particularly challenging when the preceptee does not advance as expected. The problem may relate to preceptorpreceptee incompatibility, a gap between the resume of an experienced nurse and their actual knowledge and skills, insufficient educational or clinical preparation of a new graduate for the unit of hire, or language and cultural issues. In the case of incompatibility, another preceptor may be assigned. If a new nurse or an experienced nurse enters a care setting with skill deficits, the clinical nurse educator may develop an education plan for knowledge and skill gaps to be remediated by extending orientation. Others may need help to transfer to a more suitable position. Cultural diversity issues may require interventions that include support from experts in the human resources department. The preceptor experience works best when the preceptor, the clinical nurse educator, and the nurse manager become partners, working with the preceptee as a team to resolve problems so that regardless of the outcome, patient safety is maintained. The types of programs that facilities develop for new graduate RNs as well as experienced RNs moving into new positions include enhanced orientations, preceptorships, internships, and support groups. Some advocate for RN residency programs. A literature review revealed residencies of at least 12 months have been the most successful at retaining new graduate nurses.16 Recent literature on these programs focuses on the need to enhance critical thinking in graduate nurses. One

38 | OR TODAY | APRIL 2020

study shows that doing so may increase the graduate’s interest in conducting research.17 Focused preceptor development programs have been found to increase the confidence and knowledge of preceptors.18 These studies show how focused educational strategies can make a difference for both the preceptor and preceptee in the transition into practice. Nursing is complex, and nurses typically do not adjust to a new facility in a short time. A preceptor’s patience, support, and guidance are essential for the preceptee’s development. Providing only a short period of orientation to a new facility or unit, or placing the novice nurse in demanding clinical situations prematurely may compromise patient safety and undermine the nurse’s confidence and competence. After a preceptorship, the preceptor often becomes a formal or informal coach until the preceptee no longer feels the need for continued support to manage a full assignment. This experience also can provide a sense of belonging gained through relationships developed in the clinical service. Preceptors who continue relationships with their preceptees can build on this sense of belonging and integration into the team.

Celebrating Good Work Supporting preceptors is critical to sustaining the participation of these valued employees. Recognition and support can be created in many ways, from establishing networking opportunities to providing monetary incentives. A preceptor newsletter or hospitalwide group meetings can encourage networking. Some institutions include a “preceptor fair” in hospital-wide group meetings, with speakers, helpful information updates, and/or skill stations. Recognition also can include events to honor preceptors, such as

awards at Nurses Week celebrations, pins, certificates, and/or names on unit plaques. Some hospitals provide monetary incentives, such as paying for continuing education courses or providing for tuition reimbursement. Others provide additional pay differentials for hours worked as a preceptor. Academic institutions may contribute to clinical agency preceptor rewards, such as tuition reimbursement toward a master’s degree. The importance of recognition for preceptors cannot be overestimated. The greater the benefits and rewards that preceptors receive, the more committed they are to serve as preceptors. Rewards can be tangible or intangible, but the key is to recognize the preceptors’ efforts to shape the workforce.

Why Are Preceptors So Important? Most preceptors perform conscientiously, focusing on the immediate shift functions without realizing the larger impact of their work. But the stakes are high for the preceptor, the healthcare institution, and the nursing profession. Preceptors must be made aware of how their performance may influence their organization regarding nurse turnover. Nurse turnover represents a significant cost for healthcare institutions. Turnover costs include direct expenses (advertising, recruiting, temporary labor, and time for the hiring process) and indirect costs (low morale, constant orientation and training, instability caused by using contract labor, and the time needed to precept new employees). The estimated cost of replacing a registered nurse ranges from about $22,000 to more than $64,000 per nurse.19 The cost of preceptor development is minimal compared with the cost of unit instability, poor morale related to turnover and staffing shortages, problems with patient safety related to higher nurse-patient ratios,

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IN THE OR

continuing education and the actual costs of replacing the lost nurse. In addition, how preceptors interact and support nursing students during their clinical rotations can significantly affect recruitment of these students after graduation. Precepting is giving a gift of one’s self to another, a commitment to share one’s own knowledge and expertise, and an experience that is part of the timeless tradition of nursing. Preceptors have an opportunity to prepare new graduate nurses or nurses new to the clinical setting, going beyond just teaching them how to complete their daily assignments to helping them discover their identity as professional nurses. Preceptors help others to develop their confidence in delivering outstanding patient care. Preceptors, by their power and leadership, can create a caring environment in which nurses can grow and thrive, contributing to that next generation of professional excellence.

nurses.htm#tab-6. Updated April 12, 2019. Ac-

12. Altmiller G, Szymanski K, Vottero B, et al.

cessed August 6, 2019.

Constructive feedback teaching strategy: A multisite study of its effectiveness. Nurs Educ

3. National Council of State Boards of Nursing.

Perspect. 2018;39(5):291-296. doi: 10.1097/01.

2017 NCLEX pass rate. National Council of State

NEP.0000000000000385.

Boards of Nursing Web site. https://www.ncsbn. org/10645.htm. Published January 19, 2018. Ac-

13. Piccinini CJ, Hudlun N, Branam K, Moore JM.

cessed August 6, 2019.

The effects of preceptor training on new graduate registered nurse transition experiences and

4. Vermont Nurses in Partnership: intern and

organizational outcomes. J Contin Educ Nurs.

preceptor development. VNIP Web site. http://

2018;49(5):216-220. doi: 10.3928/00220124-

www.vnip.org/preceptor.html. Published 2009.

20180417-06.

Accessed August 6, 2019. 14. Clipper B, Cherry B. From transition shock 5. Interprofessional preceptor program. Regis-

to competent practice: developing preceptors

tered nurses professional development centre

to support new nurse transition. J Continu-

Web site. https://www.rnpdc.nshealth.ca/Pro-

ing Educ Nurs. 2015;46(10):448-454. doi:

grams/RNPDC-Programs/default.asp?mn=1.55.

10.3928/00220124-20150918-02.

Published 2016. Accessed August 6, 2019. 15. Hagler D, Mays MZ, Stillwell SB, et al. 6. Gadd J. Navigating the highs and lows of

Preparing clinical preceptors to support nurs-

early career nursing. Aust Nurs Midwifery J.

ing students in evidence-based practice. J

2018;26(3):18-23.

Continuing Educ Nurs. 2012;43(11):502-508. doi: 10.3928/00220124-20120815-27.

7. Lim F, Weiss K, Herrera-Capoziello I. Preceptor education: focusing on quality and safety educa-

16. Ackerson K, Stiles K. Value of nurse residency

EDITOR’S NOTE: Mary Krugman, PhD, RN, FAAN, Joan Monchak Lorenz, MSN, RN, PMHCNS, BC, and Cynthia Saver, MS, RN, past authors of this educational activity, have not had an opportunity to influence the content of this version.

tion for nurses. Am Nurs Today. 2016;11(1):44-47.

programs in retaining new graduate nurses and

Sheila J. Leis, MS, RN-BC, is a full time nursing faculty member at Indiana Wesleyan University. Her professional experience includes more than 15 years as a professional development specialist in a centralized nursing education department at an 800+ bed Magnet hospital.

9. Preceptors: responsibilities. University of

newly graduated nurses: predictors for research

Pittsburgh School of Nursing Web site. http://

use: a quantitative cross-sectional study.

www.nursing.pitt.edu/continuing-education/

Evidence-Based Nurs. 2012;15:73. doi:10.1136/

preceptor-program/preceptor-responsibilities

ebnurs-2011-100413.

their potential effect on the nursing shortage. 8. Bruce SL, ed. Core Curriculum for Nursing

J Cont Educat Nurs. 2018;49(6):282-288. doi:

Professional Development. 5th ed. Chicago, IL:

10.3928/00220124-20180517-09.

Association for Nursing Professional Development; 2017.

17. Profetto-McGrath J, Raymond-Seniuk C. Research utilisation and critical thinking among

Accessed August 6, 2019. 18. Kamolo E, Vernon R, Toffoli L. A critical 10. Riley-Doucet C. A self-directed learning tool

review of preceptor development for nurses

for nurses who precept student nurses. J Nurs

working with undergraduate nursing students.

Staff Dev. 2008;24(2):E7-E14. doi: 10.1097/01.

International Journal of Caring Sciences.

NND.0000300874.28610.a7.

2017;10(2):1089-1100.

Web site. http://nursing.columbia.edu/alumni/

11. Undergraduate nursing preceptor/mentor

19. Robert Wood Johnson Foundation. Busi-

become-nurse-preceptor/preceptor-handbook.

handbook 2018-2019. UT Health San Antonio

ness case/cost of nurse turnover. Robert Wood

Accessed August 6, 2019.

Web site. https://www.uthscsa.edu/sites/default/

Johnson Foundation Web site. https://www.rwjf.

files/2018/undergraduate_preceptor_handbook.

org/en/library/research/2009/07/business-case-

pdf. Accessed August 6, 2019.

cost-of-nurse-turnover.html. Accessed August

References 1. Columbia University School of Nursing preceptor handbook. Columbia School of Nursing

2. Occupational outlook handbook, registered nurses. U.S. Department of Labor Web site.

6, 2019.

https://www.bls.gov/ooh/healthcare/registered-

WWW.ORTODAY.COM

APRIL 2020 | OR TODAY |

IN THE OR

continuing education Clinical Vignette Sam has agreed to precept an experienced nurse, Jane, starting on his pulmonary unit. All preliminary work seems to be in order: Jane has completed centralized clinical orientation; the nurse manager has met with Jane to review the unit’s mission, vision, values, and performance expectations; and the clinical nurse educator has reviewed Jane’s orientation plan, the unit standards of care, thus completing Jane’s orientation. Sam expects it will be a “quick start” with Jane because her resume reflects pulmonary experience.

On Jane’s first day on the unit, they attend report and start rounds to conduct initial patient assessments before medication administration. Sam reviews the computerized care plans for each patient. As the day progresses, it becomes clear that there are unanticipated issues. One patient is on remote monitoring of cardiac dysrhythmias, while another has chest tubes after lung surgery. Jane is waiting for Sam’s direction. Sam asks Jane to check the chest tube suction equipment. Jane looks at him blankly and asks, “What do I check for?”

1. As a first step to these issues, Sam should: a. Page the supervisor for immediate help b. Page the educator for immediate help c. Ask the charge RN to cover his patients; go to a private area to talk with Jane about her questions d. Tell the charge nurse Jane will never make it

b. The educator volunteering to create a detailed competency checklist for the equipment while Sam consults with another preceptor c. The educator removing Sam as preceptor, as he and Jane do not seem compatible d. The educator recommending several short meetings during the day to check on Jane’s jitters

2. Sam speaks with Jane, who says she just has first-day jitters. She says she knows chest tubes and remote monitoring. The equipment just “looks different.” Sam is uncertain about this explanation. He should: a. Start with the remote monitoring equipment, retrieving the step-by-step competency from the online computer link b. Tell Jane to keep her phone on for the calls from the telemetry technician c. Move directly to chest tubes and review all of the elements of chest tube management d. Bring the educator into the meeting with Jane so all three can discuss this together 3. Sam reviews the situation with both Jane and the educator present. Sam would be best supported by: a. The educator assuring Sam to power on; Jane just has the jitters and will overcome them

4. Sam continues with Jane’s orientation after equipment checkoffs. Jane is tense. At times she seems close to tears. They care for an adult patient with cystic fibrosis who is on a complex intervention for delivering medications by pump. Jane seems unable to follow the steps for the pump setup despite three attempts after watching Sam and having him talk her through it. Since her jitters continue, Sam should: a. Talk with Jane further about the acuity on the unit, because the patient assignments on this day were typical of the unit population b. Hold an end-of-the-day meeting with the manager c. Power on, hoping Jane will eventually relax d. Fill out the hospital’s preceptor evaluation of employee form to document Jane’s continued issues. Sign the form, have Jane sign it, and submit it to the educator.

Clinical VignettE ANSWERS 1. Answer: C, Sam cannot sound the alarm immediately without further interviewing Jane to determine what the barriers are, as she is an experienced nurse with this population and ordinarily would not question these types of equipment. 2. Answer: D, Sam cannot determine why an experienced nurse should have jitters. Because he feels confused, and Jane is not clear in her explanation, he should obtain help. In addition, he has four patients to care for, and detailed equipment checkoffs were not in the orientation plan. Sam thinks these jitters would be typical of graduate nurses but not of an experienced RN with years of med/surg experience. 3.Answer: D, Because of Jane’s uncertainty, it’s important for Sam to check in regularly. 4. Answer: D, By documenting the issues, Sam is starting a key process: to identify problems using factual data. This documentation can be used to modify the orientation plan and provide a record in case the manager needs to take future action.

40 | OR TODAY | APRIL 2020

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Deadline Courses must be completed by 9/6/2022 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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SPEAKER Spotlight “

I AM A TEACHER AND BUILDER BY HEART AND LOVE TO GET INTO THE CLINICAL WITH HOPES OF PROVIDING INSIGHT TO PRACTICE CHANGE AND PERSONNEL AND PATIENT SAFETY.

”

– Vangie Dennis, MSN, RN, CNOR, CMLSO Executive Director of Perioperative Services, WellStar Health System

Vangie is a speaker at OR Today Live! To learn more, visit www.ortodaylive.com.

APRIL 2020 | OR TODAY |

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in quality r i a t u o s ab Concern urgical s g n i r u nd the OR d en arou e b e v a res h procedu ct, the a f n I . e ng tim for a lo ion that t a t n e m cu first do atter in m e t a l u pa r t i c inhaled e b n a c l smoke surgica veoli of l a e h t osited in and dep in 1975. d e r r u c s oc the lung

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APRIL 2020 | OR TODAY |

“ If you can smell the surgical smoke, then you’re not evacuating the smoke.” – Vangie Dennis, MSN, RN, CNOR, CMLOS, Executive Director Perioperative Services, Atlanta Medical Center

However, progress toward protecting health care workers and patients by ensuring a smoke-free perioperative environment has been frustratingly slow. The good news is that momentum is starting to build toward the passage of legislation requiring hospitals and ASCs to adopt and implement policies that prevent human exposure to surgical smoke by using smoke evacuation systems. Rhode Island and Colorado were the first two states to pass such legislation. Rhode Island’s law went into effect in 2019 and Colorado’s law will go into effect in 2021. In addition, a number of other states are considering similar legislation. Such legislation could pass in Oregon, Utah, Iowa, Kentucky, Tennessee, Georgia, Maryland and New York as soon as this year.

As Bad as Cigarette Smoke Believe it or not, spending a full day in the OR could expose health care workers to as much smoke plume as smoking up to 30 cigarettes. Brenda C. Ulmer, RN, MN, CNOR, has been active for the past two years in getting surgical smoke legislation passed in Georgia. She points to research indicating that surgical smoke is just as mutagenic and dangerous as cigarette smoke. “More than 150 chemicals have been identified in surgical smoke, each with its own health concerns and side effects,” says Ulmer. One of these chemicals is benzene, which OSHA regulates to protect workers from potential hazards including leukemia in susceptible people. “The evidence clearly establishes the presence of harmful chemicals in surgical smoke,” says Mary J. Ogg, MSN, RN, CNOR, Senior Perioperative Practice Specialist with the Association of periOperative Registered Nurses (AORN). “And many of these chemical compounds, such as benzene and

46 | OR TODAY | APRIL 2020

toluene, are carcinogenic.” Ogg says there are case reports of occupational transmission of Human Papilloma Virus (HPV) to the respiratory tracts of three surgeons and an OR nurse. “All four of the infected individuals were involved in different types of surgical procedures removing anogenital condylomas,” says Ogg. “Anecdotally, I have heard of at least that many or more that have never been published as a case report.” According to Vangie Dennis, MSN, RN, CNOR, CMLOS, the Executive of Director Perioperative Services for the Atlanta Medical Center, OR personnel report twice as many incidences of respiratory illness as the general population. “Ultra-fine particulate matter acts similar to air pollution and tobacco smoke in the lungs,” says Dennis. “It can cause or exacerbate bronchiolitis, asthma, COPD/emphysema, atherosclerosis and thrombogenesis.”

What Causes Surgical Smoke? Surgical smoke in the OR results from the of use of energy-generating devices such as electrosurgical units (ESUs), lasers, electrocautery and ultrasonic devices, and powered instruments like bone saws and drills. “Surgical smoke is the by-product of using these devices during surgery,” says Ogg. “For example, drills, saws and ESUs are used during major orthopedic cases.” “A review of the published evidence supports that surgical smoke and its components are a danger to perioperative personnel and are capable of producing physical symptoms,” says Ulmer. According to Ogg, the known hazards or risks associated with surgical smoke exposure are respiratory or particulate, chemical, viral and blood. “Perioperative team members do experience respiratory issues such as asthma, acute and chronic bronchitis, and emphysema,” she says. “The particles in surgical smoke generated by surgical energy-generating devices are within the respirable range. They are able to be inhaled and deposited in the alveoli, or the gas exchange regions of the lungs, which can lead to respiratory problems.” Ogg cites a 2019 qualitative study of 672 OR nurses that determined that 73 percent of the nurses who routinely breathed in surgical smoke had at least one symptom related to smoke exposure. These included acute and chronic respiratory changes, headaches, nausea and vomiting, throat irritation, hypoxia and dizziness. Surgical smoke also poses risks to patients, Ogg adds, including a lack of visibility during laparoscopic procedures, delays during the procedure to clear

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S M O K E

Vangie Dennis, MSN, RN, CNOR, CMLOS, Executive Director Perioperative Services for the Atlanta Medical Center

the smoke, increased levels of carbon monoxide and port-site metastasis. Ulmer elaborates: “Smoke inside the abdomen is absorbed through the peritoneal membrane,” she says. “This results in an increase in the methemoglobin and carboxyhemoglobin concentrations, which reduces the oxygen carrying capacity of red blood cells.”

Take a Comprehensive Approach Ulmer encourages health care facilities to adopt a comprehensive approach to ensuring a smoke- free environment wherever surgical smoke is generated. “Components of the program include smoke knowledge testing, interprofessional education, gap analysis and compliance monitoring,” she says. Recommendations on eliminating surgical smoke have been included in the AORN Guidelines since 2004 and as a stand-alone guideline since 2017. “Perioperative team members should use the guidelines to establish policies and procedures to eliminate smoke from the surgical environment,” says Ulmer. According to Ogg, the National Institute for Occupational Safety and Health (NIOSH) and AORN recommend using a combination of ventilation techniques to control

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I N

the airborne contaminants of surgical smoke. “Because general room ventilation of 20 air exchanges per hour is insufficient to capture the contaminants, smoke evacuation — also known as local exhaust ventilation — is also necessary,” says Ogg. “General room ventilation and smoke evacuation are the first lines of protection against the hazards of surgical smoke.” Smoke evacuation technology has made vast improvements over evacuators used in the 1990s. “These were sometimes louder than a vacuum cleaner,” says Ogg. “Today’s evacuators are quieter and the electrosurgical pencil with the attached evacuation tubing is less cumbersome,” she adds. “The newer evacuators are automatically activated when the electrosurgery unit is in use.” Dennis recommends the use of inline filters at 0.1 microns for small smoke-generated cases, a 0.1 ULPA Filter Smoke evacuator for large smoke-generated cases, and insufflators that lower the cumulative effects of smoke during laparoscopy. “When determining methodology of correct algorithms for smoke evacuation, OR personnel should consider the procedure and the culture of the surgeon and staff while taking care not to interfere with the rhythm of surgery,” says Dennis. “If you can smell the surgical smoke, then you’re not evacuating the smoke.”

Barriers to Reducing Surgical Smoke Unfortunately, barriers exist to the adoption of practices and technologies to eliminate surgical smoke in the OR. “The biggest barriers to adoption typically include educating perioperative personnel about smoke evacuation equipment, getting surgeon buy-in to use the equipment due to perceived interference with surgeries, hooking equipment up correctly and the cost of the equipment,” says Dennis.

T H E

O R

Ogg says that AORN has worked for years to educate perioperative nurses about the dangers of surgical smoke and the need for surgical smoke evacuation. “Through education and awareness programs like Go Clear, AORN members across the country have convinced many hospitals and ASCs to go surgical smoke-free,” she says. The AORN Go Clear program is a comprehensive approach to protecting patient and worker safety by promoting a smoke-free environment wherever surgical smoke is generated. It includes all the tools and protocols needed to start or enhance

Brenda C. Ulmer, RN, MN, CNOR, perioperative nurse educator

smoke evacuation practices. The program includes an implementation manual explaining in detail how to accomplish each step. “It also includes supplemental resources such as templates for competencies, policies and procedures, and a product evaluation,” says Ogg. Since the program was implemented, more than 1,000 facilities have registered for the Go Clear program and 68 facilities have received the Go Clear award. “In addition, more than 13,000 staff are enrolled in the education portal,” says Ogg. To learn more about the AORN Go Clear program, visit https://www. aorn.org/member_apps/Product/ Detail?productID=9709.

APRIL 2020 | OR TODAY |

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SPOTLIGHT ON:

Tom Catena

By Matt Skoufalos

Tom Catena has dedicated the last 20 years of his life working as a medical missionary in Africa. Nine of them he spent amid almost ceaseless civil conflict in war-torn Sudan, and for almost all 20, he’s lacked the resources and infrastructure that most Western physicians take for granted. “Dr. Tom,” as he’s known among the locals, heads up a staff of some 200 at Mother of Mercy Hospital in Gidel. Most are non-medical personnel, and Catena is the only doctor among them. A majority train on the job; some who help maintain the grounds do so as charity. Occasionally, Catena has support from visiting physicians performing mission work, but even so, the amount of effort required

50 | OR TODAY | APRIL 2020

of him is constant. That’s consistent with the way of life in a region where the general populace comprises subsistence farmers who grow sorghum and peanuts just to survive. “We are extremely remote,” Catena said. “People here don’t live much differently than they did a few hundred or even a thousand years ago. Some schools are up and going, and people are keen on education, but it’s been held back by years of conflict.” Mother of Mercy is the only hospital for some 300 miles in an area of the Nuba Mountains that is home to some 1.3 million people. What in March 2008 was conceived as an 80-

bed, rural operation quickly expanded into a 430-bed campus that’s the first, last and only option for people there. “Whatever hits the door, we have to find a solution for,” Catena said. “We’ve not been able to refer patients for many, many years. We have to do what we can with each patient.” Such was the case during Catena’s first three years there. But when military violence reignited in June 2011, the “standard mission hospital” he operated “changed into a M.A.S.H. unit” almost overnight, he said. “It was a stark contrast,” Catena said. “We’d be sitting there and see 50

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to 100 wounded at our gate,” he said. “We had to triage and see who needs to go to operation now and who can wait. We treated scores and scores of wounded with bombardment, shrapnel and bullet wounds to every part of the body.” The team transitioned quickly from handling a variety of common ailments to caring for large numbers of people. But to grow capacity at the facility up to that increased operational standard, Mother of Mercy needs more physicians. Catena expects the first of them this spring. “We’ve managed to keep things going with a dedicated staff and by the grace of God,” Catena said. “I spend quite a bit of time on the job teaching my medical assistants, [and] we’re getting our first Nuba doctor here in May or June. I’m really looking forward to teaching him as much as I can.” Behind the newcomer are three or four others, Catena said. With his help, they’ll hopefully achieve a level of proficiency that will allow them to provide health care in the mountains “for generations to come,” he said. “The next goal for me is to continue passing this on to the next generation of Nuba,” Catena said. “We’re slowly getting to that.” It’s not dissimilar to Catena’s own on-the-ground instruction, which came almost as an afterthought to his interest in missionary work. Before he became a physician, the Amsterdam, New York native studied engineering at Brown University. Then came medical school at Duke University, five years in the U.S. Navy, and two-and-ahalf years in residency. Catena trained as a family practitioner at Union Hospital in Terre Haute, Indiana, and came to Kenya in January 2000. Initially, he worked in clinics and hospital wards, but quickly discovered he’d need to pick up surgical techniques to increase his effectiveness on the ground. After seven years “under the watchful eyes of mission doctors and Kenyan doctors,” Catena learned how to perform a variety of procedures, “but very low-tech in every field,” before moving to Sudan.

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Tom Catena is seen with his wife, Nasima. She is a Nuba woman that he met while working in Sudan. “We’re working in a specific environment,” he said. “This is rural African medicine. I’ve not done much else over 20 years.” Even with the relief coming in the form of additional physicians over the next few years, Catena believes the institution is still probably about a decade away from operating without his daily, intense labor. “I would like to gradually pull back a bit and get out of the day-to-day, seeing-every-single-patient mode, and start handing off some of these responsibilities to the Nuba doctors once

“I see my role as showing the love of Christ to other people, and I do that through medical work,” Catena said. “My overarching goal is to be able to create a health care institution which will be top-notch.” For that region of the country, which Catena described as having been marginalized historically, the opportunity to rise above its traditional station is showing itself in the influx of northerners who visit there for health care. “I would love to see this area having a high-class, well-functioning, very efficient, rigorous health institution

“My overarching goal is to be able to create a health care institution which will be top-notch.” they start coming,” he said. “[But] I plan to stay for the near future.” Catena comes from a big family that’s “scattered around the Northeast,” but doesn’t believe he’ll be heading home to the U.S. to visit them any time soon. His younger brother, a priest, visited in 2016, and married Catena to Nasima, a Nuba woman he met there. Even were he not so specifically connected with the land and its people, Catena views his work in Sudan as an extension of his faith and the obligations that it demands of him.

that can provide top-quality care to people all over Sudan,” Catena said. “It’s pretty hard for these guys coming from the north to look down on you if you take care of them. I think that goes a long way to helping the cause of the Nuba. “This is a much better approach than the constant war,” he said. “In the long run, you have to have an alternative. Perhaps that can be through education and establishing high-quality institutions. We hope that would be a reality someday.”

APRIL 2020 | OR TODAY |

OUT OF THE OR fitness

STABILIZATION TRAINING and Why It’s Important By Miguel J. Ortiz hen it comes to stabilization

W training, we tend to naturally think of balance exercises. Taking it to the next level is tricky because most of these exercises aren’t regularly practiced and are sometimes used for “fun” challenges. This has caused the majority of people to only perform these exercises at certain times instead of adding them to their regular routine. So, for the sake of progress and ensuring quality movements, I want you to keep it simple and start small. To do so, we must understand the benefits of this type of training. We have to understand when to add it into a program and why one should implement stabilization-focused movements. Balance exercises require a more attentive mindset and that can improve three important areas of the body. Your brain is among them, according to author John Ratey. He wrote the book “Spark, The Revolutionary New Science of Exercise and the Brain.” I was fortunate enough to be a part of a workout program that he was involved in and there was a great deal of balance. Here is what he had to say, “While aerobic exercise elevates neurotransmitters, creates new blood vessels that pipe in growth factors, and spawns’ new cells, complex

52 | OR TODAY | APRIL 2020

activities put all the material to use by strengthening and expanding (neural) networks.” Short exercises like these increase your Brain Derived Neurotrophic Factor (BDNF) which is like “miracle grow” for the brain. It allows people to remember information better and an improved attention span. The next area it can improve is your heart. By activating more muscle groups, your heart must work slightly harder, depending on the exercise of course, to get oxygen and blood to the area. The third area of improvement are your joints. Stabilization movements require you to be exactly that, stable. So, don’t think that jumping around on one foot will strengthen your ankle as much as standing on one foot (stability) for a certain amount of time will. The reason being is because the muscles in your joints work like cables on a bridge. When you look at them you can see that they are strong and holding the bridge, but they don’t move. Keep in mind you can add movement, but that goes into advanced levels of deceleration, acceleration and control throughout the movement. Let me get back to keeping it simple. So, when should someone add this into a fitness program? I recommend adding it in the beginning because it can be a great warm up to whatever other training you may be doing. Balance training increases heart rate, helps

brain activity and stabilizes the joints. It’s a fantastic way to warm up specific muscle groups before training them. Even something as simple as pushups on a BOSU ball can help increase shoulder stabilization, depending on how much you prevent the BOSU from moving. Doing a glute raise on a stability ball before squatting can help glute/hip activation and can help ankle stability for future strength movements. Plank holds on a stability ball can increase core muscle activation. The list of potential exercises is endless. Simply put, you’re working more muscles and burning more calories while improving brain and heart activity. Finally, the most important reason for stabilization training is injury prevention. The number one reason athletes are required to do balance training is for this exact reason. Adding some simple and very effective stability training to your routine will not only spice up your workout, but your body will thank you down the road. 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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AUGUST 16-18 | DENVER, CO AUGUST 16-18 | DENVER, CO

SPEAKER Spotlight SPEAKER Spotlight “ “

FROM MY FIRST EXPERIENCES AS A FROM MY FIRST STUDENT IN THE OPERATING EXPERIENCES AS A ROOM, IINALWAYS KNEW STUDENT THE OPERATING THATIWAS WHERE I ROOM, ALWAYS KNEW WANTED TO WORK. THERE THAT WAS WHERE I WAS NEVER QUESTION WANTED TO ANY WORK. THERE IN MYNEVER MINDANY THATQUESTION THE OR WAS WAS I BELONGED. IN MYWHERE MIND THAT THE OR WAS WHERE I BELONGED. – Brenda C. Ulmer, MN, RN, CNOR

” ”

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Brenda is a speaker at OR Today Live! To learn more, visit www.ortodaylive.com. Brenda is a speaker at OR Today Live! To learn more, visit www.ortodaylive.com. WWW.ORTODAY.COM

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OUT OF THE OR health

Breast Density: Separating myth from fact Courtesy of Penn State Health ammograms remain the gold standard for detecting breast cancer in its earliest stages, potentially saving lives. So, why do some women receive a letter after a negative mammogram – meaning there’s no sign of cancer – asking them to consider additional tests?

The answer, according to Rebecca Sivarajah, M.D., a specialist in breast imaging with Penn State Health, boils down to the type of tissue in a woman’s breasts. “Most breasts include both fatty tissue and the fibroglandular, or dense, tissue,” she said. While fatty tissue appears grey on a mammogram, dense tissue appears white. Some cancer lesions also appear white on a mammogram. “Therefore, high levels of dense tissue in some women may mask a cancer lesion on a mammogram,” Sivarajah said. That’s why, six years ago, Pennsylvania enacted a law requiring radiologists to notify women with dense breast tissue about supplemental screenings following a negative mammogram. While the law raised awareness of the risks associated for women with dense breast tissue, the topic itself evokes many questions and myths. Let’s separate some myths from the facts.

Myth 1: I can tell my breast density by the way they feel. Fact: “In general, you can’t de-

54 | OR TODAY | APRIL 2020

termine breast density by ‘feel,’ ” Sivarajah said. Instead, a mammogram will determine breast density. The American College of Radiology breaks down breast density into four classes. Women whose breasts rank in the “fatty” or “scattered fibroglandular tissue” classes do not have enough dense breast tissue to raise concern. Women whose breasts rank in the “heterogeneously dense” and “extremely dense” classes have high breast density. An estimated 40% of U.S. women fall into those latter two classes.

Myth 2: I can’t have dense breast tissue because I’m not overweight. Fact: Obesity has little impact on breast density. “Being overweight or obese may increase the amount of fatty tissue in a woman’s breast, but it doesn’t increase the relative amount of dense breast tissue,” Sivarajah said. However, a woman’s breast density often decreases with age.

Myth 3: Breast density doesn’t affect my cancer risk. Fact: “Women in the highest density class (‘extremely dense’) are more likely to be diagnosed with breast cancer compared to a woman in the lowest density class (‘fatty’),” Sivarajah said.

Myth 4: Because I have dense breasts, I don’t need a mammogram. Fact: Supplemental tests do not take the place of a mammogram. “While

dense breast tissue can make a mammogram less sensitive, mammograms can still find breast cancer,” Sivarajah said. In fact, some potential signs of breast cancer, such as certain calcifications and distortions, can only be found with a mammogram. For most women with high breast density, a screening breast ultrasound is the most common supplemental test. Automated Breast Ultrasound Screening (ABUS) uses soundwaves – not radiation – to create a 3-D image of the breast. During this screening, a padded, curve-shaped transducer is placed on the breast while the patient lies down. “The test is comfortable for most women,” Sivarajah says. For women with a higher lifetime risk of cancer – 20% or more as determined by a doctor – breast MRI may be recommended as a supplemental test. This test uses magnets and contrast dye to enhance any potential lesions differently from dense breast tissue. Most insurance plans cover ABUS or screening ultrasound of the breast. Breast MRI is often covered by insurance for patients who have an elevated lifetime risk greater than 20%. Patients should check with their insurance carrier to verify coverage. So, what’s the best next step for women who get a letter about their breast density? “Talk with your primary care doctor about whether a supplemental test is right for you,” Sivarajah said.

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AUGUST 16-18 | DENVER, CO

SPEAKER Spotlight

“

I STARTED IN THE KITCHEN AT A SMALL FACILITY WHERE I WOULD SEE THE PERIOP STAFF COME THROUGH MY CAFETERIA LINE DAILY. I WOULD TALK TO THEM ABOUT THEIR DAY FROM THEIR TRIUMPHS TO THEIR STRUGGLES AND WANTED SO BADLY TO BE PART OF A TEAM THAT HAD SO MUCH PASSION FOR THEIR PATIENTS.

– Cheron Rojo, AA, CRCST, CIS, CER, CFER, CHL

”

Clinical Education Coordinator, Healthmark Industries

Cheron is a speaker at OR Today Live! To learn more, visit www.ortodaylive.com.

we’re on instagram! F O L LOW U S

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APRIL 2020 | OR TODAY |

OUT OF THE OR EQ factor

An Overview of Learned Motivators By daniel bobinski hat drives us to do what we

W do? Many social scientists

say there are two types of drivers; extrinsic and intrinsic. Personally, I preferred the terms learned and natural, as I think they’re easier to understand that way. This month, I want to provide an overview of the six learned (extrinsic) motivators. Chances are you’ll resonate with a few of these. Take note! Self-awareness is the foundational starting point for emotional intelligence. Also know that assessments exist that can help you quantify the intensity of your preferences in each of these areas.

The six spectra of learned motivators First on the list is the motivation of knowledge. Essentially, this scale shines a light on how we’re motivated to acquire and use knowledge. And on one end of the scale are people motivated by understanding things as much as they can. They’re driven by the opportunity to acquire lots of knowledge in pursuit of the truth. At the other end of the knowledge scale are those who are more instinctive. They prefer relying on past

56 | OR TODAY | APRIL 2020

experience, seeking new knowledge only when needed to accomplish the task at hand. Both ends of the scale value knowledge; they just value it differently. Next is the motivation of utility. This scale is about the different ways we value the practicality of things. At one end of the scale are people driven by a strong desire to get a return on whatever time or financial investments they make. At the other end of the scale are people more concerned about completing tasks for the sake of completing tasks. They are not driven by getting something in return for it. Third on the list is surroundings. This scale identifies the way we are motivated by the environment around us. Some people are driven by having an atmosphere of visual and emotional balance. Others are driven by practicality, placing little value on harmony or aesthetics. It’s more of an objective approach, preferring function over form. The fourth scale is about community, and it has to do with what drives us to help others. At one end of the scale are very intentional people. They tend to give of their resources when there’s a direct or important connection to the recipient. At the other end of the scale are

people who give freely for the sake of giving. They are driven by the idea of being helpful and supportive. The next scale identifies how we use power. At one end of the scale are those who are driven by the opportunity to set their own direction and pace. At the other end are those who prefer to be in supporting roles. Last is the scale about life systems. At one end of this scale are people motivated to have a structured life – a system for living. At the other end of the scale are people regularly open to new philosophies and new ways to accomplish tasks. In the coming months, I’ll be taking deeper dives into each of these learned motivators. Daniel Bobinski, M.Ed. is a best-selling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach Daniel through his website, MyWorkplaceExcellence.com, or his office: (208) 375-7606.

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OUT OF THE OR nutrition

Healthy on a Budget By Charlyn Fargo ith roughly 10% of the typical American paycheck

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W spent on food, it’s easy to assume that eating

healthy costs a bundle. I hear it often as I counsel patients. But research says otherwise. According to the May 2019 Cost of Food Report from the U.S. Department of Agriculture, the average adult can eat a nutritious diet for as little as $40 a week per person. So, how can you slash your food bill and still have a kitchen packed with nutritious food? Here are a few tips to help get you started: Start with a plan. Cooking at home can translate into big savings and much healthier eating. Before you go shopping, plan your meals for the week. That way you’re only buying what you’re going to eat. Then check what you have in your pantry and what you need to put on the grocery list. Eat what you cook. The average American tosses more than 240 pounds of food a year. Wow. Decrease your food waste and you’ll automatically save money. Repurpose leftovers. Eat from your freezer. Shop the ads. My mom was the queen of finding – and buying – what was on sale at the grocery store. She scanned the ads and then made her meal plan for the week based on what was on sale. If it was hamburger, we’d have meatloaf. If it was chicken breasts, she’d make a chicken and broccoli casserole. Her inspiration came from the grocery ads. Look for the digital coupons. These days, most stores have an app with weekly digital coupons. It’s the new alternative to clipping coupons. Shop in season. We all need to include more fruits and vegetables on our plate. The best way is to buy seasonal produce. Wander through the frozen aisle. Frozen produce can be a way to eat healthfully on a budget. There are so many new products in the frozen vegetable aisle. They are frozen at the peak of freshness, they keep well and they save you prep time. Consider frozen berries, spinach, broccoli and veggie/protein blends. Stock up. Buy canned goods, such as peanut butter, tuna, beans and salmon, when they’re on sale and then store them in a cool, dry spot. Charlyn Fargo is a registered dietitian at Hy-Vee in Springfield, Illinois, and the media representative for the Illinois Academy of Nutrition and Dietetics. For comments or questions, contact her at charfarg@ aol.com. APRIL 2020 | OR TODAY |

OUT OF THE OR recipe

Moroccan Carrot Salad Ingredients: • 2 tablespoons lemon juice • 1 tablespoon pomegranate molasses • 1/2 teaspoon ground turmeric

Recipe

• Kosher salt

the

58 | OR TODAY | APRIL 2020

• Ground black pepper • 1/4 cup extra-virgin olive oil • 1/3 cup dried apricots, thinly sliced • 1 1/2 teaspoons cumin seeds, toasted • 1 pound carrots, peeled and shredded • 1/2 cup shelled roasted pistachios, toasted and chopped • 3/4 cup pitted green olives, chopped • 1/2 cup roughly chopped fresh mint, plus more to serve

BY Diane Rossen Worthington Diane is an authority on new American cooking. She is the author of 18 cookbooks, including “Seriously Simple Parties,” and a James Beard Award-winning radio show host. You can contact her at www.seriouslysimple.com. WWW.ORTODAY.COM

OUT OF THE OR recipe

Spice Up Salad with Moroccan Twist Milk Street: The New Rules by Christopher Kimball should attract amateur and serious home cooks alike. Why? The cookbook features gorgeous photography and offers interesting facts for each dish. For instance, polenta can be cooked in the oven instead of on top of the range and an addition of cornstarch to a lumpy cheese sauce can smooth out the sauce. There are also primers on ingredients like rice, chilies and spices for added information. In the following recipe for a zesty carrot salad, youâ&#x20AC;&#x2122;ll find that if you finely shred the carrots the result with be mushy. Medium-sized carrot shreds are the preferred texture here. Kimball offers an interesting fact that shredding the carrots, rather than slicing them, increases the vegetableâ&#x20AC;&#x2122;s natural sweetness. Shredding also minimizes the fibrousness of the carrots. Young carrots have a mild flavor and may be tender, but mature carrots are often sweeter with a decidedly dense texture. Select carrots that are well shaped and smooth. Look for a healthy reddish-orange color, and make sure to refrigerate the carrots so they remain sweet and crisp. In this recipe, the carrots are dressed with a fruity, tangy-sweet dressing infused with spices. Dried apricots, toasted pistachios and fresh mint are perfect accents. Pomegranate molasses, often used in Middle Eastern cooking, is a dark, thick syrup with a sweet-sour flavor; look for it in the international aisle of the grocery store or in Middle Eastern markets. This salad is a colorful and tasty addition to an array of salads on a buffet or the perfect side dish to a grilled entree. It also is a lovely first course salad along with some warm pita bread.

Moroccan Carrot Salad Serves 4 1.

In a large bowl, whisk together the lemon juice, molasses, turmeric and 1/2 teaspoon salt. While whisking, slowly pour in the oil. Add the apricots and cumin, then let stand for 5 minutes to allow the apricots to soften. 2. Add the carrots and stir until evenly coated. Stir in the pistachios, olives and mint. Taste and season with salt and pepper, then transfer to a serving bowl. Sprinkle with additional mint.

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APRIL 2020 | OR TODAY |

OUT OF THE OR pinboard

NEW

O R TO DAY

CONTEST

WORLD HEALTH ORGANIZATION'S

YEAR OF THE NURSE

The Winner Gets a $25 Bath & Body Works gift card!

Celebrate the "Year of the Nurse" by sharing a standout story about you or a nurse in your life! Each submission will be entered to win a Bath & Body Works gift card. Please visit ORToday.com/Contest to enter or email your story to Editor@MDPublishing.com.

VISIT US AT AORN BOOTH #1844

LIFE IN AND OUT

rtant days in your “The two most impo are born and the life are the day you .” day you find out why – Mark Twain

OF THE OR

An ahe im, CA • Ma rch 28– Ap ril 1, 202 0

20 20 CO NF ER EN CE #AO RN 202 0

60 | OR TODAY | APRIL 2020

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The News and Photos

that Caught Our Eye This Month

OUT OF THE OR pinboard

DRY NEEDLING: AN ALTERNATIVE TO OPIOIDS Nearly 20 million Americans suffer from chronic pain, worrying every day about flare-ups that interfere with their enjoyment of life. While many people turn to painkillers as their first line of defense, others are finding relief in opioid-free methods, such as dry needling. “Many people view pain as being a bad thing in itself, but actually it is nature’s warning system, meant to protect us,” says Nicky Snazell, a physiotherapist and author of “The 4 Keys to Health” and other books. “We need to heed that warning and address the real cause of the problem, not just look for ways to mask the symptoms,” she adds. While Snazell says painkillers have their place, she prefers an integrative approach to combating pain, combining the most potent aspects of medicine with complementary therapies. Dry needling is one of the methods she’s a proponent of and regularly practices. For those unfamiliar, here’s how the Mayo Clinic describes dry needling: A thin monofilament needle penetrates the skin and treats underlying muscular trigger points for the management of neuromusculoskeletal pain and movement impairments. Snazell practices what is known as the Gunn IMS method, which also uses dry needling to treat neuropathic pain. Research indicates that dry needling improves pain control, reduces muscle tension, and normalizes dysfunction of the motor-end plates, the sites at which nerve impulses are transmitted to muscles, according to the American Physical Therapy Association. This can help speed up the patient’s return to active rehabilitation. “Dry needling is used as part of a wider physiotherapy treatment and succeeds where other treatments fail,” says Snazell, who over three decades has performed dry needling with success

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on thousands of patients in the United Kingdom. A few points the American Physical Therapy Association says patients should know about dry needling include: • The technique uses a “dry” needle, one without medication or injection, inserted through the skin into areas of the muscle. Other terms commonly used to describe dry needling include trigger point dry needling and intramuscular manual therapy. • Although there are similarities, dry needling is not acupuncture, a practice based on traditional Chinese medicine and performed by acupuncturists. Dry needling is a part of modern Western medicine principles, and supported by research. (There has been controversy in this area, though, with acupuncturists in some states trying to block physical therapists from using the procedure, saying they are infringing on the acupuncturists’ turf.) • Physical therapists who perform dry needling obtain specific postgraduate education and training. When contacting a physical therapist for dry needling treatment, the association says, ask about their specific experience and education.

APRIL 2020 | OR TODAY |

INDEX

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ALPHABETICAL Action Products, Inc.……………………………………… 23

Cygnus Medical…………………………………………………… 9

Molnlycke Health Care……………………………………… 5

AIV Inc.…………………………………………………………………13

Diversey ……………………………………………………………… 4

OR Today Webinar Series……………………………… 49

ALCO Sales & Service Co.…………………………………17

Doctors Depot………………………………………………… 20

Ruhof Corporation……………………………………………2, 3

ASCA………………………………………………………………… 24

Healthmark Industries Company, Inc.………… 10

SIPS Consults………………………………………………………15

Avante Health Solutions………………………………… 27

Innovative Medical Products……………………………19

TBJ Incorporated……………………………………………… 64

C Change Surgical……………………………………………… 6

MAC Medical, Inc……………………………………………… 28

Total Scope, Inc………………………………………………… 57

Calzuro.com……………………………………………………… 53

MD Technologies Inc.……………………………………… 63

Capital Medical Resources…………………………………17

MedWrench……………………………………………………… 48

CATEGORICAL ANESTHESIA

HOSPITAL BEDS/PARTS

RENTAL/LEASING

Doctors Depot………………………………………………… 20

ALCO Sales & Service Co.…………………………………17

Avante Health Solutions………………………………… 27

ASSOCIATION

INFECTION CONTROL

REPAIR SERVICES

ASCA………………………………………………………………… 24

ALCO Sales & Service Co.…………………………………17

Capital Medical Resources…………………………………17

CARDIAC PRODUCTS

Cygnus Medical…………………………………………………… 9

Diversey ……………………………………………………………… 4

Doctors Depot………………………………………………… 20

Healthmark Industries Company, Inc.………… 10

REPROCESSING STATIONS

C Change Surgical……………………………………………… 6

CARTS/CABINETS

MD Technologies Inc.……………………………………… 63

ALCO Sales & Service Co.…………………………………17

Ruhof Corporation……………………………………………2, 3

Cygnus Medical…………………………………………………… 9

SIPS Consults………………………………………………………15

Healthmark Industries Company, Inc.………… 10

TBJ Incorporated……………………………………………… 64

MAC Medical, Inc……………………………………………… 28 TBJ Incorporated……………………………………………… 64

CS/SPD

INSTRUMENT STORAGE/TRANSPORT Cygnus Medical…………………………………………………… 9 Ruhof Corporation……………………………………………2, 3

MD Technologies Inc.……………………………………… 63 Ruhof Corporation……………………………………………2, 3 TBJ Incorporated……………………………………………… 64

SAFETY Calzuro.com……………………………………………………… 53 Healthmark Industries Company, Inc.………… 10

ENVIRON-MATE DM6000 SERIES MD Technologies Inc.……………………………………… 63 Ruhof Corporation……………………………………………2, 3

DISINFECTION

Cygnus Medical…………………………………………………… 9

MONITORS

Doctors Depot………………………………………………… 20

ONCOLOGY SERVICES

SINKS

Ruhof Corporation……………………………………………2, 3 TBJ Incorporated……………………………………………… 64

STERILIZATION

ENVIRON-MATE DM6000 SERIES

Diversey ……………………………………………………………… 4

Avante Health Solutions………………………………… 27

Cygnus Medical…………………………………………………… 9

Ruhof Corporation……………………………………………2, 3

ONLINE RESOURCE

Healthmark Industries Company, Inc.………… 10

DISPOSABLES

MedWrench……………………………………………………… 48

MD Technologies Inc.……………………………………… 63

OR Today Webinar Series……………………………… 49

TBJ Incorporated……………………………………………… 64

OR TABLES/BOOMS/ACCESSORIES

SURGICAL

Action Products, Inc.……………………………………… 23

Avante Health Solutions………………………………… 27

Innovative Medical Products……………………………19

MD Technologies Inc.……………………………………… 63

Healthmark Industries Company, Inc.………… 10

OTHER

SIPS Consults………………………………………………………15

MD Technologies Inc.……………………………………… 63

AIV Inc.…………………………………………………………………13

SURGICAL INSTRUMENT/ACCESSORIES

Ruhof Corporation……………………………………………2, 3

PATIENT DATA MANAGEMENT

C Change Surgical……………………………………………… 6

ALCO Sales & Service Co.…………………………………17

ENDOSCOPY Capital Medical Resources…………………………………17 Cygnus Medical…………………………………………………… 9

Total Scope, Inc………………………………………………… 57

ERGONOMIC SOLUTIONS Diversey ……………………………………………………………… 4

MAC Medical, Inc……………………………………………… 28

PATIENT MONITORING AIV Inc.…………………………………………………………………13

Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 10

TELEMETRY AIV Inc.…………………………………………………………………13

FALL PREVENTION

Avante Health Solutions………………………………… 27

ALCO Sales & Service Co.…………………………………17

POSITIONING PRODUCTS

FLUID MANAGEMENT

Action Products, Inc.……………………………………… 23

MD Technologies Inc.……………………………………… 63

Cygnus Medical…………………………………………………… 9

FOOTWEAR

Innovative Medical Products……………………………19

WARMERS

Molnlycke Health Care……………………………………… 5

MAC Medical, Inc……………………………………………… 28

PRESSURE ULCER MANAGEMENT

WASTE MANAGEMENT

Calzuro.com……………………………………………………… 53

GENERAL AIV Inc.…………………………………………………………………13

TEMPERATURE MANAGEMENT C Change Surgical……………………………………………… 6 MAC Medical, Inc……………………………………………… 28

Action Products, Inc.……………………………………… 23

MD Technologies Inc.……………………………………… 63

Molnlycke Health Care……………………………………… 5

TBJ Incorporated……………………………………………… 64

DM6000-2 Endoscopy DM6000 Utility/SPD DM6000-2 Endoscopy DM6000 Utility/SPD 62 USE THESE Capital Medical Resources…………………………………17

| OR TODAY | APRIL 2020

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ENVIRON-MATE

DM6000 SERIES

DM6000-2A Arthroscopy Urology

Optional Fluid Totalizer

DM6000 Utility/SPD

DM6000-2 Endoscopy FM99

Pays for itself in one year!

No more canisters! • Eliminate staff exposure • Reduce turnaround time

• Save canister & solidifier costs • Check cost saving on our website

Use the DM6000 for your project! • Surgery, endoscopy, SPD • Requires vacuum, electrical & drain

unlimited fluid capacity!

FILTER/MANIFOLD PROVIDES 4 CONNECTIONS FOR SCOPE, SHAVER AND FLUID COLLECTORS. 500CC CAPACITY!

ELIMINATE THESE!

46”

PROMETHEAN ISLAND® 4400 FLOOR MAT

30”

• Collect fluids before they reach the floor • Accurately measure spilled irrigation fluids • Reduce post-op clean-up/turnaround time Screw toptop minimizes risk ofrisk C. Diff. Screw minimizes of C. Diff.

Systems require plumbing most conveniently installed during new construction or remodeling.

CALL US BEFORE YOU BUILD OR REMODEL! 800-201-3060

NEW FEATURED PRODUCT

WE ONLY MAKE ONE SINK… THE BEST ONE FOR YOU DESIGNED BY YOU!

TBJ’s SurgiSonic® 1211X features a patented dual hook up method for pre-cleaning da Vinci® instruments utilizing a filtered, independent flushing system combined with ultrasonic action. The unit is independently tested for cleaning effectiveness and exceeded AAMI TIR 30. Three instruments can be pre-cleaned simultaneously.

TBJ sinks are designed specifically for the pre-cleaning of surgical instruments and endoscopes. All of our sinks are custom made to order to enable you to design a system around your specific needs. A wide range of optional features and accessories enable you to tailor a design that puts the tools you for efficient, effective and ergonomic pre-cleaning right at your fingertips.

The system is also ideal for other types of non-robotic submersible tubular instruments as six instruments can be pre-cleaned simultaneously. Available in an economical counter top unit or floor standing unit with automatic water filling and automatic drain control.

OPTIONAL FEATURES INCLUDE Integrated Ultrasonic System

Air and water pistols

Auto Fill System

Automated Lumen and Scope Flushing

717.261.9700 sales@tbjinc.com www.tbjinc.com